Category: Statistics

Diabetes Care. 2026 Aug 6:dc261042. doi: 10.2337/dc26-1042. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the link between continuous glucose monitoring (CGM) metrics and risk of severe hypoglycemia and diabetic ketoacidosis (DKA) in individuals of type 1 diabetes.

RESEARCH DESIGN AND METHODS: We pooled individual-level data from 10 studies of type 1 diabetes. From a 14-day baseline period, we derived CGM metrics (time in range [TIR] 70-180 mg/dL, time above range [TAR], time below range [TBR], sensor mean glucose, SD, and percent coefficient of variation [%CV]) and CGM-defined hypo- and hyperglycemic episodes. We used Cox regression to evaluate associations with severe hypoglycemia and diabetic ketoacidosis, with and without adjustment for HbA1c.

RESULTS: Among 1,550 participants, 65 severe hypoglycemia and 163 DKA events occurred over a median follow-up of 16 weeks. Higher TBR <70 and <54 mg/dL, SD, %CV, and CGM-defined hypoglycemic episodes were associated with greater risk of severe hypoglycemia independent of HbA1c (e.g., hazard ratio [HR] 1.52 [1.29-1.79] per 1-SD higher TBR <70). Lower TIR and higher mean glucose, SD, %CV, TAR, and hyperglycemic episodes were associated with higher DKA risk; these associations were attenuated after HbA1c adjustment, but TIR, sensor mean glucose, and SD remained statistically and clinically significant (e.g., HR 0.76, 95% CI 0.60-0.97 per 1-SD higher TIR).

CONCLUSIONS: CGM hypoglycemic and glycemic variability metrics were associated with severe hypoglycemia risk independent of HbA1c, whereas TIR, mean glucose, and SD provided information for DKA risk beyond HbA1c. This supports the complementary value of CGM and HbA1c in risk assessment for severe hypoglycemia and DKA.

PMID:42561376 | DOI:10.2337/dc26-1042

Crit Care Sci. 2026 Aug 3;38:e20260480. doi: 10.62675/2965-2774.20260480. eCollection 2026.

ABSTRACT

OBJECTIVE: We aimed to assess the effect of a short period of invasive mechanical ventilation after a successful spontaneous breathing trial, compared with immediate extubation, on the risk of reintubation within 48 hours.

METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials comparing a short period of invasive mechanical ventilation following a successful spontaneous breathing trial versus immediate extubation. We searched PubMed®, Cochrane Central, Embase, Scopus, and Web of Science. Pairs of reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane Risk of Bias tool 2.0. The primary outcome was reintubation within 48 hours after randomization. Data were pooled using a Hartung-Knapp-Sidik-Jonkman random-effects model. Trial sequential analysis was performed to determine whether the accumulated evidence was sufficient for definitive conclusions. Certainty of evidence was assessed using the GRADE approach. Secondary outcomes were reintubation or death within 7 days after extubation, intensive care unit and hospital length of stay, in-hospital mortality, and ventilator-free days up to day 28.

RESULTS: Our search identified 1,473 unique records, of which 4 randomized clinical trials (n = 1,071 patients) were eligible. The pooled risk ratio for reintubation within 48 hours in patients receiving a short period of invasive mechanical ventilation after a successful spontaneous breathing trial, compared with immediate extubation, was 0.48 (95% confidence interval 0.22 – 1.07; p = 0.06; I2 = 41.6%). Trial sequential analysis confirmed that the current evidence base is underpowered for definitive conclusions. The evidence was rated as low due to serious inconsistency and imprecision. No significant differences were observed for any of the secondary outcomes.

CONCLUSIONS: Among critically ill adults, a short period of invasive mechanical ventilation after a successful spontaneous breathing trial did not significantly reduce the risk of extubation failure within 48 hours compared with immediate extubation (low-certainty evidence). Further adequately powered trials are needed to clarify the clinical efficacy of this intervention.

PMID:42561371 | DOI:10.62675/2965-2774.20260480

An Acad Bras Cienc. 2026 Aug 3;98(3):e20251036. doi: 10.1590/0001-3765202420251036. eCollection 2026.

ABSTRACT

The Atlantic Forest Biome, historically marked by intense human occupation, hosts the majority of Brazil’s population despite covering only a fraction of the national territory. However, available population estimates lack methodological transparency, undermining their application in public policies and conservation strategies. This study aims to rigorously estimate the number of inhabitants living within the limits of the Atlantic Forest Biome, considering two official territorial boundaries: the area defined by the Atlantic Forest Law, 2006 and the domain defined by Brazilian Institute of Geography and Statistics, 2019. Using data from the 2022 Demographic Census and a standardized criterion for municipal inclusion, results indicate that approximately 57% of the Brazilian population resides within the Atlantic Forest Biome. This figure is lower than those reported in the literature but still represents a significant number, considering the biome covers approximately 15% of Brazil’s continental territory. These findings underscore the need for demographic studies based on replicable methods to support planning of policies aimed at conservation, restoration, and sustainable use of the Atlantic Forest.

PMID:42561357 | DOI:10.1590/0001-3765202420251036

Codas. 2026 Aug 3;38(5):e20250244. doi: 10.1590/2317-1782/e20250244pt. eCollection 2026.

ABSTRACT

PURPOSE: To analyze the neural response of the subcortical pathway through click and speech stimuli in infants and young children with congenital cytomegalovirus (CMVc).

METHODS: Cross-sectional and prospective study. The sample consisted of infants and young children with a median age of 6.43 months (Q1-Q3: 2.62-11.25) in the CMV group (G1; n=10) and 6.23 months (Q1-Q3: 1.60-12.06) in the control group (G2; n=10). All participants underwent Transient Evoked Otoacoustic Emissions (TEOAE) and bilateral peak positive pressure tympanometry. The procedures included anamnesis, Auditory Brainstem Response with click stimulus (ABR-click), and Frequency Following Response (FFR). Click ABR was performed at intensities of 80 and 30 dB nHL in both ears. FFR was recorded in the right ear with a speech stimulus /da/ of 170 ms. FFR responses were analyzed in the temporal and spectral domains, regarding neural synchrony, spectral representation, and stability of the speech response. The Mann-Whitney test or Student’s t-test was applied for intergroup analysis. The Wilcoxon test was applied for intragroup analysis.

RESULTS: In the analysis of click ABR latencies and amplitudes, as well as in FFR measurements related to subcortical neural coding of speech, no statistically significant differences were observed between groups or between ears in the intergroup analysis.

CONCLUSION: Preliminary results indicate a similar pattern of subcortical neural coding of speech and neural synchrony in infants and young children with and without CMVc.

PMID:42561348 | DOI:10.1590/2317-1782/e20250244pt

Codas. 2026 Aug 3;38(5):e20250202. doi: 10.1590/2317-1782/e20250202pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the clinical impact of the DHACA® method on the development of social skills in children with Autism Spectrum Disorder (ASD).

METHODS: This longitudinal quantitative intervention study conducted with 23 children with ASD, aged 3 to 6 years, who were nonverbal or minimally verbal. Individual intervention sessions using the DHACA® method were held weekly for 20 weeks. Social skills were assessed before and after the intervention using the ACOTEA-R protocol. Data were statistically analyzed using the Wilcoxon test.

RESULTS: There was a significant improvement (p < 0.05) in ten of the sixteen skills assessed, including “responds to name,” “eye contact,” “shared attention,” and “symbolic play.” Other skills, such as “responds to ‘no'” and “takes turns,” showed a tendency toward clinical improvement, although not statistically significant. Only three skills did not show relevant progress.

CONCLUSION: The DHACA® method proved effective in promoting social skills in children with ASD, contributing to greater autonomy and social participation. The results reinforce its clinical potential as a therapeutic resource in both educational and healthcare settings.

PMID:42561347 | DOI:10.1590/2317-1782/e20250202pt

Codas. 2026 Aug 3;38(5):e20250194. doi: 10.1590/2317-1782/e20250194pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the performance of the PETIT application (automated tablet-based screening) compared with conventional sweep screening in identifying the risk of hearing impairment in school-aged children, using headphones with passive noise cancellation.

METHODS: Cross-sectional observational study including 122 children (aged 5 to 8 years) from the public school of Santana de Parnaíba. The following procedures were performed: otoscopy; automated hearing screening via tablet (with Sennheiser HD-280 headphones); and conventional sweep screening. Part of the sample also underwent pure-tone audiometry. Statistical analysis used binomial and binary logistic regression tests, along with the calculation of sensitivity, specificity, and accuracy.

RESULTS: There was significant association between the results of the sweep screening and PETIT, as well as the coefficient of the predictor variable (conventional audiometry) was significant to the performance in the sweep screening. For PETIT, a sensitivity of 85.7%, specificity of 100%, and accuracy of 99.18% were observed.

CONCLUSION: The results suggest that this tool has promising applicability in schools for identifying children at risk of hearing impairments.

PMID:42561346 | DOI:10.1590/2317-1782/e20250194pt

Arq Bras Cardiol. 2026 Aug 3;123(6):e20250862. doi: 10.36660/abc.20250862. eCollection 2026.

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy.

OBJECTIVES: To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice.

METHODS: An analytical-comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch’s t-test, and effect size (Hedges’ g). Standard-deviation-based cut-off points were proposed for grading abnormality.

RESULTS: Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation.

CONCLUSIONS: International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval.

PMID:42561341 | DOI:10.36660/abc.20250862

Lang Speech Hear Serv Sch. 2026 Aug 6:1-25. doi: 10.1044/2026_LSHSS-25-00264. Online ahead of print.

ABSTRACT

PURPOSE: This study examines the impact of diglossia on the phonological awareness of dyslexic Jordanian Arabic-speaking children, focusing on deletion, segmentation, and reading tasks in both Modern Standard Arabic (MSA) and Colloquial Arabic (CA).

METHOD: Forty dyslexic and 40 typically developing (TD) children from special education resource rooms in four private schools in Amman, Jordan, participated.

RESULTS: Statistical analysis revealed that both groups performed better in MSA than in CA across all tasks, with TD children outperforming dyslexic children and task difficulty decreasing with grade level. Dyslexic children found segmentation easier than deletion, whereas TD children found both tasks equally challenging. A significant relationship was observed between reading and deletion tasks in CA for second-grade TD children and in MSA for second-grade dyslexic children.

CONCLUSIONS: MSA-CA performance gap should inform instructional strategies, suggesting that phonological awareness interventions need to target the weaker variety (CA) while maintaining support in MSA. Strengthening phonological processing in CA may reduce the phonological load associated with dialectal mismatch and facilitate bidirectional transfer of phonological skills between CA and MSA. The findings may reflect exposure to multiple dialects, individual learning styles, and the complexities of the Arabic writing system. Overall, the study provides empirically grounded guidance for designing differentiated, dialect-sensitive interventions to support dyslexic learners in diglossic Arabic contexts.

PMID:42560735 | DOI:10.1044/2026_LSHSS-25-00264

J Magn Reson Imaging. 2026 Aug 6. doi: 10.1002/jmri.70479. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional renal function markers, such as estimated glomerular filtration rate (eGFR), often fail to reflect occult renal parenchymal injury in early-stage chronic kidney disease (CKD). Renal biopsy is invasive, limiting longitudinal monitoring. Reliable noninvasive methods for early CKD detection and chronicity assessment are lacking.

PURPOSE: To evaluate 3D MR elastography (3D-MRE), arterial spin labeling (ASL), and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for detecting early CKD and grading its chronic changes.

STUDY TYPE: Prospective.

SUBJECTS: 96 CKD patients with renal biopsy (44 ± 13 years, 55 men) and 30 healthy controls (43 ± 15 years, 18 men).

FIELD STRENGTH/SEQUENCE: 3.0 T; multifrequency (60, 90, and 120 Hz) 3D vector MRE, pseudo-continuous arterial spin labeling (pCASL), and multi-b-value (0-2000 s/mm²) IVIM-DWI.

ASSESSMENT: MRE-derived renal stiffness (RS), ASL-derived renal blood flow (RBF), and IVIM-derived true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were measured. CKD was staged from 1 to 5 according to eGFR, with Stages 1-2 defined as early CKD. Chronic changes were graded by chronicity score (CS), with CS > 4 indicating moderate-to-severe chronic changes.

STATISTICAL TESTS: Mann-Whitney U test, Kruskal-Wallis test with Bonferroni correction, intraclass correlation coefficients (ICC), Bland-Altman analysis, Spearman’s rank correlation, univariable and multivariable logistic regression, area under the receiver operating characteristic curve (AUC), and DeLong’s test. p < 0.05 was considered significant.

RESULTS: The combined entire RS at 90 Hz (ERS@90) and the entire D achieved the highest AUC for distinguishing healthy controls from early CKD, significantly outperforming eGFR (AUC = 0.87 vs. 0.59). In early CKD, ERS@90 was the only independent discriminatory variable of moderate-to-severe chronic changes, significantly outperforming eGFR (AUC = 0.86 vs. 0.62).

DATA CONCLUSION: 3D-MRE showed promise for noninvasive detection of early CKD and for identifying moderate-to-severe chronic changes.

EVIDENCE LEVEL: 1.

TECHNICAL EFFICACY: Stage 2.

PMID:42560709 | DOI:10.1002/jmri.70479

J Am Geriatr Soc. 2026 Aug 6. doi: 10.1111/jgs.70630. Online ahead of print.

ABSTRACT

BACKGROUND: People with Alzheimer’s disease and related dementias (ADRD) are at increased risk of motor vehicle crash (MVC) due to cognitive decline, which often begins years before diagnosis. MVC could serve as an indicator of ADRD-related cognitive impairment and facilitate earlier diagnosis.

METHODS: We conducted a matched cohort study of Medicare beneficiaries in New Jersey aged ≥ 69 years with incident ADRD diagnoses from 2010 to 2017 compared to individuals without ADRD and with four other medical conditions: acute myocardial infarction (AMI), asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Comparison groups were sampled with replacement and matched on sex, age, and calendar quarter of diagnosis or claim (for the non-ADRD group). Crash prevalence at 6 months and 1, 2, and 3 years before diagnosis was compared using chi-square tests, and the monthly prevalence was plotted to examine longitudinal trends in crashes.

RESULTS: We identified 43,115 eligible individuals with incident ADRD diagnosis from 2010 to 2017. MVC crash prevalence was higher in the ADRD group than in non-ADRD and negative control groups at all measured pre-diagnosis time points: 6 months (2.99% vs. 2.31%-2.53%), 1 year (5.26% vs. 4.18%-4.65%), 2 years (9.52% vs. 7.88%-8.67%), and 3 years (13.64% vs. 11.29%-12.37%). The ADRD group was more likely to have multiple crashes in the pre-diagnosis period, but multiple events were rare overall (< 3%). Differences were statistically significant but represented small changes in prevalence. Crash prevalence did not reveal a clear signal of cognitive decline in the years leading up to the index diagnosis.

CONCLUSIONS: Older adults with ADRD had slightly higher prevalence of MVC in the 3 years before diagnosis than matched comparison groups, but absolute differences were small and recurrent crashes were rare. MVC alone is too rare to serve as a signal of incipient ADRD, highlighting the need for more sensitive measures.

PMID:42560687 | DOI:10.1111/jgs.70630