Category: Statistics

Emerg Med Australas. 2025 Dec;37(6):e70184. doi: 10.1111/1742-6723.70184.

ABSTRACT

OBJECTIVE: Child Life Therapists (CLT) are healthcare professionals who support children in hospital by engaging, educating and empowering them. With a high rate of procedures, the Emergency Department (ED) would seem an ideal site for CLT; however literature is limited regarding their utility. In 2024, the ED of The Royal Children’s Hospital (RCH), Melbourne commenced an integrated, extended hours CLT service. This study outlines the patient demographics, support provided by CLT and presents feedback on the effectiveness of CLT from caregivers, children and clinicians.

METHODS: A retrospective chart review in 2024 included all CLT referrals over 6 months, describing patient characteristics, CLT interventions and reported CLT effectiveness. Prospective surveys of a convenience sample of carers, children and clinicians determined the effect of CLT on the procedure, net promoter scores and satisfaction scores. Hospital ethics approval was obtained (Reference number: 3915).

RESULTS: CLT assisted 1130 patients. Median age was 5 years (IQR 3-8 years). Seventeen percent were neurodiverse or had developmental delays. Sixty-six percent were admitted to hospital. Two-thirds required support for procedures-mainly blood tests via venepuncture and finger pricks (64.4%). One hundred and eighty-five caregivers, 58 patients and 58 clinicians responded: feedback indicated that CLT eased procedures, reduced distress, worry and pain. Clinicians reported increased procedural speed and efficiency and reduced use of sedation and restraint.

CONCLUSION: Child Life Therapy enhances patient care whilst improving clinical workflow. Stakeholders indicate that CLT reduces distress, pain and worry for children and may reduce the need for sedation and restraint.

PMID:41321071 | DOI:10.1111/1742-6723.70184

Neurol Res. 2025 Nov 30:1-10. doi: 10.1080/01616412.2025.2597833. Online ahead of print.

ABSTRACT

BACKGROUND: Large vessel occlusions (LVOs) in ischemic stroke represent a critical challenge, particularly in the peri-procedural setting of cardiovascular procedures (CVPs). Mechanical thrombectomy (MT) is a well-established treatment for LVOs; however, its outcomes in patients following recent CVPs remain unclear.

OBJECTIVE: This multicenter retrospective cohort study aimed to evaluate the outcomes of MT in patients with ischemic stroke occurring within 30 days of CVPs.

METHODS: We analyzed data from four centers, including patients aged ≥18 years who underwent MT for LVO within 30 days of CVPs. CVPs included both surgical (e.g. CABG, valve replacement) and minimally invasive procedures (e.g. TAVR, PCI). Baseline characteristics, procedural metrics, and outcomes, including NIHSS and mRS scores, were collected. Statistical analyses were performed using R software.

RESULTS: Of 8,947 screened stroke patients, 27 met the inclusion criteria. The median age was 69 years (IQR 60-83), and 56% were male. Anterior circulation occlusions were present in 93% of cases, with a median baseline NIHSS score of 18 (IQR 14-21). Successful reperfusion (TICI ≥2b) was achieved in 85% of cases, with a median of one thrombectomy pass. At 90 days, 30% of patients achieved functional independence (mRS 0-2), while the mortality rate was 44%. Procedural complications were rare (3.7%).

CONCLUSION: MT in patients with peri-procedural LVO after CVPs demonstrates success but poor functional recovery compared with baseline. These findings highlight the need for prospective studies to identify patients who may benefit most from MT in this high-risk population.

PMID:41320809 | DOI:10.1080/01616412.2025.2597833

Ann Med. 2025 Dec;57(1):2594355. doi: 10.1080/07853890.2025.2594355. Epub 2025 Nov 30.

ABSTRACT

BACKGROUND: Statins reduce cardiovascular risk but may increase new-onset type 2 diabetes mellitus (NO-T2DM). Ezetimibe, a cholesterol absorption inhibitor, is often added to statins to improve lipid control, yet its impact on NO-T2DM remains uncertain.

OBJECTIVE: This systematic review evaluated moderate-intensity statin plus ezetimibe dual therapy versus high-intensity statin monotherapy for NO-T2DM risk.

METHODS: Five databases were searched to identify eligible studies. Random-effects meta-analyses generated pooled relative risks (RR) quantifying the effect of ezetimibe plus moderate-intensity statins on NO-T2DM. The Attributable Risk Fraction (ARF) was quantified utilizing the pooled estimate.

RESULTS: Ten observational studies and four clinical trials were included. In four cohort studies, ezetimibe plus moderate-intensity statin compared to high-intensity statin monotherapy was significantly linked to 18% reduced risk of NO-T2DM (pooled RR: 0.82; 95% CI: 0.77-0.87; I2 = 0.0%; p < 0.001). In three methodologically similar studies, compared to moderate-intensity statin monotherapy, adding ezetimibe to moderate-intensity statin dual therapy showed non-statistically (p > 0.05) significant 4% increased risk of NO-T2DM development (pooled RR: 1.04; 95% CI: 0.94-1.14, I2= 0.0%). Compared with patients receiving high-intensity statin therapy, 22% of NO-T2DM cases could potentially be averted with dual therapy (moderate-intensity statin plus ezetimibe). In four studies involving 5,072 patients on high-intensity statins who developed NO-T2DM, 1,115 patients (812-1,420) could have been prevented with ezetimibe plus moderate-intensity statin dual therapy.

CONCLUSION: Incorporating ezetimibe with moderate-intensity statins, rather than relying solely on high-intensity statins, may reduce the risk of NO-T2DM in patients with dyslipidemia and elevated cardiovascular disease risk.

PROSPERO REGISTRATION NUMBER: CRD42024518630.

PMID:41320800 | DOI:10.1080/07853890.2025.2594355

Pediatr Transplant. 2025 Dec;29(8):e70239. doi: 10.1111/petr.70239.

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) has become an essential curative strategy for various malignant and non-malignant pediatric diseases. However, HSCT recipients remain highly vulnerable to complications, often requiring pediatric intensive care unit (PICU) admission. Identifying key risk factors and predictors of mortality is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, risk factors, and outcomes of pediatric HSCT patients requiring PICU admission, focusing on organ failure, respiratory and cardiovascular dysfunction, and the impact of supportive therapies.

METHODS: This retrospective, single-center study included pediatric HSCT recipients admitted to a tertiary PICU between August 2019 and October 2023. Patients with PICU stays shorter than 24 h were excluded. Clinical and demographic characteristics, HSCT-related parameters, PICU admission criteria, and patient outcomes were analyzed. Logistic regression models were applied to identify independent risk factors associated with mortality.

RESULTS: Among 40 HSCT recipients requiring PICU admission, the overall mortality rate was 80%, exceeding previously reported rates. Sepsis, respiratory failure, and multiple organ dysfunction were the primary reasons for admission. Elevated PELOD scores were strong predictors of mortality. All patients requiring mechanical ventilation, inotropic support, or renal replacement therapy died (p < 0.001), whereas all patients managed with non-invasive ventilation survived, underscoring the importance of early and appropriate respiratory support.

CONCLUSION: Organ failure significantly impacts mortality in pediatric HSCT recipients, emphasizing the need for early intervention and proactive monitoring. Structured post-HSCT surveillance, particularly for patients with prior PICU admissions, is critical for identifying early signs of organ dysfunction and optimizing intensive care management.

PMID:41320799 | DOI:10.1111/petr.70239

Addiction. 2025 Nov 30. doi: 10.1111/add.70262. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: To evaluate changes in community consumption and wholesales of alcohol before and after alcohol restrictions were implemented in 2023, aimed at reducing alcohol-related crime and violence.

DESIGN: Longitudinal observational study.

SETTING: Alice Springs, a regional town in the Northern Territory, Australia, from December 2019 to February 2024.

PARTICIPANTS: The population of Alice Springs serviced by the wastewater treatment plant catchment, and wholesales data for Alice Springs.

MEASUREMENTS: Community consumption of alcohol was measured by analysing a biomarker of alcohol consumption in wastewater before and after the alcohol restrictions were implemented. Quarterly alcohol wholesales for the region were also modelled.

FINDINGS: After the restrictions, alcohol consumption in Alice Springs immediately decreased, with an average 26% decrease over 12 months [95% confidence interval (CI) = -31 to -22%]. No statistically significant difference in trend slope was observed. The largest decreases in alcohol consumption were for Mondays and Tuesdays, when takeaway alcohol sales were not allowed. Total alcohol wholesales decreased by 17% (95% CI = -31 to -22%), with greatest meaningful declines of 44% for the sales of spirits (95% CI = -50 to -36%).

CONCLUSIONS: After the implementation of the 2023 restrictions on alcohol sales in the Northern Territory, Australia, wastewater-based estimates of alcohol consumption in Alice Springs were statistically significantly reduced by 26% and this was sustained for one year until the end of the data series in 2024. Total alcohol wholesales were also reduced, with differences observed by beverage type.

PMID:41320787 | DOI:10.1111/add.70262

Malar J. 2025 Dec 1;24(1):434. doi: 10.1186/s12936-025-05676-0.

ABSTRACT

BACKGROUND: Timely malaria care-seeking and treatment is crucial to prevent severe illness and reduce onward transmission. This study assessed the reported time to care-seeking and identified its associated factors among febrile patients attending community-based malaria facilities in Myanmar and Thailand.

METHODS: Longitudinal data were collected from febrile patients suspected of malaria who sought care through Village Health Volunteers in Myanmar (December 2017-June 2021) and at malaria clinics and posts in Thailand (January 2018-June 2024). Standardized case record forms in local languages were used at diagnosis. Descriptive statistics and multivariable log-logistic Accelerated Failure Time (AFT) models were used to estimate Time Ratios (TRs).

RESULTS: In Myanmar (n = 2,960), the reported mean fever duration at diagnosis was 1.8 days (SD: 1.3). Longer time to care-seeking was associated with Shan ethnicity (TR: 1.48; 95% CI 1.41-1.55), other ethnicities (TR: 1.24; 95% CI 1.08-1.41), farmers (TR: 1.12; 95% CI 1.0-1.25), uncertain malaria history (TR: 1.26; 95% CI 1.09-1.47), and diagnosis with Plasmodium falciparum (TR: 1.10; 95% CI 1.02-1.19) or Plasmodium vivax (TR: 1.23; 95% CI 1.13-1.34). Shorter delays were associated with daily bed net use and diagnosis during the third or fourth quarters of the year. In Thailand (n = 15,576), the reported mean fever duration was 2.9 days (SD: 1.8). Longer delays were linked to farmers (TR: 1.07; 95% CI 1.02-1.11), pre- or primary education (TR: 1.02; 95% CI 1.00-1.04), uncertain malaria history (TR: 1.10; 95% CI 1.06-1.14), diagnosis with P. falciparum (TR: 1.27; 95% CI 1.09-1.46), P. vivax (TR: 1.20; 95% CI 1.17-1.23), or other malaria species (TR: 1.32; 95% CI 1.12-1.56), and diagnosis during the third (TR: 1.03; 95% CI 1.00-1.05) or fourth quarters of the year (TR: 1.06; 95% CI 1.04-1.09). Shorter care-seeking times were observed among non-agricultural occupations such as merchants and monks, individuals with prior malaria episodes, and occasional or daily bed net users.

CONCLUSIONS: Delays in malaria care-seeking remain common in both Myanmar and Thailand. The identified risk factors, including ethnicity, occupation, malaria history, and preventive behaviours, should be considered in the design of targeted interventions to promote timely care-seeking in malaria-endemic settings.

PMID:41320780 | DOI:10.1186/s12936-025-05676-0

Eur J Med Res. 2025 Dec 1;30(1):1196. doi: 10.1186/s40001-025-03492-5.

ABSTRACT

BACKGROUND AND AIMS: Elevated lactate dehydrogenase (LDH) has been linked to unfavorable outcomes across various diseases, yet its prognostic relevance in critically ill patients with ischemic stroke (IS) remains insufficiently defined. This study aimed to investigate whether LDH levels at admission to the intensive care unit (ICU) are independently associated with short-term mortality among IS patients requiring critical care.

METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV, version 3.1) database. The primary and secondary endpoints were all-cause in-hospital mortality and 30 day mortality, respectively. Associations between LDH and outcomes were evaluated using Kaplan-Meier survival curves, multivariable Cox proportional hazards models, and restricted cubic splines (RCS) analyses. Discriminative performance was assessed by time-dependent receiver operating characteristic (ROC) curves and concordance index (C-index). Incremental prognostic value beyond established clinical scores (SAPS II, APS III, OASIS, and LODS) was quantified using category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS: Of 818 patients, higher LDH was associated with worse survival (log-rank P < 0.001). After full adjustment, LDH remained independently associated with in-hospital death (36.6% vs. 7.0%; HR 2.82, 95% CI 1.46-5.46; P = 0.002) and 30 day mortality (41.0% vs. 14.8%; HR 2.07, 95% CI 1.24-3.44; P = 0.005). However, results for 30 day mortality attenuate to non-significance after full adjustment in sensitivity analysis (41.0% vs. 14.8%; HR 1.45, 95% CI 0.97-2.17; P = 0.068). RCS modeling revealed a nonlinear relationship, with mortality risk rising sharply above approximately 268 IU/L. Log-transformed LDH demonstrated modest discriminative ability for both in-hospital (AUC 0.642, 95% CI 0.583-0.701; C-index = 0.657, 95% CI 0.612-0.702) and 30 day mortality (AUC 0.668, 95% CI 0.629-0.707; C-index = 0.652, 95% CI 0.617-0.687). Incorporating LDH into conventional severity scores modestly but significantly improved discrimination (positive NRI and IDI).

CONCLUSION: Admission LDH levels are independently associated with in-hospital and 30 day mortality among critically ill IS patients and may serve as a potential adjunct to established prognostic tools for early risk stratification. External, multicenter validation is warranted to confirm these findings.

PMID:41320775 | DOI:10.1186/s40001-025-03492-5

BMC Glob Public Health. 2025 Dec 1;3(1):108. doi: 10.1186/s44263-025-00228-9.

ABSTRACT

BACKGROUND: Leprosy, or Hansen’s disease, is caused by Mycobacterium leprae and can lead to severe disabilities, social marginalisation and reduced quality of life. The disease remains a public health challenge in many low- and middle-income countries, including Pakistan. This study aimed to examine trends in leprosy cases diagnosed in Pakistan from 2001 to 2023, focusing on key epidemiological indicators such as sex, leprosy subtype, age, child cases, disability proportion and geographic distribution to reveal insights into the current situation and to inform strategies for improving case detection.

METHODS: This retrospective study analysed data from the Marie Adelaide Leprosy Centre (MALC), which operates 205 treatment centres across Pakistan. Leprosy cases diagnosed between 2001 and 2023 were examined for sociodemographic and clinical characteristics, including sex, age, and leprosy subtype. Descriptive statistics were presented for leprosy cases diagnosed during this period, and maps were created to illustrate geographic trends and distributions in leprosy incidence over four 5-year intervals between 2003 and 2022.

RESULTS: A total of 10,573 new leprosy cases were recorded with a median age of 36 years. Most cases (79.3%) were multibacillary (MB) leprosy. Until 2013, the majority of patients were male, but the proportion of female cases has steadily increased since then, rising from 40.4% in 2021 to 50.0% in 2023. The highest incidence was observed in Karachi, Sindh, and northern regions, including Khyber Pakhtunkhwa and Gilgit-Baltistan. The overall incidence of new cases declined steadily from 971 in 2001 to 236 in 2023. A decline in child cases and grade 2 disability proportions was also observed. Over the study period, 852 cases (8.1%) occurred in children under 15 years of age, while in 2023 specifically, 7.6% of new cases were in children and 17.4% presented with grade 2 disability, both key indicators for monitoring leprosy epidemiology. However, a substantial increase in the MB proportion was observed in 2023.

CONCLUSIONS: These findings indicate significant progress in leprosy control in Pakistan, but also highlight persistent transmission in specific regions. Targeted interventions in high-burden areas, along with sustained community-based case-finding and early diagnosis efforts, are essential for continued progress toward leprosy elimination in Pakistan.

PMID:41320771 | DOI:10.1186/s44263-025-00228-9

J Gambl Stud. 2025 Dec 1. doi: 10.1007/s10899-025-10459-y. Online ahead of print.

NO ABSTRACT

PMID:41320735 | DOI:10.1007/s10899-025-10459-y

Osteoporos Int. 2025 Dec 1. doi: 10.1007/s00198-025-07766-w. Online ahead of print.

ABSTRACT

Osteoporotic fractures threaten older women’s health worldwide. This nationwide study found that moderate-intensity exercise and vigorous activity performed less than six days weekly lower fracture risk, whereas overly frequent vigorous exercise may increase it. These findings provide practical guidance for balancing exercise intensity and frequency to promote safer activity in aging populations.

BACKGROUND/OBJECTIVES: Osteoporotic fractures, especially vertebral and hip fractures, pose a significant global public health burden due to their high incidence and substantial economic costs. Previous research on physical activity (PA) and fracture prevention has been limited by simplistic classifications of PA and insufficient examination of multidimensional dose-response relationships. This study aimed to elucidate detailed associations between distinct patterns of PA (type, frequency, MET-based volume) and fracture risk, hypothesizing that moderate-intensity exercise provides protective effects, whereas excessive vigorous activity paradoxically increases fracture risk.

METHODS: We conducted a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database, including 541,770 women aged 66 years, with an average follow-up of 7.3 years. Baseline PA was assessed via standardized questionnaires measuring weekly frequency of vigorous (8 METs), moderate (5 METs), and walking activities (3 METs), categorized into MET quartiles. Bone mineral density (BMD) was classified as normal, osteopenia, or osteoporosis. We employed Cox proportional hazards models, adjusted for demographic and clinical covariates, to evaluate fracture risk. Kaplan-Meier curves visualized cumulative fracture incidences.

RESULTS: Regular moderate-intensity exercise (3-5 days/week) significantly reduced vertebral (HR: 0.862-0.891, all p < 0.001) and hip fracture risk (HR: 0.882-0.890, p < 0.02), especially among the osteopenia and osteoporosis groups. Vigorous activity performed at lower weekly frequencies (< 6 days/week) was also associated with reduced fracture risk, whereas excessive vigorous activity (≥ 6 days/week) paradoxically increased hip fracture risk (HR: 1.241; 95% CI, 1.010-1.525) in osteoporosis participants. Clear dose-response relationships emerged across MET quartiles, with higher activity levels consistently lowering fracture risks in osteopenia (HR Q4 vs. Q1: 0.939; 95% CI, 0.910-0.970) and osteoporosis (HR Q4 vs. Q1: 0.894; 95% CI, 0.866-0.922).

CONCLUSION: Our findings suggest that moderate-intensity exercise (3-5 days/week) appears optimal for reducing fracture risk, while excessive vigorous activity should be approached with caution, especially for older women with compromised BMD. Future studies utilizing objective PA measures and prospective designs are warranted to further validate these recommendations.

PMID:41320717 | DOI:10.1007/s00198-025-07766-w