Tag: statistics

JACC Clin Electrophysiol. 2026 Mar 16:S2405-500X(26)00109-X. doi: 10.1016/j.jacep.2026.01.035. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiac implantable electronic device (CIED) infection represents a significant cause of morbidity and increased health care costs in patients undergoing high-risk procedures.

OBJECTIVE: This study sought to describe the incidence of infection using two prevention strategies: chlorhexidine gluconate (CHG) pocket irrigation vs antibacterial envelope (ABE).

METHODS: In this retrospective observational study, patients undergoing high-risk CIED interventions (generator change, device upgrade, lead/pocket revision, cardiac resynchronization device implantation) between 2018 and 2024, in whom either CHG irrigation or ABE was used, were included. Propensity score matching using baseline and procedural characteristics (age, sex, previous infection, intervention within 60 days, type of device, type of intervention, PADIT [Prevention of Arrythmia Device Infection Trial] score, antibiotic used) was performed.

RESULTS: A total of 1,749 patients (median age 73 years [Q1-Q3: 63-81 years], female 42%; CHG: n = 1,118) were included. After a median follow-up of 459 days (Q1-Q3: 192-852 days), there were no statistically significant differences in the risk of CIED-related infection (0.8% vs 0.8%; HR: 0.89; 95% CI: 0.3-2.66; log-rank P = 0.83) between the CHG and ABE groups. After propensity score matching, a total of 714 patients, without statistically significant differences in baseline characteristics, were analyzed. There were no significant differences in the risk of CIED-related infection (1.1% vs 1.1%; HR: 0.97; 95% CI: 0.24-3.86, log-rank P = 0.96). No adverse events associated with CHG irrigation occurred.

CONCLUSIONS: In high-risk procedures, CHG irrigation resulted in a similar risk of CIED-related infection as treatment with an ABE, without any adverse events. The lower cost of CHG and widespread availability could result in more patients being treated, thus extending the benefits to patients with a lower risk of infection.

PMID:41860497 | DOI:10.1016/j.jacep.2026.01.035

Biometrics. 2026 Jan 6;82(1):ujag047. doi: 10.1093/biomtc/ujag047.

ABSTRACT

The analysis of covariance (ANCOVA) is a commonly used method for correcting bias and improving accuracy in estimating the average treatment effect in randomized clinical trials. In this paper, we focus on using ANCOVA for longitudinal outcomes, where mixed effects regression is the standard approach. The effectiveness of ANCOVA depends on the regression model specification, including how the baseline covariates were used. Unlike traditional methods, we do not assume that the mixed effects model is correctly specified, making our approach nonparametric in nature. We investigate the optimal ANCOVA approach for longitudinal outcomes and show that appropriate covariate adjustment can greatly improve the precision of treatment effect estimates. Unfortunately, determining the optimal ANCOVA adjustment is challenging because it relies on the relationship between longitudinal outcomes and baseline covariates, which is typically unknown. We propose to use cross fitting procedure to estimate the conditional expectation of longitudinal outcomes given baseline covariates to guide the specification of ANCOVA. We provide theoretical derivations and empirical evidence from numerical studies to demonstrate the superiority of our proposed nonparametric ANCOVA method over traditional ANCOVA approaches. Our approach is robust, flexible, and can be easily implemented in practice to improve the accuracy and reliability of treatment effect estimates in clinical trials.

PMID:41860475 | DOI:10.1093/biomtc/ujag047

Mol Nutr Food Res. 2026 Mar;70(6):e70437. doi: 10.1002/mnfr.70437.

ABSTRACT

The diet-PCOS relationship remains complex and requires further investigation. Among 1424 participants (12.3% suspected PCOS), dietary patterns were evaluated using NIH criteria via FFQ: exploratory factor analysis (EFA), EAT-Lancet dietary pattern (EAT-LDP), Mediterranean, plant-based indices. EFA identified four patterns: plant-forward (PFD), animal-protein (APD), red and organ meat (ROM), and fast-food (FFD). Multivariable logistic regression, adjusted for age, BMI, education attainment, marriage situation, physical activity status, frequency of ordering takeout, depression, anxiety and stress, showed: compared to the lowest adherence group, the highest APD quartile was associated with a higher prevalence of suspected PCOS (OR = 2.20, 95% CI: 1.42-3.41, P < 0.001); the highest EAT-LDP quartile was correlated with a lower prevalence of suspected PCOS (OR = 0.40, 95% CI: 0.16-0.83, P < 0.05). Mediterranean scores ≥5 are positively associated with suspected PCOS (score 5: OR = 1.63, 95% CI: 1.09-2.44; score >5: OR = 1.89, 95% CI: 1.23-2.89, both P < 0.05), while scores ≤4 are negatively associated with suspected PCOS (OR = 0.57, 95% CI: 0.33-0.95, P < 0.05). Plant-based indices showed no significant associations with suspected PCOS. Higher adherence to the EAT-LDP, lower adherence to the APD, and moderate adherence to the Mediterranean diet are associated with a reduced prevalence of suspected PCOS. Large-scale cohort studies are needed to confirm these findings and establish causality.

PMID:41860448 | DOI:10.1002/mnfr.70437

Nephrol Dial Transplant. 2026 Mar 20:gfag065. doi: 10.1093/ndt/gfag065. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Primary membranous nephropathy (MN) and diabetes mellitus (DM) are common comorbidities, yet the impact of DM on the response to anti-CD20 monoclonal antibody therapy in MN remains unclear. We hypothesized that despite comparable B-cell depletion, MN patients with comorbid DM would exhibit a reduced treatment response compared to non-diabetic MN patients.

METHODS: In this retrospective cohort study, we included adults with primary MN who received at least one complete course of anti-CD20 antibody therapy. Propensity score matching (1:2) was applied based on age, sex, baseline eGFR, urinary protein and PLA2R antibody status. The primary outcome was remission (complete or partial) at 3,6,9,12 months. Secondary outcomes included immunological remission, B-cell depletion, and changes in renal parameters. Multivariable logistic regression, Kaplan-Meier analysis, and subgroup analyses were used to compare outcomes between MN patients with (MN+DM) and without diabetes (MN).

RESULTS: After matching, 207 patients were included (72MN+DM, 135MN). B-cell depletion and immunological remission rates showed no statistically significant differences between groups over the 12-month follow-up period. However, MN patients had significantly higher overall remission rates at 9 months (94% vs. 77%; OR=4.55, 95% CI=1.52-12.50, P<0.01) and at 12 months (97% vs. 86%; OR=5.26, 95% CI=1.25-20.00, P<0.05). Subgroup analyses confirmed consistently poorer responses in diabetic patients across multiple strata. Safety profiles were similar between groups.

CONCLUSION: Despite equivalent B-cell depletion, MN with DM patients show a reduced response to anti-CD20 antibody therapy relative to non-diabetic patients, underscoring that tight glycemic control, early supplementary anti-CD20 dosing for poor response, and combined immunosuppressive regimens may enhance their clinical outcomes.

PMID:41860432 | DOI:10.1093/ndt/gfag065

Ann Plast Surg. 2026 Mar 23. doi: 10.1097/SAP.0000000000004726. Online ahead of print.

ABSTRACT

BACKGROUND: Academic publishing underpins surgical decision-making, but the rapid adoption of generative artificial intelligence (AI) raises concerns about research credibility and patient safety. To the best of our knowledge, no prior pilot study has examined its presence in plastic and reconstructive surgery. Detection tools remain imperfect, and journals lack consensus on disclosure policies, leaving a gap between rapid adoption and effective oversight.

METHODS: This pilot analysis sampled 10% (n=67) of articles published between July 1, 2024, and July 1, 2025, across leading plastic and reconstructive surgery and burn journals. We assembled a matched control cohort from 2014 to 2015 using identical criteria. Articles were analyzed using a combined RoBERTa classifier and perplexity-based evaluation to flag potential AI-like textual characteristics.

RESULTS: At the article level, 18 of 67 articles (26.9%, 95% CI: 17.7-38.5) contained ≥1 flagged section, with 20 subsections (5.3%, 95% CI: 3.5-8.1) flagged. Flagged content clustered in methods (9.1%) and abstracts (7.5%), with lower prevalence in other sections. In our control cohort, 3 papers (4.5%, 95% CI: 1.5-12.5) and 3 subsections were flagged (0.9%, 95% CI: 0.3-2.7), representing ~6-fold and 5-fold increases, respectively. This difference was statistically significant at the article level (χ²=11.1, P<0.001).

CONCLUSIONS: AI-like textual characteristics were more frequently detected in contemporary plastic and reconstructive surgery publications than in the pre-AI cohort. Although detection does not confirm authorship, these findings underscore the need for clearer and more consistent disclosure, standardized and graded reporting policies, and reviewer training to enable responsible integration of AI into surgical publishing.

PMID:41860427 | DOI:10.1097/SAP.0000000000004726

Clin Psychol Psychother. 2026 Mar-Apr;33(2):e70261. doi: 10.1002/cpp.70261.

ABSTRACT

While selective mutism (SM) is often conceptualized as a childhood anxiety disorder, longitudinal evidence suggests persistent difficulties into adolescence, yet the underlying cognitive and emotional mechanisms remain poorly understood. We aimed to address this gap by examining whether specific neurocognitive impairments and emotion regulation difficulties characterize adolescents with SM. Eighty-nine adolescents (42 SM, 47 HC), aged 11-17 years, were assessed using the Strengths and Difficulties Questionnaire (SDQ), the Difficulties in Emotion Regulation Scale (DERS) and a neuropsychological battery evaluating attention, inhibition, processing speed, memory and social cognition. Adolescents with SM demonstrated greater emotional awareness difficulties (p = 0.010), with no differences in total DERS scores. SDQ scores indicated higher inattention/hyperactivity (p < 0.001), alongside significantly higher prosocial behaviour (p < 0.001). Neurocognitive findings revealed intact verbal learning but impaired immediate and delayed recall (p < 0.001), better delayed visual memory (p = 0.001). Children with SM made fewer total errors on Wisconsin Card Sorting Test (p = 0.021) and showed higher foil accuracy on CPT (p = 0.007), but demonstrated significantly poorer Stroop colour-word (p = 0.001) and interference scores (p = 0.001). Adolescents with SM showed a distinctive cognitive-emotional profile, suggesting that internal emotional processing and external social sensitivity are dissociated during adolescence. Longitudinal and neurobiological research is warranted to elucidate mechanisms and refine treatment strategies.

PMID:41860376 | DOI:10.1002/cpp.70261

J Alzheimers Dis. 2026 Mar 20:13872877261431845. doi: 10.1177/13872877261431845. Online ahead of print.

ABSTRACT

BackgroundNormal aging is accompanied by cognitive decline and structural changes in the brain, most notably within the hippocampus and amygdala. However, distinguishing these age-related alterations from the earliest signs of neurodegenerative disorders remains challenging.ObjectiveThis study aims to investigate and compare the alteration patterns of hippocampus and amygdala during normal aging and in cases of mild cognitive impairment (MCI) and Alzheimer’s disease (AD), which will provide insights into their distinct structural profiles.MethodsA total of 2195 participants aged 20-90 from three public cohorts (1364 cognitively normal controls, 623 MCI, and 208 AD) were grouped by decade to examine age- and disease-related differences in surface-based morphometry of hippocampus and amygdala. Radial distance, tensor-based morphometry, and multivariate tensor-based morphometry were calculated and combined to generate the Multivariate Morphometry Statistics, which capture both radial and tangential deformations at each vertex. Statistical and deformation analyses were further performed to identify the alteration patterns across 15000 surface vertices between age groups.ResultsIn healthy adults, significant intergroup differences were observed in the hippocampal CA1 and subiculum, as well as in the lateral, basolateral, and accessory basal nuclei of the amygdala. In MCI and AD, additional significant differences were detected in the hippocampal CA2-3 subfield and the central, medial, and cortical nuclei of the amygdala.ConclusionsWe provide a surface-based morphometry map of the hippocampus and amygdala across age groups in normal and pathological aging, revealing distinct morphological patterns that enhance understanding of aging and neurodegeneration.

PMID:41860363 | DOI:10.1177/13872877261431845

J Glob Health. 2026 Mar 20;16:04109. doi: 10.7189/jogh.16.04109.

ABSTRACT

BACKGROUND: The Kyrgyz Republic has recently implemented health programmes to improve the quality of care for mothers, newborns and children. To support these efforts, a three-year World Health Organization (WHO) quality improvement (QI) project aimed to strengthen clinical practices and service delivery. This study was conducted to independently assess the project’s effectiveness and inform policy and programming.

METHODS: Data were collected retrospectively from 18 hospitals: nine that implemented the intervention (IH) and nine control hospitals (CH). Medical records were randomly selected for women in labour, newborns and children hospitalised in 2019, 2021 (pre-QI project), and 2023 (post-QI project).

RESULTS: We reviewed 1707 women’s, 1736 newborns’, and 1593 children’s records. The proportion of women with a planned caesarean section before 39 + 0 weeks of gestation was 44.8% (2021) and 28.3% (2023) in IH, and 53.3% and 50.0%, respectively, in CH. Antibiotic prophylaxis use for caesarean sections was high in both IH and CH. The proportion of newborns breastfed within the first 30 minutes of life in IH was 58.3% (2021), and 50.6% (2023), and in CH 56.6% and 64.1%, respectively. Newborns were unnecessarily prescribed antibiotics in IH (13.7% in 2021, 16.2% in 2023), and in CH (24.2% and 6.1%, respectively). Children were frequently prescribed unnecessary antibiotics both in IH and CH. Children with pneumonia were unnecessarily prescribed corticosteroids both in IH (35.5% in 2019, 54.7% in 2023) and in CH (28.3% in 2019, 50.9% in 2023). The proportion of children with diarrhoea receiving oral rehydration salts (ORS) and zinc increased between the start and the end of the QI project in IH while this was not the case for zinc prescription in CH.

CONCLUSIONS: These results highlight the importance of continuous monitoring and targeted interventions to enhance quality care. Routine clinical audits based on medical record reviews should be institutionalised to support hospital managers in enhancing clinical practices.

PMID:41860341 | DOI:10.7189/jogh.16.04109

J Glob Health. 2026 Mar 20;16:04104. doi: 10.7189/jogh.16.04104.

ABSTRACT

BACKGROUND: Neonatal herpes simplex virus (nHSV) infection, caused by HSV-1 or HSV-2, is a global health concern due to its high mortality and long-term morbidity. In this study, we assessed nHSV global epidemiology, regional variations, and temporal trends.

METHODS: We conducted a systematic review of PubMed, Embase, and national surveillance reports through 12 December 2024, and reported findings in accordance with PRISMA guidelines. We used random-effects meta-analysis to estimate pooled mean outcomes and meta-regression analyses to assess associations, temporal trends, and potential sources of heterogeneity.

RESULTS: We identified 143 relevant publications from three of the six World Health Organization regions, providing 140 nHSV incidence rate measures and 103 proportions of incident nHSV-1 vs. nHSV-2 cases. The global pooled and regional population-weighted mean incidence rate was 8.2 (95% confidence interval (CI) = 5.9-10.7) per 100 000 live births. Incidence rate was highest in the Americas (13.3 cases per 100 000 live births; 95% CI = 9.9-17.2), followed by the European Region (5.2 cases per 100 000 live births; 95% CI = 3.4-7.3) and the Western Pacific Region (2.9 cases per 100 000 live births; 95% CI = 2.2-3.6). Globally, nHSV-1 and nHSV-2 accounted for pooled and weighted means of 47.3% (95% CI = 39.5-55.0) and 52.8% (95% CI = 45.2-60.5) of cases, respectively. The highest nHSV-1 proportion was in the Western Pacific Region (57.7%; 95% CI = 49.2-66.1), while the highest nHSV-2 proportion was in the Region of the Americas (60.5%; 95% CI = 55.8-65.1). Meta-regression analyses showed an annual increase of 3.5% (95% CI = 1.5-5.6) in nHSV incidence rate, alongside a yearly 1.4% (95% CI = 0.9-1.9) increase in the proportion of nHSV-1 cases and a 1.1% (95% CI = 0.6-1.6) decrease in the proportion of nHSV-2 cases.

CONCLUSIONS: nHSV affects approximately one in 10 000 newborns, with regional variations and a rising incidence rate. The increasing dominance of nHSV-1 over nHSV-2 reflects shifting HSV epidemiology.

PMID:41860333 | DOI:10.7189/jogh.16.04104

J Glob Health. 2026 Mar 20;16:04088. doi: 10.7189/jogh.16.04088.

ABSTRACT

BACKGROUND: Antenatal magnesium sulphate reduces the risk of cerebral palsy (CP) for infants born very preterm. While endorsed by the World Health Organization for global implementation in 2015, studies underpinning this recommendation were conducted in high-income countries. Our objective was to systematically gather, organise, and map published research studies on the use of antenatal magnesium sulphate for preterm foetal neuroprotection in low- and middle-income countries (LMICs), and to obtain existing relevant national and international clinical practice guidelines from (or for) LMICs.

METHODS: Following scoping review methods, we searched nine databases and the websites of societies/ministries of health for relevant qualitative or quantitative studies and national or international guidelines, published from 2015, from any LMIC. We screened each publication for inclusion, and two reviewers independently extracted information. Content analysis included narrative summaries and descriptive statistics.

RESULTS: In total, 57 research studies (12 randomised controlled trials) and 25 clinical guidelines were included in the analysis. Most (n = 75) were in English, from lower-middle (n = 45) and upper-middle (n = 31) countries, and published between 2020 and 2025 (n = 60). The most common research scope was effects and/or safety (n = 38). The remaining studies focused on intervention uptake or quality improvement programmes (n = 10), mechanisms of action (n = 5), or regimen comparisons (n = 4). Short-term outcomes were common, and CP was described in only four studies. Regarding clinical guidelines, magnesium sulphate was usually included in general guidelines (n = 24), those published by professional associations (n = 18), or those published by government bodies (n = 6). After categorisation, an upper gestational limit of 32 weeks was most common (n = 18). Treatment regimens varied, commonly including a 4 g intravenous loading dose (n = 12) and a 1 g/h intravenous maintenance dose (n = 11). One in three recommended no specific regimen.

CONCLUSIONS: A sizeable number of heterogeneous studies and clinical guidelines exist, primarily from middle-income countries, regarding magnesium sulphate for neuroprotection. Further context-specific research may include regimen comparisons, impact, and implementation studies, informing future updates to clinical guidelines globally.

REGISTRATION: OSF 10.17605/OSF.IO/ASN67.

PMID:41860331 | DOI:10.7189/jogh.16.04088