Category: Statistics

JCO Glob Oncol. 2025 May;11:e2400525. doi: 10.1200/GO-24-00525. Epub 2025 May 22.

ABSTRACT

PURPOSE: The lack of culturally appropriate tools is a key obstacle to the identification of unmet social needs in the cancer population of Nigeria. To support sustainable strategies for social needs screening and intervention, this study aimed to develop and validate a health-related social needs screening tool for the prostate cancer population in Nigeria.

PATIENTS AND METHODS: The study was performed in three stages at three Nigerian tertiary hospitals: (1) instrument adaptation using the Health Leads social needs screening toolkit as the primary framework, which involved domain specification and question item prioritization through three rounds of Delphi surveys among 15 health care workers, 15 patients with prostate cancer, and 15 caregivers; (2) face validation among 10 patients with prostate cancer through cognitive interviews for feedback on format, language clarity, ease of answering, comprehensiveness and applicability, and then member checking to review and approve question modifications; and (3) pilot testing for reliability analysis and readability assessment among 30 patients with prostate cancer. Descriptive and inferential statistics and qualitative analysis were performed.

RESULTS: During the first Delphi round, the highest three of the 10 top-ranking domains were financial resource strain (84%), sociodemographics (80%), and behavioral/mental health (80%). For single-question item prioritization, an agreement was reached in the employment, education, social isolation, and supports domains during the second round, and for the remaining domains during the third round. The format, clarity, ease of answering, and comprehensiveness of seven question items were modified, and two question items were substituted during face validation. The modified tool had a Cronbach’s α of .67 and was considered appropriate for second-grade readers.

CONCLUSION: To our knowledge, this study developed the first screening tool with acceptable internal validity and understandability to assess social needs in the prostate cancer population of Nigeria.

PMID:40403311 | DOI:10.1200/GO-24-00525

Obstet Gynecol. 2025 May 22. doi: 10.1097/AOG.0000000000005937. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the association between doula support and cesarean delivery compared with standard of care.

DATA SOURCES: We conducted a systematic review of randomized controlled trials (RCTs) and observational studies comparing in-person intrapartum doula support with standard care. We searched studies published in Ovid Medline, Embase.com, Scopus, Cochrane Central, and ClinicalTrials.gov before August 30, 2024. The primary outcome was cesarean delivery. Secondary outcomes included operative vaginal delivery, low 5-minute Apgar score, and regional anesthesia.

METHODS OF STUDY SELECTION: Titles, abstracts, and articles were screened and reviewed by two authors. Eighteen studies were included in the final analysis (n=367,662): eight RCTs (n=2,497) and 10 observational studies (n=365,165). The primary analysis was restricted to RCTs. Additional analyses were limited to studies that were observational, high quality (Downs and Black quality score in top quartile), or RCTs conducted in the United States.

TABULATION, INTEGRATION, AND RESULTS: Random-effects models were used to calculate pooled relative risks (RRs) and weighted mean difference. Heterogeneity was assessed with the Cochran Q test and I2 statistic. Intrapartum doula support was associated with a lower rate of cesarean delivery compared with standard care in RCTs (n=7, 17.5% doula support vs 23.6% standard care, pooled RR 0.71, 95% CI, 0.53-0.95). However, there were substantial study heterogeneity (I2=60.1%) and borderline evidence of small-study effects, which could suggest publication bias (Harbord test P=.046). Patients receiving intrapartum doula support in RCTs had significantly lower rates of operative vaginal delivery (n=5, 7.9% doula support vs 13.2% standard care, pooled RR 0.64, 95% CI, 0.44-0.94, I2=46.0%) but no difference in low 5-minute Apgar score (n=3, 1.6% doula support vs 4.1% standard care, pooled RR 0.47, 95% CI, 0.16-1.34; I2=0%) or regional anesthesia (n=7, 57.3% doula support vs 69.5% standard care, pooled RR 0.64, 95% CI, 0.36-1.12, I2=98.75%). Findings were similar in a sensitivity analysis limited to high-quality studies. Doula support was associated with lower cesarean delivery rates among all subgroup analyses except RCTs in the United States (four studies, 16.1% doula support vs 22.2% standard care, pooled RR 0.71, 95% CI, 0.47-1.06).

CONCLUSION: Intrapartum doula support was associated with lower rates of cesarean delivery. Results were consistent across study types and when limited to high quality studies; however, significant heterogeneity and concern for publication bias were noted.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023423577.

PMID:40403310 | DOI:10.1097/AOG.0000000000005937

J Med Internet Res. 2025 May 22;27:e65101. doi: 10.2196/65101.

ABSTRACT

BACKGROUND: Diarrhea, a common symptom of gastrointestinal infections, can lead to severe complications and is a major cause of emergency department (ED) visits.

OBJECTIVE: This study explored the temporal association between internet search queries for diarrhea and its synonyms and ED visits for diarrhea-related symptoms.

METHODS: We used data from the National Emergency Department Information System (NEDIS) and NAVER (Naver Corporation), South Korea’s leading search engine, from January 2017 to December 2021. After identifying diarrhea synonyms using ChatGPT, we compared weekly trends in relative search volumes (RSVs) for diarrhea, including its synonyms and weekly ED visits. Pearson correlation analysis and Granger causality tests were used to evaluate the relationship between RSVs and ED visits. We developed an Autoregressive Integrated Moving Average with Exogenous Variables (ARIMAX) model to further predict these associations. This study also examined the age-based distribution of search behaviors and ED visits.

RESULTS: A significant correlation was observed between the weekly RSV for diarrhea and its synonyms and weekly ED visits for diarrhea-related symptoms (ranging from 0.14 to 0.51, P<.05). Weekly RSVs for diarrhea synonyms, such as “upset stomach,” “watery diarrhea,” and “acute enteritis,” showed stronger correlations with weekly ED visits than weekly RSVs for the general term “diarrhea” (ranging from 0.20 to 0.41, P<.05). This may be because these synonyms better reflect layperson terminology. Notably, weekly RSV for “upset stomach” was significantly correlated with weekly ED visits for diarrhea and acute diarrhea at 1 and 2 weeks before the visit (P<.05). An ARIMAX model was developed to predict weekly ED visits based on weekly RSVs for diarrhea synonyms with lagged effects to capture their temporal influence. The age group of <50 years showed the highest activity in both web-based searches and ED visits for diarrhea-related symptoms.

CONCLUSIONS: This study demonstrates that weekly RSVs for diarrhea synonyms are associated with weekly ED visits for diarrhea-related symptoms. By encompassing a nationwide scope, this study broadens the existing methodology for syndromic surveillance using ED data and provides valuable insights for clinicians.

PMID:40403303 | DOI:10.2196/65101

JMIR Form Res. 2025 May 22;9:e66954. doi: 10.2196/66954.

ABSTRACT

BACKGROUND: Dengue, a mosquito-borne disease, has been a health challenge in Singapore for decades. In 2020, during the COVID-19 pandemic, Singapore encountered a serious dengue outbreak and deployed various communication strategies to raise public awareness and mitigate dengue transmission.

OBJECTIVE: Drawing on the Crisis and Emergency Risk Communication (CERC) framework, this study examines how dengue-related messages communicated on Facebook (Meta) during the COVID-19 pandemic fall into the CERC themes. This study also seeks to understand how these themes differ between dengue outbreak (eg, 2020) and nonoutbreak years (eg, 2021). In addition, we explore how message themes on dengue changed across different CERC phases within the dengue outbreak year.

METHODS: We conducted a content analysis on 314 Facebook posts published by public health authorities in Singapore between January 1, 2020, and September 30, 2022. We conducted chi-square tests to examine the differences in message themes between the dengue outbreak and nonoutbreak years. We also conducted chi-square tests to examine how these message themes varied across 3 CERC phases during the dengue outbreak year.

RESULTS: Our findings suggest that during the dual epidemics of dengue and COVID-19, Singapore’s public health communication on dengue largely adhered to CERC principles. Dengue-related messaging, particularly regarding intelligence and requests for contributions, significantly varied between outbreak and nonoutbreak years. In addition, messages on general advisories and vigilance, as well as those on social and common responsibility, significantly differed across the CERC phases during the dengue outbreak year.

CONCLUSIONS: Singapore’s public health authorities flexibly adjusted their messaging strategies on social media platforms in response to the evolving dengue situation during the COVID-19 pandemic, demonstrating the high adaptability of the government’s health communication amid the dual epidemics. However, several areas for improvement should also be noted for future public health communication to mitigate dengue transmission.

PMID:40403298 | DOI:10.2196/66954

Oncology (Williston Park). 2025 May 12;39(4):141-147. doi: 10.46883/2025.25921040.

ABSTRACT

Leptomeningeal disease (LMD) is the spread of cancer cells to the arachnoid mater, pia mater, and cerebrospinal fluid. It occurs in 5% to 10% of solid organ cancers, with higher rates in breast, lung, and melanoma cancers. The prognosis for patients with LMD remains poor, with a median survival of 1.5 months without treatment and 2 to 3 months with treatment, despite advances in cancer treatment. This retrospective study included 64 patients with LMD with primary cancers represented in the diagnosis-specific Graded Prognostic Assessment (DS-GPA) at a single institution over 5 years. Patient characteristics, treatment, and overall survival (OS) data were collected. Statistical analyses included descriptive statistics, log-rank tests, and Cox proportional hazards regression models. The median OS for the 64 patients with LMD was 2.6 months, with no statistically significant differences among cancer types. Though not statistically significant, those with higher DS-GPA scores trended toward longer survival in breast and lung cancer cohorts. Patients with LMD on imaging confined to 1 location (cerebrum, cerebellum, spine, or cranial nerves) and receiving systemic chemotherapy alone also had longer survival. The DS-GPA tool is promising for LMD prognostication and may be strengthened by incorporating imaging and chemotherapy characteristics. Larger, multicenter studies are needed to validate its prognostic utility. Keywords: Leptomeningeal disease, diagnosis-specific graded prognostic assessment, prognosis, overall survival, breast cancer, lung cancer.

PMID:40403292 | DOI:10.46883/2025.25921040

Plant Dis. 2025 May 22. doi: 10.1094/PDIS-11-24-2285-PDN. Online ahead of print.

ABSTRACT

Soybean (Glycine max L. Merr.) is a highly economically valuable crop grown extensively worldwide. However, it is prone to reduced yield and quality due to pests and diseases. A novel leaf spot disease was discovered during a soybean disease survey conducted in 2022 within a field situated at N 46°50’5.05″ E 126°30’9.77″ (Liu et al., 2023). The disease has a high incidence in the field, with an incidence rate of 23%. Affected areas turn yellow and are distributed in spots on the leaves. Severe cases develop into patches of dark green tissue lesions, and the leaves may become yellow, wilt, or even fall off. It was observed that the incidence rate in the shade under the trees was higher than that in direct sunlight, which affects soybean leaves and severely impacts their photosynthetic ability. To investigate this disease, a total of 30 diseased soybean plants were sampled from a continuous field. The infected leaf tissues were disinfected and rinsed, after which the pathogen was isolated using the single spore isolation method. After obtaining the purified pathogen, it was cultured on a PDA plate at 28°C for 7 days for future use. Molecular identification was conducted using complete rDNA-ITS sequences with primer pairs ITS1/ITS4, ACT1/ACT2, and MS1/MS2 (Raja et al., 2017). The amplification system comprised 25 µL: 12.5 µL PCR Mix, 1.5 µL DNA template, 1 µL of each upstream and downstream primer, and 9 µL ddH2O. The PCR amplification reaction conditions were as follows: pre-denaturation at 95°C for 2 minutes, denaturation at 95°C for 30 seconds, annealing at 60°C for 30 seconds, extension at 72°C for 45 seconds, final extension at 72°C for 6 minutes, and storage at 4°C, with a total of 30 cycles. The PCR products were sent to Shenggong Bioengineering (Shanghai) Co., Ltd. for sequencing. The sequences were deposited in GenBank with accession numbers OR237554 (ITS), PQ336777 (ACT), and OR137984 (MS), respectively. In this study, three diffeent genes were used to identify the species of this fungus, confirming the reliability of the strain identification results. The maximum likelihood tree revealed that the isolate clustered with representative isolates of Cladosporium cladosporioides with 96% bootstrap support (Supplement Figure 1). Thus, the isolate was identified as Cladosporium cladosporioides. based on these results. This fungus grows relatively slowly and changes from light green to dark green (Figure 1). The fungus was cultured on PDA medium for microscopic observation. Conidia were abundant, transparent, light green, oval or fusiform, measuring 2 to 3 µm × 6 to 7 µm (n=50); macroconidia were less numerous, mostly two-septate, cylindrical, measuring 2 to 3 µm × 48 µm to 50 µm (n=50). The results showed various spore types and mycelial conditions. Pathogenicity experiments were first conducted using leaf. Leaves were disinfected, inoculated with fungal cakes, and incubated at 28°C for five days. The results showed a 100% leaf incidence, with symptoms consistent with leaf spot disease observed in the field. Another experiment was conducted using potted plants with three different inoculation concentrations. After the potted plants grew for two weeks, fungal spore suspensions with concentrations of 1×106, 1×107, and 1×108 were sprayed on the leaves of soybean seedlings every two days, at a volume of 1 mL per pot each time. Symptoms began to appear after three sprays. There were no symptoms observed in the leaves of the blank control group. Six pots of potted plants were planted at each concentration, with six soybean plants per pot, resulting in a total of 36 soybean plants sprayed seven times. The three concentrations of soybean potted plants began to develop diseases, which were similar to those observed in the field. According to statistics, the incidence rate was 60%. Therefore, the pathogenicity of this pathogen is high and seriously affects the growth and yield of soybean plants, necessitating further research on this pathogen. The experimental results were consistent with Koch’s postulates. This study is the first to report Cladosporium cladosporioides causing leaf spot disease in soybean in China.

PMID:40403275 | DOI:10.1094/PDIS-11-24-2285-PDN

Am J Nurs. 2025 Jun 1;125(6):52-58. doi: 10.1097/AJN.0000000000000092. Epub 2025 May 22.

ABSTRACT

BACKGROUND: Hospital-at-home (HaH) programs provide hospital-level care in the home as an alternative to inpatient hospital stays. Because no standard system exists for storing and organizing medications during home hospitalization, the risk of medication errors and potential harm may be increased. The medication errors workgroup of an HaH program at a quaternary care academic medical center identified the need for a medication storage system to mitigate errors resulting from misplaced or misused medications.

PURPOSE: An interdisciplinary quality improvement (QI) project initiated by the medication errors workgroup aimed to support safe, patient-friendly medication management and reduce medication errors.

METHODS: A low-technology medication storage system for HaH patients was designed and implemented in August 2022. Medication errors were compared before and after the intervention. A survey assessed patient and staff satisfaction with the storage system in the postintervention period.

RESULTS: Unadjusted analysis showed that, among the 552 patients admitted to our HaH program during the study period (January through December 2022), the risk of medication error was significantly lower (odds ratio [OR], 0.55; P = 0.046) in the postintervention group (n = 260) than in the preintervention group (n = 292). After adjustment for age and HaH duration, the risk of medication error remained lower with use of the intervention (OR, 0.52; P = 0.03). Most patients and health care workers who participated in the satisfaction survey responded positively to the project.

CONCLUSION: HaH programs have unique risks for medication errors that require program-specific solutions. This QI project developed a medication storage system that improved HaH medication administration. These results are promising and may further improve medication management in the home.

PMID:40403272 | DOI:10.1097/AJN.0000000000000092

Am J Nurs. 2025 Jun 1;125(6):22-27. doi: 10.1097/AJN.0000000000000082. Epub 2025 May 22.

ABSTRACT

BACKGROUND: Hypoglycemic episodes are among the most common adverse events experienced by hospitalized patients, occurring in up to half of all inpatients, with or without diabetes. Studies have shown that patients who have episodes of severe hypoglycemia while hospitalized have higher rates of 30-day readmission and postdischarge mortality. The Centers for Medicare and Medicaid Services considers hypoglycemic episodes to be a hospital-acquired condition. The cost burden of poor glycemic control in acute care settings is undeniably substantial.

PURPOSE: The aim of this study was to identify predictors of hypoglycemia among inpatients with type 2 diabetes.

METHODS: This retrospective descriptive correlational study involved abstracting data from 2019 to 2021 electronic health records for 600 hospitalized patients. Data were analyzed using descriptive and associative statistics and multivariate logistic regression.

RESULTS: Data analysis revealed that patients who were Asian or Hispanic, had a history of hypoglycemia, were taking both insulin and a sulfonylurea, or had a podiatric or renal admitting diagnosis had significantly higher odds of experiencing hypoglycemic episodes while hospitalized. The odds of 30-day readmission were significantly lower for patients who received diabetes self-management education, had higher glomerular filtration rates, or were admitted with a diagnosis of bone fracture.

CONCLUSION: The study findings can be used to help health care institutions design and implement more effective policies and procedures to prevent or mitigate hypoglycemic episodes.

PMID:40403266 | DOI:10.1097/AJN.0000000000000082

Am J Nurs. 2025 Jun 1;125(6):13-14. doi: 10.1097/AJN.0000000000000094a. Epub 2025 May 22.

ABSTRACT

Researchers say the cause is fewer staffed beds, not more patients.

PMID:40403253 | DOI:10.1097/AJN.0000000000000094a

PLoS One. 2025 May 22;20(5):e0323619. doi: 10.1371/journal.pone.0323619. eCollection 2025.

ABSTRACT

This study investigates the determination of stratification points for two study variables within the framework of simple random sampling, with a focus on estimating the population mean using a closely related auxiliary variable. Employing a superpopulation model, the research aims to minimize overall variance by deriving simplified equations that enhance the precision of parameter estimates. Instead of categorizing variables, the study emphasizes continuous variables to establish optimal strata boundaries (OSB), which are essential for creating homogeneous groups within each stratum. This stratification leads to more efficient sample sizes (SS) and improved accuracy in parameter estimation. However, achieving optimal OSB and SS poses challenges in scenarios with a fixed total sample size, such as survey designs constrained by limited budgets. To address this, the study proposes a robust methodology for calculating OSB and SS, leveraging knowledge of the survey’s per-unit stratum measurement costs or its probability density function. An empirical application of the method is demonstrated using breast cancer data, where the mean perimeter is estimated based on mean radius and mean texture. Additionally, hypothetical examples using Cauchy and standard power distributions are provided to illustrate the versatility of the proposed approach. The newly developed method has been integrated into the updated stratifyR package and implemented in LINGO software, facilitating its practical application. Comparative analysis reveals that this approach consistently outperforms or matches existing methods in enhancing the precision of population parameter estimation. Furthermore, simulation studies confirm its higher relative efficiency, making it a valuable contribution to the field of stratified sampling.

PMID:40403232 | DOI:10.1371/journal.pone.0323619