Category: Statistics

BMC Public Health. 2025 Feb 21;25(1):719. doi: 10.1186/s12889-025-21796-3.

ABSTRACT

BACKGROUND: Heavy metals (e.g., cadmium, lead, mercury, etc.) can infiltrate the human body via diverse routes, with a propensity to accumulate in the kidney cortex, thereby precipitating kidney dysfunction. Vitamin D has been implicated in mitigating the oxidative stress and inflammatory reactions triggered by heavy metal exposure. However, the interplay between heavy metal toxicity and vitamin D deficiency in the context of incipient kidney injury remains an underexplored area of research.

METHODS: Utilizing data from the National Health and Nutrition Examination Survey spanning from 2001 to 2004, Our methodology leveraged spline smoothing within the framework of generalized additive models to more vividly elucidate the impact of heavy metal exposure and serum vitamin D levels on the trajectory of early kidney injury biomarkers (including albumin-to-creatinine ratio, β-2 microglobulin (B2M), cystatin C (CYST), and estimated glomerular filtration rate (eGFR) (serum creatinine(SCr)-based(eGFR), CYST-based eGFR, and SCr-CYST-based eGFR). Furthermore, we conducted an interaction analysis to assess the combined effects of heavy metal exposure and vitamin D deficiency on early kidney injury.

RESULTS: The cohort comprised 2,422 adults. Our results indicated that cadmium levels were positively correlated with B2M, CYST, and negatively correlated with eGFRc, eGFRs. Similarly, lead levels showed a positive correlation with ACR, B2M, and CYST, and negative correlation with eGFRc, eGFRc&s. In contrast, mercury levels were negatively correlated with B2M, CYST and positively correlated with eGFRc. In addition, there was an interaction between lead exposure and vitamin D deficiency in early kidney injury indicators (P for interaction: B2M: 0.028, CYST: 0.038, eGFRc&s: 0.011).

CONCLUSIONS: This study suggests a correlation between exposure to cadmium and lead and an increased risk of early kidney injury. It highlights the potential importance of targeted vitamin D supplementation and reduction in lead exposure in mitigating early kidney injury. However, these findings warrant validation through further prospective research.

PMID:39984925 | DOI:10.1186/s12889-025-21796-3

BMC Med. 2025 Feb 21;23(1):109. doi: 10.1186/s12916-025-03947-w.

ABSTRACT

BACKGROUND: Processed packaged foods are readily available in Fiji; however, the extent to which ultra-processed foods (UPFs) currently contribute to energy and nutrient intake is unknown. This study aimed to assess the contribution of UPFs to total energy intake and nutrients of concern (sodium, sugar, fat) in a representative sample of adults in the central division of Fiji, identify the main food category sources of UPFs and assess variation by sociodemographic characteristics.

METHODS: A random sample of 700 adults was selected from two statistical enumeration areas (one semi-urban, one rural). Participant characteristics were collected, and a three-pass 24-h diet recall was undertaken. Foods consumed were coded based on the level of processing, in alignment with the NOVA categorisation system.

RESULTS: The contribution of UPFs to total energy, fat, sugar, and sodium intake and dietary sources of UPFs (based on the per cent daily energy contribution of UPFs from food groups) were estimated and assessed by sex, age group, ethnicity and location. A total of 534 adults participated (76% response rate, 50% female). UPFs contributed 21.5% (95% CI, 21.4% to 26.6%) of total energy intake, 22.8% (95% CI 20.5% to 25.1%) of total sodium intake, 24.0% (95% CI, 21.4% to 26.6%) of sugar intake and 18.6% (95% CI 16.5% to 20.7%) of total fat intake. Key food group contributors to UPF intake were bread and bakery products 42.9% (38.3% to 47.6%), non-alcoholic beverages 26.8% (22.4% to 31.1%), convenience foods 8.6% (6.3% to 10.8%), and meat, poultry, and meat alternatives 6.9% (4.8% to 8.9%). The contribution of UPFs to sodium, sugar and fat intake was similar for men and women; however, differences were observed by age group, ethnicity and region (semi-urban compared to rural).

CONCLUSIONS: This study identified that UPFs appear to be a large contributor to energy, sodium, fat and sugar intake in adults in the Central division of Fiji. A reduction of UPF consumption in Fiji may lead to a reduction of harmful nutrients such as sodium, fat, and sugar, crucial to reducing the diet-related burden of disease.

PMID:39984924 | DOI:10.1186/s12916-025-03947-w

BMC Med. 2025 Feb 21;23(1):106. doi: 10.1186/s12916-025-03942-1.

ABSTRACT

BACKGROUND: Cardiometabolic disorders are the leading cause of mortality and contribute substantially to the First Nations Health Gap in Australia. Central obesity is the major contributor to metabolic syndrome. We investigated factors associated with central obesity and how normal-weight central obesity is associated with cardiometabolic disorders among Aboriginal and Torres Strait Islander Australians (hereafter respectfully referred to as ‘Indigenous Australians’).

METHODS: This study used the 2018-2019 Australian Bureau of Statistics (ABS) National Aboriginal and Torres Strait Islander Health Survey dataset. A total of weighted 4864 Indigenous adults (18 + years) were included. Normal-weight central obesity refers to individuals with a normal body mass index (BMI) but with an elevated waist circumference (WC ≥ 102 cm for males and ≥ 88 cm for females). Main outcomes included self-reported type 2 diabetes, hypertension, high cholesterol and heart disease. Multi-level logistic regression models were used to examine the relationship between explanatory variables and outcomes.

RESULTS: The overall prevalence of central obesity was 46.2% (95% confidence interval [CI]: 42.8, 49.72) in males and 67.7% (95% CI: 64.90, 70.4) in females. Physical inactivity increased the risk of central obesity in males (odds ratio [OR] = 1.34; 95% CI: 1.09, 1.65), while daily consumption of soft drinks was associated with central obesity in females (OR = 1.35; 95% CI: 1.12, 1.62). Males living in very remote areas had a lower risk of central obesity, while females in very remote areas had a higher risk. Our findings also showed that females with normal-weight central obesity had a higher risk of hypertension (OR = 3.29; 95% CI: 1.95, 9.62) and higher total cholesterol (OR = 4.62; 95% CI: 2.22, 9.62). Similarly, males with normal-weight central obesity were associated with a higher risk of type 2 diabetes (OR = 4.13; 95% CI: 1.23, 13.94).

CONCLUSIONS: This was the first study to report that approximately 12% of Indigenous Australians with normal BMI have central obesity. Relying solely on BMI to identify such high-risk individuals may be inadequate for early intervention. Public health initiatives targeting obesity should include individuals with a normal BMI and central obesity.

PMID:39984922 | DOI:10.1186/s12916-025-03942-1

BMC Med Educ. 2025 Feb 21;25(1):287. doi: 10.1186/s12909-025-06804-9.

ABSTRACT

BACKGROUND: Palliative care training at the undergraduate level is poor in India. With the need for palliative care rising in India and globally, it is possible to train physicians in resource-limited settings in palliative care via online training programs owing to ease of access and convenience. However, there is limited evidence available from India on the development and implementation of such a training program. This study aims to describe the development of an online training program offered by the Trivandrum Institute of Palliative Sciences (TIPS), Kerala, and the impact of the program on the confidence of physicians in managing various palliative care needs of their patients.

METHODS: The course was developed by an interdisciplinary expert team from TIPS. The course content was made keeping in mind the local sociocultural factors in India and was peer-reviewed by two external experts. The program was started in 2018 and updated and revised over the years. Currently, the program has 20 sessions, each lasting for 90 min. The course content was disseminated using project-ECHO’s (Extension of Community Health Outcomes) telementoring model. To assess the impact of the training program, self-reported change in confidence from twenty-two batches of physicians, trained from January 2020 to August 2023. Feedback from participants was also assessed to identify areas of improvement in the training program.

RESULTS: A total of 1159 physicians were trained during the study period. At the end of the course, 51.2% of the participants completed the evaluation survey and had a statistically significant (p < 0.05) improvement in confidence in pain, gastrointestinal symptoms and breathlessness management, morphine prescription, and psychosocial communication. The duration of each session and the entire course was reported to be ideal by 88.6% and 87.9% of participants, respectively.

CONCLUSION: Our results show that online training can be effectively used to build confidence in physicians in managing various palliative care needs.

TRIAL REGISTRATION: Not applicable.

PMID:39984918 | DOI:10.1186/s12909-025-06804-9

Malar J. 2025 Feb 21;24(1):55. doi: 10.1186/s12936-025-05289-7.

ABSTRACT

BACKGROUND: The study focused on the full population of children from Nigeria, where the dataset was obtained from the demographic and health surveys (DHS). About 10245 children were selected for the current study and based on the rapid diagnostic test (RDT) results, there is about 37% prevalence of malaria in children under 5 years old in Nigeria. Malaria is the leading public health concern, that contributes to child mortality in the African region.

METHODS: The Nigeria Malaria Indicator Survey (NMIS) 2021 was utilized in this investigation. For the 2021 NMIS, a two-stage sampling technique was used. According to the NIMS study, the children chosen for anaemia and RDT testing were under 5 years of age.

RESULTS: A generalized linear mixed model (GLMM) was used to examine malaria RDT findings in conjunction with demographic, geographic, and socioeconomic characteristics. The following underlying risk factors for malaria in children were discovered in the study: altitude, anaemia level, age in months, fever status in the past 2 weeks, toilet facility, main wall material, main roof material, household wealth index, type of place of residence, sex of the child, mother’s education level, and knowledge of the preventative measures that can be used to prevent malaria.

CONCLUSION: Missing data were not deleted in this investigation; instead, multiple imputations utilizing chained equations were used to approximate the missing observation. Based on the results found by using the GLMM, the findings of this study may influence how the government combats malaria in Nigeria. The novelty of this study is that the missing values were not dropped. However, imputation techniques were explored, and multiple imputation by chained equations was used.

PMID:39984916 | DOI:10.1186/s12936-025-05289-7

BMC Cancer. 2025 Feb 21;25(1):313. doi: 10.1186/s12885-025-13570-w.

ABSTRACT

OBJECTIVES: This study aimed to assess the effectiveness and safety of conventional transarterial chemoembolization (c-TACE) followed by irreversible electroporation (IRE) for the treatment of hepatocellular carcinoma (HCC).

METHODS: From January 2019 to September 2019, 12 patients with HCC who received c-TACE followed by IRE comprised the study group. The control group comprised 15 patients who received c-TACE followed by radiofrequency ablation (RFA). The 1-month, 3-month, 6-month, and 12-month local control rates and median progression-free survival (PFS) were compared between the two groups. Additionally, postoperative complications were assessed.

RESULTS: The study group comprised 12 patients (median age: 57.5 years; range: 46-68 years), while the control group consisted of 15 patients (median age: 56 years; range: 31-69 years). Local control rates at 1, 3, 6, and 12 months were 91.7%, 91.7%, 83.3%, and 33.3%, respectively, for the study group, and 73.3%, 66.7%, 66.7%, and 20.0% for the control group. Statistical analysis revealed no significant differences between the two groups. In terms of survival, 9 patients (75%) in the study group and 11 patients (73.3%) in the control group were still alive at the last follow-up. The median PFS was 8 months in the study group and 7 months in the control group, with no significant difference between the two groups (p = 0.96). Notably, no severe surgery-related side effects were observed in either group, and also no significant differences were found in postoperative complications between the two groups (p = 0.64).

CONCLUSIONS: The long-term therapeutic outcomes of c-TACE followed by IRE were found to be similar to those of c-TACE followed by RFA in the study. The research suggests that c-TACE followed by IRE offered an effective and safe treatment option for HCC.

PMID:39984913 | DOI:10.1186/s12885-025-13570-w

BMC Neurol. 2025 Feb 21;25(1):72. doi: 10.1186/s12883-025-04061-3.

ABSTRACT

BACKGROUND: Guillain-Barré syndrome (GBS) is a group of immune-mediated peripheral neuropathies that causes acute flaccid paralysis. The global incidence of GBS was 0.6-4/100 000, and the incidence in China was 0.698/100 000. Although the diagnosis and treatment of GBS has made rapid progress, approximately 20% of patients with GBS are still unable to walk alone within 6 months after the onset of GBS, and 40% of patients have sequelae, such as weakened strength, limb pain, and numbness, seriously affecting their life and work. We aimed to retrospectively analyze the clinical characteristics of patients with GBS in Shenzhen, China and analyze the factors affecting disease severity to provide a reference for the precise treatment of GBS.

METHODS: Clinical data of inpatients diagnosed with GBS in several hospitals in Shenzhen from April 2010 to October 2021 were obtained from an electronic medical record system (HIS system). The clinical characteristics of patients with GBS and the factors affecting disease severity were analyzed.

RESULTS: A total of 146 patients were identified for this study, and 13 were lost during follow-up. During the follow-up period, three patients had acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP). One hundred and thirty patients with complete data, comprising 90 males (69.23%) and 40 females (30.77%) with a median age of 39.50 ± 23.75 years, were included in the statistical analyses. Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common electrophysiological variant (106 cases [81.54%]). Miller-Fisher syndrome (MFS), acute motor axonal neuropathy (AMAN), and acute motor-sensory axonal neuropathy (AMSAN) were noted in 21 (16.15%), 2 (1.54%), and 1 (0.77%) patients, respectively. The clinical course of the disease was mainly mild in 95 cases (73.08%), while 35 patients (26.92%) experienced severe disease. Logistic multivariate regression analysis showed that age ≥ 60 years old and having pneumonia may be associated with the severity of the disease.

CONCLUSIONS: AIDP is the most common electrophysiological variant of GBS in Shenzhen. Most cases of GBS in our setting are mild, and the long-term prognosis is favorable. Old age (≥ 60 years) and having pneumonia are independent risk factors for severe GBS.

PMID:39984908 | DOI:10.1186/s12883-025-04061-3

Poult Sci. 2025 Feb 6;104(3):104886. doi: 10.1016/j.psj.2025.104886. Online ahead of print.

ABSTRACT

Heat stress is a potent modulator of the avian neuroendocrine system with concomitant impact on the gut microbiome. As an interkingdom signaling molecule, serotonin is largely derived from the gut and found in large concentrations in the avian gut lumen. Despite the role of serotonin in animal stress physiology and related host-microbe interactions, whether heat stress alters avian enteric concentrations of serotonin is unknown. As such, the present study sought to determine whether acute or chronic exposure to moderate heat stress alters both enteric serotonin concentrations and the microbiome in the chicken gut. Chickens were, or were not, subjected to an acute (1 day), repeated acute (2 days) or chronic (6 days) moderate ambient cyclic heat stress (12h per day, 31°C). Enteric concentrations of serotonin were significantly decreased in the acute heat stress group (P < 0.05), and rebounded to become elevated in the chronic heat stress group (P < 0.05). Shotgun metagenomic sequencing revealed heat stress caused both functional and taxonomic changes in the cecal microbiome. Abundances of bacterial taxa that are known to interact with the host via the serotonergic system, including Lactobacillus spp., and Bifidobacterium spp., were significantly (P < 0.05) altered by heat stress. As these findings demonstrate that heat stress can alter serotonin concentrations in the chicken intestinal tract, with distinct outcomes depending on duration of the stressor, serotonergic signaling may serve as potential leverageable point of intervention in host-microbe interactions including foodborne pathogen colonization in the chicken gut. In addition, this study provides novel insight into the impact of acute and chronic heat stress on the avian microbiome, and its relationship to stress-driven changes in the enteric serotonergic system.

PMID:39983259 | DOI:10.1016/j.psj.2025.104886

Surgery. 2025 Feb 20;181:109258. doi: 10.1016/j.surg.2025.109258. Online ahead of print.

ABSTRACT

BACKGROUND: The role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma is debated. This study presents the findings from a 10-year follow-up of a single-institution randomized controlled trial assessing the role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma.

METHODS: Between 2008 and 2010, a total of 196 patients with clinically node-negative papillary thyroid carcinoma were randomly assigned to 2 groups in a 1:1 ratio to undergo total thyroidectomy (group A) or total thyroidectomy with prophylactic central compartment lymph node dissection (group B). Patients received low-dose radioactive iodine treatment (30 mCi) postoperatively, with additional doses as needed. Monitoring included serum thyroglobulin, thyroglobulin antibodies, and neck ultrasound imaging.

RESULTS: At the end of the follow-up, 151 patients were analyzed, after 28 from group A and 17 from group B were excluded. The 2 groups were similar in age at diagnosis (P = .643), sex distribution (P = .735), body mass index (P = .134), ultrasound-estimated thyroid volume (P = .650), and histologic tumor features. After >10 years (12.9 ± 2 years), no significant differences were observed in surgical and oncologic outcomes. The mean thyroglobulin levels were 0.1 ± 0.1 ng/mL in group A and 0.3 ± 1.3 ng/mL in group B (P = .146). Both groups showed similar findings in the need for further surgery (P = .917), for additional radioactive iodine (P = .979), and mean radioactive iodine dosage (P = .822). No difference was documented in permanent recurrent laryngeal nerve palsy (P = .640), permanent hypocalcemia (P = .238), and serum calcium level (P = .181). The only observed distinction was more parathyroid removal in prophylactic central compartment lymph node dissection cases based on histologic examination (P = .005).

CONCLUSION: Prophylactic central compartment lymph node dissection does not significantly affect surgical and oncologic outcomes in patients with clinically node-negative small papillary thyroid carcinoma after long-term follow-up.

PMID:39983243 | DOI:10.1016/j.surg.2025.109258

Phys Rev Lett. 2025 Feb 7;134(5):050801. doi: 10.1103/PhysRevLett.134.050801.

ABSTRACT

Understanding the thermalization dynamics of quantum many-body systems at the microscopic level is among the central challenges of modern statistical physics. Here we experimentally investigate individual spin dynamics in a two-dimensional ensemble of electron spins on the surface of a diamond crystal. We use a near-surface nitrogen-vacancy center as a nanoscale magnetic sensor to probe correlation dynamics of individual spins in a dipolar interacting surface spin ensemble. We observe that the relaxation rate for each spin is significantly slower than the naïve expectation based on independently estimated dipolar interaction strengths with nearest neighbors and is strongly correlated with the timescale of the local magnetic field fluctuation. We show that this anomalously slow relaxation rate is due to the presence of strong dynamical disorder and present a quantitative explanation based on dynamic resonance counting. Finally, we use resonant spin-lock driving to control the effective strength of the local magnetic fields and reveal the role of the dynamical disorder in different regimes. Our work paves the way towards microscopic study and control of quantum thermalization in strongly interacting disordered spin ensembles.

PMID:39983194 | DOI:10.1103/PhysRevLett.134.050801