Category: Statistics

J Neuroeng Rehabil. 2025 May 28;22(1):120. doi: 10.1186/s12984-025-01650-8.

ABSTRACT

BACKGROUND: Tai Chi (TC) is recognized for enhancing balance and postural control. However, studies on its effects on the central nervous system are limited and often involve static experiments despite the dynamic nature of TC. This study addressed that gap by examining cortical network activity during dynamic, multisensory conflict balance tasks. We aimed to determine whether long-term TC practice leads to neuroplastic changes in brain connectivity that improve sensory integration for postural control.

METHODS: Fifty-two young adult participants (long-term TC practitioners = 22; non-practitioners = 30) performed balance tasks under sensory congruent and conflict conditions using a virtual reality headset with a rotating supporting surface. EEG was performed, and generalized partial directed coherence was used to assess directed functional connectivity in the mu rhythm (8-13 Hz) between predefined regions of interest (ROIs) in the cortex implicated in sensory and motor integration. Graph-theoretic measures (in-strength and out-strength) indexed the total incoming and outgoing connection strengths for each region. Statistical analysis used mixed-design ANOVAs (Group × Condition) to compare balance and connectivity measures.

RESULTS: TC practitioners demonstrated significantly better postural stability under both sensory conditions, with a reduced sway area. EEG analysis revealed that increased sensory conflict decreased the global efficiency of the visual integration network but increased that of the somatosensory integration network. Furthermore, TC practitioners demonstrated enhanced out-strength of the somatosensory cortex and lower out-strength of the right posterior parietal cortex (PPC) compared to non-practitioners.

CONCLUSIONS: Long-term TC practice is associated with quantifiable neuroplastic changes in mu-band cortical effective connectivity, specifically enhanced information outflow from somatosensory reduce parietal influence regions. Our findings demonstrate central mechanisms by which TC practice may improve balance, providing neuroengineering evidence for TC as a neuroplasticity-driven balance intervention.

PMID:40437591 | DOI:10.1186/s12984-025-01650-8

BMC Med. 2025 May 28;23(1):308. doi: 10.1186/s12916-025-04150-7.

ABSTRACT

BACKGROUND: There is a lack of studies exploring the performance of Transformers-based language models in common risks assessment among psychiatric inpatients. We aim to develop a scalable risk assessment model using multidimensional textualized data and test the stability, robustness, and benefit of this approach.

METHODS: In this real-world cohort study, a deep learning language model was developed and validated using first hospitalized cases diagnosed with schizophrenia, bipolar disorder, and depressive disorder between January 2016 and March 2023 in three hospitals. The algorithm was externally validated on an independent testing cohort comprising 1180 patients. A total of 140 features, including first medical records (FMR), laboratory examinations, medical orders, and psychological scales, were assessed for analysis. The outcomes were short- and long-term impulsivity (STI and LTI), risk of suicide (STSS and LTSS), and need of physical restraint (STPR and LTPR) assessed by qualified nurses or clinicians. Analysis was carried out between August 2024 and June 2024. Models with different architectures and input settings were compared with each other. The area under the receiver operating characteristic curve (AUROC) was used to assess the primary performance of models. The clinical utility was determined by the net benefit under Youden’s threshold.

RESULTS: Of 7451 patients included in this study, 2982 (47.6%) were male, and the median (interquartile range) age was 42 (28-57) years. The overall incidence of outcomes was 635 (8.5%), 728 (10.5%), 659 (8.8%), 803 (10.8%), 588 (7.9%), and 728 (9.8%) for STPR, LTPR, STSS, LTSS, STI, and LTI, respectively. The multitask semi-structured Transformers-based language (SSTL) model showed more promising AUROCs (STPR: 0.915; LTPR: 0.844; STSS: 0.867; LTSS: 0.879; STI: 0.899; LTI: 0.894) in the prediction of these outcomes than single-tasked or multimodal language models and traditional structured data models. Combining FMR with other data from electronic health records led to significant improvements in the performance and clinical utility of SSTL models based on demographic, diagnosis, laboratory tests, treatment, and psychological scales.

CONCLUSIONS: The SSTL model shows potential advantages in prognostic evaluation. FMR is a strong predictor for common risks prediction and may benefit other tasks in psychiatry with minimum requirements for data and data processing.

PMID:40437564 | DOI:10.1186/s12916-025-04150-7

BMC Med. 2025 May 28;23(1):299. doi: 10.1186/s12916-025-04122-x.

ABSTRACT

BACKGROUND: Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities.

METHODS: A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green (‘healthy’), amber (‘less healthy’), or red (‘unhealthy’) according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables.

RESULTS: No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001).

CONCLUSIONS: Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation.

PMID:40437554 | DOI:10.1186/s12916-025-04122-x

BMC Med. 2025 May 28;23(1):303. doi: 10.1186/s12916-025-04137-4.

ABSTRACT

BACKGROUND: Socioeconomic deprivation is associated with adverse clinical outcomes in patients with heart failure (HF). However, in the context of improved medical and device therapy for HF, it is unknown whether the influence of socioeconomic deprivation on HF outcomes is changing over time, especially in relation to evolving life expectancy patterns in the general population. Therefore, we aimed to describe temporal trends in the association of socioeconomic deprivation with loss of actuarially predicted life expectancy amongst ambulatory patients with HF.

METHODS: Between 2006 and 2014, 1802 patients (73.2% male, mean age 69.6 years) with HF and left ventricular ejection fraction ≤ 45% were consecutively recruited across four hospitals in the United Kingdom (UK). Patients were stratified into socioeconomic deprivation tertiles defined by the UK Index of Multiple Deprivation (IMD) score with IMD tertile 1 denoting the least deprived and IMD tertile 3 the most deprived. The primary outcome was all-cause mortality, and relative survival predictions-in relation to age- and sex-matched background mortality rates-were calculated using UK National Life Tables. Relative survival was illustrated in terms of excess mortality risk and years of life expectancy lost. Recruitment period was split into 3-year intervals (2006-2008, 2009-2011 and 2012-2014).

RESULTS: During a median follow-up of 5.0 years, 1302 participants (72.3%) died. Unadjusted mortality rate was highest in tertile 2. However, adjusted to the age-sex matched UK population, a stepwise increase in excess mortality risk was observed across tertiles, with tertile 1 experiencing an excess mortality risk of 11.1% (95% CI: 6.1-16.1%) and tertile 3 24.2% (95% CI: 19.4-28.0%). This corresponded to a loss of life expectancy of 1.76 years (95% CI: 1.50-2.03) for tertile 1 and 2.30 years (95% CI: 2.03-2.57) for tertile 3 over a 10-year period. We observed disparity in actuarial survival between tertiles over time, with participants in tertile 1 losing less life expectancy at 10 years compared to those in tertiles 2 and 3. However this was only statistically significant for those recruited between 2012 and 2014 (p < 0.05).

CONCLUSIONS: The impact of socioeconomic deprivation on HF outcomes in an unselected diverse UK population appears to have worsened over time.

PMID:40437552 | DOI:10.1186/s12916-025-04137-4

BMC Pharmacol Toxicol. 2025 May 28;26(1):113. doi: 10.1186/s40360-025-00952-w.

ABSTRACT

BACKGROUND: This study aimed to investigate the relationship between short-term blood pressure variability (BPV) and anticholinergic burden (ACB) in adults with hypertension.

METHODS: This study included 238 hypertensive patients aged 50 and older who underwent ambulatory blood pressure monitoring. The medications used by the patients were recorded, and the ACB of each medication was calculated using the ACB Scale. The BPV was assessed based on 24-hour ambulatory blood pressure measurements using three methods: standard deviation (SD), coefficient of variation of the standard deviation (SD-CoV), and weighted standard deviation (wSD), with evaluations conducted for both day-time and night-time periods.

RESULTS: A total of 139 patients (58.40%) had no ACB score, 64 (26.89%) had an ACB score of 1, and 35 (14.71%) had an ACB score of 2 or higher. ACB scores were significantly higher among patients with heart disease, and ACB tended to increase with age. However, no statistically significant relationship was found between ACB and mean blood pressure, nocturnal blood pressure dips, or any parameters of short-term BPV including Sd, SD-CoV and wSD.

CONCLUSION: No significant association was found between ACB and short-term BPV. To the best of our knowledge, this is the first study to investigate this relationship, which may inspire further research.

PMID:40437537 | DOI:10.1186/s40360-025-00952-w

BMC Med. 2025 May 28;23(1):297. doi: 10.1186/s12916-025-04109-8.

ABSTRACT

BACKGROUND: Obesity and overweight are prevailing concerns in modern society, but high BMI shows an established correlation with the risk of cancers that impacts not only medical issues but also economic performance. This study analyzes the economic loss due to high BMI-caused cancers (HBCCs).

METHODS: This study used the comprehensive Global Burden of Disease (GBD) 2021 database and estimated the economic loss of HBCCs through the Value of Statistical Life approach (VSLA), incorporating a willingness-to-pay metric. Health burdens are expressed in age-standardized DALYs and death rates, and economic burdens are shown in dollars lost (2021 PPP) calculated from total DALYs. A joinpoint regression analysis was utilized to capture the temporal trends, cancer incidence, and economic losses attributed to high BMI across various countries and income levels. We calculated the average annual percentage change (AAPC) in total economic loss to evaluate the trend over the study period.

RESULTS: There is a growing trend in both economic loss and disease burden of HBCCs on a global level. Colon and rectum cancer (CRC) show the highest economic loss ($2593.159 million, UI: 1109.04-4119.61, to $7294.52 million, UI: 3134.75-11,511.13), with pancreatic (AAPC: 10.47*, CI: 8.01-13.51) and liver cancer (AAPC: 8.08*, CI: 5.77-10.35) being the fastest growing cause. The cancer burden for all measures positively correlates with the country’s income level; high-income countries are the only group to experience a decreasing trend in the health burden, but they are still increasing in economic burden. Differences in loss of certain types of cancer and gender gap are observed in different income tiers.

CONCLUSIONS: These findings indicate a significant upward trend in economic loss, highlighting the urgency for strengthened policy measures. It is crucial for policymakers to implement effective risk reduction and resilience-building strategies to mitigate future economic loss and better protect vulnerable communities.

PMID:40437534 | DOI:10.1186/s12916-025-04109-8

BMC Womens Health. 2025 May 29;25(1):263. doi: 10.1186/s12905-025-03758-4.

ABSTRACT

BACKGROUND: This study aims to analyze the changes in inflammatory cytokines and state fatigue after exposure to a mental or physical fatiguing activity in breast cancer survivors (BCS).

METHODS: A total of 46 BCS women (age: 58.9 ± 9.1) were recruited for this study and randomly assigned to one of three groups: exposure to physical fatigue (n = 16), mental fatigue (n = 15), or control (n = 15). Participants exposed to physical fatigue performed a 6-minute walk/run test. Participants exposed to mental fatigue performed a version of a dual 2-back task on a computer. Participants in the control group watched a video for 6 min. Clinically significant fatigue was defined by the FACIT-F. Analytes in serum were profiled using the Bio-Plex 200 Suspension Array System, specifically IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, eotaxin, TNF-α, TGF-β1, and VEGF.

RESULTS: Changes in inflammatory factors in response to the assigned fatigue-inducing tasks were mainly not statistically significant. The presence of clinically significant fatigue reported at baseline was, however, related to reactions to fatigue-inducing stimuli. Levels of TGF-β and eotaxin were consistently altered in reactions to fatigue-inducing tasks, particularly in those with clinical fatigue.

CONCLUSIONS: Clinically significant fatigue is related to increased inflammatory reactions to mentally or physically fatiguing tasks, highlighting the consistent impact that fatigue has across various challenges of daily activities. Acute fatigue challenges, the kind that BCS would be exposed to in everyday circumstances, does increase inflammatory responses, and those with clinically significant levels of fatigue at baseline are more likely to show these effects.

PMID:40437526 | DOI:10.1186/s12905-025-03758-4

Int J Behav Nutr Phys Act. 2025 May 28;22(1):63. doi: 10.1186/s12966-025-01761-4.

ABSTRACT

BACKGROUND: Addressing prolonged workplace sitting is an identified priority. A national implementation trial of BeUpstanding™ – an online workplace intervention supporting teams of desk-based workers to sit less and move more – successfully reduced worker sitting time in a large sample of workers. However, it is unclear which strategies workers used to sit less and move more, how usage changed following intervention, and how this related to changes in work activity and sitting.

METHODS: BeUpstanding collected data from staff before and after the 8-week champion-delivered intervention regarding self-reported work behaviours (percentage of worktime sitting and moving; percentage sitting in prolonged bouts) and the usage (0 = never to 4 = always/nearly always) of 21 sit less/move more strategies (13 emphasised ‘move more’). Strategy usage during versus before intervention were compared via linear mixed models. Strategy usage (0-4) and changes (-4-4) were tested in relation to post-intervention behaviours and behaviour changes using linear mixed models. Interaction tests and conditional inference trees compared strategies in their effectiveness.

RESULTS: Across 1614 staff (43.1 ± 11.3 years; 66% female) from 66 workplaces, the number of strategies used at least sometimes averaged 9.56 (SE = 0.19) pre-intervention. Strategy usage increased significantly (p < 0.05) in the number of strategies used (2.45 [95% CI: 2.18, 2.73], p < 0.001), mean strategy usage (0.37 [0.33, 0.41], p < 0.001), move-more strategy usage, and for every strategy except active travel. Every strategy was used by > 10% of staff following intervention. Strategy usage and changes were significantly associated with all behaviours and behaviour changes (all p < 0.01). There were significant differences in the strength of these associations between strategies (p < 0.05) and for move-more strategies versus other strategies (p < 0.05); however, no strategies were statistically counterproductive. Conditional inference trees identified various combinations of strategies whose usage predicted outcomes.

CONCLUSIONS: All strategies showed acceptability (used by > 10%), most were modifiable (increased with intervention), and, to varying degrees, their usage was associated with work behaviours. Findings suggest all 21 strategies are suitable for Australian desk-based workers to select based on personal and contextual fit. Strategies most strongly linked with all behaviours or targeted behaviours (i.e., increasing movement) might be emphasised to enhance effectiveness.

TRIAL REGISTRATION: ACTRN12617000682347. The trial was prospectively registered on the 12th May, 2017 (ACTRN12617000682347) before the soft launch online and last updated on the 11th June 2019, before the national implementation trial recruitment commenced (12th June, 2019).

PMID:40437510 | DOI:10.1186/s12966-025-01761-4

BMC Oral Health. 2025 May 28;25(1):816. doi: 10.1186/s12903-025-06191-z.

ABSTRACT

BACKGROUND: The forces of the jaw muscles are transmitted to the dentition and the temporomandibular joints (TMJs). Imbalances in the force distribution can lead to occlusal trauma, excessive tooth wear, or TMJ osteoarthritis, making the assessment of bite force (BF) distribution clinically significant. Existing thin-film BF measurement devices capture the magnitudes of a system of BFs distributed at multiple occlusal contacts (OCs), but fail to capture their directional components, limiting their clinical utility. This study aimed to develop a method for representing BF systems as a wrench, a simplified force-couple model, using digital dentistry tools and to evaluate its reliability in terms of interexaminer reproducibility.

METHODS: A semi-automated system was developed to integrate thin-film BF measurement data with digital models of maxillary and mandibular dental arches. BF systems were represented as wrenches with six parameters: force magnitude, axis location (x, y), axis orientation (frontal, sagittal), and pitch (moment-to-force ratio).Ten young adult participants (5 women, 5 men; mean age: 20.1 ± 2.9 years) were recruited. BF measurements were performed on all participants using the developed system. Two independent examiners manually assigned BFs to the identified OCs separately, and the reliability of these assignments was evaluated based on inter-examiner agreement. Intraclass correlation coefficients (ICCs) for wrench parameters were calculated to assess the consistency of biomechanical outcomes using appropriate statistical tests, with significance set at p < 0.05.

RESULTS: The proposed system allowed substantial automation, and the manual steps were limited to segmenting the interocclusal record model for each mandibular tooth and assigning BFs to the identified OCs. The interexaminer agreement was evaluated for the BFs assigned to the identified OCs, which yielded an 87% match rate. Furthermore, the impact on wrench parameters was assessed using ICCs, which ranged from 0.93 to 0.99, indicating high reliability.

CONCLUSIONS: The developed system efficiently integrates BF measurements and three-dimensional OC analysis, providing a practical method for clinical evaluation of the BF systems. In addition, the system provided consistent outcomes in biomechanical analyses across different examiners.

PMID:40437504 | DOI:10.1186/s12903-025-06191-z

BMC Oral Health. 2025 May 28;25(1):832. doi: 10.1186/s12903-025-06189-7.

ABSTRACT

BACKGROUND: Lichen planus (LP) is a chronic inflammatory disease that affects the skin and mucous membranes, including the oral cavity. The prevalence of oral lichen planus (OLP) in the general population is estimated to be between 0.5% and 2%, with a higher incidence observed in women aged between 30 and 80 years. The etiology of OLP remains unclear, which presents a significant challenge in terms of diagnosis and treatment. This systematic review assessed the efficacy of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) in the treatment of OLP.

METHODS: A comprehensive literature search was conducted via multiple databases in accordance with the PRISMA 2020 guidelines.

RESULTS: A total of seven randomized controlled trials were subjected to analysis. It has been demonstrated that both PRP and i-PRF have the capacity to significantly improve clinical outcomes, including pain and lesion severity. However, the majority of studies have not demonstrated statistically significant differences between PRP/i-PRF and corticosteroid treatments.

CONCLUSIONS: While PRP and i-PRF demonstrate potential in alleviating symptoms and promoting tissue healing, their effectiveness appears to be analogous to that of corticosteroids in the majority of RCTs. Further high-quality, standardized studies are required to substantiate their function as alternative or adjunctive therapies in the management of OLP.

TRIAL REGISTRATION: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 November 2024 (PROSPERO 2024 CRD42024615291).

PMID:40437498 | DOI:10.1186/s12903-025-06189-7