Category: Statistics

Front Public Health. 2025 Oct 14;13:1659127. doi: 10.3389/fpubh.2025.1659127. eCollection 2025.

ABSTRACT

College and university faculty and staff in the United States experience diabetes rates higher than the national average, elevated cholesterol levels, receive fewer than the recommended 7 h of sleep per night, and routinely experience overwhelming anxiety. In response, some universities have implemented top-down approaches to employee wellness but there is scant evidence of student-driven approaches to faculty and staff wellness. The current study examines improvement in faculty and staff participation consistency when enrolled in a fully student-developed, -implemented, and -evaluated 8-week health and wellness program. The 78 participants in the study were asked to complete both a pre- and post-intervention Likert scale questionnaire, which was assessed by independent T-tests. There was a statistically significant difference in mean of the participation of staff in the wellness program activities within the university and at local community activities pre- and post-challenge (Mean difference: -0.456, 95% CI: -0.882 – -0.048; p = 0.029). In a similar vein, there was a statistically significant difference between pre-intervention and post-intervention participation in nutritional programs at the university and the surrounding local community by staff and faculty (Mean difference: -0.472, 95% CI: -0.817 – -0.127; p = 0.008). This increased participation could be the result of nudging used throughout the intervention, which included weekly consistency reporting reminders, weekly newsletters, regular email promotions, mailbox stuffers, and personal reminders to participate. It is our belief that this nudging approach led to habituation of participation amongst faculty and staff members.

PMID:41164848 | PMC:PMC12558935 | DOI:10.3389/fpubh.2025.1659127

Front Public Health. 2025 Oct 14;13:1683985. doi: 10.3389/fpubh.2025.1683985. eCollection 2025.

ABSTRACT

Syndemics involving Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) remain a major public health challenge in sub-Saharan Africa, and understanding their spatial and temporal dynamics is critical for effective interventions. Using data from two consecutive, population-based cross-sectional surveys conducted in 2014 and 2015 under the HIV Incidence Provincial Surveillance System (HIPSS) in KwaZulu-Natal, South Africa, we applied a Bayesian spatio-temporal framework grounded in latent variable modeling to quantify and map the syndemic burden of HIV and other STIs. A confirmatory factor analysis constructed a continuous latent syndemic score from four binary indicators (HIV diagnosis, HIV testing, STI diagnosis, and STI symptoms), which was modeled using Bayesian hierarchical spatial methods via Integrated Nested Laplace Approximation (INLA), incorporating spatial random effects through the Stochastic Partial Differential Equation (SPDE) approach and temporal effects via a first-order random walk. Local spatial autocorrelation, assessed using Local Moran’s I and Getis-Ord Gi^* statistics, revealed consistent hotspots and coldspots. Syndemic burden of HIV and other STIs was higher among younger adults (20-49 years), women, individuals with incomplete secondary education, those engaging in sexual risk behaviors or reporting forced sexual debut, and those facing socioeconomic vulnerabilities such as food insecurity. Access to healthcare and treatment for depression were also positively associated, likely reflecting increased detection. Local Moran’s I identified 11 significant clusters (three hotspots, eight coldspots), and Getis-Ord Gi^* identified 32 (17 hotspots, 15 coldspots), with hotspot patterns persisting across both years, indicating temporal stability. These findings highlight the utility of Bayesian latent variable and spatio-temporal modeling in integrating multiple co-occurring health conditions into a single spatial framework, providing actionable evidence to support geographically targeted, multi-sectoral interventions that address structural and behavioral drivers of co-epidemics in resource-limited settings.

PMID:41164847 | PMC:PMC12558856 | DOI:10.3389/fpubh.2025.1683985

Front Public Health. 2025 Oct 14;13:1650147. doi: 10.3389/fpubh.2025.1650147. eCollection 2025.

ABSTRACT

BACKGROUND: To analyze the equity of the current allocation of health human resources using statistical data on health resources in the Yangtze River Delta region.

METHODS: The Gini coefficient quantifies the level of distributional equality, the Theil index assesses the source of inequality, and the health resource agglomeration degree (HRAD) measures the accessibility of health resources, combining the three methods to evaluate the equity of the current allocation of health human resources in the Yangtze River Delta region. Furthermore, trend analysis of fairness indicators was conducted using regression models.

RESULTS: Human resources for health in the Yangtze River Delta region have been increasing between 2014 and 2022. The Gini coefficient and Theil index in the Yangtze River Delta region are more equitable in terms of the distribution of healthcare resources based on population and gross domestic product (GDP) rather than geographical region. In Anhui Province, HRAD and HRAD/PAD (population agglomeration degree) were both less than 1. In Zhejiang Province, HRAD for health technicians and registered nurses was less than 1.

CONCLUSION: Human resources for health and healthcare ratios in the Yangtze River Delta region have continued to grow. However, the equity of health resources allocated based on population and economic factors is superior to that allocated based on geographical factors, and the equity of health resource concentration remains to be improved. To address this equity issue, it is necessary to comprehensively consider various factors such as population, geography, and GDP, and formulate corresponding measures accordingly.

PMID:41164836 | PMC:PMC12558889 | DOI:10.3389/fpubh.2025.1650147

Front Public Health. 2025 Oct 14;13:1591186. doi: 10.3389/fpubh.2025.1591186. eCollection 2025.

ABSTRACT

The increasing efforts among public health researchers to examine the connections between police violence and health outcomes has resulted in growing discoveries about the implications for both direct and vicarious exposure as well as disparities by race and ethnicity. To date, the conceptualization of police violence and health has largely focused on single causes and/or mechanisms at one point in time and focused on individuals most proximal to impact. However, the prevailing conceptualizations are limited in scope. They are relatively linear, do not account for multiple dimensions of harm, and are void of temporal factors that span across communities and generations-all factors that are sustained by forms of structural racism. We offer a reconceptualization guided by the Public Health Critical Race Praxis (PHCRP), a public health offshoot of Critical Race Theory, that offers public health professionals a framework and semi-structured process for centering racism in their analyses and implications of police violence on health. Our conceptualization is supported by multiple case studies, and we conclude with concrete recommendations for public health professionals to draw on as strategies to address police violence and advance health equity.

PMID:41164835 | PMC:PMC12558832 | DOI:10.3389/fpubh.2025.1591186

Front Public Health. 2025 Oct 14;13:1615781. doi: 10.3389/fpubh.2025.1615781. eCollection 2025.

ABSTRACT

BACKGROUND: Evidence on frontline implementation of integrated HIV/TB prevention in resource-limited, ethnic minority regions remains limited. Liangshan Yi Autonomous Prefecture in Southwest China carries a dual HIV/TB burden. This study explored healthcare workers’ experiences with China’s Integrated Prevention and Control of Four Diseases (IPC4D) policy to identify barriers and enablers of service integration.

METHODS: A qualitative phenomenological study was conducted from July to December 2024. 37 semi-structured interviews were held with purposively sampled healthcare workers across prefectural CDCs, infectious disease hospitals, county hospitals, and township health centers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed following Braun and Clarke’s six-phase framework. Reflexive memos and triangulation across facility levels, professional roles, and ethnic groups enhanced study rigor.

RESULTS: Four themes emerged. First, policy-driven progress: participants reported greater governmental support, increased resource inputs, and modest improvements in public awareness. Second, structural barriers: chronic underfunding of TB services, workforce shortages, and burnout weakened integration. Third, the multi-sectoral “1 + M + N + P” model-local government leadership (“1”), township centers (“M”), village doctors and maternal-child health staff (“N”), and public security departments (“P”)-expanded service reach but also generated task overload, cultural-linguistic challenges, and inter-sectoral friction. Fourth, urban-rural divergence: township providers faced more severe infrastructure gaps and patient non-adherence, often driven by stigma and financial constraints.

CONCLUSION: The IPC4D policy demonstrates potential to reduce HIV/TB disparities in Liangshan, yet sustained progress requires dedicated TB financing, culturally competent workforce training, rational task redistribution, and stigma-reduction strategies that leverage Yi community networks. These findings provide practical insights for adapting integrated disease-control policies in other high-burden, resource-constrained settings.

PMID:41164833 | PMC:PMC12558838 | DOI:10.3389/fpubh.2025.1615781

Front Public Health. 2025 Oct 14;13:1592366. doi: 10.3389/fpubh.2025.1592366. eCollection 2025.

ABSTRACT

OBJECTIVES: This study aimed to verify the hypothesis that the improvement in the subjective assessment of population health in certain European countries after the COVID-19 pandemic was driven by the mortality of the majority of vulnerable citizens with the worst health status.

METHODS: We extended the trend of the share of the oldest age group and compared it with the observed fraction, thereby identifying the “missing population.”

RESULTS: We observed a substantial deficit in the population of the oldest age group, especially in countries where people tend not to age well.

CONCLUSION: The temporary improvement in population health indicators, as measured by Healthy Life Years (HLY), during the pandemic in some countries was most likely an artifact resulting from the mortality of the majority of vulnerable individuals with poor health status. It is unlikely that this apparent improvement reflects healthier lifestyles or genuine gains in the efficiency or resilience of health systems during the pandemic. Therefore, the interpretation and use of HLY values from the COVID-19 period in Europe should be carefully reconsidered and further validated.

PMID:41164832 | PMC:PMC12558791 | DOI:10.3389/fpubh.2025.1592366

Precis Radiat Oncol. 2025 Jun 28;9(3):167-176. doi: 10.1002/pro6.70022. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: When validating intracranial multi-lesion CyberKnife M6/S7 plans with SRSmapcheck, setting the array to a fixed 0° measures only one target dose distribution, leaving the other lesions unmeasured. Moreover, the CyberKnife treatment planning system does not support roll verification tools, and testing confirms that X-sight fiducial marker guidance is incompatible with free array roll. A novel method and workflow are required to validate multi-lesion plans with random positions.

METHODS: A geometric model was established based on the relationship between SRSmapcheck and the tumor location. For two tumors spaced 77 mm apart (each 20 mm in diameter, or one 40 mm apart and the other infinitesimally small), the corresponding array roll angle interval was approximately 15.05°. The SRSmapcheck and StereoPHAN computed tomography (CT) images were acquired at 15° intervals, starting at 0°, and preprocessed into phantom plans for verification. A total of 101 intracranial multi-lesion plans were verified using the fixed 0° and pre-set roll angle methods to optimize the dose distribution, particularly in high-dose and rapidly varying areas. A two-sample test compared the results of the 0° versus pre-set roll angle verification and assessed the performance under different criteria to determine suitable criteria for pre-set roll angle verification.

RESULTS: The equivalent diameter of the 296 tumors ranged from 5 to 45 mm (average: 21.86 mm). Each plan had an average of 2.97 lesions. Using the pre-set roll angle method, 2.34 targets were assessed on average (89.83% of lesions had diameters ranging from 10 to 40 mm), compared to 1.32 targets on average in 0° plans. Statistically significant differences occurred at 2 mm/1% and 2 mm/2% in the γ analysis, showing that plan pass rates were stable between the fixed 0° and pre-set roll angle methods. Relaxing either the distance to agreement or dose deviation significantly increased the pass rates during pre-set roll angle verification, whereas cross-transforming criteria had minimal impact. For pre-set roll angle methods, it is recommended to use 1 mm/1% (action limit: 86.0% ± 13.3%) and 1 mm/2% (action limits: 91.6% ± 7.9%) for γ analysis.

CONCLUSION: SRSmapcheck with the pre-set roll angle method can verify intracranial multi-lesion CyberKnife plans by measuring multiple targets in a single validation and comparing the 1 mm/1% and 1 mm/2% γ analysis criteria.

PMID:41164809 | PMC:PMC12559907 | DOI:10.1002/pro6.70022

Precis Radiat Oncol. 2025 Aug 23;9(3):177-184. doi: 10.1002/pro6.70025. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: Radiation recall pneumonitis (RRP) is a localized inflammatory reaction occurring in previously irradiated lung regions, typically triggered by certain anticancer agents. In clinical settings, we have observed that COVID-19 infection may also act as a precipitating factor for RRP. However, its true incidence and possible risk factors remain poorly defined.

METHODS: Lung cancer patients who received radiotherapy and were diagnosed with COVID-19 between November 2022 and February 2023 were included. RRP was defined as pulmonary changes limited to the previously irradiated regions, occurring at least 6 months after radiotherapy. Patients medical records and radiation dose distribution data were analyzed to identify potential contributing factors to RRP.

RESULTS: The study included 140 patients who underwent thoracic radiotherapy with a minimum six-month interval before COVID-19 diagnosis. Among these, 62 patients (44.2%) developed RRP, and 45% of these experienced grade ≥ 2 pneumonitis. No radiotherapy dose-related factors were significantly associated with RRP. However, statistical analysis showed that RRP incidence was significantly associated with baseline T-stage (P = 0.034) and the time interval from radiotherapy completion to COVID-19 infection (P < 0.001).

CONCLUSIONS: A 44.2% incidence of COVID-19-related RRP was identified, which is notably higher than previously reported. While radiotherapy dosimetry did not correlate with RRP risk, baseline T-stage and timing of COVID-19 infection after radiotherapy were significantly associated with its occurrence.

PMID:41164806 | PMC:PMC12559899 | DOI:10.1002/pro6.70025

Clin Ophthalmol. 2025 Oct 24;19:3933-3939. doi: 10.2147/OPTH.S545977. eCollection 2025.

ABSTRACT

PURPOSE: To evaluate the visual performance, refractive stability, and glistening-free clarity of the Clareon^® monofocal intraocular lens (IOL) implanted using the AutonoMe^® automated delivery system in a real-world North American setting.

PATIENTS AND METHODS: A prospective, single-arm study was conducted at a single Canadian site involving 46 patients, or 85 eyes, undergoing cataract surgery with Clareon^® IOL implantation. Eligible participants were ≥22 years old with best-corrected distance visual acuity (BCDVA) of 0.3 logMAR or worse, targeted for emmetropia, and had <1.0 D of preoperative astigmatism. Exclusion criteria included retinal disease, glaucoma, amblyopia, corneal pathology, and prior intraocular or corneal surgery. Manifest refraction, uncorrected (UDVA), best-corrected (BCDVA), and low-contrast visual acuity (LCVA) were assessed at 1, 3, and 12 months postoperatively. Glistenings were graded using the Miyata scale at 3 and 12 months.

RESULTS: No statistically significant changes were observed in manifest refraction, UDVA, or BCDVA between 1 and 3 months (p > 0.05). At 3 months, the mean spherical equivalent was +0.09 D, with low residual astigmatism (-0.33 D). Mean logMAR UDVA and BCDVA were 0.13 and 0.02, respectively. LCVA was 0.04 logMAR. No glistenings were observed at either 3 or 12 months in any patient. Refractive and visual outcomes remained stable over time, with no device-related complications reported.

CONCLUSION: The Clareon^® IOL demonstrated excellent refractive accuracy, stable visual performance, and sustained optical clarity with no glistenings up to one year postoperatively. Its compatibility with the AutonoMe^® delivery system supports its utility as a reliable option for cataract surgery.

PMID:41164804 | PMC:PMC12560656 | DOI:10.2147/OPTH.S545977

Vasc Health Risk Manag. 2025 Oct 24;21:889-894. doi: 10.2147/VHRM.S559706. eCollection 2025.

ABSTRACT

INTRODUCTION: A greater association of systemic arterial hypertension with worse prognosis in patients hospitalized with COVID-19 was described. Early in the pandemic, concerns were raised that the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) could lead to unfavorable outcomes.

OBJECTIVE: To evaluate whether there is an association between the use of the ACEi and ARB medications with unfavorable outcomes in hypertensive patients hospitalized with COVID-19.

METHODS: This is a descriptive and retrospective study, collecting data through electronic medical records of patients with COVID-19 admitted to a University Hospital in 2020. Demographic data, use of ACEi or ARB medications, comorbidities, and outcomes, defined by the use of invasive ventilatory support (IVS), renal failure with progression to renal replacement therapy, and death were evaluated.

RESULTS: 700 medical records were analyzed, 374 were of hypertensive individuals. The mean age of the patients was 66 ± 14 years, 51% were male, and 89% were white. There was a significantly higher prevalence of hospital discharge among patients who received ACEi/ARB compared to those who did not take these medications, (p-value = 0.027). There was no statistically significant difference in the use of ACEi/ARB for IVS (p-value = 0.062) and for renal replacement therapy (p-value = 0.587).

CONCLUSION: The use of ACEi/ARB drugs is not associated with worse outcomes in individuals with COVID-19. The present study demonstrated lower mortality rate associated with the use of these classes of drugs, similar to recent studies.

PMID:41164788 | PMC:PMC12560647 | DOI:10.2147/VHRM.S559706