Category: Statistics

Schizophr Bull. 2025 May 7:sbaf043. doi: 10.1093/schbul/sbaf043. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Digital remote monitoring (DRM) captures service users’ health-related data remotely using devices such as smartphones and wearables. Data can be analyzed using advanced statistical methods (eg, machine learning) and shared with clinicians to aid assessment of people with psychosis’ mental health, enabling timely intervention. Such methods show promise in detecting early signs of psychosis relapse. However, little is known about clinicians’ views on the use of DRM for psychosis. This study explores multi-disciplinary staff perspectives on using DRM in practice.

STUDY DESIGN: Fifty-nine mental health professionals were interviewed about their views on DRM in psychosis care. Interviews were analyzed using reflexive thematic analysis. Study Results: Five overarching themes were developed, each with subthemes: (1) the perceived value of digital remote monitoring; (2) clinicians’ trust in digital remote monitoring (3 subthemes); (3) service user factors (2 subthemes); (4) the technology-service user-clinician interface (2 subthemes); and (5) organizational context (2 subthemes).

CONCLUSIONS: Participants saw the value of using DRM to detect early signs of relapse and to encourage service user self-reflection on symptoms. However, the accuracy of data collected, the impact of remote monitoring on therapeutic relationships, data privacy, and workload, responsibility and resource implications were key concerns. Policies and guidelines outlining clinicians’ roles in relation to DRM and comprehensive training on its use are essential to support its implementation in practice. Further evaluation regarding the impact of digital remote monitoring on service user outcomes, therapeutic relationships, clinical workflows, and service costs is needed.

PMID:40329411 | DOI:10.1093/schbul/sbaf043

J Health Popul Nutr. 2025 May 6;44(1):146. doi: 10.1186/s41043-025-00904-4.

ABSTRACT

BACKGROUND: The World Health Organization defines low birth weight as a birth weight of less than 2500 g, regardless of the gestational age. It is regarded as the most significant predictor of infant mortality overall, particularly for deaths that occur in the first few months of life. Among all the months of a person’s existence, the neonatal period, the first month of life, has one of the highest death rates. The necessity for an umbrella review is highlighted by the lack of a comprehensive synthesis of collective meta-analytic evidence connecting antenatal care as a factor of low birth weight and newborn death. Thus, this umbrella review’s main goal is to thoroughly synthesize the existing meta-analytic evidence, with a focus on assessing the relationship between antenatal care with low birth weight and neonatal mortality.

METHODS: All English-language meta-analyses of cohort, case-control, and cross-sectional studies that looked at the relationship between antenatal care with low birth weight and neonatal mortality will be included, regardless of the time and location of publication. To find pertinent literature for review, major medical electronic databases including Embase, CINAHL, Cochrane database, and PubMed will be used. Two reviewers will screen the eligible articles, extract data, and evaluate their quality independently. The reviewers will work together to reach a consensus on any disagreements. If there are still issues, a third reviewer will be consulted in order to fix them. The meta-umbrella R package will be used for all statistical analysis. The random-effects model and 95% prediction interval for the summary estimate will be used for both outcomes. Q and I² test statistics will be calculated to determine the degree of heterogeneity. We will use Egger’s regression asymmetry test to assess publication bias, the Ioannidis test for excess significance bias, and Hedges’ g value for each risk factor.

DISCUSSION: This is the first comprehensive analysis of the effect of antenatal care on low birth weight and neonatal mortality that we are aware of. For clinicians and researchers seeking to lower low birth weight and neonatal mortality, summarizing this evidence is helpful.

TRIAL REGISTRATION: PROSPERO-CRD42024567150.

PMID:40329410 | DOI:10.1186/s41043-025-00904-4

BMC Health Serv Res. 2025 May 6;25(1):646. doi: 10.1186/s12913-025-12833-3.

ABSTRACT

BACKGROUND: Validation studies of prognostic models used in critical care have yet to be conducted in Palestine. The intense conflict in the Gaza Strip presents an opportunity to evaluate the performance of local ICUs and validate the performance of the MPM and SAPS models within a resource-limited and highly stressed healthcare system.

METHODS: A prospective study conducted from October to December 2024 included all patients admitted to ICUs in three of the four critical care units operating in the Gaza Strip. Sociodemographic, clinical, physiological, and laboratory parameters were collected, along with information regarding the clinical course and ICU outcomes. The MPM-III and SAPS-III scores were calculated, and their discrimination and calibration were assessed using AUROC and the Hosmer-Lemeshow test, respectively. Furthermore, the difference between the predicted and actual mortality rates was visualized, and standardized mortality rates (SMR) were calculated. Except for the Hosmer-Lemeshow test, a p-value of less than 0.05 was deemed statistically significant. All statistical analyses were conducted using R Studio.

RESULTS: The cohort included 101 patients, of whom 72.27% were surgical cases and 58.41% were admitted from the ER. The ICU mortality rate was 30.69%. The median duration of ICU admission was four days [IQR 2-9] and was significantly longer for surgical cases than for medical cases. Physiological and laboratory parameters, along with interventions associated with higher mortality, included a lower GCS, burns, elevated leukocyte and platelet counts, lower PPO2, dysrhythmias, intracranial mass effect, and the need for mechanical ventilation or central venous catheterization. The predicted mortality rates were 16.63% for MPM0-III and 16.82% for SAPS-III. SMRs indicated that both models underestimated ICU mortality (SMR, MPM0-III 1.85; SAPS-III 1.83), with the discrepancy more likely to occur in high-risk patients. ROC curves demonstrated acceptable to good discriminatory power for both models (AUROC, MPM0-III 0.79 (95% CI 0.7-0.88); SAPS-III 0.87 (95% CI 0.80-0.94)). The Hosmer-Lemeshow test yielded statistically insignificant results for both models, indicating good calibration.

CONCLUSION: The outcomes of critical care units in the Gaza Strip during the studied period of the war were comparable to those of other hospitals in the West Bank and other LMICs without active conflicts. The MPM-III and SAPS-III demonstrated good discrimination and calibration, making them valid tools for enhancing ICU performance and improving resource utilization in the Gaza Strip.

PMID:40329400 | DOI:10.1186/s12913-025-12833-3

Orphanet J Rare Dis. 2025 May 6;20(1):214. doi: 10.1186/s13023-024-03479-1.

ABSTRACT

The lack of essential information when reporting animal studies causing lower reproducibility has been stressed for decades. The ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines were first published in 2010, to improve reporting of animal research, making in vivo studies more transparent thereby improving the scientific quality. Regardless of an endorsement from the scientific community, there is still a continuous need to improve animal research reporting, which unfortunately also is the case in the field of Niemann-Pick type C disease (NPC). NPC is a lipid storage disorder, caused by mutations in either the Npc1 or Npc2 gene. Despite years of research, no cure for this fatal disease exists. In 2020, an updated version of the ARRIVE guidelines (ARRIVE 2.0), was published, describing the ten most essential elements to be included when reporting pre-clinical studies. Here we systematically reviewed the compliance with the ARRIVE guidelines using the “ARRIVE Essential 10” checklist in a series of pre-clinical studies investigating gene therapy as a treatment strategy for NPC. None of the reviewed papers fulfilled the ARRIVE 2.0 guidelines. Information regarding sample size, randomization, blinding, and statistical methodology was lacking. Hopefully, the newly updated ARRIVE guidelines will aid researchers in planning and publishing in vivo experiments in the future. More awareness of the importance of including these essential items is needed, both from editors, reviewers and researchers, for complete endorsement of the ARRIVE guidelines in the scientific community.

PMID:40329398 | DOI:10.1186/s13023-024-03479-1

BMC Psychol. 2025 May 6;13(1):477. doi: 10.1186/s40359-025-02785-y.

ABSTRACT

BACKGROUND AND OBJECTIVES: Physical activity is associated with social network site addiction in adolescents, yet the mechanisms remain unclear. This study examines whether anxiety and ego-depletion mediate this relationship.

METHODS: A survey was conducted among 1,174 Chinese adolescents (614 boys, 560 girls; mean age = 12.59, SD = 1.13). Physical activity was assessed with a single item on moderate-to-vigorous exercise in the past 7 days. Social network site addiction, anxiety, and ego-depletion were measured using validated self-report questionnaires. Descriptive statistics, correlation analyses, and a chained mediation model were employed.

RESULTS: Physical activity was negatively correlated with social network site addiction (r = -0.165, p < 0.001), anxiety (r = -0.121, p < 0.001), and ego-depletion (r = -0.119, p < 0.001). Anxiety was positively correlated with ego-depletion (r = 0.574, p < 0.001) and social network site addiction (r = 0.388, p < 0.001). Ego-depletion was positively associated with social network site addiction (r = 0.456, p < 0.001). Anxiety and ego-depletion sequentially mediated the relationship between physical activity and social network site addiction.

CONCLUSION: This study clarifies the psychological mechanisms linking physical activity and social network site addiction in adolescents, identifying anxiety and ego-depletion as key mediators. The findings emphasize the need to target these factors for more effective interventions.

PMID:40329384 | DOI:10.1186/s40359-025-02785-y

Microb Cell Fact. 2025 May 6;24(1):99. doi: 10.1186/s12934-025-02717-w.

ABSTRACT

BACKGROUND: Staphyloxanthin (STX) is a secondary metabolite pigment associated with membrane structures, recognized for its significant antioxidant properties. It plays a crucial role in combating reactive oxygen species (ROS), positioning it as a promising and effective alternative in cancer treatment. This study focused on enhancing the production of STX pigment by employing statistical optimization of media components, alongside the evaluation of its safety and anticancer properties.

RESULTS: A total of 59 Staphylococcus aureus isolates were screened and quantitatively estimated for STX production. The best pigment-producing isolate was identified based on molecular phylogenetic analysis as S. aureus A2, with accession number PP197164. A Box-Wilson central composite design was employed to evaluate the intricate interactions among six variables affecting the pigment yield. The most optimal conditions resulted in the highest production of STX of OD₄₅₆ = 0.328, which is approximately 1.5-fold greater than the yield (OD₄₅₆ = 0.215) obtained from OFAT optimization. The final response surface model fitting the data achieved a R² of 0.8748. STX exhibited marked cytotoxicity against the A549 NSCLC cell line with IC50 of 57.3 µg/mL, a safe dose in normal Vero cells. The anticancer activity of STX was predominantly mediated by the apoptotic pathway, as confirmed by confocal microscopy, the annexin V-FITC apoptosis assay, and the overexpression of caspase-3. Moreover, STX disrupted cell cycle at pre-G1 and G0/G1 phases in lung cancer. Intriguingly, STX exhibited its antitumor activity through reducing the EGFR expression. The molecular docking study revealed the potential binding interactions and affinities within the active sites of both wild-type and mutant EGFR.

CONCLUSION: The bioprocess for optimized production, combined with the biological profiling and low cytotoxicity, substantiates the potential application of STX pigment in combating lung cancer.

PMID:40329373 | DOI:10.1186/s12934-025-02717-w

J Orthop Surg Res. 2025 May 6;20(1):446. doi: 10.1186/s13018-025-05835-8.

ABSTRACT

OBJECTIVE: Lumbar fusion surgery is a common procedure for treating various degenerative spinal conditions. However, the incidence of proximal adjacent segment degeneration (PASD) remains a concern. This study aimed to investigate the effect of proximal facet joint angle (FJA) on PASD and then identify factors that influence prognosis after lumbar fusion surgery.

METHODS: In this retrospective study, the cases of 192 patients who underwent lumbar fusion surgery between January 2020 and June 2022 were analysed. Patients were classified in accordance with their baseline proximal FJA into the high (≥ 40°) and low (< 40°) FJA groups. Prognosis was evaluated during the last follow-up by using clinical, imaging and functional recovery criteria. PASD was assessed using Weishaupt criteria, and imaging parameters were measured on postoperative computed tomography (CT) reconstructions. Statistical analyses, including univariate and multivariate logistic regression, were performed to identify prognostic factors. Receiver operating characteristic (ROC) curves were used to assess predictive value.

RESULTS: The high FJA group exhibited significantly higher rates of PASD compared with the low FJA group (P < 0.001). No significant differences were observed in sex, age, body mass index (BMI) or follow-up duration between the two groups. Poor prognosis was associated with higher BMI, larger FJA and wider facet joint diameter. Logistic regression analysis identified BMI (odds ratio [OR] = 1.801, P = 0.001), FJA (OR = 6.320, P < 0.001) and facet joint sagittal (OR = 1.888, P < 0.001) and coronal (OR = 1.462, P < 0.001) diameters as independent predictors of poor prognosis. A smaller screw inclination angle was associated with better outcomes (OR = 0.907, P = 0.017). Joint ROC analysis underscored the significant predictive power of these factors (area under the curve = 0.881).

CONCLUSION: This study demonstrates that a larger proximal FJA is associated with increased PASD. It also identifies several prognostic factors that influence outcomes after lumbar fusion surgery. Patients with higher BMI, larger FJA and wider sagittal and coronal diameters are at increased risk for poor prognosis. These findings highlight the importance of comprehensive preoperative assessments to optimise surgical planning and improve outcomes in lumbar fusion surgery.

PMID:40329372 | DOI:10.1186/s13018-025-05835-8

BMC Health Serv Res. 2025 May 6;25(1):650. doi: 10.1186/s12913-025-12818-2.

ABSTRACT

BACKGROUND: Evidence-based Practice (EBP) is essential for improving the quality of care, patient outcomes, and the cost-effectiveness of healthcare services. Curricula and innovative teaching methods, such as virtual education, should be strongly emphasized to foster nursing students’ intentions to engage in the EBP process. This study investigated the effect of a virtual training program on nursing students’ intentions to engage in EBP.

METHODS: This interventional study included 79 nursing students in the sixth and eighth semesters of the School of Nursing who had completed courses in nursing research and nursing information technology and had started their clinical training. A virtual training program on the intentions to engage in EBP was delivered through a website in the form of one module during a week. Questionnaires on demographic information and the Persian version of Intentions to Engage in EBP Process, originally developed by Rubin and Parrish (2010), were used to collect data before the intervention and one month later. Data were collected from March to April 2023 and analyzed using SPSS (version 21). Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent samples t-test, paired t-test, chi-square test and analysis of covariance) were used. A significance level of ≤ 0.05 was utilized.

RESULTS: Prior to the intervention, an independent t-test revealed no statistically significant difference between the two groups (p = 0.15). However, post-intervention results indicated a statistically significant difference (p = 0.03), with the intervention group reporting higher intentions to engage in EBP (44.62 ± 3.67) compared to the control group (36.56 ± 3.53), demonstrating the effectiveness of the educational program. A paired t-test confirmed that the improvement within the intervention group was statistically significant (p = 0.02), whereas the change observed in the control group was not (p = 0.06).

CONCLUSIONS: This study demonstrated a change in undergraduate nursing students’ intentions to engage in EBP following virtual training. Based on these findings, health policymakers, planners, and healthcare providers should prioritize strategies that empower and equip nursing students with EBP competencies to effectively implement EBP in their future professional practice.

PMID:40329371 | DOI:10.1186/s12913-025-12818-2

Genome Med. 2025 May 6;17(1):45. doi: 10.1186/s13073-025-01474-0.

ABSTRACT

BACKGROUND: The convergence of resistance and hypervirulence in Klebsiella pneumoniae represents a significant public health threat, driven by the horizontal transfer of plasmids. Understanding factors affecting plasmid transfer efficiency is essential to elucidate mechanisms behind emergence of these formidable pathogens.

METHODS: Hypermucoviscous K. pneumoniae strains were serially passaged in LB medium to investigate capsule-deficient phenotypes. Capsule-deficient mutants were analyzed using genetic sequencing to identify the types and insertion sites of insertion sequences (IS). Bioinformatics and statistical analyses based on the NCBI and National Microbiology Data Center (NMDC) database were used to map the origins and locations of IS elements. Conjugation assays were performed to assess plasmid transfer efficiency between encapsulated and capsule-deficient strains. A murine intestinal colonization model was employed to evaluate virulence levels and IS excision-mediated capsule restoration.

RESULTS: Our research revealed that a hypervirulent K. pneumoniae (hvKP) strain acquired a bla_NDM-1-bearing IncX3 plasmid with IS5 and ISKox3 elements. These IS elements are capable of inserting into capsular polysaccharide synthesis genes, causing a notably high frequency of capsule loss in vitro. The IS-mediated capsular phase variation, whether occurring in the donor or recipient strain, significantly increased the conjugation frequency of both the resistance plasmid and the virulence plasmid. Additionally, capsular phase variation enhanced bacterial adaptability in vitro. Experiments in mouse models demonstrated that capsule-deficient mutants exhibited reduced virulence and colonization capacity. However, during long-term intestinal colonization, IS element excision restored capsule expression, leading to the recovery of hypervirulence and enhanced colonization efficiency.

CONCLUSIONS: Our findings reveal that IS elements mediate capsular phase variation by toggling gene activity, accelerating the genomic convergence of multidrug resistance and hypervirulence in K. pneumoniae, as well as facilitating adaptive transitions in different environments.

PMID:40329368 | DOI:10.1186/s13073-025-01474-0

AIDS Res Ther. 2025 May 6;22(1):51. doi: 10.1186/s12981-025-00745-5.

ABSTRACT

BACKGROUND: HIV/AIDS persists as a global health challenge despite significant advancements in antiretroviral therapy (ART). The transformation of HIV into a chronic condition, coupled with regional disparities and evolving epidemiological trends, necessitates an updated analysis of the disease burden.

METHODS: We conducted a comprehensive analysis of HIV/AIDS burden among individuals aged 15-79 years from 1990 to 2021 using the latest data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. Multiple statistical approaches were employed to investigate temporal trends, geographic variations, and health inequalities.

RESULTS: From 1990 to 2021, global HIV/AIDS age-standardized incidence rates (ASIR) decreased by 41%, while age-standardized prevalence rates (ASPR), mortality rates (ASMR), and disability-adjusted life year rates increased by 222%, 57%, and 59%, respectively. Sub-Saharan Africa demonstrated the highest HIV/AIDS ASPR in 2021, with High-middle and Middle SDI regions, particularly Oceania, South Asia, and Eastern Europe, experiencing the most significant ASPR growth over three decades. Joinpoint analysis identified 1997 and 2015 as critical years for ASIR declines, and 2004 for ASMR reductions. Decomposition analysis revealed population growth as the primary driver of increasing incidence in lower SDI regions, while epidemiological changes were more influential in higher SDI areas. The age-period-cohort model showed peak HIV/AIDS incidence among individuals aged 25-34, with diminishing incidence risk across successive birth cohorts and periods. Health inequality analysis from 1990 to 2021 revealed a substantial widening of disparities across countries, with the slope index of inequality rising from 265 to 1006.

CONCLUSION: While global efforts have reduced HIV/AIDS incidence, increasing prevalence due to extended survival with antiretroviral therapy presents ongoing challenges. Regional disparities and rising incidence among specific demographics underscore the need for sustained, targeted interventions.

PMID:40329367 | DOI:10.1186/s12981-025-00745-5