Tag: statistics

Sex Reprod Healthc. 2026 Apr 18;48:101219. doi: 10.1016/j.srhc.2026.101219. Online ahead of print.

ABSTRACT

OBJECTIVE: Early pregnancy loss (EPL) affects over 15% of clinically confirmed pregnancies. Despite typically uncomplicated medical courses, EPL is associated with significant psychological burden. While international studies have documented gaps in EPL care, comparable data from Germany are largely absent. This study examined healthcare experiences of women following EPL in Germany.

METHODS: An online cross-sectional survey was conducted between February and April 2025. Recruitment took place via social media and peer support organizations. Women aged 18 and older who had experienced EPL within the past five years in Germany were eligible. Quantitative data were analyzed using descriptive statistics, binary logistic regression, and linear regression. Free-text responses were analyzed using structuring qualitative content analysis following Kuckartz.

RESULTS: Of 720 participants, 633 were included in the analysis. Only 24.2% reported being offered all three management options (expectant, medical, surgical), 20% did not receive their preferred option. More than half of participants received no emotional or psychological support. Midwifery care was significantly associated with higher rates of expectant management and higher perceived emotional support.

CONCLUSION: The results reveal discrepancies between guideline recommendations and the actual care experienced by women following EPL in Germany. The sample was predominantly highly educated and recruited via digital platforms, introducing likely self-selection bias; findings should therefore be interpreted with caution and may not be representative of all affected women. Woman-centered counseling, systematic emotional support, greater integration of midwives, and the development of digital support tools warrant further consideration to improve care quality.

PMID:42044584 | DOI:10.1016/j.srhc.2026.101219

Water Res. 2026 Apr 17;300:125962. doi: 10.1016/j.watres.2026.125962. Online ahead of print.

ABSTRACT

This study evaluated wastewater-based epidemiology (WBE) for monitoring dengue virus (DENGV) and chikungunya virus (CKV) during Brazil’s most severe arbovirus epidemic, focusing on the city of Belo Horizonte, Minas Gerais. From March 2022 to August 2024, 24-hour composite raw sewage samples were collected weekly from two major wastewater treatment plants, encompassing over 80% of the city’s population. Viral RNA was quantified via RT-qPCR and positive samples underwent genome sequencing for genotype characterization. DENGV and CKV RNA were detected in over 90% of samples across both wastewater treatment plants (WWTPs), demonstrating sustained and widespread viral circulation throughout epidemic and inter-epidemic periods. Although CHIKV concentrations varied significantly across years, DENGV concentrations remained statistically stable, and no significant correlations were observed between wastewater viral loads and reported clinical cases. A considerable proportion of samples presented concentrations below the limit of quantification, indicating that while WBE is highly sensitive for qualitative detection of arboviruses, quantitative interpretation remains methodologically constrained. Sequencing confirmed the presence of DENGV-1 sorotype I and CKV genotype V, clustering with contemporaneous Brazilian strains and reflecting regional transmission dynamics. Wastewater-based modelling further suggested that reported clinical cases may substantially underestimate true infection burden, although quantitative estimates were highly sensitive to assumptions regarding viral shedding variability. These findings demonstrate that WBE provides a sensitive, non- invasive, population level approach for tracking arboviral circulation and viral diversity during large-scale outbreaks and could complement public health surveillance frameworks, especially in regions with limited diagnostic capacity or high levels of underreporting, to enhance epidemic response and control strategies.

PMID:42044571 | DOI:10.1016/j.watres.2026.125962

Medwave. 2026 Apr 27;26(3):e3122. doi: 10.5867/medwave.2026.03.3122.

ABSTRACT

INTRODUCTION: In the global context of the HIV pandemic, the biopsychosocial environment of key populations remains marked by a culture that fosters stigma and discrimination. These attitudes, based on misconceptions of what it means to live with HIV, transcend the healthcare sphere and negatively impact people’s quality of life. In Mexico, systematic documentation of this issue within hospital settings remains limited. The objective of this study was to estimate the frequency of HIV-related stigma and discrimination among healthcare personnel of a secondary-level public hospital, as well as to identify differences by job category.

METHODS: We conducted an observational, descriptive, cross-sectional study from February to March 2025 at a secondary-level public hospital in Cancún, Quintana Roo, Mexico. We applied the short version of the HIV stigma questionnaire proposed by Nyblade et al. A total of 316 healthcare workers from different areas participated. To identify differences in stigmatizing attitudes across professional groups and to explore potential associations between sociodemographic variables and HIV-related beliefs, descriptive statistical analyses were performed, along with non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman correlations) and post hoc comparisons using Dunn’s test with Bonferroni correction.

RESULTS: A total of 22.5% of participants reported having witnessed refusal to work with people living with HIV, and 30.1% observed lower-quality care toward them. Additionally, 32.9% agreed that people living with HIV are irresponsible, and 30.4% believed they “do not care about spreading the infection.” Significant differences in stigma levels were found across occupational categories (p < 0.001). Medical assistants and interns showed higher levels of stigmatizing attitudes, while family physicians, nursing supervisors, and laboratory staff demonstrated greater empathy. Personally knowing someone living with HIV was significantly associated with greater acceptance of the right to become pregnant (p = 0.047).

CONCLUSIONS: Stigma toward people living with HIV remains present in hospital environments. There is an urgent need to implement institutional training and awareness programs to reduce discriminatory attitudes and promote respect, accurate information, and empathy among all healthcare staff.

PMID:42044522 | DOI:10.5867/medwave.2026.03.3122

Ultrasound Q. 2026 Apr 27;42(2):e00739. doi: 10.1097/RUQ.0000000000000739. eCollection 2026 Jun 1.

ABSTRACT

This study aims to evaluate the implementation of the uterine sliding sign in routine pelvic ultrasound examinations for improving the diagnosis of deep endometriosis. A retrospective analysis was conducted at Mayo Clinic’s Florida and Arizona campuses, including 200 premenopausal and perimenopausal women with chronic pelvic pain, infertility, or suspected endometriosis. Sonographers performed a uterine sliding maneuver during transvaginal ultrasound, and the acquisition times were recorded. Sonographer experience and the time required to perform the sliding sign were analyzed using Microsoft Excel. The median acquisition time for the uterine sliding sign was 26 seconds, with no statistically significant difference based on sonographer experience. The addition of this maneuver extended the ultrasound examination by <1 minute on average, regardless of sonographer experience level. Incorporating the uterine sliding sign into routine pelvic ultrasound protocols is a quick and efficient method that enhances the detection of deep endometriosis, potentially reducing the significant diagnostic delay associated with endometriosis. This study supports the feasibility and minimal time impact of implementing the Society of Radiologists in Ultrasound (SRU) recommendations for augmented pelvic ultrasound in clinical practice.

PMID:42044514 | DOI:10.1097/RUQ.0000000000000739

Anesth Analg. 2026 Apr 27. doi: 10.1213/ANE.0000000000008049. Online ahead of print.

ABSTRACT

BACKGROUND: Dexamethasone is used in primary total joint arthroplasty (TJA) to reduce postoperative nausea and vomiting, and there is emerging evidence that it also ameliorates adverse events more broadly. Despite a lack of supporting data, a vocal minority has continued to question the appropriateness of dexamethasone in cases where the hyperglycemic burden and/or risk of infection are increased. This study sought to assess the benefits and potential harms of dexamethasone in a cohort of patients undergoing revision TJA for periprosthetic joint infection (PJI). We hypothesize that perioperative dexamethasone exposure is associated with fewer postoperative complications, regardless of diabetes status.

METHODS: An all-payer, US hospital-based dataset was queried. Patients ≥18 years with a diagnosis of hip or knee PJI between 2015 and 2023 were identified using billing and procedural codes, and verified using hospital charges for antibiotics and spacers. The primary outcome was composite complications. Secondary outcomes (wound and infectious complications, as well as mortality) were evaluated to probe for potential safety signals.

RESULTS: In total, 61,527 patients were identified. A total of 30,644 nondiabetic patients and 14,996 diabetic patients were 1:1 matched based on dexamethasone exposure, with good balance. Dexamethasone-treated patients had fewer aggregate complications in both cohorts (nondiabetic: adjusted odds ratio [aOR], 0.934 and 95% confidence interval [CI], 0.760-0.978; diabetic: aOR, 0.814 and 95% CI, 0.746-0.889). Dexamethasone was also associated with fewer wound complications (nondiabetic: aOR, 0.891 and 95% CI, 0.823-0.964; diabetic: aOR, 0.879 and 95% CI, 0.787-0.981) and infectious complications (nondiabetic: aOR, 0.891 and 95% CI, 0.823-0.964; diabetic: aOR, 0.827 and 95% CI, 0.754-0.908) . Only diabetic patients saw a statistically significant decrease in mortality (aOR, 0.692 and 95% CI, 0.532-0.901).

CONCLUSIONS: As with any retrospective study, findings should be interpreted cautiously due to the possibility of residual confounding. Nevertheless, dexamethasone appears to be safe to use in patients undergoing first-stage revision for TJA for PJA regardless of diabetic status. Further, findings suggest that dexamethasone is associated with lower odds of aggregate complications, and contrary to conventional wisdom, these benefits may be even greater among diabetics.

PMID:42044508 | DOI:10.1213/ANE.0000000000008049

JMIR Serious Games. 2026 Apr 27;14:e87847. doi: 10.2196/87847.

ABSTRACT

BACKGROUND: Problematic gaming and internet gaming disorder (IGD) symptoms are prevalent in adolescence, yet the longitudinal interplay between physical activity (PA), loneliness, and IGD symptoms, as well as potential sexual differences, remains unclear.

OBJECTIVE: This study aimed to examine reciprocal within-person associations between PA, loneliness, and IGD symptoms among Chinese adolescent gamers and test sexual differences in these associations.

METHODS: We conducted a three-wave prospective cohort study among 1332 Chinese adolescents selected using convenience sampling from five middle schools in central China who had engaged in online gaming during the previous year (n=441, 33.1%, females; mean age 3.64, SD 0.76, years). PA, loneliness, and IGD symptoms were assessed using the Physical Activity Rating Scale-3, the three-item short form of the University of California, Los Angeles Loneliness Scale, and the nine-item Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition IGD Checklist, respectively, at three 6-month intervals: wave 1 (baseline, T1), wave 2 (T2), and wave 3 (T3). A random intercept (RI) cross-lagged panel model (CLPM) and multigroup analyses were conducted.

RESULTS: RI-CLPM indicated that at the within-person level, higher PA predicted decreased subsequent loneliness (T1→T2: β=-0.12, 95% CI -0.16 to -0.08; T2→T3: β=-0.13, 95% CI -0.17 to -0.08) and IGD symptoms (T1→T2: β=-0.10, 95% CI -0.16 to -0.04, P=.009; T2→T3: β=-0.10, 95% CI -0.16 to -0.04). Increased loneliness (β=-0.22, 95% CI -0.26 to -0.18) and increased IGD symptoms (β=-0.08, 95% CI -0.12 to -0.04) each predicted later reductions in PA, indicating a mutually reinforcing cycle. Increased loneliness also predicted an increase in subsequent IGD symptoms (T1→T2: β=0.14, 95% CI 0.11-0.17), and increased IGD symptoms, in turn, predicted greater loneliness in the next wave (T1→T2: β=0.18, 95% CI 0.14-0.22). Multigroup models indicated that the protective effect of PA on later loneliness and the prospective effect of loneliness on subsequent IGD symptoms were stronger among girls than boys. In males, PA significantly predicted loneliness (β=-0.08 to -0.09, 95% CI -0.15 to -0.01), and loneliness significantly predicted IGD symptoms (β=0.09, 95% CI 0.03-0.15). In females, the cross-lagged effects from PA to loneliness were significant but stronger (β=-0.17, 95% CI -0.23 to -0.11), and the paths from loneliness to later IGD symptoms were also significant (β=0.16, 95% CI 0.11-0.21).

CONCLUSIONS: PA, loneliness, and IGD symptoms are reciprocally linked in adolescent gamers. By using RI-CLPM to distinguish within-person changes from stable between-person differences, this study extends prior research based mainly on cross-sectional designs or traditional CLPMs and provides a clearer understanding of the dynamic interplay among behavioral, emotional, and gaming-related factors. The findings highlight that interventions aiming to prevent IGD symptoms should simultaneously promote PA and reduce loneliness, with particular attention to sex-specific patterns, especially in girls.

PMID:42044501 | DOI:10.2196/87847

J Immunol. 2026 Apr 15;215(4):vkag064. doi: 10.1093/jimmun/vkag064.

ABSTRACT

The immune system is a complex “network of networks,” where interactions between various immune cell subsets determine immune competence and influence disease onset or control. These interactions dictate whether the body remains in a healthy state or develops pathological conditions. Traditional statistical methods largely ignore these interactions and rely only on statistical changes in cell frequencies. To address this gap, we developed CyNET (Cytometry Network), a network science-based analysis platform that quantifies immune system properties at both the systems and subset levels. We used CyNET to analyze immune development across different age groups, examining peripheral blood cells from healthy newborns, adults (20-55 yr), and elderly individuals (≥70 yr) using CyNET and single-cell RNA sequencing. The analysis revealed that changes in the centrality of immune subsets, rather than just their frequency alone, provide deeper insights into biological functions. For instance, although CD28- CD8 T cells increase in frequency with age, their reduced centrality and diminished intracellular interaction potential explain cellular senescence and exhaustion. Additionally, CyNET identified key systems properties-such as -network edge density, degree centralization, and assortativity score-that reflect immune system development and help characterize the immune network’s functional architecture across different ages.

PMID:42044498 | DOI:10.1093/jimmun/vkag064

J Immunol. 2026 Apr 15;215(4):vkag044. doi: 10.1093/jimmun/vkag044.

ABSTRACT

Salmonella Paratyphi A is a major cause of paratyphoid fever. Despite growing global concern, knowledge of S. Paratyphi A immunity remains limited, and no licensed vaccine exists. In a controlled human infection model (CHIM) homologous S. Paratyphi A rechallenge showed a non-significant reduction in risk of acute disease. This study evaluates humoral immunity following experimental S. Paratyphi A exposure and vaccination with a bivalent S. Typhi-S. Paratyphi A conjugate vaccine (Sii-PTCV). Serum samples from 2 UK CHIM studies and a Phase I trial in India of Sii-PTCV were analyzed. S. Paratyphi A-specific IgG, serum bactericidal activity (SBA), antibody-dependent monocyte phagocytosis (ADMP), and neutrophil phagocytosis (ADNP) were measured pre and post-exposure or vaccination. Statistical differences were assessed using Wilcoxon matched-pairs signed rank test or the Mann-Whitney test. Experimental challenge significantly increased IgG, SBA, ADMP, and ADNP (all P < 0.0001), with strongest responses in participants who developed systemic infection. No immune marker correlated with protection in rechallenged individuals. Baseline antibody levels were higher in the Indian cohort than in the United Kingdom (P = 0.0041), suggesting prior natural exposure enhances humoral immunity. Vaccination with Sii-PTCV induced significantly greater responses than challenge, particularly for IgG (P < 0.0001), SBA (P < 0.001), and ADMP (P < 0.001). This study highlights differences in S. Paratyphi A immunity between naive and exposed populations. Both challenge and vaccination with S. Paratyphi A elicited strong humoral responses, with vaccination producing higher magnitude responses. The bivalent vaccine shows promise for paratyphoid prevention, though a clear correlate of protection remains to be defined.

PMID:42044495 | DOI:10.1093/jimmun/vkag044

JMIRx Med. 2026 Apr 27;7:e76822. doi: 10.2196/76822.

ABSTRACT

BACKGROUND: Generative artificial intelligence models, especially reasoning large language models (LLMs), are gaining adoption in health care for diagnostic decision support and medical education. DeepSeek R1 is a reasoning LLM that generates extended chain-of-thought explanations to make its decision-making process more explicit. Traditional medical benchmarks often lack complexity and authenticity, motivating the adoption of scenario-rich datasets, such as the Massive Multitask Language Understanding Pro (MMLU-Pro) professional medicine subset, which provides multispecialty clinical vignettes for reasoning-centric evaluation.

OBJECTIVE: The objective of this study is to assess the diagnostic accuracy, reasoning quality, reasoning transparency, and practical usability of DeepSeek R1 and Gemini 3 Pro across closed- and open-ended clinical scenarios, with the intention of guiding their prospective application in practical clinical education and training. This evaluation was conducted by analyzing 162 diverse medical scenarios (both closed- and open-ended) from the MMLU-Pro health subset.

METHODS: In a 2-phase, dual-model evaluation, DeepSeek R1 and Gemini 3 Pro were applied to 162 matched clinical vignettes from the MMLU-Pro professional medicine subset spanning 21 specialties. Closed-ended, multiple-choice, and open-ended prompts were constructed for the same scenarios, and model outputs were coded for accuracy, reasoning steps, and citation behavior; descriptive statistics and the McNemar test were used to compare performance across formats.

RESULTS: DeepSeek R1 achieved an accuracy of 86.4% (140/162 scenarios) on closed-ended tasks and 80.9% (131/162) on open-ended questions across 162 clinical scenarios, indicating modest attenuation of performance when answer cues were removed. Gemini 3 Pro demonstrated 90.7% (147/162) closed-ended and 88.9% (144/162) open-ended accuracy on the same scenarios, showing a similar pattern of decreased performance without answer options. Error analysis indicated that incorrect answers typically involved longer reasoning chains, suggesting overthinking. In a structured review of open-ended responses, DeepSeek R1 produced an average of 18.7 (range 0-52) references per case, with 5.2 unrelated references and 13.1 (range 3-67) reasoning steps, whereas Gemini 3 Pro averaged 22.5 (range 12-50) references, 1.9 (range 0-8) unrelated references, and 4.4 (range 1-10) reasoning steps per case.

CONCLUSIONS: DeepSeek R1 demonstrated moderate-to-excellent accuracy and reasoning in evaluating both closed- and open-ended medical scenarios. In parallel, Gemini 3 Pro showed broadly comparable but distinct performance and reasoning patterns. While the closed-ended format may inflate accuracy due to cueing, the open-ended evaluation yielded richer insights into the fidelity of reasoning. Side-by-side evaluation of two large reasoning models highlights the importance of format, specialty, and citation behavior when considering clinical and educational use. Continued validation across a wider range of specialties and real-world contexts will enhance the model’s trustworthiness for diagnostic and teaching applications.

PMID:42044491 | DOI:10.2196/76822

J Agric Food Chem. 2026 Apr 27. doi: 10.1021/acs.jafc.6c00179. Online ahead of print.

ABSTRACT

Microalgae are promising future food sources with short growth cycles and high nutritional value. UPLC-HRMS analysis of eight edible microalgal species identified over 500 lipid molecular species, including glycolipids, phospholipids, sphingolipids, glycerides, and betaine lipids. Nannochloropsis gaditana exhibited the highest lipid content, with polar lipids accounting for 75.2% of the total lipids and ahigh eicosapentaenoic acid content of 29.9% of the total fatty acids, while Dunaliella salina was highly enriched in sphingolipids (50.3% of the total lipids), making the two species ideal industrial raw materials for glycolipid and sphingolipid production, respectively. These eight edible microalgal species were abundant in polyunsaturated fatty acids. In addition, a rare acylated derivative of sulfolipid, acyl-sulfoquinovosyldiacylglycerol (acSQDG), was identified in five microalgal species. Multivariate analysis confirmed lipid classes as effective biomarkers for discriminating the eight cross-phyla edible microalgal species. Overall, this study provides comprehensive lipidomic characterization of these eight microalgae and offers valuable guidance for the industrial development of microalgal oils.

PMID:42044488 | DOI:10.1021/acs.jafc.6c00179