Tag: statistics

Euro Surveill. 2026 Jun;31(22). doi: 10.2807/1560-7917.ES.2026.31.22.2500394.

ABSTRACT

BACKGROUNDWest Nile virus (WNV) is a zoonotic mosquito-borne pathogen increasingly reported in Europe.AIMWe aimed to characterise heterogeneities in the average annual human risk of WNV infection (force of infection, FOI) and in WNV surveillance across Europe.METHODSWe conducted a systematic review following the PRISMA guidelines to identify serological studies on WNV in humans with IgG-based assays in Europe. We then used mathematical models fitted to both age-stratified serosurvey and case data to reconstruct spatially explicit FOI estimates, the sensitivity of syndromic surveillance and age-dependent trends in case reporting.RESULTSWe extracted 92 serosurvey datasets from 21 countries. Based on 10 age-stratified serosurvey datasets from Greece, Hungary, Italy, Romania and Spain and case data from seven countries (Austria, Cyprus, Greece, Hungary, Italy, Romania and Spain), we estimated the WNV FOI for 119 European nomenclature of territorial units for statistics level (NUTS) 0-3 regions. We found evidence of spatial heterogeneities in transmission intensity and estimated that on average less than 0.2% of human WNV infections were notified, with country variability and age-dependent trends in the propensity of reporting WNV disease.CONCLUSIONThis study shows that the intensity of WNV transmission, the average annual incidence of infection and the sensitivity of surveillance are heterogeneous across Europe. Due to differences in case reporting across countries, the incidence of reported WNV cases does not necessarily reflect the same proportion of WNV infections and hence the actual infection incidence, which highlights the importance of conducting WNV seroprevalence surveys.

PMID:42246068 | DOI:10.2807/1560-7917.ES.2026.31.22.2500394

Stat Med. 2026 Jun;45(13-14):e70636. doi: 10.1002/sim.70636.

ABSTRACT

Population Attributable Fraction (PAF) is a key epidemiological measure used to quantify the contribution of risk factors to the overall disease burden. However, when an exposure affects an outcome through multiple ordered mediators, traditional PAF estimation methods face challenges in accurately identifying the impact of each mediating pathway. These challenges arise from mediator-outcome relationships, interactions among mediators, and the presence of potential confounders. In this study, we propose new measures, termed mPAFs, to quantify the fraction of disease attributable to a specific mediation pathway. The proposed framework incorporates a multiply robust estimator that yields consistent estimates of mPAFs provided that at least two of the three types of models are correctly specified: the exposure models, mediator models, or outcome model. The asymptotic properties of the estimator are formally established, and a comprehensive simulation study is conducted to demonstrate its robustness against model misspecification. In a real-data application using TCGA lung cancer cohorts, we analyzed the effect of smoking on mortality mediated through TTK and MAD2L1. In lung adenocarcinoma, the total PAF was estimated at 4.45%, with a direct effect of 1.82% and pathway-specific contributions of -1.95% (TTK) and 0.68% (MAD2L1). In contrast, lung squamous cell carcinoma showed a higher total PAF of 10.43%, with most of the effect attributable to the direct pathway (10.22%), suggesting minimal mediation via the selected genes.

PMID:42246056 | DOI:10.1002/sim.70636

Clin Teach. 2026 Aug;23(4):e70448. doi: 10.1111/tct.70448.

ABSTRACT

INTRODUCTION: Self-efficacy, the belief in one’s capacity to execute actions necessary to achieve specific objectives, is a significant predictor of academic performance and well-being in medical training. Longitudinal studies examining the dynamic evolution of self-efficacy throughout undergraduate medical education remain scarce in the Brazilian context. This study prospectively evaluated perceived self-efficacy among medical students during critical curricular transitions.

METHODS: A prospective longitudinal study followed 50 medical students from a Brazilian public university at four time points: course entry (T1-2021), end of first year (T2-2022), midpoint of clinical cycle (T3-2023) and beginning of fifth year/internship (T4-2025). The Self-Efficacy Scale for Higher Education (SESHE), a validated 34-item instrument assessing five dimensions, was administered. Statistical analyses included repeated measures ANOVA, Wilcoxon test and effect size calculations (Cohen’s d).

RESULTS: The study observed a dynamic evolution in perceived self-efficacy, characterised by a notable shift in total self-efficacy from 2021 to 2023, followed by partial recovery by 2025. This pattern included significant reductions in several dimensions. Self-efficacy in proactive actions experienced the most pronounced change (d > 0.8), while self-efficacy in social interaction demonstrated relative stability. Baseline analyses revealed higher self-efficacy in social interaction among male students (d = 0.51).

CONCLUSION: These findings suggest that the observed changes in self-efficacy represent an adaptive recalibration, moving toward a more realistic self-assessment essential for professional development. Therefore, strategies that support this healthy recalibration are crucial. These interventions should aim to facilitate adaptive adjustment, fostering robust and accurate self-efficacy throughout medical training.

PMID:42246054 | DOI:10.1111/tct.70448

Front Neurol. 2026 May 20;17:1636511. doi: 10.3389/fneur.2026.1636511. eCollection 2026.

ABSTRACT

BACKGROUND: Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are prevalent complications in aging stroke survivors and are often overlooked due to the lack of early diagnostic indicators, leading to poor prognosis. Identifying reliable predictors is crucial for timely intervention.

METHODS: This prospective cohort study followed 78 acute stroke survivors for 6 months. A composite neuropsychological outcome-defined as the development of PSD and/or PSCI-was determined using the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) and NINDS-CSN criteria. To account for the limited sample size, multivariable Firth’s penalized logistic regression was employed to identify independent predictors, generating robust odds ratios (ORs) and 95% confidence intervals (CIs). An exploratory classification and regression tree (CART) analysis was also conducted for hypothesis generation.

RESULTS: The final cohort comprised 78 acute ischemic stroke survivors with a median age of 62 years (IQR 51-71). Among these participants, 26.0% were women, and the median admission score on the National Institutes of Health Stroke Scale (NIHSS) was 3 (IQR 1-5). Within 6 months, 56 patients (71.8%) developed the composite outcome (13 experienced PSCI alone, 24 had PSD alone, and 19 had both conditions). A multivariable analysis revealed that right hemisphere lesions (OR = 9.019, 95% CI: 1.329-61.213, p = 0.016), greater baseline emotional distress (higher 9-item Patient Health Questionnaire (PHQ-9) scores; OR = 5.157, 95% CI: 1.835-14.494, p < 0.001), and pre-existing cognitive vulnerability (lower Mini-Mental State Examination (MMSE) scores; OR = 0.714, 95% CI: 0.517-0.984, p = 0.023) were independent predictors of poor neuropsychological outcomes. Advanced age (p = 0.094) and elevated urea levels (p = 0.095) showed only marginal trends. Exploratory CART modeling highlighted the hierarchical interaction of these baseline clinical scores for risk stratification.

CONCLUSION: Right hemisphere lesions, early emotional distress, and baseline cognitive vulnerability independently predicted a high risk of composite neuropsychological impairment at 6 months post-stroke. Rather than serving merely as novel biomarkers, high baseline PHQ-9 scores and low MMSE scores reflected the persistence of early distress and poor cognitive reserve, respectively. These highly accessible clinical parameters facilitate early risk stratification, emphasizing the absolute need for immediate psychological triage and integrated, long-term cognitive-emotional monitoring.

PMID:42246052 | PMC:PMC13229621 | DOI:10.3389/fneur.2026.1636511

Front Neurol. 2026 May 20;17:1802303. doi: 10.3389/fneur.2026.1802303. eCollection 2026.

ABSTRACT

INTRODUCTION: Accurate diagnosis of disorders of consciousness (DoC), including unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), remains a long-standing and unresolved challenge in clinical practice. Current diagnostic frameworks rely predominantly on behavioral responsiveness, with the Coma Recovery Scale-Revised (CRS-R) serving as the clinical gold standard. However, behavior-based evaluation is intrinsically vulnerable to examiner subjectivity and cognitive-motor dissociation, contributing to misdiagnosis rates of up to 40%. From a theoretical perspective, consciousness comprises both external awareness and self-awareness, yet existing DoC assessments focus almost exclusively on external sensory processing, leaving self-awareness substantially underassessed. This imbalance highlights a critical gap that motivates for complementary assessment approaches targeting underexplored dimensions of consciousness.

METHODS AND ANALYSIS: This study protocol aims to develop an EEG-based paradigm and evaluate its feasibility for assessing gut-related interoceptive processing in patients with DoC, using controlled, non-invasive rectal balloon distension. Standardized stimulation procedures, synchronized EEG acquisition, and predefined analytical pipelines will be implemented to characterize the temporal and spatial features interoceptive event-related potentials.

RESULTS: Electrophysiological and statistical analyses will be conducted to assess the feasibility, signal characteristics, and response profiles of gut-related interoceptive EEG activity across diagnostic categories. Exploratory analyses will further examine associations between interoceptive EEG markers and clinical behavioral measures.

DISCUSSION: By systematically investigating an under assessed dimension of consciousness, this study protocol aims to establish the feasibility and signal-level characteristics of gut-related interoceptive EEG responses in patients with disorders of consciousness. By providing methodological and exploratory evidence at the group level, the findings are intended to inform the design of future hypothesis-driven and validation studies, and to support the longer-term development of complementary assessment approaches that extend beyond behavior-based evaluation, with potential relevance for clinical research and public health-oriented diagnostic strategies.

CLINICAL TRIAL REGISTRATION: [ClinicalTrials.gov], identifier [NCT07208942].

PMID:42246050 | PMC:PMC13229987 | DOI:10.3389/fneur.2026.1802303

Front Neurol. 2026 May 20;17:1846726. doi: 10.3389/fneur.2026.1846726. eCollection 2026.

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) is the gold standard for obstructive sleep apnea (OSA), but its clinical effectiveness in cardiovascular risk management is often limited by suboptimal adherence.

OBJECTIVE: To systematically evaluate and compare the effects of mandibular advancement devices (MAD) vs. CPAP and inactive controls on blood pressure (BP), sleep-related respiratory events, and treatment adherence in patients with OSA.

METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to February 2026. RCTs reporting ambulatory BP outcomes pre- and post-MAD treatment were included. Secondary outcomes included the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and objective treatment adherence. Data were pooled using mean differences (MD) and 95% confidence intervals (CIs).

RESULTS: Fourteen independent RCTs (comprising 16 reports) encompassing a total of 1,141 patients, met the inclusion criteria. Compared with inactive controls, MAD showed overall trends of BP reduction. In head-to-head comparisons with CPAP, MAD demonstrated comparable cardiovascular benefits on 24-h and nighttime BP parameters. Notably, MAD achieved a significantly greater reduction in daytime systolic BP compared with CPAP (MD = -1.99 mmHg, 95% CI: -3.82 to -0.17; p = 0.03). While CPAP demonstrated superior physiological efficacy in reducing AHI (MD = 8.45 events/h, p < 0.001), MAD and CPAP yielded comparable improvements in subjective sleepiness (ESS). Crucially, pooled objective tracking data revealed that MAD had significantly longer nightly adherence than CPAP (MD = 0.71 h/night, 95% CI: 0.30 to 1.13; p < 0.001).

CONCLUSION: Despite a physiological inferiority in reducing AHI, MAD appears to offer cardiovascular benefits comparable to CPAP and demonstrates a statistically significant reduction in daytime SBP, which may be partially facilitated by its superior objective adherence. Therefore, for OSA patients who cannot tolerate CPAP, MAD may serve as a viable alternative option for cardiovascular risk management.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261303916, identifier: CRD420261303916.

PMID:42246045 | PMC:PMC13229622 | DOI:10.3389/fneur.2026.1846726

Front Neurol. 2026 May 20;17:1784525. doi: 10.3389/fneur.2026.1784525. eCollection 2026.

ABSTRACT

BACKGROUND: The Cerebellar Neuropsychiatric Rating Scale Version 2 (CNRS-2) measures affective symptoms in cerebellar disease patients across five postulated domains of attentional control, emotional control, autism spectrum, psychosis spectrum, and social skill set, each with overshoot and undershoot symptom subdomains. A data-driven approach is needed to test our a priori model and to further explore the internal structure of the scale.

OBJECTIVES: To explore the latent structure of the CNRS-2 and evaluate the five-domain and overshoot-undershoot structure of the scale items.

METHODS: CNRS-2 was administered to 279 cerebellar subjects. Data suitability for factor analysis was assessed. Eigenvalues and parallel analysis scree plots were evaluated for factor extraction. Exploratory factor analysis (EFA) was performed to identify an optimal factor solution. The EFA-derived solution and our a priori five-domain model were examined via confirmatory factor analysis (CFA). Fit indices, item loadings, and conceptual interpretability were compared. Bifactor analysis was performed on each of the five domains of the a priori model to evaluate whether variance in domain scoring was attributable to the construct measured by the domain versus two subfactors. CFA was also applied to each domain to test the validity of the overshoot-undershoot item groupings.

RESULTS: We extracted 5, 6, and 7 factors based on eigenvalues and parallel analysis. EFA indicated that a six-factor solution best balanced statistical fit and theoretical interpretability. CFA on this EFA-derived solution and on our a priori five-domain model showed both to have acceptable statistical fit and internal consistency, but the five-domain model demonstrated stronger conceptual coherence. The bifactor analysis revealed variation in the interpretability of two subfactors within each of the domains, while CFA validated the overshoot-undershoot clustering of symptoms.

CONCLUSION: Factor analysis of the items comprising CNRS-2 provided empirical support for the clinically derived conceptual framework that defines the five domains of cerebellar neuropsychiatry. Sub-analyses of the individual domains supported the overshoot-undershoot dichotomy. Convergence between our a priori domain model and the solutions derived from EFA revealed stable and interpretable symptom clusters. These findings underscore the presence of coherent, multidimensional interrelated neuropsychiatric constructs in cerebellar disease that can be identified and measured by CNRS-2.

PMID:42246044 | PMC:PMC13230212 | DOI:10.3389/fneur.2026.1784525

Front Neurol. 2026 May 20;17:1789811. doi: 10.3389/fneur.2026.1789811. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate oculomotor, vestibular, reaction time, and cognitive (OVRT-C) function in patients with vestibular migraine (VM) using objective eye-tracking-based metrics and to identify patterns of dysfunction relative to healthy controls.

BACKGROUND: Vestibular migraine is a common yet underdiagnosed cause of vertigo. Diagnosis remains primarily clinical, because objective neurologic and vestibular findings are often absent or inconsistent. Quantitative methods capable of capturing the multisystem manifestations of VM may improve objective characterization of the disorder.

METHODS: Participants with a clinical diagnosis of vestibular migraine were recruited from a tertiary headache center and assessed using a battery of OVRT-C tests administered with a portable eye-tracking system (Spryson Dx-100; n = 52). The test battery assessed gaze stability, saccades, antisaccades, smooth pursuit, vergence, optokinetic responses, and visual and auditory reaction times. Participants also underwent bedside neurologic and vestibular examinations and completed the Dizziness Handicap Inventory (DHI). OVRT-C metrics were compared with normative data from a database of 300 healthy adults. Univariate and stepwise multivariate logistic regression models were used to identify metrics that differentiated VM patients from controls.

RESULTS: A substantial proportion of VM patients aged 18 to 45 demonstrated abnormal OVRT-C performance compared with normative data, most prominently in horizontal and vertical saccades (54.3 and 51.4%, p < 0.0001), vertical smooth pursuit (62.9%, p < 0.0001), optokinetic responses (43.8%, p < 0.0001), and gaze stability (65.7%). Several OVRT-C metrics showed strong discriminative ability in logistic regression analyses when considering a single OVRT-C metric is considered (adjusted for participant age and gender). A multiple logistic regression model identified six OVRT-C metrics as significant indicators of VM and demonstrated excellent classification performance (AUC = 0.996), with estimated specificity of 95.9% and sensitivity of 99.7% for probability cutoff of 0.5. Moderate but statistically significant correlations were observed between OVRT-C metrics, bedside neurologic and vestibular findings, and DHI domain scores.

CONCLUSION: Objective OVRT-C testing reveals quantifiable abnormalities in oculomotor, vestibular, and cognitive dysfunction in patients with vestibular migraine. These findings support the feasibility of eye-tracking-based multimodal assessments as complementary tools for characterizing vestibular migraine and warrant further validation in larger and longitudinal cohorts.

PMID:42246042 | PMC:PMC13229772 | DOI:10.3389/fneur.2026.1789811

Patient Prefer Adherence. 2026 May 29;20:583856. doi: 10.2147/PPA.S583856. eCollection 2026.

ABSTRACT

PURPOSE: Hypertension (HTN) combined with prediabetes (pre-DM) has become an important public health concern worldwide. Patients need to adhere to both pharmacological and non-pharmacological treatments in order to regulate both blood pressure and blood glucose levels and reduce the risk of serious complications. This study examined factors associated with treatment adherence in people with both HTN and pre-DM.

METHODS: A cross-sectional study was conducted between January and March 2025. A sample of 275 people with both HTN and pre-DM was recruited from 11 subdistrict health-promoting hospitals (HPHs) in Sai Noi, a semi-rural district in Nonthaburi Province, Thailand. Data were collected using structured questionnaires. Multiple regression analysis was used to examine factors associated with treatment adherence.

RESULTS: It was revealed that female sex, knowledge about HTN and pre-DM/T2DM, social support, patient-provider relationship, convenience of traveling to health services, and convenience in using these services were significantly positively correlated with adherence to treatment. Meanwhile, experience of medication side effects, smoking, and alcohol consumption were negatively correlated with it. The multiple regression model was statistically significant in predicting treatment adherence (F = 11.36 (5, 269), p < 0.001) and included overall support from family (B = 2.23, p < 0.001), smoking (B = -132.61, p < 0.001), experience of medication side effects (B = -89.51, p = 0.004), knowledge of pre-DM/T2DM (B = 14.67, p = 0.013), and patient-provider relationship (B = 2.23, p = 0.033) as significant factors.

CONCLUSION: Disease-related knowledge, support from family, and patient-provider relationship positively influence treatment adherence of people with both HTN and pre-DM, while side effects of medication and smoking negatively influence it. These findings provide valuable insights for health officials that could inform future intervention and management strategies for this dual-risk population.

PMID:42246022 | PMC:PMC13231884 | DOI:10.2147/PPA.S583856

Front Cell Infect Microbiol. 2026 May 20;16:1831616. doi: 10.3389/fcimb.2026.1831616. eCollection 2026.

ABSTRACT

BACKGROUND: Fluoroquinolone resistance in Escherichia coli isolated from urinary tract infections (UTIs) is an increasing global concern, with marked variation across regions and specific agents. Estimating resistance prevalence is essential to guide empirical therapy and strengthen antimicrobial stewardship programs.

METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines, including English-language observational studies published through December 2025. PubMed, Embase, and Web of Science were searched for reports on fluoroquinolone-resistant E. coli in UTIs. Study quality was evaluated using the modified Newcastle-Ottawa Scale. Pooled prevalence estimates were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic. Subgroup analyses were performed by fluoroquinolone agent. Robustness was examined through sensitivity analyses, while meta-regression explored associations between sample size and resistance prevalence. Publication bias and influential studies were evaluated using DOI and Baujat plots.

RESULTS: Among 9,033 identified records, 36 studies met the inclusion criteria. The overall pooled prevalence of fluoroquinolone resistance in E. coli was 31.09% (95% CI, 24.89%-38.05%). Resistance estimates were 30.32% (95% CI, 22.60%-39.34%) for ciprofloxacin, 27.57% (95% CI, 9.01%-59.40%) for levofloxacin, and 68.75% (95% CI, 55.94%-79.76%) for pefloxacin. Sensitivity analyses demonstrated stable pooled estimates ranging from 30% to 32%. Meta-regression suggested an inverse association between study sample size and reported resistance rates. One study contributed modestly to heterogeneity.

CONCLUSION: This analysis demonstrates substantial and geographically heterogeneous fluoroquinolone resistance in E. coli causing UTIs, with particularly high rates reported in China, Iran, and Bangladesh. While ciprofloxacin resistance was considerable, pefloxacin exhibited the highest prevalence. These findings reinforce the importance of enhanced stewardship initiatives, improved resistance surveillance, harmonized reporting standards, and further investigation into resistance mechanisms and data gaps in underrepresented regions.

PMID:42246010 | PMC:PMC13229869 | DOI:10.3389/fcimb.2026.1831616