Tag: statistics

Cardiovasc Diabetol. 2026 Feb 3. doi: 10.1186/s12933-025-03043-6. Online ahead of print.

ABSTRACT

BACKGROUND: The atherogenic index of plasma (AIP) serves as a crucial indicator for assessing atherosclerotic risk. It reflects the degree of dyslipidaemia and cardiovascular disease (CVD) risk. The cardiometabolic index (CMI) provides a comprehensive evaluation of obesity-related metabolic risk, acting as a key biomarker for predicting multiple cardiometabolic diseases. The relationship between AIP and CMI in patients with non-alcoholic fatty liver disease (NAFLD) and mortality or CVD risk remains unclear.

METHODS: This study included 5792 adult (≥ 18 years) NAFLD patients from the US National Health and Nutrition Examination Survey (NHANES, 1999-2018). Weighted logistic regression and Cox proportional hazards models were employed to investigate the association between AIP, CMI and all-cause mortality, CVD mortality and CVD risk. Restricted cubic spline (RCS) curves assessed non-linear associations. Subgroup analyses and mediation analyses examined the effect modifiers and mediators. The incremental predictive value of AIP and CMI was evaluated. Sensitivity analyses were conducted to validate the robustness.

RESULTS: During follow-up, 721 all-cause deaths (including 241 CVD deaths) and 726 total CVD events were recorded. After adjusting for confounding factors, patients in the highest quartiles of AIP and CMI had a significantly higher risk of specific CVD events. The strongest association was observed for CHF (AIP: OR = 3.157, 95% CI 1.684, 5.922, p < 0.001; CMI: OR = 3.604, 95% CI 1.843, 7.047, p < 0.001), followed by heart attack and CHD. CMI consistently demonstrated a stronger effect than AIP. RCS analysis indicates a non-linear relationship between CMI and CHD, angina pectoris. Subgroup analysis revealed that both AIP and CMI demonstrated high predictive value for all-cause mortality in the 40-60 age cohort. Mediation analysis revealed that Mets, NLR, hypertension and HOMA-IR partially mediated the aforementioned associations. The inclusion of AIP and CMI partially improved the predictive capability of the basic model. Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS: In patients with NAFLD, CMI is a stronger predictor of non-fatal CVD than AIP. While both indices show limited value for predicting mortality, CMI holds promise as a practical supplementary tool for clinical risk assessment.

PMID:41634708 | DOI:10.1186/s12933-025-03043-6

BMC Complement Med Ther. 2026 Feb 3. doi: 10.1186/s12906-026-05265-x. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension (HTN), a chronic inflammatory condition, is a major cardiovascular risk factor. Dysregulation of inflammatory cytokines and brain-gut peptides contributes to its progression. This study aimed to evaluate the effects of a Tai Chi rehabilitation program on blood pressure, inflammatory cytokines [interleukin-6 (IL-6), interleukin-10 (IL-10)], and brain-gut peptides [neurotensin (NT), gastrin (GAS)] in patients with HTN, hypothesizing that Tai Chi would improve these parameters compared with Fitness exercise or no intervention.

METHODS: A randomized controlled trial enrolled 105 patients with HTN and coronary heart disease. Participants were randomized into the Tai Chi group (n = 35), Fitness group (n = 35), or Blank group (n = 35). The intervention lasted 24 weeks (3 sessions per week, 60 min per session, 40-60% heart rate reserve). Blood pressure and serum levels of IL-6, IL-10, NT, and GAS were measured before and after the intervention using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with SPSS version 27, applying paired t-tests, analysis of variance (ANOVA), and Pearson correlation.

RESULTS: Ninety participants completed the study (Tai Chi group: 31, Fitness group: 28, Blank group: 31). The Tai Chi group showed significant reductions in systolic blood pressure (SBP) and IL-6 (p < 0.001), along with increases in IL-10, NT, and GAS (p < 0.001) compared to baseline. Compared with the Fitness group, the Tai Chi group achieved greater increases in NT and GAS (p < 0.05). Compared with the Blank group, the Tai Chi group demonstrated superior reductions in SBP and IL-6 (p < 0.05). Reductions in IL-6 were negatively correlated with increases in NT and GAS (p < 0.001).

CONCLUSION: Tai Chi rehabilitation lowered systolic blood pressure, reduced inflammation, and improved brain-gut peptides, supporting its role as a complementary therapy for hypertension. The modest sample size, 14.3% dropout rate, and recruitment from two hospitals may limit generalizability, and larger multi-center studies with longer follow-up are needed.

TRIAL REGISTRATION: The trial was registered with the International Traditional Medicine Clinical Trial Registry (Registration No. ITMCTR2024000813; registration date: 2024/12/13).

PMID:41634677 | DOI:10.1186/s12906-026-05265-x

BMC Med Educ. 2026 Feb 4. doi: 10.1186/s12909-026-08715-9. Online ahead of print.

ABSTRACT

BACKGROUND: The existing undergraduate training uses comprehensive models, including theoretical, preclinical, and clinical practice, and aims to provide the candidate with the specific knowledge and skills required to perform the relevant treatments. The prevalence of integrating new systems in endodontic education and their contribution to the applicability of endodontic treatments have not been evaluated from the perspective of trainees and educators before/after graduation. This study aimed to determine which endodontic preclinical training model contributes more to clinical applicability and success. In light of the obtained data, it seeks to raise awareness by proposing the most appropriate education model or model combination.

METHODS: A questionnaire was initially prepared and transferred to an online platform. The survey consists of 3 parts and 36 questions in total. The first part is about the participants’ demographics. The second section assessed information on endodontic preclinical training models participants experienced during undergraduate/postgraduate training, their general perspectives on endodontics, and their self-assessment of the contribution of these models to clinical practice competence. The third aimed to determine participants’ knowledge of the material properties used in endodontic simulation, their advantages and disadvantages, and their preferred model based on trainee and educator perspectives. After validating the questionnaire, the data were analysed using Fisher-Freeman-Halton, Pearson chi-square, Yates correction, and Fisher Exact Test with Monte Carlo correction for categorical variables (p < 0.05).

RESULTS: The internal consistency and construct validity demonstrated strong inter-item correlations (r = 0.81-0.90), indicating high internal coherence. The content validity index for all items exceeded the acceptable threshold (≥ 0.80). The distribution of participants (n = 238) was as follows: students (46.8%), dentists (29.1%), PhD students/residents (9.7%), endodontists (7.6%), and lecturers/educators (8.9%). Most participants reported completing preclinical training with only extracted teeth (54.2%). The preclinical training model the current students received had a statistically significant content, with simulated models included (p < 0.003). Among dentists and students trained solely on extracted teeth, those not sympathetic to endodontics were significantly more common (p = 0.042). Those who responded that they understood and practised endodontics better had been trained by simulated models and phantom bodies in addition to extracted teeth (P < 0.001). Participants generally reported that combining extracted teeth, simulated models, and phantom scenarios contributed more to endodontic education (p = 0.001).

CONCLUSIONS: Integrating simulated models into the endodontic training module is highly promising. Advances in materials science and simulation technologies enable the development of realistic models.

PMID:41634668 | DOI:10.1186/s12909-026-08715-9

BMC Public Health. 2026 Feb 3. doi: 10.1186/s12889-026-26443-z. Online ahead of print.

ABSTRACT

BACKGROUND: Inappropriate antibiotic use has become a significant driver of the global burden of antimicrobial resistance (AMR). Our study aims to identify the proportion and associated factors of inappropriate antibiotic use, including self-medication of antibiotics, and non-adherence to antibiotic prescriptions among Myanmar migrants in Thailand.

METHODS: A cross-sectional study was conducted among 348 Myanmar migrants from three Myanmar migrant communities in Samut Sakhon, Thailand. The sample was recruited using convenience sampling, and the survey was conducted using face-to-face interviews. The variables, including predisposing, reinforcing, and enabling factors based on the PRECEDE-PROCEED model, were constructed. Descriptive statistics, Chi-square or Fisher’s Exact tests, and multiple logistic regression were performed to identify associated factors.

RESULTS: The proportion of self-medication among all participants was 28.4% (n = 348), and non-adherence among migrants who took prescribed antibiotics was 67.5% (n = 249). Factors positively associated with antibiotic self-medication are; never visiting a hospital in Thailand (AOR = 3.54, 95% CI = 2.00-6.27), inability to recognize common antibiotic drugs in the photos (AOR = 2.80, 1.56-5.02), and lack of AMR information in the past year (AOR = 1.98, 1.04-3.76). Factors positively associated with non-adherence to antibiotic prescription includes alcohol drinking (AOR = 37.58, 4.55-310.63), moderate to severe legal status-related acculturative stress (AOR = 6.49, 2.10-20.05 for severe stress and AOR = 2.60, 1.20-5.68 for moderate stress), receiving information regarding antibiotic use (AOR = 2.79, 1.40-5.58), working 7 days per week (AOR = 2.36, 1.12-5.01), lack of health insurance (AOR = 2.20, 1.17-4.14) and proximity to a hospital (AOR = 2.22, 1.15-4.28).

CONCLUSION: High levels of inappropriate antibiotic use among Myanmar migrants highlight the need to integrate migrants into Thailand’s national action plan on AMR. The high prevalence of antibiotic misuse among Myanmar migrants highlights the need to include migrants in Thailand’s national plan to combat antimicrobial resistance. To improve patient understanding and adherence to treatment, healthcare professionals should provide medication guidelines and education on the risks of antimicrobial resistance. Policymakers should focus future policies and interventions on providing interpretation services and establishing institutional mechanisms to ensure migrants’ access to healthcare.

PMID:41634652 | DOI:10.1186/s12889-026-26443-z

BMC Public Health. 2026 Feb 4. doi: 10.1186/s12889-026-26469-3. Online ahead of print.

ABSTRACT

BACKGROUND: A majority of adolescents do not meet the recommended levels of physical activity, while reported levels of mental health problems are increasing, and socioeconomic disparities in academic performance are widening. Many schools are implementing physical activity in different forms, but there is inconclusive evidence on what types of interventions improve mental health, cognitive functions, and academic performance and how to implement such interventions. There is a critical need for integrated, feasible, and equitable interventions. The objective of this study is to develop an effective multi-component school-based intervention that will target both physical activity and homework support during an extended school day and evaluate its effects on mental health, cognitive function and academic performance.

METHODS: The study is designed as a cluster-randomised controlled trial with 54 schools and approximately 2,700 students in grade 8 (age 14-15). The intervention includes three weekly 60-minute sessions: (1) Different types of physical activities (2), Homework support with short activity breaks, and (3) Walking and listening to audiobooks. This study will evaluate both outcome effects and implementation process. The primary outcome is anxiety, assessed using the Spence Children’s Anxiety Scale (SCAS-S). Secondary outcomes include physical activity, sedentary time and behaviours measured by accelerometry and questionnaire, cognitive functions assessed by a computer-based test battery, mental health and sleep with questionnaires, and academic performance by grades. Process evaluation will include fidelity, dose, feasibility, acceptability and context, using structured documentation, interviews, focus groups, and observations. The effectiveness of outcomes between groups will be assessed using mixed-effects regression analysis, adjusting for relevant covariates. Process data will be analysed using descriptive statistics and content, and thematic analysis.

DISCUSSION: This study addresses key knowledge gaps in school-based health promotion by integrating physical activity and homework support within the school structure. The results will yield insights into both effectiveness and implementation, informing future policy and practice in schools to promote health and facilitate students’ learning. The intervention targets youth in diverse socioeconomic contexts and is expected to contribute to reducing health and education inequalities.

TRIAL REGISTRATION: The trial was retrospectively registered on April 27, 2021. ISRCTN78666212.

PMID:41634640 | DOI:10.1186/s12889-026-26469-3

BMC Surg. 2026 Feb 3. doi: 10.1186/s12893-026-03494-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective cross-sectional study aimed to investigate the differences and influencing factors between the headache patients who achieved complete remission or significant reduction in headache frequency postoperatively and those whose frequency remained unchanged.

METHODS: The study was conducted on 386 patients who underwent bariatric surgery at the four university hospitals between January 2018 and June 2024. Patients were divided two groups as with or without headache and then patients with headache were divided into migraine and tension-type headache groups.

RESULTS: Headache duration, HIT-6 and VAS scores were also significantly reduced after operation. Bariatric surgery was significantly and negatively correlated with headache duration (r=-0.170; p < 0.05), HIT-6 (r=-0.353; p < 0.01) and VAS (r=-0.408; p < 0.01). Bariatric surgery had significant effect on HIT-6 (OR: 7.120; p < 0.01), headache frequency (OR: 13.634; p < 0.01) and VAS (OR: 2.024; p < 0.01). In migraine group; duration, HIT 6 and VAS levels were significantly decreased after operation (p < 0.05). In tension type group; only VAS level was significantly decreased after operation (p < 0.05).

CONCLUSION: After bariatric surgery, a statistically significant decrease in headache in terms of impact and severity was observed. This situation reveals that bariatric surgery has a direct and significant effect on headache. In patients with a BMI value on the borderline for bariatric surgery, these values ​​can be lowered slightly in case of severe headache.

PMID:41634636 | DOI:10.1186/s12893-026-03494-y

Transl Oncol. 2026 Feb 2;65:102670. doi: 10.1016/j.tranon.2026.102670. Online ahead of print.

ABSTRACT

Nasopharyngeal carcinoma (NPC) is prevalent in Southeast Asia, including Taiwan. It exhibits higher morbidity as well as mortality in males than in females. However, the role of the androgen receptor (AR) in NPC remains unclear. In this study, AR expression was detected in most NPC cell lines and patient-derived xenografts. Treatment with enzalutamide, an antiandrogen, substantially inhibited patient-derived xenografts growth and demonstrated additive antitumor effects when combined with chemotherapy in AR-positive models. Additionally, transcriptome analysis following enzalutamide treatment revealed activation of hypoxia-inducible factor-1, steroid hormone, and AR pathways, alongside suppression of interferon and tumor necrosis factor pathways. Protein analysis further supported these transcriptomic changes. In AR-overexpressing NPC-B13 cells, AR appeared to regulate thyroid transcription factor-1 (TTF-1, encoded by NKX2-1 gene) and its downstream target epidermal growth factor receptor (EGFR), thereby promoting cancer cell proliferation. Furthermore, chromatin immunoprecipitation suggested that AR may directly bind to the NKX2-1 promoter to upregulate its mRNA expression. Under AR overexpression, Epstein-Barr virus (EBV) remained in a latent state, accompanied by suppression of lytic gene expression. Additionally, Epstein-Barr nuclear antigen-1 enhanced AR transactivation in a dose-dependent manner in NPC cell line reporter assays. Among 96 metastatic NPC tumor samples, AR expression was observed in 35 cases (36.5%), predominantly in males (33/83, 39.8%). AR expression correlated with poorer overall survival, with statistical significance noted in the full cohort and particularly in male patients. This study suggests that AR may promote metastatic NPC progression via the TTF-1/EGFR signaling pathway and interact with EBV to influence disease behavior, especially in males.

PMID:41633021 | DOI:10.1016/j.tranon.2026.102670

ESMO Open. 2026 Feb 2;11(2):106065. doi: 10.1016/j.esmoop.2026.106065. Online ahead of print.

ABSTRACT

BACKGROUND: Although patients with Eastern Cooperative Oncology Group performance status (PS) of 2 constitute a significant proportion of the cancer population, they are often excluded from pivotal clinical trials owing to presumed higher risks of treatment effect dilution, toxicity, and lower compliance. Here, we conducted a systematic review and meta-analysis to evaluate the impact of including PS 2 participants on efficacy and safety outcomes in pivotal cancer clinical trials.

MATERIALS AND METHODS: We searched the ‘Oncology/Hematologic Malignancies Approval Notifications’ and ‘Drugs@FDA’ databases for clinical trials supporting ‘Food and Drug Administration’ anticancer drug approvals from 1 January 2009 to 31 December 2024. Eligible studies were randomized phase III clinical trials of systemic therapies for metastatic solid tumors permitting the inclusion of PS 2 participants. We assessed efficacy outcomes [progression-free survival (PFS) and overall survival (OS)] and safety outcomes [occurrence of any-grade adverse events (AEs), high-grade AEs, serious AE (SAEs), AE-related deaths, and treatment modifications] in the included studies.

RESULTS: Thirty-six trials were included. In subgroup analyses, no statistically significant differences were found between PS 2 and PS ≤1 participants for PFS [hazard ratio (HR) 0.45, 95% confidence interval (CI) 0.30-0.69 versus HR 0.52, 95% CI 0.41-0.66, P = 0.59] and OS (HR 0.81, 95% CI 0.68-0.97 versus HR 0.71, 95% CI 0.66-0.77, P = 0.18). In meta-regression analyses, no significant associations were found for efficacy outcomes. However, a higher proportion of PS 2 participants was significantly associated with an increased risk of SAEs, AE-related deaths, and treatment discontinuations.

CONCLUSIONS: Although PS 2 participants showed a greater propensity to serious toxicity, no significant differences in efficacy outcomes were observed compared with those with PS ≤1. Our results support the inclusion of PS 2 participants in clinical trials, as their exclusion limits the generalizability of results.

PMID:41633012 | DOI:10.1016/j.esmoop.2026.106065

Ultrasonics. 2026 Jan 23;163:107973. doi: 10.1016/j.ultras.2026.107973. Online ahead of print.

ABSTRACT

Reliable Lamb-wave-based Structural Health Monitoring (SHM) depends on accurate baseline selection under varying temperatures. This study presents LambNet-T, a lightweight path-conditional Transformer-based autoencoder for temperature-aware baseline learning across multiple transducer paths. LambNet-T employs Attention Pooling (AP) to generate contextual embeddings and enables robust baseline selection using Cosine Similarity (CS) with a Median-based evaluation strategy, improving diagnostic accuracy and temperature robustness in multi-path Lamb-wave SHM. Experiments on a composite panel over -10 to +50 °C used only four baseline temperatures to reflect practical constraints, with quadratic interpolation for data augmentation. LambNet-T demonstrated significantly higher training efficiency than a convolutional autoencoder (CAE-GAP). During inference, the Median of the highest path-specific CS values identified the optimal temperature-compensated baseline. The method achieved high precision (R² = 0.994 ± 0.001), outperforming both CAE-GAP and conventional Optimal Baseline Selection (OBS). Integration with an existing damage localization framework reduced impact location errors to as low as 4.12 mm. A conservative statistical filter, based on baseline selection variability, was applied to manage uncertainty. All experimental datasets are openly available for reproducibility.

PMID:41633009 | DOI:10.1016/j.ultras.2026.107973

Burns. 2026 Jan 29;52(3):107877. doi: 10.1016/j.burns.2026.107877. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric burn injuries pose significant health concerns and rank fifth globally in non-fatal injuries. Current evidence associates lower socioeconomic status (SES) with higher incidence of burn injury, greater TBSA, higher need for admission, and greater involvement of child protective services. There is a paucity of Canadian data on the topic, and effects of indices of deprivation on outcomes have not been investigated extensively.

METHODS: A retrospective single-centre study was carried out to examine effects of SES and Ontario Marginalization Index (OMI) on pediatric burn patient outcomes. One-way ANOVA with post hock Bonferroni correction was used for continuous dependent variables (i.e. TBSA, length of stay), and Pearson chi-square analysis was done for categorical variables (i.e. CAS involvement, need for OR, need for admission). P-value of 0.05 was set a priori to determine statistical significance.

RESULTS: No differences in outcomes were found between the four quartiles of SES categories. Analysis of the OMI for Material Resources, Racialized and Newcomer Populations, Age and Labour Force, and Household and Dwellings produced statistically significant findings. Patients with a higher degree of marginalization for most indices tended to have greater TBSA, time to surgery, and length of stay. An unexpected finding was that patients with the lowest Age and Labour Force deprivation indices were likely to have greater TBSA.

CONCLUSION: Identifying the effects of various social determinants of health on pediatric burn patients remains a challenging problem. While this study found no differences in patient outcomes based on income alone, examination of the granularity in deprivation provided notable differences. These effects could be further clarified with a cross-provincial or national study.

PMID:41633001 | DOI:10.1016/j.burns.2026.107877