Category: Statistics

Glob Health Action. 2025 Dec;18(1):2490330. doi: 10.1080/16549716.2025.2490330. Epub 2025 Apr 24.

ABSTRACT

BACKGROUND: The Karamoja region in the East African drylands is a rural, impoverished setting where pastoralism is increasingly replaced by other livelihood strategies. Understanding the socioeconomic contexts as well as their local variations is key for sustainable development of communities.

OBJECTIVE: The aim of the present paper is to describe the baseline survey of the Drylands Transform project, its setting, methods and key findings.

METHODS: In June 2022, a survey was conducted with 944 randomly selected households at four study sites in the Karamoja border region of Kenya and Uganda. Data were analyzed using descriptive statistics.

RESULTS: Main livelihood forms were pastoralism and agropastoralism, while many households also relied on other sources of income. At some study sites, livestock keeping was abandoned by many residents due to cattle raiding and droughts. Only 4% of households were rated as food secure. The proportion of malnutrition among children aged 6-59 months varied across sites between 3% and 17% and was considerably higher among women.

CONCLUSIONS: Climate change, water shortage, social conflicts and marginalization pose barriers to food security and wellbeing for rural populations in the East African drylands. There are, however, opportunities for development through income diversification, the improvement of land health, the promotion of kitchen gardens and other measures of sustainable agriculture.

PMID:40270287 | DOI:10.1080/16549716.2025.2490330

Biomark Med. 2025 Apr 24:1-7. doi: 10.1080/17520363.2025.2496128. Online ahead of print.

ABSTRACT

INTRODUCTION: Coronary artery disease (CAD) is a multifactorial disorder influenced by both genetic and clinical risk factors. Lipid metabolism genes such as apolipoprotein B(APOB) (rs515135) and proprotein convertase subtilisin/kexin type 9 (PCSK9)(rs505151), have been associated with susceptibility to CAD. Study investigates the potential role of these genetic polymorphisms with risk of CAD in the Indian population.

MATERIALS AND METHODS: A case-control study including 150 CAD cases and 150 controls. Angiographically proven Cases were recruited from the Cardiology Unit, Department of Medicine, Era’s Lucknow Medical College. Genotyping was done using specific primers and restriction digestion; statistical analysis included t-tests, odds ratios, and haplotype analysis.

RESULTS: CAD cases(mean age 49.93 ± 9.13 years) had higher serum cholesterol and VLDL but lower systolic and diastolic BP compared to controls (mean age 56.47 ± 9.39 years). The APOB G allele showed a significant protective effect against CAD (OR: 0.431,p = 0.001).

CONCLUSION: The APOB G allele may serve as a protective factor against CAD, highlighting its potential role in genetic screening for lower disease risk. Further large-scale studies are required to confirm these findings.

PMID:40270278 | DOI:10.1080/17520363.2025.2496128

Stroke. 2025 Apr 24. doi: 10.1161/STROKEAHA.124.050045. Online ahead of print.

ABSTRACT

BACKGROUND: Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.

METHODS: This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within seven days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.

RESULTS: The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3-4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5-26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9-6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4-5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5-58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18).

CONCLUSIONS: ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling.

PMID:40270248 | DOI:10.1161/STROKEAHA.124.050045

Palliat Support Care. 2025 Apr 24;23:e103. doi: 10.1017/S1478951525000422.

ABSTRACT

OBJECTIVES: Effective communication during specialist palliative care (PC) referral is linked to improved health outcomes. Initiating a conversation about PC is difficult and poor communication can lead to stigma. The aim of this descriptive phenomenological study was to explore the communication experiences of persons referred to specialist PC services and their carers and explore strategies to improve such experiences.

METHODS: Purposive sampling was used to recruit 17 participants who were either receiving specialist PC and/or caring for someone who was receiving specialist PC. Participants were recruited from a hospice. Inductive thematic analysis was conducted.

RESULTS: Four themes were identified: (i) The why, who, what, when, where, and how of PC referral; (ii) initial thoughts and feelings about referral to PC; (iii) enhancing the communication of PC referral; and (iv) addressing practical needs during PC referral. Participants were referred either through their general practitioner or oncologist. Initially, participants linked PC referral to death. This perception changed when participants started availing of the services. Compassion, empathy, hope, privacy, in-person communication, individualized referral, and information dosing were identified as building blocks for effective communication. Participants stressed the importance of raising public awareness of PC and addressing the practical needs of individuals being referred.

SIGNIFICANCE OF RESULTS: The communication of PC referral should be tailored to meet the individual needs of patients and carers. Delivering clear and simple information is important to help patients and carers understand and accept the referral.

PMID:40270246 | DOI:10.1017/S1478951525000422

Circ Heart Fail. 2025 Apr 24:e012446. doi: 10.1161/CIRCHEARTFAILURE.124.012446. Online ahead of print.

ABSTRACT

BACKGROUND: Peripheral microvascular dysfunction is a hallmark feature of both heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) pathophysiology, due partly to impairments in nitric oxide signaling secondary to tetrahydrobiopterin (BH₄) deficiency and oxidative stress.

METHODS: Using a randomized, double-blind, placebo-controlled crossover design, this study examined the impact of enteral BH₄ (10 mg/kg), an antioxidant cocktail (AOx), and coadministration of these 2 agents (BH₄+AOx) on microvascular function in patients with HFrEF (n=14, 64±10 years) and HFpEF (n=19, 74±9 years). Passive limb movement was utilized to assess locomotor muscle microvascular function, and biomarkers of inflammation and oxidative damage were measured.

RESULTS: Compared with placebo, the peak change in leg blood flow was not statistically different after AOx administration (HFrEF, P=0.60; HFpEF, P=0.61), but improved following BH₄ (P=0.033) and BH₄+AOx (P=0.019) in both HFrEF (placebo: 234±31; BH₄: 357±45; BH₄+AOx: 355±49 mL/min) and HFpEF (placebo: 269±33; BH₄: 367±47; BH₄+AOx: 394±65 mL/min). The total hyperemic response to passive limb movement (leg blood flow area under the curve) was not statistically different across treatments in patients with HFrEF (P=0.29), but increased following BH₄ (P=0.016) and BH₄+AOx (P=0.040) in the HFpEF group. CRP (C-reactive protein) was lower following BH₄ (P=0.007) and BH₄+AOx (P=0.007) in HFpEF (placebo: 4268±547; BH₄: 2721±391; BH₄+AOx: 2779±376 ng/mL), but was not statistically different in HFrEF (P=0.39).

CONCLUSIONS: Together, these results provide new evidence for the efficacy of acute BH₄ administration to improve some aspects of locomotor muscle microvascular function in patients with HFrEF and HFpEF, with no apparent benefit of AOx administration, alone or in combination with BH₄, in either group. These findings lend further conceptual support for the nitric oxide pathway as a modifiable target in the treatment of heart failure.

PMID:40270242 | DOI:10.1161/CIRCHEARTFAILURE.124.012446

Haematologica. 2025 Apr 24. doi: 10.3324/haematol.2024.287206. Online ahead of print.

ABSTRACT

Prophylactic and pre-emptive donor lymphocyte infusion (pro/preDLI) is used to prevent haematological relapse of AML and MDS after allogeneic stem cell transplantation. For lack of prospective trials, outcome reports, risk factor analyses and published recommendations for DLI administration had to rely on registry studies, frequently limited by inconsistent reporting and missing data. Therefore, we performed an extensive chart review on recipients of pro/preDLI in two German centers to investigate the clinical applicability of current guidelines in a well-defined cohort. Beyond, as outcome after pro/preDLI is unsatisfactorily described by conventional parameters, we constructed a model for treatment success, defined as leukaemia-free survival (LFS) without intensive immunosuppressive treatment for Graft-versus-Host-Disease (GvHD). Eighty-three patients had received proDLI (n=36), preDLI for incomplete chimerism (preDLIIC, n=27) or for persisting minimal residual disease/molecular relapse (preDLI-MRD, n=20). According to current guidelines concerning initial T cell doses and timing of DLI, 42% of patients had received DLI as recommended (standard-intensity), whereas 30%/28% had received DLI in lower/higher cell doses and/or at a later/earlier time point (low-/highintensity). Two-year rates of overall survival (OS), LFS, relapse incidence and non-relapse mortality within the entire cohort were 80%/67%/27%/8%. One-year rates of high-grade acute/chronic GvHD were 34%/27% among all patients and 53%/33% after high-intensity DLI. One-year treatment success rate were 72%/69% after low-/standard intensity, in contrast to 34% after high-intensity DLI. Apart from advanced disease at alloSCT, high-intensity DLI was the major risk factor for lower OS (HR=6.12), LFS (HR=5.43), higher aGvHD (HR=2.51), and lower treatment success (HR=0.41), supporting adherence to current recommendations.

PMID:40270206 | DOI:10.3324/haematol.2024.287206

Work. 2025 Apr 24:10519815251323988. doi: 10.1177/10519815251323988. Online ahead of print.

ABSTRACT

BackgroundToday, researchers try to recognize and improve the weaknesses of complex systems using resilience engineering (RE) principles.ObjectiveThis descriptive-analytical epidemiological study aims to evaluate the resilience performance of the hospital staff based on the principles of RE to enhance personnel performance.MethodA questionnaire containing 27 questions in four areas (anticipation, monitoring, response, and learning) was designed based on Hellangel’s model and field surveys to collect data from nurses and managers of various wards of five hospitals. The face validity and reliability of the questionnaire were confirmed by 16 professors and some individuals from the statistical sample.A hybrid approach utilizing entropy, TOPSIS, and DEA was employed in the Excel environment to process the collected data.ResultsThe results of the entropy method indicated that the responding and monitoring indicators, with values of 0.29 and 0.23, respectively, had the greatest impact on the resilience performance of the studied units. The outcomes of TOPSIS revealed that hospital D possesses the highest level of resilience. According to the DEA method, the first, second, and fifth efficient units were associated with hospital B.ConclusionBy evaluating the cornerstone of resilience, this study’s findings empower nurses and managers to mitigate the impacts of stress, emotional exhaustion, and burnout, fostering work interactions and improving their performance in the face of workplace challenges. The main limitation of the study was the spread of COVID-19, which impeded the training of personnel in the field of RE and its indicators, as well as the distribution, collection, and completion of questionnaires, along with challenging access to personnel.

PMID:40270181 | DOI:10.1177/10519815251323988

Folia Med (Plovdiv). 2025 Mar 21;67(2). doi: 10.3897/folmed.67.e137670.

ABSTRACT

Maxillofacial space infection refers to infections in the potential spaces and fascial planes of the maxillofacial region. The primary objective was identifying predictive variables associated with increased hospital stay in patients with odontogenic maxillofacial space infections.

PMID:40270143 | DOI:10.3897/folmed.67.e137670

Folia Med (Plovdiv). 2025 Mar 21;67(2). doi: 10.3897/folmed.67.e145825.

ABSTRACT

Malignant pleural effusions are a common and debilitating complication of advanced malignancies, affecting approximately one million patients annually. This condition leads to significant morbidity and a decline in quality of life. Accurate diagnosis and effective management are critical yet challenging due to the overlap in biochemical markers between malignant and benign pleural effusions.

PMID:40270142 | DOI:10.3897/folmed.67.e145825

Am J Rhinol Allergy. 2025 Apr 24:19458924251335075. doi: 10.1177/19458924251335075. Online ahead of print.

ABSTRACT

BackgroundPatients with chronic rhinosinusitis (CRS) refractory to medical management often require endoscopic sinus surgery (ESS). Oral corticosteroids (OCSs) are frequently prescribed postoperatively, but the evidence of their efficacy is limited.ObjectiveThe purpose of this study is to evaluate the efficacy of OCS use in patients with CRS following ESS.MethodsA systematic search was performed to identify studies examining the use of OCSs in patients undergoing ESS for CRS. The primary outcomes were sinonasal outcome test (SNOT) and Lund-Kennedy (LK) endoscopic scores. Secondary outcomes were visual analog scale (VAS) scores. Meta-analysis was conducted using a fixed effects model with a heterogeneity test via the I2 statistic.ResultsThe search yielded 1899 articles, and 22 were included in the qualitative analysis, 14 of which were randomized controlled trials with 793 total patients. OCS use differed based on type, dosage, and duration. Studies included in meta-analysis did not show a significant difference in SNOT (Standardized Mean Difference [SMD] -0.03, Confidence Interval [CI] -0.47-0.40, I2 0%), LK (SMD -0.20 CI -0.57-0.17 I2 58%), or VAS (SMD 0.19 CI -0.25-0.63 I2 54%) scores between steroid and non-steroid groups. Two studies that assessed OCSs in the allergic fungal rhinosinusitis (AFRS) subtype of CRS showed significant improvement in outcomes. Two additional studies examined OCS versus itraconazole in AFRS, with both groups showing improvement but neither one with greater significance.ConclusionThis study showed no significant difference in SNOT, LK, or VAS scores in patients with CRS who received OCSs following ESS. Given the limited number of studies in the analysis, further investigations are warranted before making recommendations.

PMID:40270102 | DOI:10.1177/19458924251335075