Category: Statistics

BMC Health Serv Res. 2025 Feb 24;25(1):301. doi: 10.1186/s12913-025-12451-z.

ABSTRACT

BACKGROUND: When the health administration department re-assumed the responsibilities for occupational safety and health supervision and management in 2018, the Chinese government allocated special funds annually to the Centers for Disease Control and Prevention (CDCs) at all levels to enhance their capacity to monitor occupational diseases and hazardous factors. Thus, the CDCs’ technical support capacity for occupational disease surveillance and assessment (TSCODSA) has garnered increasing attention. Against this backdrop, we aimed to develop a comprehensive evaluation model to assess the CDCs’ TSCODSA, taking the municipal and county-level CDCs in Sichuan Province as an example.

METHODS: In 2023, a survey was conducted on the municipal and county-level CDCs across 21 cities (including three autonomous prefectures) in Sichuan Province. Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) was used to evaluate the TSCODSA of these CDCs, combined with the Rank Sum Ratio (RSR) method for classification. The obstacle degree model was used to analyze the primary factors influencing their capacity.

RESULTS: Among the 21 cities of Sichuan Province, only 4 cities (19.05%) had a “good” rating for the TSCODSA, while the remaining 17 cities (80.95%) were classified as either “medium” or “poor”. Cities with “good” ratings for the TSCODSA of CDCs were predominantly concentrated in the Chengdu Plain Economic Zone, while cities with “poor” ratings were mainly concentrated in the Northeast Sichuan Economic Zone. Obstacle degree analysis revealed that core capacity building and human resources constitute significant barriers impacting the capacity levels of CDCs across cities.

CONCLUSION: The overall TSCODSA level of CDCs in Sichuan Province is relatively low, with pronounced disparities in support capability across different economic zones, indicating imbalanced development. The evaluation system proposed in this study effectively reflects the level of TSCODSA of CDCs in various cities of Sichuan Province.

PMID:39994623 | DOI:10.1186/s12913-025-12451-z

BMC Oral Health. 2025 Feb 24;25(1):297. doi: 10.1186/s12903-025-05675-2.

ABSTRACT

BACKGROUND: To investigate the geometric characteristics of the danger zone in the mesial roots of mandibular molars using micro-computed tomography (micro-CT).

METHODS: A total of 75 extracted mandibular first (50 were 2-rooted [2RM1] and 25 were 3-rooted [3RM1]) and 35 2-rooted mandibular second molars (2RM2) were collected and evaluated using micro-CT. The morphological aspects of the mesial roots associated with the danger zone (the canal curvature, minimum mesial [MWT] and distal canal wall thickness [DWT], depth and level of root concavities) were evaluated. One-way analysis of variance (ANOVA) was used for multiple group comparisons. Student’s t-test or paired t-test was used to test the means between two groups.

RESULTS: All mesial roots curved severely (81.8%, 90/110) or moderately (18.2%, 20/110) towards the furcation side, and the mean angle was 25.3 ± 7.2 degrees. The presence of a distolingual root only had limited influence on the geometricgeometry of the mesial root. In the majority of cases, the mean DWT was less than the MWT, and statistical significance (all p < 0.05) was detected at 0-3 mm (MB and ML of 3RM1), 0-4 mm (MB of 2RM1, and MB and ML of 2RM2), 0-5 mm (single mesial canals of mandibular first and second molars), and 0-6 mm (ML of 2RM1) below furcation. The mean depth of distal concavities is always greater (all p < 0.05) than the mesial ones at each root level. Generally, the mean depth of distal concavities increased apically in the cervical portion, reaching the maximum value at 2 mm below furcation, and then declined gradually in the apical portion.

CONCLUSIONS: The mesial roots of mandibular first and second molars often exhibit severe distal curvature, with a mean Schneider’s angle of 25.3 degrees, and the thinnest dentin wall is typically on the distal side. Distal root concavities are significantly deeper than mesial ones, with the maximum depth generally located 2 mm below the furcation. When identifying the danger zone, factors such as DWT should not be considered in isolation. Canal curvature, distal root concavities, and the type of instrument used are also critical in affecting the likelihood and location of strip perforation, though their precise roles warrant further investigations.

PMID:39994614 | DOI:10.1186/s12903-025-05675-2

BMC Pregnancy Childbirth. 2025 Feb 24;25(1):196. doi: 10.1186/s12884-025-07284-x.

ABSTRACT

BACKGROUND: The incidence of inadequate or excessive gestational weight gain (GWG) is an indicator of reproductive health problems. However, scientific evidence for the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Ethiopia is sparse. This study aimed to assess the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Southeast Ethiopia.

METHODS: A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control) from February to December 2021. Study participants were selected by multistage cluster sampling followed by systematic sampling. Women receiving the intervention received six nutrition education sessions, while women in the control group received standard care. GWG was the difference between the last recorded weight before delivery and the weight recorded during the first trimester. BW was measured within the first hour of delivery. The generalized structural equations model (GSEM) and structural equations model (SEM) were used to examine the direct, indirect, and total effects of nutrition education on GWG and BW via the dietary diversity score (DDS), food security (FS), and knowledge.

RESULTS: The GSEM revealed that receiving intervention during pregnancy had a total effect on GWG [(AOR = 2.056, 95% CI: 1.705, 2.695)]. Having dietary diversity had direct and total effects on GWG [(AOR = 1.105, 95% CI: 1.022, 1.196)]. Having food security had a total effect on GWG [(AOR = 1.928, 95% CI: 1.817, 2.052)]. Having fruit and vegetable knowledge had a total effect on GWG [(AOR = 1.971, 95% CI: 1.856, 2.105)]. The SEM revealed that receiving intervention during pregnancy had a direct effect on BW (unstandardized β = 0.144, 95% CI: 0.034, 0.252). Similarly, it revealed that receiving intervention during pregnancy had a direct effect on DDS (β = 0.580, 95% CI: 0.024, 1.038). Likewise, it indicated that receiving intervention during pregnancy had a total effect on increasing BW (β = 0.137, 95% CI: 0.029, 0.243). Nevertheless, there was no statistically observed indirect effect of nutrition education during pregnancy on GWG and BW via mediators.

CONCLUSION: The SEM revealed that receiving nutrition education interventions during pregnancy had a total effect on GWG and direct and total effects on BW. The generalized structural equation modelling (GSEM) and structural equation modelling (SEM) findings show that integrating theory-based nutrition education during pregnancy will improve gestational weight gain (GWG) and birth weight (BW) in Ethiopia.

TRIAL REGISTRATION: The trial was registered on Pan African Clinical Trials Registry (PACTR202201731802989, retrospectively registered on 24/01/ 2022).

PMID:39994611 | DOI:10.1186/s12884-025-07284-x

BMC Cancer. 2025 Feb 24;25(1):332. doi: 10.1186/s12885-025-13750-8.

ABSTRACT

BACKGROUND: The relationship between vasectomy and the risk of prostate cancer (PCa) remains unclear, with observational studies reporting inconsistent results. To clarify this ambiguity, we embarked on a comprehensive investigation comprising both a meta-analysis and a Mendelian randomization (MR) study. This dual approach aimed to thoroughly examine not only the association but also the causality between undergoing a vasectomy and the subsequent risk of PCa.

METHODS: Our systematic review meticulously examined cohort studies published until January 2024, employing a random effects model for the computation of relative risks (RR) and their 95% confidence intervals (CI). For MR Analysis, we leveraged aggregated data from the IEU Open GWAS database, investigating the correlation between genetic predisposition to vasectomy and PCa. We chose single nucleotide polymorphisms (SNPs) of European descent as instrumental variables (IVs) for this analysis. The primary method for calculating the odds ratios (ORs) and their 95% CIs was inverse variance weighting (IVW). Through sensitivity analysis, we confirmed the robustness of our findings.

RESULTS: Our investigation synthesized data from 19 cohort studies, encompassing over four million participants. The combined analysis revealed a statistically significant link between vasectomy and an elevated risk of PCa across any grade (RR = 1.09; 95%CI: 1.05-1.14; P = 0.001; I² = 83.3%). This association was observed for both localized PCa (RR = 1.08; 95% CI: 1.04-1.13; P < 0.001; I² = 48.8%) and advanced PCa (RR = 1.07; 95% CI: 1.01-1.13; P = 0.016; I² = 0%). Nonetheless, the discovery cohort MR Analysis indicated no genetic causal link between vasectomy and PCa (OR = 0.067; 95%CI = 0.002-1.535; P = 0.09). A validation set in the Finnish population confirmed the robustness of the results. This conclusion remained consistent even after controlling for variables such as prostate-specific antigen (PSA) testing and body mass index (BMI), suggesting that while a statistical association exists, the genetic evidence does not support a causal relationship.

CONCLUSION: The cumulative analysis indicates a possible elevated risk of PCa in patients who have had a vasectomy. However, MR Analysis has not confirmed a direct causal link between vasectomy and PCa. This suggests that the association observed may not stem from direct causation, allowing for the continued consideration of vasectomy as a viable long-term contraceptive choice. Further research is imperative to uncover any factors that could potentially link vasectomy to an increased risk of prostate cancer, aiming to provide a more comprehensive understanding of the implications.

PMID:39994603 | DOI:10.1186/s12885-025-13750-8

BMC Cancer. 2025 Feb 24;25(1):331. doi: 10.1186/s12885-025-13515-3.

ABSTRACT

BACKGROUND: Metastatic colorectal cancer (mCRC) poses a high rate of morbidity and mortality despite various treatment advances. Cetuximab, an anti-EGFR, has shown promising efficacy in improving outcomes when combined with chemotherapy. Understanding its efficacy is essential for optimizing treatment strategies in mCRC. This systematic review and meta-analysis aims to evaluate the effectiveness of combining cetuximab with chemotherapy in mCRC.

METHODS: PubMed and Google Scholar were systematically searched following the benchmarks indicated by PRISMA. The primary outcomes of the study were progression-free survival (PFS) and overall survival (OS). Statistical analyses were executed using Stata version 16.

RESULTS: The meta-analysis encompassed 25 studies involving 3788 mCRC patients. The median age spans from 18 to 77 years. The cetuximab plus chemotherapy exhibited a higher PFS and OS with a significant difference (PFS: HR = 0.79, 95% CI = 0.63-0.96, p < 0.01, I² = 38% and OS: HR = 0.78, 95% CI = 0.60-0.91, p < 0.01, I² = 47%) compared to the control group. Subgroup analysis based on randomized controlled trials demonstrated consistent treatment effects for PFS (HR = 0.77, 95% CI = 0.62-0.93) and OS (HR = 0.76, 95% CI = 0.61-0.88) in the cetuximab treatment group.

CONCLUSIONS: Combining cetuximab with chemotherapy offers a potential benefit in improving survival outcomes for metastatic colorectal cancer patients, as indicated by this study. These results suggest that cetuximab may be a valuable addition to mCRC treatment strategies, warranting further clinical investigation and integration into standard care.

PMID:39994602 | DOI:10.1186/s12885-025-13515-3

BMC Public Health. 2025 Feb 24;25(1):750. doi: 10.1186/s12889-025-21948-5.

ABSTRACT

BACKGROUND: Prolonged sitting time is associated with an increased risk of cardiovascular disease (CVD) in the general population. However, it is unclear how these risks differ across occupational groups. This study aimed to investigate the association between sitting time and CVD in manual and non-manual workers among Chinese adults.

METHODS: This population-based cohort study recruited 47,931 participants aged 35 to 70 years from 115 communities across 12 provinces in China between 2005 and 2009. Daily sitting time was measured using the International Physical Activity Questionnaire (IPAQ). The main outcome was a major CVD event (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Information on each participant’s occupation was collected using standardized questionnaires and categorized into manual and non-manual occupations according to the Italian National Institute of Statistics 2001 (ISTAT-2001) occupational classification standard. Cox frailty models were used to examine the associations.

RESULTS: Of 43,256 in the final sample (excluding those with CVD at baseline and missing data), 25,252 (58.4%) were women, and the mean (± SD, Standard Deviation) age was 50.6 ± 9.5 years. During a median follow-up of 11.9 (IQR, Interquartile Range: 9.5-12.6) years, 3,408 major CVD events (899 myocardial infarctions, 2,400 strokes, 240 incident heart failure, and 764 cardiovascular deaths) were documented. Compared with the reference group (< 4 h per day of sitting), the risk of major CVD events was positively associated with increasing sitting time among manual workers (HR, 1.20; 95% CI, 1.05-1.37 for 6-8 h per day; HR, 1.43; 95% CI, 1.12-1.82 for ≥ 8 h per day), while the risk among non-manual workers was greater for those reporting daily sitting times of more than 8 h (HR, 1.86; 95% CI, 1.18-2.95). Similar trends were observed when CVD mortality and incidence were analysed separately.

CONCLUSIONS: Longer daily sitting time was associated with an increased risk of major CVD in both manual and non-manual occupational groups, and the risk was especially high among non-manual workers. Our findings highlight the importance of including measures to reduce sedentary behaviour within a comprehensive strategy to reduce the burden of cardiovascular disease in China.

PMID:39994596 | DOI:10.1186/s12889-025-21948-5

BMC Pregnancy Childbirth. 2025 Feb 24;25(1):201. doi: 10.1186/s12884-025-07322-8.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) affects a significant proportion of pregnant women, impacting both physical and psychological well-being. This study aimed to investigate the factors influencing quality of life (QoL) in women with GDM.

METHODS: This systematic review followed PRISMA guidelines and was registered in PROSPERO (ID: CRD42024612587). A comprehensive search was conducted in PubMed, Scopus, ProQuest, Web of Science, and CINAHL, using MeSH terms related to gestational diabetes and quality of life. Eligible studies included adult women with gestational diabetes and assessed factors influencing their quality of life. The included studies were related to various stages including antenatal, during pregnancy or postpartum. Data extraction was performed independently by two authors, and study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted in STATA, including meta-analysis with a random-effects model.

FINDINGS: The findings reveal that women with GDM experience significantly lower QoL compared to healthy pregnant women, with sexual dysfunction being a notable contributor. Women with GDM reported lower sexual desire, satisfaction, and higher pain levels, which were significantly associated with poorer QoL, particularly in mental health and pain domains. Socio-demographic factors such as age, education, income, and marital status were significantly linked to QoL, with younger women and those with lower education or income reporting poorer outcomes. Psychological factors, including stress, depression, and anxiety, negatively impacted QoL, while social support, self-efficacy, and illness acceptance were positively correlated with better QoL outcomes. Additionally, stress was found to be the main predictor of QoL for women over 30, while social relationships were more important for younger women. Treatment with insulin or a combination of insulin and oral hypoglycemic agents was associated with lower QoL compared to dietary management alone.

CONCLUSION: This systematic review identified key psychosocial and medical factors influencing the quality of life in women with gestational diabetes. The findings emphasize the importance of addressing psychological well-being, social support, and treatment approaches to enhance QoL in these women. Further research is needed to explore interventions targeting mental health and stress management to improve outcomes for women with gestational diabetes.

PMID:39994595 | DOI:10.1186/s12884-025-07322-8

Spine (Phila Pa 1976). 2025 Mar 15;50(6):357-367. doi: 10.1097/BRS.0000000000005213. Epub 2024 Nov 13.

ABSTRACT

STUDY DESIGN: Retrospective cohort study of prospectively enrolled database.

OBJECTIVE: We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.

BACKGROUND: Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.

MATERIALS AND METHODS: Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.

RESULTS: A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P < 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36’s physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05).

CONCLUSION: Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.

PMID:39992724 | DOI:10.1097/BRS.0000000000005213

Paediatr Int Child Health. 2025 Feb 24:1-8. doi: 10.1080/20469047.2025.2459964. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital malaria, characterised by low parasitaemia in newborns’ peripheral blood, is difficult to diagnose by conventional techniques. Owing to its high sensitivity, polymerase chain reaction (PCR) allows for effective detection of low-density plasmodium infections. This study determined the prevalence of congenital malaria by PCR in newborns of mothers living in a malaria-endemic area of Kinshasa, Democratic Republic of Congo (DRC).

METHODS: A total of 576 mother-newborn pairs were enrolled in two clinical trials in Kinshasa. Maternal peripheral blood was collected at enrolment. At delivery, samples were taken from maternal and newborn peripheral blood, placental blood and placental imprints.

RESULTS: The prevalence of congenital malaria detected by PCR was 2.4% (14/576) compared with 0.9% (5/576) by microscopy. The prevalence of malaria at delivery was 8.9% (51/570), and placental malaria was 10.6% (59/556) by microscopy. At delivery, maternal malaria was significantly associated with congenital malaria [adjusted odds ratio (aOR) 16.06, 95% CI 2.6-98.5, p < 0.01). Placental malaria also increased the risk of congenital malaria (aOR 5.77, 95% CI 0.9-35.2, p = 0.05). Although 10 of 72 women (16.7%) with placental malaria gave birth to low-weight infants, the association was not statistically significant.

CONCLUSIONS: Although this first assessment of congenital malaria by PCR in DRC found a low prevalence, maternal and placental malaria at delivery were still associated with congenital malaria, highlighting the importance of maternal health in preventing neonatal infections.Abbreviations: Aor adjusted odds ratio; CI confidence interval; cOR crude odds ratio; DNA de-oxyribonucleic acid; GAPDH glyceraldehyde-3-posphate dehydrogenase; g/dL grams per decilitre; Hb haemoglobin; IQR interquartile range; IPTp-SP Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine; ITN insecticide-treated nets; PA pyronaridine-artesunate; PCR polymerase chain reaction; RDT rapid diagnostic tests; SD; standard deviation; uRDTs ultra-sensitive rapid diagnostic tests; WHO World Health Organization; µL microlitre.

PMID:39992706 | DOI:10.1080/20469047.2025.2459964

Cancer Cytopathol. 2025 Mar;133(3):e70003. doi: 10.1002/cncy.70003.

ABSTRACT

INTRODUCTION: The aim of this project is to assess interobserver agreement for programmed death-ligand 1 (PD-L1) scoring on of non-small cell lung cancer (NSCLC) on cytological specimens in a large-scale multicenter study, by exploiting the cell block-derived tissue microarray (cbTMA) approach.

METHODS: A total of 65 cell blocks (CB) diagnosed as NSCLC were retrospectively collected and selected for TMA preparation. Hematoxylin-eosin and PD-L1 stained slides were digitized and uploaded on a free web sharing platform. Participants were asked to provide PD-L1 assessment by using the clinically relevant cutoff of tumor proportion score (TPS) (<1%; 1%-49%; >50%). Interobserver agreement was calculated using Fleiss’s κ.

RESULTS: Of 65 CBs, 11 were deemed not suitable; therefore, an overall number of 54 cores were used for the preparation of four TMAs. A total of 1674 evaluations were provided by 31 cytopathologists from 21 different institutions in nine countries. The statistical analysis showed a moderate overall agreement (κ = 0.49). The highest agreement was achieved in the TPS >50% category (κ = 0.57); moderate agreement was observed in TPS <1% category (κ = 0.51) and the lowest κ value was obtained for TPS 1%-49% category (k = 0.32).

CONCLUSIONS: The overall moderate agreement observed showed that there is still room for improvement in inter-pathologist agreement for PD-L1 evaluation on cytological samples, highlighting the need for standardization in sample preparation, focused training in PD-L1 evaluation on cytological material, and the integration of machine learning tools to improve interobserver consistency.

PMID:39992702 | DOI:10.1002/cncy.70003