Category: Statistics

Microsc Res Tech. 2026 Aug 16. doi: 10.1002/jemt.70173. Online ahead of print.

ABSTRACT

Histological image classification plays a critical role in biomedical research and diagnostic processes. Advances in the field of deep learning present significant opportunities for enhancing diagnostic accuracy and developing automated decision support systems. This study aims to comparatively evaluate the out-of-distribution generalization and cross-domain classification performance of different deep neural network encoders. In this study, models were trained on an internal dataset of 4307 hematoxylin and eosin (H&E) stained images of male rat lung, cerebellum, and adipose tissues, obtained under ethical committee approval (Ege University, HADYEK 2026-06). To evaluate genuine generalization, testing was conducted on a separate, diverse external cohort of 600 mixed human-and-animal images. Nine different deep learning architectures-MobileNetV3-S, MobileNetV3-L, DenseNet121, DenseNet201, ConvNeXt-S, ConvNeXt-B, DINOv3 ViT-S, DINOv3 ViT-H+, and the pathology foundation model UNI2-h-were evaluated using frozen feature extraction combined with a linear probe. For performance evaluation, accuracy, sensitivity, specificity, F1 score, Cohen’s κ, and ROC-AUC metrics were analyzed along with per-image inference times. While all models achieved near-perfect results during internal cross-validation, their performance diverged significantly on the external dataset, confirming that the observed differences reflect genuine cross-domain generalization capabilities rather than under-fitting. All competitive models demonstrated high performance in classifying adipose and cerebellum tissues, achieving an F1 score of 95% or higher for these tissues. In distinguishing the lung tissue, which has the most diverse structure and is the most difficult to classify, the UNI2-h model emerged as the most successful, achieving an F1 score of 97.4% and a recall of 95.0%. When evaluated in terms of computational efficiency, the MobileNetV3-Small model stood out as having the lowest processing time among all scenarios, demonstrating an inference time of 9.4 ms on the CPU and 12.5 ms on the GPU. In conclusion, while the pathology foundation model UNI2-h achieved the highest accuracy values across all metrics, the ConvNeXt-Small model was identified as the system providing the optimal balance between speed and accuracy. These findings indicate that although UNI2-h stands out for the most precise results in cross-domain classifications, the ConvNeXt-Small architecture emerges as an ideal alternative, particularly in practical applications where computational efficiency is critical and resources are constrained.

PMID:42604434 | DOI:10.1002/jemt.70173

Arch Iran Med. 2026 Feb 1;29(2):69-76. doi: 10.34172/aim.36812. Epub 2026 Feb 1.

ABSTRACT

INTRODUCTION: The 8-item Inflammatory Bowel Disease control Questionnaire-8 (IBDcQ-8) is a patient-reported measure designed to capture the core domains of disease control and quality of life. The aim of this study was to evaluate the validity and reliability of the Persian version of the IBDcQ-8 in the Iranian IBD population.

METHODS: A standardized forward-backward translation procedure was employed to adapt the questionnaire into Persian. Content validity was evaluated through structured interviews with a panel of 10 evaluators. Construct validity was examined by structured interview and clinical visits of 101 patients. Harvey Bradshaw Index (HBI), partial Mayo score, and IBD Questionnaire (IBDQ) were used as comparator instruments. Patients’ responses were compared with clinical global assessment, Harvey Bradshaw Index (HBI), partial Mayo score, IBDQ score , and laboratory markers using Spearman’s rank correlation. Test-retest reliability was evaluated by calculating the intraclass correlation coefficient (ICC) between the two subsequent interviews. A P-value<0.05 was considered statistically significant.

RESULTS: Half of the subjects (n=51 (50.5%)) were female. The mean age was 38 years (SD=14). Sixty-seven patients (66%) had UC. IBDcQ-8 scores showed strong correlations with HBI and IBDQ, and moderate correlations with the partial Mayo score, CRP, and clinical evaluation at the first visit (P-value<0.05). Agreement was excellent for one-day follow-up (ICC=0.82, 95% CI: 0.71-0.89, P<0.001), and moderate for two-week follow-up (ICC=0.61, 95% CI: 0.44-0.73, P<0.001).

CONCLUSION: The Persian version of the IBDcQ-8 questionnaire demonstrated robust validity and acceptable reliability even when administered by telephone interview, supporting its usefulness for evaluating disease-specific quality of life in patients with IBD and its applicability in future studies.

PMID:42604425 | DOI:10.34172/aim.36812

Arch Iran Med. 2026 Feb 1;29(2):62-68. doi: 10.34172/aim.34939. Epub 2026 Feb 1.

ABSTRACT

INTRODUCTION: Cerebrovascular disorders (CeVDs) are among the leading causes of death worldwide. This study aims to analyze the trends in mortality due to CeVDs in northern Iran between 2016 and 2023.

METHODS: In this cross-sectional study, we included all documented Deaths due to CeVDs in Babol County, north of Iran, from 2016 to 2023. The crude mortality rate (CMR) and age-standardized mortality rate (ASMR) were used to assess the trends in CeVDs mortality. The Cochran-Armitage trend test and Joinpoint regression were employed to analyze the changes in disease trends.

RESULTS: During the study period, a total of 1,798 deaths from CeVDs were reported, with a mean age of 76.8±13.2 years. The CMR and ASMR for CeVDs decreased from 38.4 and 28.3 per 100,000 population in 2016 to 30.9 and 23.3 per 100,000 in 2023 (P<0.001). The trend decreased in both genders and urban and rural populations (P<0.05). Joinpoint regression indicated a break point in 2018. Between 2018 and 2023, the ASMR trend decreased, with an annual percentage change of -7.98% (95% CI, -18.72% to -4.88%).

CONCLUSION: This study reveals a significant decrease in CeVDs mortality in the region, indicating progress in therapeutic interventions. However, death rates in rural areas remain high. Addressing this condition requires targeted approaches and increased resource allocation.

PMID:42604424 | DOI:10.34172/aim.34939

Arch Iran Med. 2026 Jan 1;29(1):1-11. doi: 10.34172/aim.34141. Epub 2026 Jan 1.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD), a major cause of the burden of diseases, is associated with a considerable rate of inadequate treatment and high costs. We assessed the pattern of service use, quality, and costs of healthcare for MDD in Iran.

METHODS: We assessed a national sample of 265 patients in the acute phase of MDD recruited from outpatient/inpatient settings at baseline and in three follow-up points of one, three, and six months. The pattern of service use and selected quality indicators were assessed, and the costs of care for an episode of MDD were estimated using the bottom-up approach.

RESULTS: The subjects were primarily female (73.6%), with a mean age of 43.3 years (±13.8). Of 173 respondents at the end of the study, 65.3% were on treatment for at least six months. Regarding quality indicators, the majority of the patients (97.7%) were prescribed antidepressants. However, only 71.2% of the patients initiated their antidepressants following prescription at the initial visit. At the end of the study, 40.1% were in remission and 58.1% had at least a 50% improvement in depressive symptoms. However, no standardized process or outcome measures were documented on the patients’ medical records. The average out-of-pocket and total costs for an episode of MDD per patient were estimated at Int$ 1331.4 and 2107.4, respectively.

CONCLUSION: We recommend establishing an infrastructure for monitoring the clinical evaluation and treatment, and proper documentation based on standard quality of care, especially for ambulatory clinical practice.

PMID:42604415 | DOI:10.34172/aim.34141

Med Care Res Rev. 2026 Aug 16:10775587261471942. doi: 10.1177/10775587261471942. Online ahead of print.

ABSTRACT

Hospitals spend billions of dollars annually on major construction projects and facility upgrades, but limited research to date has examined whether this expenditure benefits patients. Using a novel dataset of California hospital construction projects opening between 2010 and 2019, we estimate the effect of project opening on patient experience and clinical measures using a difference-in-differences framework. We find sizable, statistically significant improvements in patient experience-cleanliness, quietness at night, and likelihood to recommend-with effects persisting for at least 2 years after opening. We find no measurable impact on clinical outcomes, 30-day mortality, and readmission for heart attacks and heart failure. These results suggest infrastructure investments meaningfully affect perceived care environments but may not translate into near-term changes in clinical performance. Policymakers and hospital leaders should weigh these returns when evaluating capital expenditures and potential support for hospital construction.

PMID:42604414 | DOI:10.1177/10775587261471942

Int J Methods Psychiatr Res. 2026 Sep;35(3):e70100. doi: 10.1002/mpr.70100.

ABSTRACT

BACKGROUND: Secondary depression frequently develops in people with chronic diseases, and it may hinder disease progress and treatment outcomes. This study aimed to examine the construct validity and measurement invariance of the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) among patients with chronic physical conditions.

METHODS: This cross-sectional study used confirmatory factor analysis (CFA) and multigroup CFA to evaluate the Arabic PHQ-9 in a convenience sample comprising patients with cancer, heart failure (HF), and renal failure (RF) from Oman and Yemen.

RESULTS: Out of eight models, the unidimensional PHQ-9 (depression) displayed satisfactory fit when three pairs of error were correlated whereas a similar fit was exhibited by a three-factor (somatic, cognitive/affective, and concentration/motor) solution, which was modified into (somatic, affective, and cognitive-psychomotor) solution based on partial scalar analysis tests. This structure was invariant across all sociodemographic characteristics, with better values of reliability coefficients, average variance extracted, and heterotrait-monotrait ratios of correlation.

CONCLUSION: The Arabic PHQ-9 is a reliable and psychometrically stable tool that may differentiate depressive symptoms in people with chronic disorders into three symptom groups. Meaningful comparisons between countries support higher psychological burden of physical disorders in Yemen than Oman.

PMID:42604413 | DOI:10.1002/mpr.70100

Cureus. 2026 Jul 16;18(7):e112807. doi: 10.7759/cureus.112807. eCollection 2026 Jul.

ABSTRACT

BACKGROUND: Hypertension is a major global public health concern and a leading contributor to cardiovascular morbidity and mortality. Non-pharmacological and lifestyle-based strategies are increasingly recognized as important adjuncts to pharmacological management. However, evidence on the effects of grain-free dietary interventions within naturopathic programs on blood pressure remains limited.

OBJECTIVES: This study aimed to evaluate the short-term effects of an integrated naturopathy and yoga intervention, including a structured grain-free diet, on blood pressure and related hemodynamic parameters in individuals with hypertension.

METHODS: A single-arm pilot study was conducted among 20 hypertensive inpatients (aged 30-60 years) at a dedicated naturopathy and yoga hospital. Participants received a seven-day structured grain-free dietary intervention (five supervised meals/day) within an integrated naturopathy and yoga intervention. Primary outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP); secondary outcomes were pulse rate (PR), pulse pressure (PP), and mean arterial pressure (MAP). Measurements were obtained at baseline (day 1) and post-intervention (day 7). Paired t-tests, 95% confidence intervals (CIs), and Cohen’s d effect sizes were computed.

RESULTS: Significant reductions were observed in all measured parameters following the intervention. SBP decreased by 16.60 mmHg (95% CI: 11.96-21.24; p < 0.001; Cohen’s d = 1.68) and DBP by 12.60 mmHg (95% CI: 8.20-17.00; p < 0.001; d = 1.34). Pulse rate decreased by 6.35 bpm (95% CI: 3.41-9.29; p < 0.001; d = 1.01), pulse pressure by 4.00 mmHg (95% CI: 0.36-7.64; p = 0.032; d = 0.51), and MAP by 14.00 mmHg (95% CI: 9.49-18.51; p < 0.001; d = 1.45). No adverse events were reported.

CONCLUSIONS: A seven-day integrated naturopathy and yoga intervention incorporating a grain-free diet demonstrated meaningful and statistically significant short-term improvements in blood pressure and hemodynamic parameters in hypertensive individuals. Attribution to the dietary component alone is limited by the integrated naturopathy and yoga intervention design. Larger randomized controlled trials with dietary-only arms are recommended.

PMID:42604410 | PMC:PMC13477420 | DOI:10.7759/cureus.112807

Cureus. 2026 Jul 16;18(7):e112791. doi: 10.7759/cureus.112791. eCollection 2026 Jul.

ABSTRACT

Introduction The association between mandibular third molars and mandibular anterior crowding remains controversial. Although several studies have investigated the relationship between third molar characteristics and lower anterior crowding, the relative influence of third molar position and angulation remains inconclusive. This study aimed to evaluate the association between lower third molar position, angulation, and mandibular anterior crowding in a Chhattisgarh population using panoramic radiographs and mandibular study models. Materials and methods This retrospective observational study included 234 pretreatment orthodontic records comprising panoramic radiographs and mandibular study models. Subjects aged 16-23 years with Angle’s Class I molar relationship and bilaterally present mandibular third molars were allocated into a crowded group (n = 117) and a non-crowded group (n = 117). Mandibular anterior crowding was assessed using pretreatment mandibular study models. Third molar position was evaluated using the retromolar space-to-third molar crown width ratio (Ganss ratio), while third molar angulation was assessed using the inclination between the mandibular second and third molars (Angle A) and the angulation of the mandibular third molar relative to the mandibular base (Angle B). Intergroup comparisons were performed using the independent Student’s t-test, and a p-value of <0.05 was considered statistically significant. Results The crowded group demonstrated significantly lower Ganss ratios than the non-crowded group on both the right (p = 0.0003) and left (p = 0.0031) sides. Angles B were significantly lower in both tails (right: p = 0.030; left: p = 0.038), but Angle A was only significant on the left (p = 0.0006). The right-sided Angle A had no statistically significant difference (p = 0.349). In general, the third molar position showed a more reliable relationship with mandibular anterior crowding compared to angular measurements. Conclusion Lower third molar position and angulation were both associated with mandibular anterior crowding. One of the radiographic measures, the Ganss ratio, showed the lowest variance of association, implying that the available retromolar space measure may offer more diagnostic utility than the angular measurements. These radiograph parameters can be used as helpful adjuncts, but not to be the basis of the prophylaxis of the mandibular third molar extraction in orthodontic diagnoses, as well as treatment planning.

PMID:42604409 | PMC:PMC13477424 | DOI:10.7759/cureus.112791

Pan Afr Med J. 2026 Apr 2;53:151. doi: 10.11604/pamj.2026.53.151.49695. eCollection 2026.

ABSTRACT

INTRODUCTION: Hepatitis B virus (HBV) remains a major occupational hazard for healthcare workers (HCWs), particularly in low-resource settings like Sierra Leone, where systemic challenges hinder effective prevention efforts. Despite the availability of an effective vaccine since 1982 and widespread screening initiatives, HBV vaccination uptake among HCWs remains alarmingly low. This study investigates the disconnect between HBV screening and subsequent vaccination among HCWs in Sierra Leone, examining individual, institutional, and systemic factors.

METHODS: we employed a mixed-methods cross-sectional design. A total of 432 HCWs were sampled across public, private, NGO, and faith-based hospitals using multi-stage techniques to assess screening uptake, vaccination coverage, and influencing factors. Additionally, 12 in-depth interviews were conducted with senior staff and health administrators. Quantitative data were analysed using SPSS, while the qualitative data were thematically analysed.

RESULTS: quantitative findings revealed suboptimal levels of HBV vaccination and screening among HCWs. Overall, – 65% of HCWs were screened for HBV, while 52% received at least one vaccine dose, and only 34% completed the full three-dose series. Nearly half of those screened were not vaccinated, exposing critical failures in follow-up care. Screening and vaccination rates varied by cadre. Higher uptake was observed among administrators (100.0%), doctors (88.2%), community health officers (68.8%), other clinical staff (68.8%), and laboratory technicians (54.2%). In contrast, nurses (43.4%), pharmacists (34.9%), and other essential staff (13.2%) reported lower coverage levels. Differences were also noted across facility types. Private facilities recorded the highest screening (77.3%) and vaccination (62.5%) rates, followed by NGOs (70.8% and 66.7%). Faith-based facilities recorded moderate levels (56.4% screening and 54.5% vaccination), while public facilities had 64.4% screening but relatively the lowest 44.7% vaccination coverage. Screening and vaccination uptake were significantly associated (Χ² = 317.27, p < 0.05).

CONCLUSION: the findings underscore critical missed opportunities in HBV prevention among HCWs in Sierra Leone. Despite moderate screening rates, vaccine coverage remains low, primarily due to institutional weaknesses such as inadequate follow-up systems, limited vaccine access, and weak policy enforcement – rather than individual neglect. These gaps place frontline health professionals at continued risk of HBV infection. Strengthening HBV prevention requires integrated screening-vaccination programs, mandatory occupational health policies, and sustainable vaccine supply systems. Targeted education, consistent advocacy, and inclusive strategies that engage all healthcare worker cadres are also vital. Such interventions are essential not only for protecting the healthcare workforce but also for reinforcing public health resilience in Sierra Leone.

PMID:42604405 | PMC:PMC13477185 | DOI:10.11604/pamj.2026.53.151.49695

Pan Afr Med J. 2026 Apr 17;53:163. doi: 10.11604/pamj.2026.53.163.49196. eCollection 2026.

ABSTRACT

INTRODUCTION: WHO and other partners initiated Big Catch-up (BCU) to catch up children aged 12 to 59 months (about 5 years) who have never been vaccinated or are under-vaccinated because of the COVID-19 pandemic. Among the eligible countries are 16 from Central and West Africa. This study aims to analyze challenges and opportunities for this global initiative’s success.

METHODS: this was a secondary analysis of aggregated program data conducted in 16 countries in Central and West Africa eligible for the BCU. Data were collected through the BCU plans developed by countries, on vaccination coverage for each antigen included, epidemiological surveillance data for vaccine-preventable diseases (VPD) in countries and narrative reports on the implementation of BCU. The proportions of remaining targets to be achieved by country are obtained by dividing the number of children vaccinated in the numerator by the targets for zero doses or under-immunized children in the denominator by antigen. A simple logistic regression was performed to establish relationships between vaccination and the occurrence of vaccine-preventable diseases after COVID-19 and the implementation of BCU.

RESULTS: outbreaks of VPD increase significantly in post-COVID-19 cases and during BCU implementation. All countries except Nigeria still have at least 70% of targets to catch up by December 2025. Two countries are categorized as making good progress, having achieved more than 50% vaccination coverage and DTP and measles: Nigeria and Mali. Cameroon, Côte d’Ivoire and Burkina Faso are making average progress in terms of vaccination coverage of the same antigens between 20-49%.

CONCLUSION: this initiative helped to curb the occurrence of VPD epidemics. However, the challenges are enormous. Countries must continue to organize further large-scale catch-up rounds and seize every opportunity for vaccination to significantly reduce ZD and Ui and thus VPD epidemics.

PMID:42604400 | PMC:PMC13477188 | DOI:10.11604/pamj.2026.53.163.49196