Category: Statistics

Open Forum Infect Dis. 2025 Oct 8;12(10):ofaf634. doi: 10.1093/ofid/ofaf634. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Long COVID is a heterogeneous post-infectious condition. Although patient-reported outcome (PRO) measures for diagnosis or therapeutic monitoring have been adapted from related complex chronic illnesses, no PRO has been validated specifically in Long COVID. The STOP-PASC randomized, placebo-controlled trial of nirmatrelvir/ritonavir (NMV/r) in adults with Long COVID showed no overall treatment effect. This exploratory analysis aimed to identify distinct symptom trajectories and clinical characteristics associated with improvement or worsening over time.

METHODS: We performed latent class trajectory modeling (LCTM) on PRO measures-including the Patient Global Impression of Severity (PGIS), Patient Global Impression of Change (PGIC), PROMIS domains, and core symptoms-among 155 randomized participants. Participants were followed for 15 weeks with serial symptom assessments. Trajectory groups were identified using Bayesian Information Criteria and characterized using descriptive statistics and absolute standardized differences.

RESULTS: LCTM revealed heterogeneity in symptom trajectories. Two groups emerged for PGIS (improving n = 17, persistent/severe n = 136) and PGIC (improving n = 130; worsening n = 22). PROMIS-Physical Function modeling identified four groups (improving, normal/mild, moderate, and severe), fatigue core symptom modeling identified three (improving; moderate; severe). Worsening groups had higher proportions of NMV/r-treated participants and greater prevalence of cardiovascular symptoms and low-dose naltrexone use. Improving groups had shorter time since infection and higher baseline physical function. No subgroup showed a clear benefit from NMV/r.

CONCLUSIONS: Distinct PRO trajectories reflect the clinical heterogeneity of Long COVID. NMV/r showed no clear benefit across subgroups. These findings emphasize the need for validated, Long COVID-specific PRO instruments and targeted therapeutic trials tailored to Long COVID subtypes.

PMID:41164784 | PMC:PMC12560753 | DOI:10.1093/ofid/ofaf634

Brain Commun. 2025 Oct 28;7(5):fcaf356. doi: 10.1093/braincomms/fcaf356. eCollection 2025.

ABSTRACT

Duchenne muscular dystrophy is a monogenic X-linked genetic disorder that is caused due to the absence of dystrophin. In addition to the skeletal and cardiac manifestations, challenges in executive function are pervasive and persistent, affecting a majority of young individuals with Duchenne muscular dystrophy. Executive function-related disability is linked to chronic stress, academic under-achievement and poor vocational attainment. Of the executive function domains, inhibitory control and working memory are disproportionately affected, and linked to academic under-achievement in Duchenne muscular dystrophy. Despite its consequential importance to the quality-of-life in affected individuals, the neural substrates underpinning working memory challenges are poorly understood in this disease. The dynamic interactions of bilateral dorsolateral prefrontal cortex as part of the frontoparietal network is critical for working memory. Atypical neural connectivity within the frontoparietal network may underlie the neural basis of working memory challenges in Duchenne muscular dystrophy. Effective (directional) connectivity analysis of brain functional MRI is an advanced analytical approach that quantitates the directionality and the nature (facilitatory or inhibitory) causal interactions between brain regions. The strength of effective connectivity in Hertz-stronger (facilitatory) versus weaker (inhibitory)-within the frontoparietal network was analysed using dynamic causal modelling in 11 right-handed male participants with Duchenne muscular dystrophy and 9 right-handed male neurotypicals while they completed an n-back working memory task. Participants also completed standardized neurocognitive assessments out-of-scanner. Age-corrected working memory scores were comparable in Duchenne muscular dystrophy (mean 100.0, standard deviation 16.0) and neurotypicals (mean 109.0, standard deviation 8.0) (P = 0.15). Task-based hypoactivation of frontoparietal-occipital regions was observed in Duchenne muscular dystrophy. The group difference in mean frontoparietal effective connectivity during the in-scanner n-back working memory tasks was statistically lower by Bayes factor of 3 in Duchenne muscular dystrophy, compared to neurotypicals. The right posterior parietal → dorsolateral prefrontal connectivity correlated negatively to out-of-scanner working memory performance in Duchenne muscular dystrophy. Median reaction times during the 0-back and 2-back working memory tasks were longer in Duchenne muscular dystrophy compared to neurotypicals, but the difference did not reach statistical significance (P = 0.2). Median reaction time during the 0-back fearful facial condition was longer in Duchenne muscular dystrophy compared to neurotypicals (P = 0.01). Our work implicates atypical task-based effective connectivity within the frontoparietal network and impaired perceptual processing in Duchenne muscular dystrophy. Dynamic neural network signatures can serve as mechanistic targets for pharmacological and non-pharmacological interventions to mitigate executive function impairment in Duchenne muscular dystrophy.

PMID:41164778 | PMC:PMC12560160 | DOI:10.1093/braincomms/fcaf356

Front Pharmacol. 2025 Oct 14;16:1681113. doi: 10.3389/fphar.2025.1681113. eCollection 2025.

NO ABSTRACT

PMID:41164767 | PMC:PMC12558836 | DOI:10.3389/fphar.2025.1681113

Front Psychol. 2025 Oct 14;16:1666403. doi: 10.3389/fpsyg.2025.1666403. eCollection 2025.

ABSTRACT

This study investigates the prevalence and predictors of anxiety among Emirati university students in the post-pandemic period, focusing on the influence of socio-demographic variables, mental health comorbidities, and lifestyle behaviors. A cross-sectional online survey was conducted across 16 UAE public university campuses from November 2022 to February 2023, yielding 7,244 complete responses from students aged 18 and above. The survey assessed anxiety using the Generalized Anxiety Disorder 7-item (GAD-7) scale and included items on demographics, physical and mental health, support systems, and behavior patterns such as substance use and internet engagement. Multivariable logistic regression models examined associations between anxiety and key explanatory variables. Results revealed that 8% of respondents experienced severe anxiety, with significant associations observed between anxiety and gender, age, income, disability status, and physical health conditions. Females, younger individuals, those with household incomes below AED 10,000, and students with chronic illnesses or disabilities were at higher risk. Mental health comorbidities such as depression, panic attacks, eating disorders, OCD, and ADHD showed strong associations with anxiety severity. Furthermore, behavioral correlations including excessive internet use, gaming, alcohol consumption, and prescribed medication use were linked to elevated anxiety levels, although not all were statistically significant. Despite efforts to increase mental health awareness in the UAE, stigma and cultural norms remain barriers to help-seeking. The study underscores the need for culturally tailored mental health interventions that address stigma, promote early screening, and consider the role of maladaptive coping behaviors. Universities should implement accessible support systems that incorporate Arabic-language resources, peer mentoring, and family or religious engagement. These findings contribute to the global understanding of anxiety in higher education and highlight the importance of localized mental health strategies in post-pandemic recovery.

PMID:41164735 | PMC:PMC12558803 | DOI:10.3389/fpsyg.2025.1666403

Front Psychol. 2025 Oct 14;16:1678675. doi: 10.3389/fpsyg.2025.1678675. eCollection 2025.

ABSTRACT

BACKGROUND: The relationship between social media use and subjective well-being is an important research topic. Nevertheless, limited research has specifically explored the role of social media use for information acquisition on life satisfaction. This study investigated how the use of social media for information acquisition influenced life satisfaction by examining a proposed theoretical model.

METHODS: Data were collected online through a survey company. A total of 1,651 individuals responded to the survey invitation via email and participated in the study. Data cleaning was conducted, resulting in a final valid sample of 1,513 cases. In this study, SPSS 22.0 was used to perform descriptive statistics and correlation analysis on the data. The mediation model was tested using the SPSS macro PROCESS (Model 6), with the significance of indirect effects assessed through the bootstrap method.

RESULTS: The results indicated that social media use for information acquisition exerted both a direct positive effect on life satisfaction and an indirect effect through the sequential mediation of health knowledge and self-efficacy. Notably, only perceived knowledge demonstrated a significant mediating effect, whereas actual knowledge did not. Additionally, self-efficacy significantly mediated the relationship in conjunction with both types of knowledge.

CONCLUSION: By differentiating the roles of perceived and actual knowledge within digital environments, this study extends of the knowledge, beliefs, and practices theory and provides practical implications for health-related interventions.

PMID:41164734 | PMC:PMC12558970 | DOI:10.3389/fpsyg.2025.1678675

Front Psychol. 2025 Oct 14;16:1631504. doi: 10.3389/fpsyg.2025.1631504. eCollection 2025.

ABSTRACT

INTRODUCTION: A high discrepancy between a generally positive attitude and consent to donation has been observed in Italy, as in 2021 only 68.2% of registered individuals had provided consent. Understanding which variables may play a role in this decision-making process, considering the experiences of different groups, is essential to support the development and implementation of targeted policies. The aim of this study was to investigate the demographic and psychosocial variables associated with the decision to register consent for post-mortem organ donation in Italy, and to compare the experiences of different population groups to support the development of targeted policies.

METHODS: A quantitative study was conducted in 2021 in collaboration with the National Centre for Transplantation. A total of 353 participants-including healthcare professionals, citizens, opinion leaders and registry office employees-completed an ad-hoc questionnaire before and after participating in a focus group on organ donation. Descriptive statistics and regression analyses were conducted.

RESULTS: Of the 353 participants, 93.8% reported a positive attitude toward post-mortem organ donation (score > 5 on a 7-point Likert scale). In the pre-focus group questionnaire, the mean attitude was 6.45 (SD = 1.05), which increased significantly to 6.56 (SD = 0.99) after the focus groups (Z = -4.06, p < 0.001). Regarding actual behavior, 50.4% had already registered their consent to donation. Significant associations emerged between positive attitude and gender (women reporting higher scores; U = 13,129, p = 0.045), level of education (r = 0.156, p = 0.004), familiarity with donation (e.g., knowing a donor or someone who registered consent; p < 0.001), and being registered with donation-related associations (p < 0.001). Intention to register was strongly predicted by attitude (p < 0.001), and actual consent registration was more likely among participants with higher education and those familiar with donation practices.

CONCLUSION: Findings highlight the role of demographic factors, familiarity, and personal values in shaping donation behavior, supporting the use of multivariable models to better explain consent registration. These insights underline the need to implement targeted awareness campaigns and policies aimed at promoting informed choices about organ donation.

PMID:41164729 | PMC:PMC12558963 | DOI:10.3389/fpsyg.2025.1631504

Sex Health. 2025 Dec 23;22(6):SH25065. doi: 10.1071/SH25065.

ABSTRACT

BACKGROUND: Pre-exposure prophylaxis (PrEP) use could be accelerated by offering alternatives that overcome key barriers associated with oral PrEP. This study aimed to understand willingness and preferences for long-acting injectable cabotegravir (CAB-LA) among gay men and other men who have sex with men (MSM), and transgender women (TGW) in Asia.

METHODS: An online cross-sectional survey was conducted from May to November 2022 among HIV-negative or unknown status MSM and TGW aged ≥18 years across 15 and 11 Asian countries/territories, respectively. Survey items included awareness and use of PrEP and CAB-LA, willingness to use current and emerging PrEP options, and attitudes towards CAB-LA. Descriptive statistics and logistic regression were used to analyse associations with willingness to use CAB-LA.

RESULTS: Among 11,870 MSM and 980 TGW, 21.4% (n = 2448) and 32.5% (n = 295) were aware of CAB-LA, respectively, and 17.2% (n = 2036) and 16.8% (n = 165) were willing to use it. CAB-LA was the most preferred PrEP option for 3.6% (n = 400) of MSM and 6.5% (n = 61) of TGW. Awareness and willingness varied across countries/territories and populations. Key benefits of CAB-LA included HIV protection (57.8% MSM, 46.8% TGW), no need for daily pills (42.6% MSM, 31.1% TGW) and longer-term protection (38.0% MSM, 23.6% TGW). Main concerns included cost (39.6% MSM, 22.1% TGW), side-effects (37.5% MSM, 22.2% TGW), insufficient knowledge (33.3% MSM, 20.6% TGW) and pain (21.4% MSM, 24.9% TGW).

CONCLUSIONS: Successful introduction of CAB-LA, or other new long-acting injectable PrEP options, in Asia will require strategies to raise awareness and demand-generation that responds to the perceived benefits and concerns of communities.

PMID:41162336 | DOI:10.1071/SH25065

Acad Radiol. 2025 Oct 28:S1076-6332(25)00955-9. doi: 10.1016/j.acra.2025.09.049. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Spontaneous portosystemic shunt (SPSS) embolization represents a promising intervention for refractory hepatic encephalopathy (HE). This systematic review and meta-analysis evaluate the efficacy and safety of SPSS embolization in cirrhotic patients without transjugular intrahepatic portosystemic shunts (TIPS).

METHODS: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library through June 12, 2024 to identify studies investigating SPSS embolization for HE. Meta-analysis was performed using fixed-effect or random-effects models to calculate clinical success (defined as HE remission), procedural success rates, and complication frequencies.

RESULTS: Analysis of 10 retrospective studies encompassing 289 cirrhotic patients yielded the following pooled outcomes: hepatic encephalopathy remission rate of 83.1% (95% CI: 70.4%-93.1%), procedural success rate of 99.8% (95% CI: 98.3%-100%), and long-term adverse event rate of 42.9% (95% CI: 34.7%-51.4%). The predominant long-term complications included ascites (51.6% of complications), variceal progression (23.4%), and thrombosis (8.0%), while primary procedure-related adverse reactions were infection (37%) and fever (29%). Subgroup analyses demonstrated no statistically significant effect of etiology (p=0.788) or shunt type (p=0.271) on disease remission rates, but revealed significant differences between surgical approaches (p<0.001), with balloon-occluded retrograde transvenous obliteration (BRTO) showing the highest efficacy (97.4%-100%).

CONCLUSION: SPSS embolization demonstrates both high efficacy for refractory hepatic encephalopathy (83.1% remission rate) and exceptional procedural success (99.8%). Despite substantial long-term complications (42.9%, predominantly portal hypertension sequelae), current evidence from predominantly retrospective studies supports its consideration as a therapeutic option. Technique selection should be individualized pending further validation of BRTO’s superiority.

PMID:41162300 | DOI:10.1016/j.acra.2025.09.049

J Surg Educ. 2025 Oct 28:103755. doi: 10.1016/j.jsurg.2025.103755. Online ahead of print.

ABSTRACT

OBJECTIVE: Previously, we developed the Inpatient Leadership Assessment Device (I-LEAD), a multisource feedback (MSF) instrument assessing the essential leadership skills for surgical resident physicians leading inpatient teams. This pilot study sought to evaluate the feasibility of utilizing I-LEAD in real-world contexts and acquire psychometric evidence to support the validity and reliability of its leadership scores.

DESIGN: At the end of a clinical rotation, surgical attendings, advanced practice providers (APPs), interns, and senior residents were invited to complete the I-LEAD instrument, which is structured as a 27-item online survey. Ratings were summarized with descriptive statistics, and psychometric properties were characterized with a many-facet Rasch model (MFRM) encompassing measures of resident leadership ability, item difficulty, and rater role severity.

SETTING: An academic general surgery residency program at a tertiary hospital in the Northeast United States over 9 months during the 2024 to 2025 academic year. It encompassed 6 inpatient general surgery services.

PARTICIPANTS: Twenty senior residents were evaluated by 8 attendings, 7 APPs, and 19 interns.

RESULTS: Residents had a mean of 3.1 evaluations. Overall, 65.5% of all item ratings were “Excellent,” 24.0% “Good,” 2.5% “Marginal,” 0.3% “Poor,” and 7.6% “Unable to assess,” resulting in a mean of 3.71 of 4. All 27 items demonstrated good fit with the MFRM. There was also good fit among rater roles with statistically significant differences in scores across groups (p < 0.001): attendings and interns assigned higher scores than APPs and senior residents. The model demonstrated strong reliability.

CONCLUSIONS: It is feasible to solicit structured MSF from surgical inpatient team members regarding senior resident leadership behaviors via the I-LEAD instrument. Differences in scores across rater roles emphasizes the value of soliciting input from team members with varying perspectives. Next steps are to create and assess the effectiveness of educational interventions to enhance specific resident leadership behaviors.

PMID:41162292 | DOI:10.1016/j.jsurg.2025.103755

J Surg Educ. 2025 Oct 28:103731. doi: 10.1016/j.jsurg.2025.103731. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore program-level variations in ACGME Milestone 2.0 ratings for Interpersonal & Communication Skills (ICS) and Professionalism (PROF) in general surgery residency programs.

DESIGN: Descriptive analysis of milestone 2.0 ratings using intraclass correlation coefficients (ICCs) to assess program-level variation at each PGY level across ICS and PROF sub-competencies. Wilcoxon Rank Sum tests were conducted to compare program sizes between uniform and nonuniform rating programs.

SETTING: General surgery residency programs across the United States during the 2020 to 2021 academic year.

PARTICIPANTS: About 7,581 residents in PGY1 through PGY5 from 328 general surgery residency programs.

RESULTS: Analysis of descriptive statistics highlighted considerable variation across programs. Analysis of ICC revealed that program-level differences contributed to 0.298 to 0.713 of the total variance in milestone ratings. ICCs were highest in PGY1 and PGY5 residents, suggesting stronger program influence at the start and end of residency. Uniform rating-where all residents at a given PGY level received the same rating-was common, particularly in PGY1 and PGY5, occurring in up to 41.2% of programs. Programs with uniform patterns tended to be smaller in size.

CONCLUSIONS: This study highlights substantial program-level variation in milestone ratings for ICS and PROF across all PGY levels in general surgery residency. High ICCs and uniform rating patterns suggest that milestone ratings may reflect institutional norms rather than resident performance. Future research should explore contributing factors and develop strategies to enhance fairness and quality in resident assessment.

PMID:41162291 | DOI:10.1016/j.jsurg.2025.103731