Category: Statistics

Syst Rev. 2025 May 3;14(1):99. doi: 10.1186/s13643-025-02827-x.

ABSTRACT

BACKGROUND: Long-acting reversible contraceptives (LARCs), including implants and intrauterine contraceptive devices (IUCDs), are essential in preventing unintended pregnancies and empowering women by providing long-term, reliable contraception that supports informed decision-making about family planning and reproductive health. However, their uptake and acceptability remain low in Ethiopia due to various individual, social, and systemic barriers. This study systematically reviews the factors influencing LARC acceptability and utilization among Ethiopian women, adolescents, and healthcare providers, using the Capability, Opportunity, Motivation, and Behaviour (COM-B) framework.

METHODS: A systematic search of PubMed, Embase, Scopus, African Journals OnLine, and EBSCOhost (CINAHL) was conducted, along with gray literature sources, to identify studies published between January 2021 and June 2024. Inclusion criteria encompassed studies conducted in Ethiopia that examined the acceptability and utilization of LARCs, focusing on implants and IUCDs. The types of studies considered included quantitative, qualitative, and mixed-method designs, focusing on postpartum, post-abortion, and nonpostpartum women, adolescents, and healthcare providers. Data on barriers, facilitators, and associated factors of acceptability and utilization were extracted, and the findings were mapped to the COM-B framework. Atlas.ti v.9 software was used in the analysis process.

RESULTS: A total of 58 cross-sectional, qualitative, and mixed-method studies were included, encompassing diverse Ethiopian populations and geographies. Among immediate and extended postpartum women, barriers included limited awareness and fear of insertion pain for IUCDs, low awareness, and limited access to LARCs, while postpartum counselling emerged as a facilitator. For adolescents, social stigma, male partner disapproval, and misconceptions about LARC side effects were prominent barriers; school-based education and youth-friendly services supported acceptability. Healthcare providers noted inadequate training on family planning methods as a barrier, while targeted training improved their confidence in recommending LARCs. Nonpostpartum women frequently cited partner opposition and cultural beliefs as barriers, but family planning programs with partner engagement facilitated greater acceptance.

CONCLUSIONS: The findings highlight an urgent need to expand community-based education programs to dispel myths and misconceptions about LARCs, particularly in rural and pastoral regions. Prioritizing provider training to improve counselling and service delivery, alongside engaging male partners in family planning discussions, is essential for enhancing LARC utilization and meeting reproductive health needs in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024594288.

PMID:40319326 | DOI:10.1186/s13643-025-02827-x

Cardiovasc Diabetol. 2025 May 3;24(1):192. doi: 10.1186/s12933-025-02720-w.

ABSTRACT

BACKGROUND AND PURPOSE: Epicardial adipose tissue (EAT) comprises three distinct lipid components, each exerting differential effects on cardiovascular diseases. During disease progression, dynamic alterations in lipid composition and spatial distribution contribute to the inherent heterogeneity of EAT. The excessive activation of inflammatory cells may contribute to chronic inflammation, promoting atherosclerosis and cardiac diseases. However, the role of EAT in patients with myocardial infarction (MI) who develop heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aims to quantify the overall and perivascular volumes of EAT using cardiac magnetic resonance (CMR) imaging and assess its heterogeneity, exploring the predictive value of EAT heterogeneity and different EAT volumes combined with inflammatory cells for the occurrence of HFpEF in MI patients with normal left ventricular ejection fraction (LVEF).

METHODS: This retrospective cohort study enrolled patients diagnosed with MI with preserved LVEF via clinical assessment and CMR at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. Patients who did not undergo percutaneous coronary intervention (PCI) were followed, with the incidence of HFpEF serving as the primary endpoint. The cohort was stratified into two groups: those without HFpEF and those who developed HFpEF.Cardiac structure, function, EAT volume, and infarct volume parameters were obtained using the CMR post-processing software CVI-42, while EAT heterogeneity parameters entropy were derived using Python software. Independent sample t-tests, non-parametric tests, and chi-square tests were employed to analyze the differences in clinical baseline data and CMR metrics between the two groups. Spearman’s rank correlation was utilized to analyze the associations between EAT parameters and inflammatory cells, inflammatory markers, and diastolic dysfunction indicators. Furthermore, we conducted univariate and multivariate Cox regression analyses to determine the predictive value of each parameter for the development of HFpEF in MI patients. Time-dependent ROC curves were generated to evaluate the efficacy of each parameter in predicting HFpEF, the AIC values of each parameter and the final model were calculated to evaluate the predictive performance. The optimal cut-off values were identified using time-dependent ROC curves in R software, and Kaplan-Meier event-survival curves were plotted to illustrate the event-free rates based on these optimal thresholds.The median follow-up time was calculated using the reverse Kaplan-Meier method.

RESULTS: A total of 203 MI patients with normal LVEF were included, with 74 in the HFpEF group and 129 in the non-HFpEF group. No significant differences were observed between the two groups regarding age, sex, and infarct volume; however, significant statistical differences were noted in BMI, diabetes, renal failure, leukocytes, neutrophils, monocytes, total EAT, EAT entropy, left ventricular EAT (LV EAT), left atrial end-systolic volume (LAESV), triglycerides, NHR, MHR and LACI(Left atrioventricular coupling index) (P < 0.05). Both overall and local EAT volumes showed a positive correlation with leukocytes and monocytes,as well as with the inflammatory markers MHR and SIRI. Furthermore, EAT volume exhibited a positive correlation with the LACI, a marker of diastolic dysfunction. Univariate and multivariate Cox regression analyses indicated that BMI, diabetes, monocyte, LV EAT, and EAT entropy are independent risk factors for HFpEF. And the AIC value of the multivariate regression model was the smallest.Further time-dependent ROC analysis revealed that the maximum AUC for BMI was 0.67, while the AUC for LV EAT was 0.63, and EAT entropy was 0.60, the maximum AUC for monocyte was 0.70, and the combined prediction of LV EAT and EAT entropy had a maximum AUC of 0.70. After a median follow-up of 34 months, Kaplan-Meier survival curves demonstrated that LV EAT greater than 21.23 mL was associated with the occurrence of HFpEF, whereas EAT entropy was not.

CONCLUSIONS: In patients with chronic MI, normal LVEF, and no prior PCI, the occurrence of HFpEF is not correlated with infarct volume; however, BMI, diabetes, monocyte, LV EAT, and EAT entropy are independent risk factors for HFpEF with significant predictive value, with the highest predictive efficacy observed monocyte and when combining EAT entropy and LV EAT. Additionally, both overall and local EAT volumes exhibit a moderate positive correlation with leukocytes,monocytes and inflammatory markers, and were also positively correlated with diastolic dysfunction. This suggests that, in clinical practice, beyond traditional indicators, there should be an increased focus on EAT heterogeneity and perivascular EAT in MI patients with normal LVEF who have not undergone PCI to to reduce the incidence of HFpEF.

PMID:40319313 | DOI:10.1186/s12933-025-02720-w

BMC Public Health. 2025 May 3;25(1):1642. doi: 10.1186/s12889-025-22779-0.

ABSTRACT

BACKGROUND: Dry Eye Disease (DED) is a multifactorial ocular condition characterized by the disturbance of the tear film and interpalpebral ocular surface. It is characterized by ocular itchiness, grittiness, burning, and visual disturbances. Many risk factors were linked to DED, including occupational-related risk factors. This study aimed to investigate the prevalence and impact of DED on work productivity among outdoor and indoor workers in the West Bank of Palestine and the impact of DED on daily activities performance.

METHODS: A population-based descriptive cross-sectional study was conducted on male and female Palestinian workers aged 18 years or older, carried out between July to October 2024. Structured interview questionnaires using the Arabic version of the Ocular Surface Disease Index questionnaire (Arab-OSDI) and the Work Productivity and Activity Impairment questionnaire (WPAI) for participants who scored 13 or higher on OSDI.

RESULTS: A total of 464 participants were included, ages 18 or older. Males were 81.3% of the study population. 50% of the sample were indoor workers and 50% were outdoor workers. The prevalence of DED in Palestinian workers was 61.4%, which was higher among outdoor workers (64.7%) than indoor workers (58.2%), but this difference was not statistically significant (p = 0.15). The impact of DED on work productivity was reported in all severity levels (p < 0.001); participants with severe DED had a mean of 5.93 h, which is higher than the mean for moderate and mild DED patients (4.71 and 3.42 h), respectively. Similarly, the impact on the ability to perform daily activities was significant (p < 0.001), greatest among respondents with severe disease (5.86 h).

CONCLUSIONS: Outdoor workers have been associated with DED more than in-office workers in the West Bank. Meanwhile, workers with DED report lower productivity and struggle with everyday tasks regardless of the severity level. This underlines the detrimental effects of the workplace on the ocular surface, which present a significant risk for the onset and exacerbation of dry eye symptoms.

PMID:40319299 | DOI:10.1186/s12889-025-22779-0

Acta Neuropathol Commun. 2025 May 3;13(1):90. doi: 10.1186/s40478-025-01998-x.

ABSTRACT

Traumatic brain injury (TBI) occurs in 2-3 million Americans each year and is a leading cause of death and disability. Among the many physiological consequences of TBI, the hypothalamic pituitary axis (HPA) is particularly vulnerable, including a reduction in growth hormone (GH) and insulin-like growth factor (IGF-1). Clinical and preclinical supplementation of IGF-1 after TBI has exhibited beneficial effects. IGF-1 receptors are prominently observed in many tissues, including in the brain and in the gastrointestinal (GI) system. In addition to causing damage in the brain, TBI also induces GI system damage, including inflammation and alterations to intestinal permeability and the gut microbiome. The goal of this study was to assess the effects of systemic IGF-1 treatment in a rat model of TBI on GI outcomes. Because GI dysfunction has been linked to hippocampal dysfunction, we also examined proliferation and immature granule cells in the hippocampal dentate gyrus. 10-week-old male rats were treated with an intraperitoneal (i.p.) dose of IGF-1 at 4 and 24 h after lateral fluid percussion injury (FPI). At 3- and 35-days post-injury (DPI), gut permeability, gut dysmorphia, the fecal microbiome, and the hippocampus were assessed. FPI-induced permeability of the blood-gut-barrier, as measured by elevated gut metabolites in the blood, and this was prevented by the IGF-1 treatment. Gut dysmorphia and alterations to the microbiome were also observed after FPI and these effects were ameliorated by IGF-1, as was the increase in immature granule cells in the hippocampus. These findings suggest that IGF-1 can target gut dysfunction and damage after TBI, in addition to its role in influencing adult hippocampal neurogenesis.

PMID:40319295 | DOI:10.1186/s40478-025-01998-x

J Orthop Surg Res. 2025 May 3;20(1):442. doi: 10.1186/s13018-025-05858-1.

ABSTRACT

BACKGROUND: Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella’s shape and tracking. Although biomechanical studies suggest potential benefits of APD, clinical evidence remains inconclusive.

METHODS: A systematic review and meta-analysis following PRISMA guidelines was conducted to compare the clinical outcomes of MDD and APD in a modern posterior-stabilized TKA (ATTUNE system). We searched PubMed, Scopus, Embase, and Web of Science on January 10, 2025, without language or date restrictions. Eligible studies included randomized controlled trials (RCTs) and comparative cohort designs evaluating patient-reported outcome measures (PROMs), revisions, complications, range of motion (ROM), and radiologic measures of patellar stability. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for cohort studies. Pooled effect sizes were calculated using Hedges’s g and random-effects modeling.

RESULTS: Seven studies, including three RCTs and four cohort studies, with a total of 1,069 patients and 1,113 knees (507 APD vs. 606 MDD), were included. The meta-analysis demonstrated no significant difference in PROMs (Hedges’s g = 0.09; 95% CI [-0.04 to 0.22]; P = 0.17) or ROM (Hedges’s g = 0.02; 95% CI [-0.21 to 0.26]; P = 0.83) between APD and MDD. While revision rates and complications were higher for APD, the differences were not statistically significant compared to MDD (14 vs 9). Radiographic measures showed inconsistencies and did not definitively favor either design.

CONCLUSIONS: Current evidence suggests that APD offers no clear clinical advantage over MDD in the ATTUNE posterior-stabilized TKA. Both designs yield broadly comparable PROMs and knee function outcomes. Larger RCTs with extended follow-up are warranted to clarify the safety of APD.

LEVEL OF EVIDENCE: III.

PMID:40319293 | DOI:10.1186/s13018-025-05858-1

BMC Public Health. 2025 May 3;25(1):1643. doi: 10.1186/s12889-025-22538-1.

ABSTRACT

Worldwide, home care in the form of home healthcare and home help, has become increasingly more available. This systematic review aims to provide a deeper understanding of factors that are of particular importance for infection control in the home care setting for older adults. Five databases were searched (MEDLINE, Embase, ProQuest, Web of Science, CINAHL) for eligible studies using any research design reporting on individual, medical, behavioral and environmental factors. Retrieved studies were screened and assessed for quality. The Joanna Briggs Institute manual guided the research process and the work of generating a synthesis. Qualitative findings were compiled using meta-aggregation. For quantitative evidence, meta-analyses were conducted when possible. Of 19,484 unique records, 27 studies (7 cohort studies, 9 cross-sectional and 11 qualitative) were included in the review. Risk factors for infection reported in the quantitative studies referred to individual, medical, social, behavioral, environmental, and organisational aspects. Meta-analyses showed associations between urinary catheter use (OR 3.97, 95%CI 2.56-6.15) and limited mobility (OR 1.49, 95%CI 1.31-1.68), respectively, and risk of infection. Pooled ORs of urinary incontinence and risk of infection were not statistically significant. Findings from the qualitative studies covered perceived and observed risk factors to infection control and prevention. The evidence resulted in five synthesised findings covering attitudes, behaviors, home environment, personal interactions, lack of equipment, unsafe disposal of material, pets, unsafe practices and procedures, and lack of training. The combined quantitative and qualitative evidence sheds light on separate yet interconnected elements of risks for infection that may reinforce each other, potentially exposing vulnerable older adults to amplified risks.

PMID:40319285 | DOI:10.1186/s12889-025-22538-1

BMC Infect Dis. 2025 May 3;25(1):650. doi: 10.1186/s12879-025-10983-7.

ABSTRACT

OBJECTIVES: Viral respiratory infections can be complicated by bacterial superinfections. SARS-CoV-2 patients may suffer from superinfections, and negative effects of additional infections have been identified. When analysing hospital data, patients typically leave the facility of observation, due to discharge or death, which leads to changes in the study cohort over time. This may distort the estimate of the impact of superinfection. Therefore, it is essential for the statistical analysis of hospital data to acknowledge this change of the risk set over time. We analysed superinfections in a retrospective cohort study with 268 critically ill patients, taking into account discharge and death as competing risks in the statistical analysis.

METHODS: We evaluated bacterial respiratory infections and bloodstream infections and used multi-state statistical modelling to account for the different patient states. We calculated risks of superinfection, probability of discharge or death over time and analysed subgroups according to age and sex.

RESULTS: The observed pathogen spectrum was mainly composed of Enterobacterales, Nonfermenters but also Staphylococcus aureus. We identified an elevated mortality due to bacterial infection of the respiratory tract or bloodstream infection (adj. cause-specific HR 1.7, CI 1.15-2.52) as well as a reduced discharge rate (adj. cause-specific HR 0.51, CI 0.36-0.73). Female patients showed a tendency to have a reduced risk of acquiring a superinfection (adj. subdistribution HR 0.71, CI 0.48-1.04), and in case of infection a higher mortality compared to male patients (interaction effect HR 1.49, CI 0.67-3.30).

CONCLUSIONS: The study accounts for competing risks and quantifies the risk of death associated with bacterial superinfection in critically ill COVID-19 patients. We observed an increased risk of death for patients who developed a superinfection, with Enterobacterales being the predominant agent. The results emphasize the need for microbiological sampling in SARS-CoV-2-infected patients.

CLINICAL TRIAL NUMBER: German Clinical Trials Register number: DRKS00031367, registration date: 01.03.2023 ( https://drks.de/search/de/trial/DRKS00031367 ).

PMID:40319280 | DOI:10.1186/s12879-025-10983-7

BMC Sports Sci Med Rehabil. 2025 May 3;17(1):113. doi: 10.1186/s13102-025-01167-6.

ABSTRACT

BACKGROUND: Efficient methods to reduce erector spinae stiffness are important for solving lumbar spine problems, however, the trunk training positions effective for reducing erector spinae stiffness are unclear. Furthermore, it unclear whether whole-body vibration and trunk training are synergistic. Therefore, this study aimed to clarify the differences in the immediate effects on reducing erector spinae stiffness among three types of training: simple spinal flexion training, spinal neutral position training, and spinal flexion training combined with whole-body vibration.

METHODS: This single-blind randomized controlled trial included 36 healthy university students who were assigned to either the spinal neutral position training group, spinal flexion training group, or whole-body vibration (vibration conditions: 35 Hz, 4 mm) + spinal flexion training group. Training consisted of only one session of the assigned exercise in each group (20 s × 8 sets, rest 15 s). The outcomes measured were erector spinae stiffness, tenderness threshold of the erector spinae, lumbar proprioception, and maximum lumbar forward bending angle. All statistical analyses were performed using a split-plot design analysis of variance.

RESULTS: There were no significant group × period interactions for erector spinae stiffness; however, a significant main effect of time was observed (p < 0.01). Comparison of pre- and post-intervention stiffness indicated no significant differences in the spinal flexion training group. In contrast, both the spinal neutral position (p < 0.01, pre-intervention: 49.0 [10.6], post-intervention: 47.1 [6.4]) and whole-body vibration + spinal flexion training groups (p = 0.02, pre-intervention: 49.8 [12.6], post-intervention: 47.9 [9.4]) showed significantly less stiffness post-intervention compared to pre-intervention.

CONCLUSIONS: Trunk training performed in the spinal neutral position or spinal flexion position combined with whole-body vibration reduces erector spinae stiffness more effectively than simple spinal flexion training.

TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials as a clinical trial (ID: jRCT1042240153; registration date: 20/12/2024).

PMID:40319275 | DOI:10.1186/s13102-025-01167-6

BMC Pregnancy Childbirth. 2025 May 3;25(1):526. doi: 10.1186/s12884-025-07613-0.

ABSTRACT

BACKGROUND: It is ambiguous whether the multiple COS with supraphysiologic hormonal doses impact ovarian reserve functions or pregnancy outcomes. The aim is to explore the effect of multiple COS during ART on ovarian reserve function and clinical pregnancy outcomes in infertile women.

METHODS: The retrospective study included 45,555 IVF/ICSI fresh cycles enrolled between January 2015 and March 2021 and were segregated into 5 different cycle cohorts. The participants were retrospectively grouped according to the number of repeated cycles. The primary observables symbolizing ovarian reserve function were antral follicle count (AFC) and anti-Müllerian hormone (AMH). We analyzed clinical pregnancy rate (CPR), live birth rates (LBR), and early miscarriage rate (EMR) to explore clinical pregnancy outcomes.

RESULTS: Among populations with different numbers of COS cycles, regression analyses found that the number of COS cycles had no significant impact on pregnancy outcomes (p > 0.05) after adjusting for confounding factors. However, factors such as age, BMI, and embryo transfer parameters showed significant associations with pregnancy outcomes. Intra-group analysis within same population revealed that, basal FSH, basal LH, AMH, and AFC exhibit no significant distinction (P > 0.05). Cycle 2 in Group B (aOR = 8.29; 95% CI, 6.80-10.12; P = 0.000), Cycle 3 in Group C (aOR = 6.05; 95% CI, 3.28-11.15; P = 0.000) and Cycle 4 in Group D (aOR = 20.46; 95% CI, 3.05-137.24; P = 0.002) had the highest CPR within each group; Cycle 2 in Group B and Cycle 3 in Group C had the highest LBR and lowest EMR within each group, and the differences did not reached statistical significance in the remaining groups.

CONCLUSION(S): The number of COS cycles did not significantly adversely affect pregnancy outcomes across different populations. In self-controlled comparisons within the same population, repeated COS (≤ 5 cycles) may not impair ovarian reserve function, while repeated COS (≤ 4 cycles) positively influenced clinical pregnancy outcomes, suggesting a potential cumulative effect.

PMID:40319269 | DOI:10.1186/s12884-025-07613-0

BMC Neurol. 2025 May 3;25(1):194. doi: 10.1186/s12883-025-04209-1.

ABSTRACT

BACKGROUND: Seeking medical attention promptly after an acute stroke is essential for effective treatment and improved patient outcomes. However, delayed medical intervention after acute stroke contributes to increased mortality and morbidity. This study explored factors that contribute to the delayed appearance of stroke patients at the emergency department.

METHODS: A prospective cross-sectional study was conducted for 9 months at a referral hospital in Addis Ababa. Data was collected using questionnaires administered to stroke patients or their caregivers upon their arrival at the emergency department. Electronic medical records were further reviewed, and the treating physicians described the subsequent management of the patient after their arrival at the emergency department. Data was analyzed using descriptive and analytic parameters.

RESULTS: Only 33.3% (n = 30) arrived at the emergency department within 4.5 h. Hemorrhagic stroke was a statistically significant predictor of early presentation to the emergency department (OR = 3.182; 95% CI (1.258-8.046); p = 0.036). The absence of any substance was another marginally significant predictor for early appearance (OR = 2.555; 95% (0.936-6.970); p = 0.067). One of the marginally significant predictors for late presentation was low drug adherence (OR = 0.224; 95% CI (0.48-1.044); p = 0.057). The other factors attributed to the time of arrival, though not statistically significant, were level of education, perception of stroke as a serious illness, and prior number of health visits before arrival to the emergency department.

CONCLUSION: The study found that many of the factors that cause delays in getting to the hospital can be changed, except for the type of stroke. Time spent in the hospital could also be positively impacted by the intervention from the appropriate authorities.

PMID:40319255 | DOI:10.1186/s12883-025-04209-1