Category: Statistics

JAMA Netw Open. 2026 May 1;9(5):e2611913. doi: 10.1001/jamanetworkopen.2026.11913.

ABSTRACT

IMPORTANCE: Upstream social determinants, including structural disadvantages, are critical drivers of health and aging. While structural disadvantages shape biological aging and inflammatory processes among older adults, it is less clear how this association emerges and endures over the life course.

OBJECTIVE: To assess whether adolescent exposure to structural disadvantage is associated with epigenetic aging and inflammation-related DNA methylation (DNAm) in early midlife and to evaluate whether associations differ by race.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from non-Hispanic Black and White respondents in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Add Health comprises a nationally representative cohort of US adolescents in grades 7 to 12 in 1994 (wave I) followed for over 20 years across 6 waves of data. Venous blood samples were collected (2016-2018) and analyzed for DNAm (2021-2024) among Add Health respondents in early midlife (ages 33-43 years at blood collections). Data were analyzed from September 2024 to February 2026.

EXPOSURE: The main exposure was structural disadvantage in adolescence, assessed as 5 county-level economic, education, and segregation indicators from the 1990 decennial US Census.

MAIN OUTCOMES AND MEASURES: The main outcomes included 3 epigenetic clocks (PhenoAge, GrimAge2, and DunedinPACE) and 2 measures of inflammation-related DNAm (C-reactive protein [CRP] and tumor necrosis factor-α). Confirmatory factor analysis was used to derive a latent factor of structural disadvantage in adolescence, and multivariate regression models assessed the association between the structural disadvantage latent measure and each outcome.

RESULTS: Data from 3788 participants (mean [SD] age at wave V, 38.4 [0.01] years; 50.9% [SE, 1.1%] female and 49.1% [SE, 1.1%] male; and 19.7% [SE, 0.9%] Black and 80.3% [SE, 0.9%] White) were analyzed. Considering average associations across the sample, exposure to higher vs lower levels of structural disadvantage in adolescence was associated with accelerated epigenetic aging (GrimAge2: β, 0.35 [95% CI, 0.09-0.61]; DunedinPACE: β, 0.08 [95% CI, 0.03-0.13]) and greater CRP-related DNAm (β, 0.07 [95% CI, 0.02-0.12]), even after adjusting for self-reported race and family socioeconomic status. Findings from an interaction model suggested that while Black respondents experienced faster epigenetic aging and greater CRP-related DNAm overall, the association between adolescent structural disadvantage and these outcomes was slightly negative for Black respondents, yet positive for White respondents.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of adults in early midlife, the results suggest that early-life contexts were important factors for accelerated epigenetic aging and CRP-related DNAm. These findings enhance understanding of when and how disparities in aging-related diseases may emerge, informing effective solutions for addressing the rising burden of aging-related diseases.

PMID:42113514 | DOI:10.1001/jamanetworkopen.2026.11913

Iran J Allergy Asthma Immunol. 2026 Feb 1;25(2):212-221. doi: 10.18502/ijaai.v25i2.20800.

ABSTRACT

Anti-recombinant human acid α-glucosidase (anti-rhGAA) antibody formation is a major challenge in patients with Pompe disease receiving enzyme replacement therapy (ERT). The clinical significance of these antibodies and their detection methods remain uncertain. This study aimed to evaluate the diagnostic and functional relevance of anti-rhGAA antibodies in late-onset Pompe disease (LOPD) and to compare the performance of ELISA and Western blot assays. Fourteen patients with LOPD undergoing ERT and 14 age- and sex-matched healthy controls were studied. Serum anti-rhGAA antibodies and their IgG, IgM, and IgA isotypes were quantified using ELISA and verified by Western blot. Motor function was assessed using the Pompe Motor Function Levels Questionnaire, an adapted version of the GMFCS validated for Pompe disease. Total and isotype-specific anti-rhGAA antibody levels were significantly higher in patients than in controls. ROC analysis showed excellent discrimination between groups. Strong agreement was observed between ELISA and Western blot results. However, antibody levels were not significantly correlated with motor function grade. Given the small sample size (n = 14), this non-significant result may reflect limited statistical power rather than a true lack of association. Anti-rhGAA antibody detection effectively distinguishes LOPD patients from healthy individuals. Western blot provides a reliable, low-cost alternative to ELISA, particularly useful in resource-limited settings. Nevertheless, the prognostic utility of antibody titers for functional outcomes remains uncertain and warrants larger, multicenter validation studies.

PMID:42113496 | DOI:10.18502/ijaai.v25i2.20800

Iran J Allergy Asthma Immunol. 2026 Feb 1;25(2):161-169. doi: 10.18502/ijaai.v25i2.20795.

ABSTRACT

Asthma is a common chronic respiratory disease in children, often leading to acute exacerbations marked by dyspnea, cough, and wheezing, which frequently necessitate emergency medical care. While standard therapies are effective, the exploration of novel drug delivery routes continues. Oral montelukast is a recognized treatment, but the efficacy of its intranasal formulation for acute attacks remains underexplored. This study aimed to evaluate the clinical effectiveness of intranasal montelukast as an adjunct therapy for pediatric asthma exacerbations. A single-blinded, placebo-controlled, single-center trial was conducted involving children aged 2-12 years hospitalized with moderate to severe acute asthma. Participants were randomized to receive either intranasal montelukast or a placebo alongside standard care. Key outcomes, including the Pulmonary Index Score (PIS), respiratory rate, oxygen saturation, and length of hospital stay, were systematically assessed. The analysis of 25 patients in each group revealed no significant baseline differences. The intranasal montelukast group demonstrated a statistically significant and sustained reduction in PIS scores at critical intervals (8, 12, and 24 hours) compared to the placebo group. Improvements in respiratory rate and oxygen saturation were also more pronounced with the active treatment. Notably, the mean hospital stay was significantly shorter for the montelukast group (2.16 days) than the placebo group (3.12 days). In conclusion, intranasal montelukast shows significant promise as an effective adjunct therapy for acute pediatric asthma, correlating with accelerated clinical improvement and a reduced duration of hospitalization. These encouraging results justify further investigation through larger, multicenter trials to definitively establish its efficacy and safety profile.

PMID:42113491 | DOI:10.18502/ijaai.v25i2.20795

Int J Pharm Pract. 2026 May 11:riag061. doi: 10.1093/ijpp/riag061. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the acceptability of the ‘I manage my meds’ toolkit in supporting adults aged 65 years and above to manage multiple medications at home. A secondary objective was to assess the extent to which ‘I manage my meds’ acceptability differs between different demographic groups, in this study, those from a South Asian background.

METHODS: A community researcher facilitated study was conducted in Bradford, UK. Sixty participants aged 65-94 years, each managing at least five medications, were recruited. As a focus of this study was to explore whether the culturally adapted toolkit was acceptable, half of the sample recruited were from a South Asian background. Participants engaged with the toolkit, available in English and Urdu, before completing a structured questionnaire based on the theoretical framework of acceptability. Quantitative data were analysed using factor analysis, descriptive statistics, and comparative tests between ethnic groups.

KEY FINDINGS: The toolkit demonstrated high overall acceptability, with a mean score of 2.93 out of 4. Acceptability did not significantly differ by age but varied across domains of the framework. Intervention Coherence received the highest ratings, indicating that participants found the toolkit easy to understand, while self-efficacy scored lowest, suggesting some limitations in confidence for medicine self-management. South Asian participants reported significantly higher overall acceptability (mean 3.33) compared with non-South Asian participants (mean 2.61). Significant differences were found across multiple domains, with South Asian participants reporting greater perceived usefulness and fewer barriers to use.

CONCLUSIONS: The findings indicate that the ‘I manage my meds’ toolkit is a clear, practical, and well-received resource for older adults managing polypharmacy at home. The culturally adapted version demonstrated high acceptability among South Asian participants, highlighting the importance of tailoring health interventions to diverse populations.

PMID:42113487 | DOI:10.1093/ijpp/riag061

J Biopharm Stat. 2026 May 11:1-28. doi: 10.1080/10543406.2026.2667334. Online ahead of print.

ABSTRACT

The win ratio (WR) is a widely used metric to compare treatments in randomized clinical trials with hierarchically ordered endpoints. Counting-based approaches, such as Pocock’s algorithm, are the standard for WR estimation. However, this algorithm treats participants with censored or missing data inadequately, which may lead to biased and inefficient estimates, particularly in the presence of heterogeneous censoring or missing data between treatment groups. Although recent extensions have addressed some of these limitations for hierarchical time-to-event endpoints, no existing methods – aside from the computationally intensive multiple-imputation approach – can accommodate settings that include nonsurvival endpoints that are subject to missing data. In this paper, we propose a simple nonparametric maximum likelihood estimator (NPMLE) of WR for two hierarchical endpoints that are subject to censoring and missing data. Our method uses all observed data, avoid strong parametric assumptions and come with a closed-form asymptotic variance estimator. We demonstrate its performance using simulation studies and two data examples, based on the HEART-FID and ISCHEMIA trials. The proposed method provides a consistent estimator, improves estimation efficiency, and is robust under noninformative censoring and missing at random (MAR) assumptions, offering a flexible alternative to existing WR estimation methods. A user-friendly R package, WinRS, is available to facilitate implementation.

PMID:42113484 | DOI:10.1080/10543406.2026.2667334

Phys Eng Sci Med. 2026 May 11. doi: 10.1007/s13246-026-01742-2. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most frequently diagnosed cancer among women. Accurate diagnosis and effective management rely heavily on high-quality positron emission tomography (PET) imaging. A novel time-of-flight (TOF)-enhanced deep learning reconstruction (DLR) technique has recently been introduced for the Omni Legend (GE Healthcare) PET/CT system. However, its clinical utility in breast cancer imaging has not yet been fully established. This study aims to assess the impact of the DLR method on ¹⁸F-FDG PET/CT imaging in patients with breast cancer.

METHODS: This retrospective study included 30 female breast cancer patients who underwent ¹⁸F-FDG PET/CT using the Omni Legend system. PET images were reconstructed using the Bayesian penalized likelihood (BPL) method and a DLR method with three TOF enhancement levels: low (L-DLR), medium (M-DLR), and high (H-DLR). Image quality was evaluated using liver noise level (Noise) and lesion signal-to-background ratios (SBR). Percentage changes in these metrics between BPL and each DLR setting were calculated. The four reconstruction methods were compared using the Friedman test with Bonferroni correction. P-values < 0.05 were used to denote statistical significance.

RESULTS: Noise values for BPL, L-DLR, M-DLR, and H-DLR were 0.08, 0.06, 0.06, and 0.08, respectively (P < 0.001), whereas SBR values were 3.75, 3.85, 4.09, and 4.39, respectively (P < 0.001). Compared with BPL, L-DLR and M-DLR significantly reduced Noise by 33.20% (P < 0.001) and 22.21% (P < 0.001), respectively, whereas M-DLR and H-DLR significantly improved SBR by 8.96% (P < 0.001) and 16.79% (P < 0.001), respectively.

CONCLUSIONS: The TOF-enhanced DLR method improves PET image quality metrics compared with the BPL method and has the potential to enhance image quality in ¹⁸F-FDG PET/CT for patients with breast cancer.

PMID:42113440 | DOI:10.1007/s13246-026-01742-2

J Egypt Public Health Assoc. 2026 May 11;101(1):15. doi: 10.1186/s42506-026-00218-1.

ABSTRACT

BACKGROUND: With the changing perception of Caesarean Section (CS) from a lifesaving to a routine procedure, non-medically indicated CS is increasing. This study assessed the prevalence, indications, and preference for CS among women attending primary health care (PHC) units in Port Said Governorate, Egypt.

METHODS: A cross-sectional study was conducted from December 2023 to February 2024 in six primary health care units across Port-Said Governorate, Egypt. Married women of childbearing age who had experienced at least one childbirth (primiparous and multiparous) were included. A total of 179 participants were recruited using multistage sampling, combining random selection of PHC units and consecutive sampling of eligible women. Data were collected using a validated structured questionnaire covering socio-demographics, obstetric history, last delivery experience, and preference for the next delivery. Statistical analysis was performed using SPSS v26, including univariate and multivariate logistic regression to identify factors associated with CS and delivery preference.

RESULTS: A total of 179 women participated in the study. Of these, 68% had CS for their last delivery. The most frequently reported reasons for previous CS were fear of labor (56%), prolonged labor (18%), and long distance to the hospital (15.6%). Regarding future delivery preferences, (61.5%) of women expressed a preference for CS. The leading reasons cited were less pain (81.8% ), the belief that CS is safer for the baby (57.3%), and the knowledge of the time of delivery (32.2%). Multivariate logistic regression identified independent predictors for each outcome. Women with higher income [AOR 10.0, 95% CI 2.7-36.9, < 0.001] and those whose doctor suggested CS [AOR 19.2, 95% CI 5.5-67.1, p < 0.001] were more likely to have had a CS in their last delivery. In contrast, preference for CS in the next delivery was independently associated with higher husband education [AOR 12.1, 95% CI 1.2-124.3, p = 0.036] and a history of previous CS [AOR 14.7, 95% CI 6.2-34.6, p < 0.001].

CONCLUSION: Fear of labor and previous CS were the main drivers of past and preferred future CS deliveries, with non-medical factors outweighing medical indications. Findings highlight the need for educational interventions to support informed delivery choices.

PMID:42113390 | DOI:10.1186/s42506-026-00218-1

J Egypt Natl Canc Inst. 2026 May 11;38(1):24. doi: 10.1186/s43046-026-00364-9.

ABSTRACT

BACKGROUND: Data on specific single nucleotide polymorphisms (SNPs), including rs2072454 and rs2227983, remain limited, particularly in North African populations. This study aimed to evaluate the association between these two SNPs and lung cancer risk in a Western Algerian population.

METHODS: This is a case-control study including 143 participants, 73 lung cancer patients recruited from the University Hospital Centre of Oran, and 70 healthy controls recruited from the blood transfusion centre of the University Hospital Establishment of Oran (UHEO) and volunteer pool. Genotyping of EGFR rs2072454 and rs2227983 polymorphisms was performed using polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). Statistical analyses were conducted using R software, with logistic regression models adjusted for gender and smoking status.

RESULTS: The CT genotype of rs2072454 showed a nominal association with increased lung cancer risk under the overdominant model (OR = 2.35, 95% CI: 1.04-5.30, p = 0.04). For rs2227983, while the dominant model (AG/ GG vs AA) demonstrated the best fit based on AIC/BIC criteria, however, only the AG genotype showed a borderline association in adenocarcinoma cases under the codominant model (OR = 2.76, 95% CI: 1.0-7.5, p = 0.04). No significant haplotype associations or linkage disequilibrium was observed between the two SNPs.

CONCLUSIONS: These findings suggest potential, but uncertain, associations between EGFR polymorphisms and lung cancer susceptibility in this population. The results should be interpreted cautiously due to the limited sample size and require validation in larger cohorts.

PMID:42113385 | DOI:10.1186/s43046-026-00364-9

Appl Microsc. 2026 May 11;56(1):14. doi: 10.1186/s42649-026-00136-8.

ABSTRACT

The histological structure and morphometric characteristics of the skin of the Korean ice goby Leucopsarion petersii were investigated using light microscopy, two histological staining techniques, and SPSS statistical analysis. Skin samples from adult L. petersii fishes were collected from five body regions, including the head, operculum, dorsal body, lateral body, and ventral body. In all examined regions, the skin of L. petersii exhibited the general structure as in other teleost fishes, consisting of an epidermis and dermis separated by a distinct basement membrane with underlying skeletal muscle. The epidermis was composed of outermost flattened cells, basal cells, club cells, and mucous cells. However, some histological findings differed from the typical teleost fishes: I), the dermis was mainly characterized by a well-developed stratum compactum with an almost complete absence of the stratum laxum; II), Although epithelial thickness showed significant regional variation, it was positively correlated with basement membrane thickness (r = 0.417, p < 0.001; n = 100); III), Mucous cells, suggesting the formation of a protective mucosal barrier on the skin surface, were distributed in the outer epidermal layer; IV), club cells, implying retention of chemical defense mechanisms against environmental stress, were confirmed within the epidermis. Consequently, the skin histology of the skin of L. petersii may reflect adaptive responses to its thin body surface and to the fluctuating environmental conditions encountered in coastal and estuarine habitats.

PMID:42113373 | DOI:10.1186/s42649-026-00136-8

Prev Sci. 2026 May 11. doi: 10.1007/s11121-026-01918-y. Online ahead of print.

ABSTRACT

There has been growing interest in preventive intervention “crossover” effects on suicidal thoughts and behaviors (STBs), in which targeting early risk factors may mitigate distal risk for STBs without STBs having been the targeted outcomes of the primary study. The present study extends an 11-study integrative data analysis of the Coping Power (CP) intervention (N = 3182) to assess indirect effects of different forms of CP on teacher- and parent-reported STBs as transmitted through different subdimensions of internalizing and externalizing problems. Compared to school-as-usual, all forms of CP (Standard/Group CP, Individual CP, CP with Mindfulness, Internet-Enhanced CP) led to reductions in parent- and/or teacher-reported youth STBs. Subgroup analyses suggested that boys benefitted from Individual CP and CP with Mindfulness mediated by reductions in aggressive behavior, whereas boys in Standard CP saw reductions in STBs mediated by reductions in conduct problems. Girls saw reductions in STBs in CP with Mindfulness mediated by reductions in anxiety. Some inferences made for individual $\hat{\alpha }$ and $\hat{\beta }$ paths and mediation effects differed when using standard parametric approaches for inference versus bias-corrected percentile bootstrapping. These differences highlight cautions regarding statistical inference for prevention researchers who study highly skewed zero-inflated latent variables such as STBs. Findings are discussed in light of (a) earlier etiological research on biological sex-specificity in the pathways to early risk for suicide and (b) how variation in program components of CP and its adaptations may reduce STB risk across different populations, age groups, and modes of program delivery.

PMID:42113366 | DOI:10.1007/s11121-026-01918-y