Category: Statistics

Sci Rep. 2025 May 26;15(1):18284. doi: 10.1038/s41598-025-94067-1.

ABSTRACT

Cervical cancer is the second most common cancer among females in Cameroon, with human papillomavirus (HPV) being the primary cause. While HPV vaccines are highly effective and have been introduced by Cameroon’s Ministry of Health (MOH), uncertainties persist regarding the determinants of HPV-related vaccine hesitancy. This study investigated the factors associated with parental HPV and cervical cancer awareness as well as parental HPV vaccine hesitancy in Cameroon. This cross-sectional study included 1,187 participants residing in Buea Health District (BHD) from August 2023 to March 2024. A pretested questionnaire adapted from the WHO’s vaccine hesitancy tool was used for data collection. Multivariable logistic regression generated adjusted odds ratios for lack of awareness and vaccine hesitancy. Younger ages and lower education levels were significantly associated with greater odds of HPV and cervical cancer unawareness. Parents with lower educational attainment and those unaware of HPV and cervical cancer had higher odds of vaccine hesitancy. Additionally, concerns about vaccine safety and side effects, distrust in the MOH and pharmaceutical companies, and lack of support from religious leaders were associated with parental vaccine hesitancy. In contrast, parents with a history of chronic illness had lower odds of being hesitant. The study identified several factors associated with parental HPV vaccine hesitancy. Addressing these factors could play a key role in improving vaccine uptake among children and eventually reducing cervical cancer rates in Cameroon.

PMID:40415103 | DOI:10.1038/s41598-025-94067-1

Sci Rep. 2025 May 25;15(1):18200. doi: 10.1038/s41598-025-03434-5.

ABSTRACT

This study aimed to assess the clinical management of warfarin therapy in Western China by investigating: the rate of international normalized ratio (INR) target achievement and its influencing factors, and the incidence and risk factors for hemorrhagic complications. The primary goal was to identify high-risk patient populations requiring intensified monitoring in this resource-limited region with distinct demographic challenges including multi-ethnic populations and limited healthcare access. We conducted a retrospective cohort analysis of 154 consecutive inpatients prescribed warfarin at a tertiary care center in Western China. Data were systematically collected from: baseline demographics, detailed medication histories, INR monitoring results, and documentation of bleeding events. Statistical analysis employed Pearson chi-square tests to evaluate associations between clinical variables and primary outcomes: achievement of target INR ranges (2.0-3.0 for most indications; 1.8-2.5 for mechanical valves) and development of hemorrhagic complications. Secondary analysis examined factors influencing bleeding severity. The study revealed several critical findings regarding INR control: the overall therapeutic achievement rate was 32.3% for the 2.0-3.0 range (n = 130) and 50.0% for the 1.8-2.5 range (n = 24). Notably, we observed universal therapeutic failure (0% achievement) in three high-risk subgroups: octogenarians (≥ 81 years), underweight patients (BMI < 18.5 kg/m²), and amiodarone users. In contrast, structured physician education demonstrated substantial benefit (72.13% achievement rate vs 27.87% without instruction). Regarding safety outcomes, Bleeding complications were strongly associated with heart failure (16.07% vs 83.93% without), pulmonary infections (20.72% vs 79.28% without), and PPI use (42.86% vs 57.14%). A striking disparity emerged in bleeding severity: cardiothoracic surgery patients experienced minor bleeding at markedly higher rates (66.7%) compared to other departments (≤ 6.7%). This study identifies three high-risk populations in Western China requiring prioritized monitoring: vulnerable patients (advanced age, low BMI), individuals with cardiopulmonary comorbidities, and those prescribed interacting medications (amiodarone, PPIs). These findings have important clinical implications, particularly for resource-limited settings, we propose: implementation of Structured Medication Education Programs, intensive medication monitoring for high-risk patients, development of specialty-specific monitoring protocols in cardiothoracic departments, and establishment of multidisciplinary anticoagulation management teams. These findings underscore the need for context-specific strategies to optimize warfarin therapy in ethnically diverse, under-resourced regions, while highlighting critical areas for future research.

PMID:40415097 | DOI:10.1038/s41598-025-03434-5

Sci Rep. 2025 May 26;15(1):18287. doi: 10.1038/s41598-025-03106-4.

ABSTRACT

To establish and compare the prediction effect of SES and SARIMA model, and select the best prediction model to predict the number of patients in neurology department. The data came from HIS and medical record management system of a Grade-A hospital in Zhejiang Province. The number of inpatients from January 2019 to September 2023 was selected to establish SES and SARIMA model, respectively. Compare the fitting parameters, The larger the R²_adjusted, R², the smaller the RMSE, MAPE, MAE and standardized BIC, The better model is selected. Finally, the established model was used to predict the number of hospital admissions from October to December 2023, and the prediction effect of the MRE judgment model was compared. The number of admissions to the department of neurology shows a cyclical change, and drops sharply in January-February each year and rises rapidly in March. The best fitting models of SES model and SARIMA model were Winters addition model and SARIMA(0,1,1)(0,1,1)₁₂ model, respectively. The two models were selected to predict the number of admissions in the Department of neurology from October to December 2023, and the average relative error was 0.04 and 0.03, respectively. The prediction effect of SARIMA(0,1,1)(0,1,1)₁₂ model was better. Age and Spring Festival may be the factors that affect the periodic change of the number of admissions in neurology department. Both SES and SARIMA model can be used to predict the number of admissions in the department of neurology, and the SARIMA model may be better.

PMID:40415093 | DOI:10.1038/s41598-025-03106-4

Clin Exp Med. 2025 May 25;25(1):175. doi: 10.1007/s10238-025-01710-2.

ABSTRACT

Diabetic neuropathy (DN) is a common complication of type 2 diabetes mellitus (T2DM), yet its impact on bone mineral density (BMD) remains unclear. This study combines cross-sectional and meta-analytic methods to comprehensively explore the relationship between DN and osteoporosis in T2DM patients. The cross-sectional study included 523 T2DM patients, classified into DN and non-DN groups. BMD was measured using dual-energy X-ray absorptiometry (DXA), and multivariate analysis identified osteoporosis-related factors. The meta-analysis included studies published from 1999 to 2021, comparing BMD between patients with and without DN. The results showed that while significant differences in clinical characteristics and biochemical indices (such as age, HbA1c, and 25(OH) vitamin D levels) were observed between the groups, no significant association between DN and osteoporosis was found after adjusting for covariates like body mass index and blood pressure. Additionally, the meta-analysis confirmed no significant impact of DN on BMD across skeletal sites, including the lumbar spine, hip, and femoral neck. These findings suggest that while DN may indirectly affect bone health through alterations in bone metabolism (such as bone formation markers), its direct impact on BMD is limited. The study’s limitations include its cross-sectional design, which restricts causal inference, and retrospective data collection, underscoring the need for prospective studies to further elucidate the mechanisms behind DN’s effects on bone health. These results highlight the complex interplay of factors influencing osteoporosis risk in T2DM and underscore the importance of a multifactorial approach to bone health management in this population.

PMID:40415081 | DOI:10.1007/s10238-025-01710-2

Sci Rep. 2025 May 25;15(1):18162. doi: 10.1038/s41598-025-03116-2.

ABSTRACT

To evaluate the efficacy and safety of ultrasound – guided transabdominal injection of Botulinum toxin A (BoNT – A) in the treatment of refractory overactive bladder (rOAB). This retrospective cohort study included 64 patients with rOAB admitted to the Department of Urology, the Third People’s Hospital of Hangzhou, from January 2021 to February 2025. They were divided into an observation group (ultrasound – guided transabdominal injection, 32 cases) and a control group (transurethral cystoscopic injection, 32 cases). Both groups received BoNT – A (100 U) intramural injection of the bladder. In the observation group, the injection was performed under real – time ultrasound guidance through the abdominal wall, while the control group underwent the standard cystoscopic injection method. The primary outcome measures included the parameters of the micturition diary (urgency episodes, daytime urination frequency, nocturia episodes) and bladder capacity (initial desire capacity, maximum bladder capacity) before treatment, 1 month, and 6 months post-treatment. The secondary outcomes covered the standardized scale scores of patients (ICIQ – OAB, OAB – Q), global impression of improvement (PGI – I), visual analog pain score (VAS), incidence of complications, retreatment rates, and immediate willingness to repeat the procedure. There were no statistically significant differences in baseline characteristics (age, sex, and pre – treatment symptom scores) between the two groups (all P > 0.05). After treatment, both groups of patients showed significant improvement in urgency episodes, daytime urination frequency, nocturia episodes, bladder capacity, and ICIQ – OAB and OAB – Q scores (all P < 0.05), but there was no significant difference in therapeutic effects between the groups (all P > 0.05).Six months after treatment, the observed indicators in the observation and control groups increased compared with 1 month after treatment, but were still significantly better than the baseline level (all P < 0.05). There was no significant difference in efficacy between the two groups (all P > 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P < 0.01), and the VAS pain score was lower (3.32 ± 1.25 vs. 4.82 ± 1.61, P = 0.006), with a higher immediate willingness to repeat the procedure (8.28 ± 1.54 vs. 6.86 ± 2.19, P = 0.004). There was no significant difference in PGI-I scores between the groups (2.27 ± 0.92 vs. 1.95 ± 0.43, P = 0.08). There was no significant difference in the repeat injection rate between the two groups at 6 months after treatment (28.13% vs. 18.75%, P = 0.375). Ultrasound – guided transabdominal injection of BoNT – A for rOAB is as effective as transurethral cystoscopic injection, but it can significantly reduce the risk of complications and improve patient acceptance of treatment, providing a safer and more compliant alternative option for clinical practice.

PMID:40415074 | DOI:10.1038/s41598-025-03116-2

Sci Rep. 2025 May 25;15(1):18152. doi: 10.1038/s41598-025-99978-7.

ABSTRACT

Current guidelines for elective nodal irradiation in oropharyngeal squamous cell carcinoma (OPSCC) recommend including large portions of the contralateral lymphatic system in the clinical target volume (CTV-N), even for lateralized tumors with no clinical lymph node involvement in the contralateral neck. This study introduces a probabilistic model of bilateral lymphatic tumor progression in OPSCC to estimate personalized risks of occult disease in specific lymph node levels (LNLs) based on clinical lymph node involvement, T-stage, and tumor lateralization. Building on a previously developed hidden Markov model for ipsilateral lymphatic spread, we extend the approach to contralateral neck involvement. The model represents LNLs I, II, III, IV, V, and VII on both sides of the neck as binary hidden variables (healthy or involved), connected via arcs representing spread probabilities. These probabilities are learned using Markov chain Monte Carlo (MCMC) sampling from a dataset of 833 OPSCC patients, enabling the model to reflect the underlying lymphatic progression dynamics. The model accurately and precisely describes observed patterns of lymph node involvement with a compact set of interpretable parameters. Midline extension of the primary tumor is identified as the primary risk factor for contralateral involvement, with advanced T-stage and extensive ipsilateral involvement further increasing risk. Occult disease in contralateral LNL III is highly unlikely if upstream LNL II is clinically negative, and in contralateral LNL IV, occult disease is exceedingly rare without LNL III involvement. This model offers an interpretable, probabilistic framework to inform personalized elective CTV-N volume reduction. For lateralized tumors that do not cross the midline, it suggests the contralateral neck may safely be excluded from elective irradiation. For tumors extending across the midline but with a clinically negative contralateral neck, elective irradiation could be limited to LNL II, reducing unnecessary exposure of normal tissue while maintaining regional tumor control.

PMID:40415030 | DOI:10.1038/s41598-025-99978-7

Sci Rep. 2025 May 25;15(1):18188. doi: 10.1038/s41598-024-84418-9.

ABSTRACT

The aim of this study was to evaluate dental treatment outcomes and safety in the Intensive Care Unit (ICU). Data collected included the frequency of dental interventions, the incidence of ventilator-associated pneumonia (VAP), patient demographics, length of ICU stay, and mortality. In the statistical analysis, logistic regression models were utilized to explore associations between dental care and patient outcomes, calculating odds ratios for mortality outcomes, with adjustments for potential confounders. More than three interventions were associated with a lower risk of mortality in both crude (p < 0.0001) and adjusted analyses (p < 0.0001), suggesting a protective effect. Patients who received more frequent dental care demonstrated improved survival outcomes. VAP did not significantly increase mortality risk in this cohort (p = 0.3511). Dental procedures were not conclusively linked to a reduction in mortality; however, they were not associated with any important adverse effects, indicating that they are safe for ICU patients. The findings indicate that regular dental treatment in the ICU may be beneficial to patient survival and does not pose additional safety risks. While VAP did not independently predict mortality, receipt of comprehensive dental care was a protective factor.

PMID:40415019 | DOI:10.1038/s41598-024-84418-9

Cancer Radiother. 2025 May 23;29(3):104642. doi: 10.1016/j.canrad.2025.104642. Online ahead of print.

ABSTRACT

PURPOSE: Reconstructive surgery with a flap is standard practice in advanced oral cavity squamous cell carcinoma to restore essential functions. However, these functions may be compromised by postoperative radiotherapy. This study evaluates relapse patterns and treatment-related toxicity in these patients.

METHODS AND MATERIALS: A multicentre 2018-2023 study included 247 patients with oral cavity squamous cell carcinoma. Uni- and multivariate analyses estimated the cumulative incidence of locoregional failures, survival rates, and prognostic factors.

RESULTS: Among the patients, 74.0 % had pT3-4 tumours, 78.5 % had free flaps, regional pedicled flaps (12.6 %), or local flaps (8.5 %). Flaps were not delineated on planning CTs. Median follow-up for living patient was 36.8months. Fifty-eight patients (23.0 %) had involved soft-tissue margins; no correlation was found between margin involvement, stage, or flap type. Forty patients experienced local relapse within a median of 8.23months. Local relapse rates were higher in patients with involved (28.6 %) versus clear margins (9.3 %, P<0.004). Two-year locoregional relapse and survival rates were 17.8 %, and 74.3 %, respectively. Performance status greater than 1, locoregional relapse, and distant relapse were associated with poorer survival. Coregistration of planning-relapse CTs is challenging due to flap changes, limiting relapse pattern analysis. Subgroup analysis of locoregional relapses (14 out of 53) at the main contributing centre revealed that five relapses occurred at the native tissue-flap junction, with minor flap involvement in two cases and no intraflap failure. All other relapses occurred outside the flap.

CONCLUSIONS: Involved margin rates correlating with increased local relapse risk and were not different according flap type. Further investigation into flap segmentation and planning optimization is needed. The OPTIFLAP trial (NCT06798922, PHRC2024) aims to determine whether radiotherapy can be optimized to spare flaps without increasing the risk of locoregional failure.

PMID:40411928 | DOI:10.1016/j.canrad.2025.104642

Cancer Radiother. 2025 May 23;29(3):104644. doi: 10.1016/j.canrad.2025.104644. Online ahead of print.

ABSTRACT

PURPOSE: Despite its slow growth pattern, adenoid cystic carcinoma of the lacrimal gland poses challenges due to its high recurrence rate. The rarity of this entity hinders the establishment of prospective studies and a consensus on optimal treatment strategies. Herein, we aim to report the results of patients with adenoid cystic carcinoma of the lacrimal gland treated with hypofractionated stereotactic body radiations or conventionally-fractionated radiations.

MATERIALS AND METHODS: This study included patients with non-metastatic adenoid cystic carcinoma of the lacrimal gland treated with a curative-intent from 2006 to 2019. Patient data, tumour characteristics, treatment details, and follow-up information were collected. Recurrence patterns, oncologic outcomes, and toxicity were assessed.

RESULTS: We evaluated the data of 12 patients with a median 29years of age who received stereotactic body radiotherapy (n=5) or conventionally-fractionated radiotherapy (n=7). After a median follow-up of 98months, the overall local control rate was 50 %, with recurrences mostly marginal to the radiotherapy field. Although the 10-year overall survival rate was a promising 92 %, the respective rate for local recurrence-free survival was 37 %, which was significantly lower in patients who received stereotactic body radiotherapy (20 %) compared to patients who had with conventionally-fractionated radiotherapy (72 %). Although not statistically significant, patients in the stereotactic body radiotherapy arm encountered a higher rate of severe late toxicity (80 % versus 17 % in the conventionally-fractionated radiotherapy arm, P=0.07). The overall eye preservation rate was 64 %, all eye-losses due to local recurrence.

CONCLUSION: Our findings raise concerns about using stereotactic body radiotherapy for adenoid cystic carcinoma of the lacrimal gland based on increased rates of severe late toxicity and local recurrence. Conventional radiotherapy techniques should be applied to these patients to successfully control the local tumour with less toxicity.

PMID:40411927 | DOI:10.1016/j.canrad.2025.104644

J Low Genit Tract Dis. 2024 Oct 1;28(4):365-370. doi: 10.1097/LGT.0000000000000835.

ABSTRACT

OBJECTIVE: The aim of this study was to develop a mobile application for vulvar self-examination and to examine its effect on performing vulvar self-examination.

MATERIALS AND METHODS: This is a quasi-experimental study. Forty-seven women accepted to participate. The mobile application was uploaded to the women’s phones and the women’s vulvar self-examination practices were followed through the application for 6 months. Obtained data were analyzed with descriptive statistics and the McNemar’s test.

RESULTS: The mean age of the participants was 35.34 ± 9.85 years. Initially, out of all the participants, none performed vulvar self-examination, 95.7% did not regularly have their yearly gynecological examination, 29% did not have pap smear, and 91.5% had no information about vulvar self-examination. In the third month after the mobile application was downloaded, 68.1% were performing vulvar self-examination and this percentage decreased to 57.4% in the sixth month without a significant difference (p < .05). The women reported that they had difficulty in performing the examination in the first follow-up and did not have time to do it in the second follow-up.

CONCLUSIONS: The mobile application increased the rate of examination, and there was no significant difference in the number of the women performing the examination between the follow-ups.

PMID:40411888 | DOI:10.1097/LGT.0000000000000835