Category: Statistics

Matern Child Nutr. 2026 Jan;22(1):e70136. doi: 10.1111/mcn.70136.

ABSTRACT

Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women’s empowerment, defined through both fundamental capabilities and household decision-making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen’s capability approach and Kabeer’s empowerment framework, we examined the associations between two distinct dimensions of women’s empowerment and child stunting across Ethiopia’s diverse regions. We analyzed 18,466 mother-child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women’s empowerment and child stunting across Ethiopia’s 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women’s decision-making authority increased (mean score: 0.70-0.78), while capabilities remained stable (0.17- 0.16). Higher capabilities were significantly associated with lower odds of stunting (β = -0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision-making showed no association (β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision-making was observed (β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision-making. The study findings suggest that interventions should prioritize capability development through region-specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi-sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.

PMID:41316894 | DOI:10.1111/mcn.70136

Matern Child Nutr. 2026 Mar;22(1):e70146. doi: 10.1111/mcn.70146.

ABSTRACT

Maternal diet quality and perinatal depression significantly impact maternal and child health, yet their relationship remains underexplored in low-resource settings. This cross-sectional study examined the association between overall diet quality and risk of depression during the third trimester among 296 pregnant women receiving antenatal care at Dhulikhel Hospital, Nepal (August 2023-January 2024). Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with scores ≥ 12 indicating elevated symptoms. Diet quality was measured using an adapted Nepali version of the 23-item PrimeScreen questionnaire, generating a Prime Diet Quality Score (PDQS) ranging from 0 to 46. Multivariable logistic regression models were used to estimate the association between PDQS and depression risk, adjusting for age, education, ethnicity, occupation, parity, gestational week, physical activity, and pre-pregnancy BMI. The mean PDQS was 24.7 (SD = 3.1), and 22.3% of participants screened positive for depression. Each 1-point increase in PDQS was associated with 16% lower odds of depression (adjusted OR: 0.84; 95% CI: 0.70-0.90; p = 0.002). These findings suggest that higher overall diet quality is associated with a reduced likelihood of third trimester depression. Further longitudinal studies are warranted to assess causality and inform targeted nutritional interventions. If supported by further studies, incorporating brief dietary assessments like PrimeScreen into antenatal care may potentially offer a feasible strategy to identify women with suboptimal diet quality and co-occurring depressive symptoms in low- and middle-income countries.

PMID:41316875 | DOI:10.1111/mcn.70146

Mov Disord. 2025 Nov 29. doi: 10.1002/mds.70120. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate the efficacy of immediate-release (IR) amantadine in reducing the risk of peak-dose dyskinesia in early Parkinson’s disease (PD) as add-on to levodopa.

BACKGROUND: While the use of amantadine to manage dyskinesia in PD is well supported by controlled clinical trials, data on its efficacy in patients without motor complications remain limited.

METHODS: This 22-month, multicenter, randomized, placebo-controlled trial (NCT01538329) enrolled early PD patients on stable levodopa (≥150 mg/day for ≤1 year) without motor complications. The study included three double-blind phases: an 18-month treatment phase with adjunct amantadine-IR (200 mg/day) or placebo (Period 1), a 3-month delayed-start phase where all participants received amantadine-IR (Period 2), and a 1-month washout with placebo (Period 3). The primary outcome was dyskinesia incidence at month 18; secondary outcomes included dyskinesia rates at the end of Periods 2 and 3 to assess potential long-lasting mechanisms of the drug. Exploratory outcomes investigated the potential effects of amantadine-IR on motor and non-motor symptoms and quality of life.

RESULTS: A total of 207 patients were randomized to amantadine-IR (N = 99) or placebo (N = 108). Significantly fewer patients in the amantadine-IR group developed dyskinesia versus placebo during Period 1 (11% vs. 22%, P = 0.025), while the mean daily dose of levodopa (95% CI) increased by 70 (21-119) mg less (P = 0.005). The proportion of patients with dyskinesia was less in the amantadine-IR group versus placebo at the end of Periods 2 and 3, but the difference was not statistically significant (12% vs. 20%, P = 0.13 and 16% vs. 22%, P = 0.23, respectively). Mild but significant positive effects on freezing of gait, fatigue, and quality of life were observed during Period 1. The safety profile of amantadine-IR was in line with previous reports.

CONCLUSIONS: Adjunctive amantadine-IR in early PD halved dyskinesia incidence over 18 months. Long-lasting mechanisms could not be demonstrated and merit further investigation. Exploratory positive findings on the potential benefit of amantadine-IR on symptoms like freezing of gait and fatigue also call for further investigation. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:41316871 | DOI:10.1002/mds.70120

Anat Rec (Hoboken). 2025 Nov 29. doi: 10.1002/ar.70097. Online ahead of print.

ABSTRACT

As habitat salinity markedly differs between the endangered, freshwater-dwelling Saimaa ringed seal (Pusa saimensis Nordquist, 1899) and the brackish water-inhabiting Baltic ringed seal (Pusa hispida botnica Gmelin, 1788), we investigated whether this difference has resulted in morphological changes to their kidneys. We studied kidney anatomy using dissection, silicone casts, and standard histological methods. The Saimaa ringed seal had statistically significantly fewer reniculi than the Baltic ringed seal, and the mean number of reniculi was significantly smaller in both studied species than that previously reported from Arctic ringed seals (Pusa hispida hispida Schreber, 1775). We described four of the most common branching patterns of the renal artery. Contrary to previous findings in other ringed seal studies, we observed veins resembling arcuate and interlobar veins in histological sections of both species.

PMID:41316870 | DOI:10.1002/ar.70097

Biom J. 2025 Dec;67(6):e70100. doi: 10.1002/bimj.70100.

ABSTRACT

In this paper, some aspects concerning the causal interpretation of hazard contrasts are revisited. It is first investigated, in which sense the hazard ratio constitutes a causal effect. It is demonstrated that the hazard ratio at a timepoint $t$ represents a causal effect for the population at baseline, but in general not for any population at risk at time $t$ . Moreover, the scenario is studied, in which the survival curves coincide up to some timepoint $t$ and then separate. This investigation provides valuable insight both on the causal interpretation of the conventional hazard ratio and on properties of the recently proposed causal hazard ratio. The findings suggest that, without making further assumptions, there is in general no meaningful estimand for a treatment effect at time $t>0$ . It is therefore advocated to develop alternative estimands grounded in medically plausible assumptions about the joint distribution of counterfactual survival times.

PMID:41316856 | DOI:10.1002/bimj.70100

Curr Opin Psychiatry. 2025 Nov 28. doi: 10.1097/YCO.0000000000001056. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Accurate dementia risk prediction is critical for prevention, yet it remains unclear which predictors add meaningful value beyond chronological age. This review evaluates the extent to which multivariable dementia risk models identify modifiable risk factors that enhance prediction value.

RECENT FINDINGS: We systematically reviewed cohort studies reporting both age-only and multivariable dementia prediction models in the same populations. Six age-only models across five cohorts were included. Age-only models achieved poor to good discrimination (C-statistics 0.66-0.84). Adding modifiable cardiovascular and lifestyle factors provided consistent, modest improvements of 0.02-0.05 in the UK Biobank, Atherosclerosis Risk in Communities (ARIC), and Rotterdam cohorts. Larger improvements of 0.07-0.12 were observed in models including cognitive testing or genetic factors [e.g., UK Biobank Dementia Risk Score (UKBDRS-APOE)] with the Hanley-McNeil z-test confirming the improvements were significant, indicating genuine improvement rather than random variation.

SUMMARY: While age is a significant risk factor for dementia, modifiable cardiovascular and lifestyle factors provide incremental predictive value beyond age and represent actionable targets for prevention. Despite modest statistical improvements, these factors offer the most clinically relevant targets for prevention strategies. Future efforts should prioritise interventions addressing these modifiable determinants to reduce dementia risk across populations.

PMID:41316844 | DOI:10.1097/YCO.0000000000001056

Expert Rev Hematol. 2025 Nov 29. doi: 10.1080/17474086.2025.2597360. Online ahead of print.

ABSTRACT

BACKGROUND: Pain is the most prevalent and debilitating symptom of sickle cell disease (SCD). However, there is a paucity of community-based, longitudinal data from low- and middle-income countries. This study is to systematically document phenotypic details of SCD-related pain in a cohort through a prospective, year-long study in underserved regions of five Indian states.

RESEARCH DESIGN AND METHODS: Individuals with SCD were monitored prospectively for 24 fortnights. Pain-related data, including episode frequency, intensity, anatomical distribution, quality descriptors, and patterns, were collected. Statistical analyses comprised descriptive statistics, tests of significance and the Jonckheere – Terpstra trend test, etc.

RESULTS: Across 6,048 visits to 252 patients, 2,042 pain episodes were reported, with 86.1% of patients experiencing at least one episode. Pain most frequently affected the lower legs and calves, with significantly higher rates among females (p < 0.001). Continuous and rhythmic pain patterns were associated with severe pain (p < 0.001). Sensory descriptors were more prevalent among high-intensity cases, suggesting neuropathic components.

CONCLUSION: This is the first Indian community-based longitudinal study revealing a significant prevalence of unreported pain and phenotypic variability. It contributes to the development of region-specific pain management frameworks by considering chronicity, gender, and sociocultural expressions of pain.

PMID:41316843 | DOI:10.1080/17474086.2025.2597360

Phys Sportsmed. 2025 Nov 29. doi: 10.1080/00913847.2025.2597177. Online ahead of print.

ABSTRACT

OBJECTIVES: Ultrasonography is a widely accepted imaging method for evaluating anatomical structures around the shoulder joint. However, the consistency of measurements across different devices and operators remains a critical issue for clinical and research validity. The aim of this study is to assess the inter-device and intra-operator reliability of ultrasound-based measurements of four key anatomical shoulder distances and to establish normative reference values in a healthy population.

METHODS: A total of 195 healthy volunteers (390 shoulders) underwent ultrasonographic evaluation of the acromioclavicular distance (AC), coracoclavicular distance (CC), acromiohumeral distance (AH), and coracohumeral distance (CH). Two physicians, TC (radiologist) and GB (sports medicine), performed the measurements independently using two different ultrasound machines: Siemens S3000 and C10X, respectively. To assess intra-rater temporal reliability, all measurements were repeated on the same participants after two weeks. Stratified sex-matched randomization was applied during participant recruitment.

RESULTS: AC, AH, and CH ultrasound measurements showed intra- and inter-rater reliability with minimal bias and acceptable limits of agreement, indicating good consistency and interchangeability. In contrast, CC measurements exhibited significant inter-rater differences (p = 0.034 and p = 0.023) and wide limits of agreement, reflecting greater variability and limited interchangeability.

CONCLUSION: Given their consistent performance across statistical methods, AC, AH, and CH measurements may be used interchangeably across different raters or sessions, particularly in clinical or research settings where reliable reproducibility is essential. However, due to its high inter-rater variability and broad limits of agreement, CC measurements are not recommended for interchangeable use between evaluators or devices.

PMID:41316842 | DOI:10.1080/00913847.2025.2597177

Appl Psychol Health Well Being. 2025 Dec;17(6):e70086. doi: 10.1111/aphw.70086.

ABSTRACT

Physical activity can improve mental health by improving mood and by lowering depressive symptoms. This systematic review uses a structured narrative synthesis to summarise within-person associations between physical activity and affect in naturalistic settings, and how these associations may differ by level of depressive symptomatology. We also reviewed the methodological choices that could influence these outcomes and provide a methodological roadmap as a recommendation for future studies. A systematic review was conducted up to December 2024 of studies that addressed within-person associations between daily physical activity and affect using ambulatory assessment techniques in individuals aged 4-65 years and assessed depressive symptoms. Our selection yielded 32 eligible studies. A consistent finding was the positive within-person association between physical activity and concurrent or subsequent positive affect, while results were mixed for negative affect. Results were further inconclusive regarding the role of depression in this relationship. Common challenges affecting replicability include an often-inadequate assessment of measurement reliability and validity, and insufficient controls for relevant (contextual) factors in these analyses, such as the length of the time-lag and mode of physical activity. Future studies should employ emerging best practices regarding study design, analysis and reporting of ambulatory assessment data. Such rigorous research practice will strengthen our understanding of these relationships and further inform more effective, personalised physical activity interventions to improve mood and depressive symptoms.

PMID:41316836 | DOI:10.1111/aphw.70086

Clin Chem Lab Med. 2025 Dec 1. doi: 10.1515/cclm-2025-0179. Online ahead of print.

ABSTRACT

OBJECTIVES: Dehydroepiandrosterone sulfate (DHEAS), the sulfate ester of dehydroepiandrosterone, is one of the most common steroid hormones in the human body and the precursor of several other androgens. It is primarily used as a diagnostic or prognostic indicator in adrenal and reproductive disorders. Present immunoassays for DHEAS lack sensitivity and specificity, being vulnerable to cross-reactivity with endogenous interferences. Therefore, an isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure (RMP) was developed to quantify DHEAS in human serum/plasma.

METHODS: We ensured traceability to the International System of Units by using quantitative nuclear magnetic resonance to characterize a commercially available DHEAS reference material used for assay calibration. To mitigate matrix effects and prevent interference co-elution, a two-dimensional heart-cut LC method was employed for LC-MS/MS, in combination with a solid phase extraction sample preparation protocol. Selectivity was determined by spiking the prepared internal standard with the interferences testosterone, epi-testosterone, dehydroepiandrosterone, 5α-dihydrotestosterone, and estrone, in analyte free matrix. A post-column infusion experiment and comparison of standard line slopes were performed to evaluate matrix effects. Precision and accuracy were assessed via a multi-day validation experiment, and variability components estimated using analysis of variance-based variance-components analysis. Measurement uncertainty (MU) was evaluated in compliance with current guidelines.

RESULTS: This RMP was suitable for analyzing DHEAS within the 0.800 to 8,400 ng/mL (2.17-22,800 nmol/L) range, demonstrating selectivity, sensitivity, and matrix-independence. Trueness and accuracy assessment revealed a relative bias (n=6) between -1.9 and 0.3 % for surrogate matrix samples (except for 5.9 % at the lowest level), -2.3 to 3.6 % for Li-heparin plasma samples and sample dilutions, and an overall bias between 0.7 and 1.8 % (n=60), indicating no statistically significant bias. The measurement process resulted in standard measurement uncertainties (MUs) ranging from 4.0 to 5.6 % for the low range and 3.5-4.2 % for the high range. At a 95 % confidence level (k=2), these uncertainties expanded to 7.9-11.1 % and 7.1-8.3 %, respectively. Reference values, determined from six measurements over multiple days (n=6), had standard MUs between 1.6 and 2.1 % for the low range and 0.9-1.7 % for the high range, with expanded MUs of 3.2-4.3 % and 1.9-3.5 %.

CONCLUSIONS: This RMP exhibited high analytical performance for DHEAS quantification and met requirements for measurement uncertainty. Additionally, it enabled differentiation between the DHEAS and other androgens. Consequently, this RMP is suitable for routine assay standardization and clinical sample evaluation.

PMID:41316814 | DOI:10.1515/cclm-2025-0179