Category: Statistics

Eur J Med Res. 2025 Dec 11. doi: 10.1186/s40001-025-03599-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a nomogram-based risk prediction model utilizing patients’ clinical characteristics for post-endoscopic submucosal dissection hemorrhage, and to evaluate its clinical utility.

METHODS: A total of 250 patients who developed postprocedural hemorrhage after endoscopic submucosal dissection (ESD) for gastrointestinal tumors at our institution (2022-2024) were enrolled. Enrichment criteria included at least one high-risk factor for complications (e.g., lesion size > 10 mm, antithrombotic medication use, or comorbid diabetes/hypertension) or early post-ESD symptoms suggestive of complications. Patients were randomly divided into a training set (n = 175) and a validation set (n = 75) at a 7:3 ratio. In the training set, multivariate logistic regression identified independent prognostic risk factors to construct the nomogram. Model performance was assessed via receiver operating characteristic (ROC) curves and calibration plots, with external validation performed in the validation set.

RESULTS: Hemorrhage occurred in 70/175 cases (40.00%) in the training set and 28/75 (37.33%) in the validation set, with no statistically significant intergroup differences in incidence or baseline characteristics (P > 0.05). Univariate analysis revealed significant disparities between hemorrhage and non-hemorrhage groups in age, hemoglobin, white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen (P < 0.05). Multivariate analysis confirmed age, hemoglobin, white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen were independent risk factors (P < 0.05). The nomogram demonstrated C-index were 0.861 and 0.841 (validation), and mean absolute errors were 0.151 and 0.171, respectively. AUC values were 0.849 (95% CI 0.778-0.920) and 0.824 (95% CI 0.707-0.941), indicating high predictive accuracy.

CONCLUSIONS: The clinical feature-based nomogram exhibits good predictive performance and reliability in both training and validation cohorts, serving as a valuable tool for prognostic evaluation in gastrointestinal tumor patients who experience post-ESD hemorrhage.

PMID:41382183 | DOI:10.1186/s40001-025-03599-9

BMC Psychol. 2025 Dec 11. doi: 10.1186/s40359-025-03808-4. Online ahead of print.

ABSTRACT

BACKGROUND: In today’s volatile, uncertain, complex and ambiguous (VUCA) environment, organizations expect employees to change from passively accepting task requests to actively pursuing improvement. Feedback-seeking behavior has gained widespread attention. The study aims to adopt Conservation of Resources Theory to examine the influence mechanism and boundary condition of performance pressure and time pressure on employee feedback-seeking behavior.

METHODS: To investigate the mediating role of work rumination and the moderating role of competitive climate on the relationship between performance pressure, time pressure and employee feedback-seeking behavior, data were collected from 410 Chinese employees through a two-wave survey distributed via WJX.cn. Statistical analyses were performed with Spss 26, Amos 26 and Process 4.0.

RESULTS: The findings indicate that work rumination mediates the relationship between performance pressure, time pressure and employee feedback-seeking behavior. The impact of performance pressure is stronger than that of time pressure. Competitive climate positively moderates the indirect influence of performance pressure and time pressure on employee feedback-seeking behavior through work rumination.

CONCLUSION: The study deepens the understanding of how diverse workplace stressors shape employees’ feedback-seeking behavior. Particularly in competitive work environments, organizations can foster a culture of healthy competition by implementing well-designed performance requirements and reasonable time expectations, thereby motivating employees to transform work pressures into proactive feedback-seeking for professional growth.

PMID:41382169 | DOI:10.1186/s40359-025-03808-4

J Surg Res. 2025 Dec 10;317:173-180. doi: 10.1016/j.jss.2025.11.018. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric gunshot wounds to the head (GSWH) are among the most devastating injuries, with mortality rates ranging from 20% to 65%. Prognostic tools such as the St. Louis Score (SLS) and Rotterdam computed tomography (CT) Score have been studied, but data specific to pediatric populations are limited. This study aimed to identify factors predictive of mortality and functional outcomes in pediatric GSWH and evaluate the predictive accuracy of existing scoring systems.

METHODS: We retrospectively reviewed all 14 pediatric patients (≤18 y old) with GSWH at an urban, level 1 trauma center between 2010 and 2023. Patient demographics, injury characteristics, imaging findings, and outcomes were analyzed. Predictive tools were evaluated using receiver operator curve analysis, and statistical comparisons were conducted between survivors and nonsurvivors and between favorable (Glasgow Outcome Score ≥ 4) and unfavorable outcomes.

RESULTS: The overall mortality rate was 65%. Survivors had significantly higher admission Glasgow Coma Scale (11 versus 4, P = 0.008), lower international normalized ratio (1.1 versus 1.7, P = 0.015), lower serum glucose (138 versus 225, P = 0.021), and lower Rotterdam CT Scores (3 versus 5, P = 0.038). SLS and Rotterdam CT Score demonstrated poor predictive accuracy for mortality.

CONCLUSIONS: Survivors of pediatric GSWH exhibited distinct clinical and laboratory profiles on admission, including higher Glasgow Coma Scale and lower international normalized ratio and glucose levels. While the Rotterdam CT Score performed better than the SLS, both prognostic tools were suboptimal to predict favorable outcomes for this cohort. Larger studies are needed to refine predictive models and improve management strategies in pediatric GSWH.

PMID:41380225 | DOI:10.1016/j.jss.2025.11.018

Sleep Med. 2025 Dec 6;138:108708. doi: 10.1016/j.sleep.2025.108708. Online ahead of print.

ABSTRACT

Although sodium-glucose transporter 2 inhibitors (SGLT2is) are recommended medications for the treatment of type 2 diabetes mellitus (T2DM), conclusive evidence suggesting that they could alleviate the common complication of obstructive sleep apnea (OSA) in T2DM is lacking at present. Our objective is to systematically summarize the clinical evidence of SGLT2is for OSA in patients with T2DM by searching 12 databases and registers from the establishment to July 25, 2025. We included randomized controlled trials (RCTs) and non-randomized studies evaluating the use of SGLT2is for OSA in participants with T2DM. This analysis was registered on the PROSPERO website (CRD42024576637) and performed in accordance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data were extracted by two investigators separately, and the meta-analysis of sleep-disordered breathing parameters, metabolic parameters, and adverse events outcomes was conducted using Review Manager 5.4 and Stata 15.0. Nine studies, including six RCTs and three non-RCTs, were included. The results demonstrated that the efficacy of SGLT2is in reducing the apnea-hypopnea index (AHI) (mean difference [MD] = -12.57, 95 % confidence interval [CI]: [-21.47, -3.66], P = 0.006, I² = 87 %) and increasing the lowest oxygen saturation (lowest SpO₂) was superior to that of the control interventions with other hypoglycemic drugs. Patients with T2DM showed a 50 % relative risk reduction for incident OSA when receiving SGLT2is in comparison with placebo. Furthermore, the adverse event rate in the SGLT2i group was comparable to that in the control group. Considering of the risk reduction for incident OSA and the enhanced metabolic parameters observed with SGLT2i administration, these drugs may be recommended as useful medication for the management of T2DM and OSA. However, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments rated the evidence quality as low to moderate because of inconsistency and indirectness. Given the weak strength of the evidence, further trials with sufficient statistical power are still needed to confirm efficacy and safety.

PMID:41380220 | DOI:10.1016/j.sleep.2025.108708

Burns. 2025 Dec 3;52(1):107819. doi: 10.1016/j.burns.2025.107819. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertrophic scarring (HTS) is a major concern after burns. While conservative therapy is standard for superficial partial thickness burns and debridement for deep burns, the optimal treatment for intermediate depth burns remains unclear. This retrospective study assesses whether enzymatic debridement with Nexobrid® (EDNX) can reduce HTS in intermediate depth burns.

METHODS: Patients with intermediate depth burns (healing potential (HP) 14-21 days), assessed by laser Doppler imaging (LDI), were retrospectively analysed for HTS following conservative therapy or EDNX. Regions of interest (ROIs) were analysed for flux values, surface area, and wound closure time. HTS within ROIs was evaluated at 3-6, 6-12, and 12-24 months post-injury, independently by two burn specialists.

RESULTS: In total, 87 ROIs were analyzed in 62 patients, with 44 ROIs treated conservatively and 43 ROIs treated with EDNX. HTS was still present after 12 months in 13.6 % (6/44) of ROIs in the conservative group and 9.3 % (4/43) in the EDNX group, showing no statistically significant difference between the two groups (p = 0.186). The conservative group and EDNX group were comparable, with no statistically significant difference in flux values (346.41 ± 22.90 vs. 340.19 ± 20.75, p = 0.275) or wound closure time (22.70 ± 7.90 vs. 23.42 ± 7.47, p = 0.862). A statistically significant correlation was found between HTS formation and wound closure time (p = 0.001); however, no significant correlation was observed between HTS formation and flux values (p = 0.262).

CONCLUSION: The overall incidence of HTS after scar maturation was low in both the conservative group (13.6 %) and in the EDNX group (9.3 %). A small, but in significant difference was observed in HTS prevalence between intermediate depth burns treated conservatively and those treated with EDNX. These findings support conservative management through local wound care as the preferred approach for intermediate depth burns.

PMID:41380209 | DOI:10.1016/j.burns.2025.107819

Drug Alcohol Depend. 2025 Dec 5;278:112995. doi: 10.1016/j.drugalcdep.2025.112995. Online ahead of print.

ABSTRACT

BACKGROUND: Primary care settings tailored for persons with experience of homelessness (PEH) could enhance opioid use disorder treatment delivery, but evidence is lacking.

OBJECTIVE: To examine medication treatment for opioid use disorder (MOUD) among PEH who received homeless-tailored primary care in the Department of Veterans Affairs (VA).

METHODS: Receipt of MOUD was assessed from electronic health records among VA primary care patients with experience of homelessness and OUD in 2016-2020. We estimated the proportion who received MOUD over time and applied mixed effect Poisson models with entropy balance weighting to estimate differences in MOUD by primary care type (homeless-tailored vs. mainstream). Secondary analyses examined the consistency of findings across 18VA service regions.

FINDINGS: The percentage of eligible PEH (n = 45,864) receiving any MOUD rose from 42.1 % to 51.0 % over time. Half (51.3 %) of those initiating MOUD received > 30 days MOUD over one year. In unadjusted models, the proportion receiving MOUD was slightly higher in homeless-tailored primary care, compared to mainstream primary care (48.8 % vs 46.4 %, Unadjusted Incidence Rate Ratio=1.09, 95 % CI=1.03-1.16). After covariate adjustment, there was no statistical difference between groups (Adjusted IRR=0.97, CI=0.92-1.02). This proved broadly consistent across VA service regions.

CONCLUSIONS: Concomitant with a national VA initiative to tailor primary care services for PEH, half of diagnosed patients received MOUD. Yet evidence of durable treatment was low, and the homeless-tailored clinics did not outperform mainstream clinics. Efforts to tailor primary care for PEH may require specialized addiction staffing and implementation support to improve MOUD care in these settings.

PMID:41380198 | DOI:10.1016/j.drugalcdep.2025.112995

Appl Radiat Isot. 2025 Dec 8;229:112372. doi: 10.1016/j.apradiso.2025.112372. Online ahead of print.

ABSTRACT

BACKGROUND: Medical imaging is a major source of ionizing radiation exposure in healthcare. Effective radiation protection relies not only on facility design but also on healthcare staff knowledge, attitudes, and practices (KAP).

OBJECTIVE: To evaluate KAP related to radiation protection among staff at two nuclear medicine facilities such as Facility A and Facility B in Addis Ababa, Ethiopia, and assess relationships with occupational exposure and facility design.

METHODS: A cross-sectional study was conducted among 28 personnel using structured questionnaires, checklists, and interviews. KAP scores were calculated, with thresholds for satisfactory performance defined as ≥67 % for knowledge, attitude (corrected for misconceptions), and practice. Occupational doses were measured and compared with ICRP limits.

RESULTS: Eighty-five point seven percent of participants demonstrated satisfactory knowledge, while only 64.3 % had a good attitude after correcting misconceptions, such as the incorrect belief that dosimeters prevent all radiation. Seventy-five percent of personnel followed adequate radiation protection practices. The mean annual occupational dose was 0.33 ± 0.13 mSv, significantly below the ICRP limit of 20 mSv/year, indicating low actual exposure despite some gaps in understanding. Although education and occupation influenced practice, no statistically significant associations were found with overall knowledge, attitude, and practice (KAP) scores.

CONCLUSION: While personnel show adequate knowledge and practice, critical misconceptions about dosimeter function remain. Continuous training and education are necessary to correct these misconceptions. Occupational exposure levels are low, but improved safety culture and awareness are needed to maintain long-term protection. Future research should explore correlations between individual KAP scores and dose readings.

PMID:41380183 | DOI:10.1016/j.apradiso.2025.112372

J Acquir Immune Defic Syndr. 2026 Jan 1;101(1):95-102. doi: 10.1097/QAI.0000000000003765.

ABSTRACT

OBJECTIVE: To examine the association between mild kidney disease and coronary plaque parameters using coronary computed tomography angiography in people living with HIV (PWH) compared with people without HIV in Uganda.

DESIGN: Cross-sectional secondary analysis.

METHODS: We studied 165 participants aged >45 years with ≥1 cardiovascular risk factor (78 PWH on stable antiretroviral therapy, 87 HIV-negative). Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). Coronary artery disease (CAD) was characterized by segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium score. Multivariable Tobit regression assessed associations of kidney function measures with CAD parameters, testing for differences by HIV status.

RESULTS: The median (interquartile range) age was 57.0 (53-62) years, 62.4% of subjects were female, and 87.3% had hypertension. Among PWH, mildly impaired eGFR (<90 mL/min/1.73 m2) was associated with higher SIS [β 3.31, 95% confidence interval (CI): 0.41 to 6.21, P = 0.03] and SSS (β 5.95, 95% CI: 0.54 to 11.36, P = 0.03). The association with SIS remained significant after adjusting for age, gender, and 10-year ASCVD score (β 2.58, 95% CI: 0.10 to 5.06, P = 0.04). Associations of ACR with coronary plaque were not statistically significant for participants with or without HIV (all P > 0.07).

CONCLUSION: In PWH, mildly reduced eGFR was associated with greater coronary plaque burden (SIS, SSS) but not coronary artery calcium; ACR showed no associations with any CAD measures. Incorporating kidney function measures into cardiovascular risk assessment may be valuable in HIV care.

PMID:41380171 | DOI:10.1097/QAI.0000000000003765

J Addict Nurs. 2025 Dec 5. doi: 10.1097/JAN.0000000000000686. Online ahead of print.

ABSTRACT

BACKGROUND: Stigma is a key barrier to accessing or receiving substance use services. Those with substance use disorders (SUD) who seek health care services experience stigmatizing attitudes and behaviors from health care providers, including nurses. Integrating substance use-related content into core courses for advanced practice nursing students may help reduce stigma and prepare them to assist patients with SUDs across various specialties where advanced practice nurses work. This exploratory descriptive study assessed advanced practice nursing students’ attitudes and stigma perceptions related to caring for people with alcohol and drug use.

METHOD: An online survey was used to obtain demographic information and responses to three established measures focusing on substance use-related attitudes, perceptions, and stigma. Data were collected from students (baseline group) scheduled to take core required “3P” courses (Physical Assessment, Pathophysiology, and Pharmacotherapy) into which enhanced substance use-related content was infused. A separate group (postcourse) completed the measures after the enhanced courses. Descriptive statistics were obtained for demographic data, and means and standard deviations were calculated for subscales and total scores of the Person-Centered Drug and Drug Problems Perception Questionnaire, the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire, and the Opening Minds Scale to examine differences before and after the enhanced content.

RESULTS: Eleven students completed the baseline survey and 12 completed the postcourse survey. Although statistical comparison was not possible, postcourse responses reflected more favorable attitudes toward people with SUD.

CONCLUSION: The more favorable attitudes following the 3P courses are promising. Future research should use more rigorous pre-post or longitudinal designs.

PMID:41380164 | DOI:10.1097/JAN.0000000000000686

Obstet Gynecol. 2025 Dec 11. doi: 10.1097/AOG.0000000000006147. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine preferences for human papillomavirus (HPV) specimen self-collection, and collection location, in a nationally representative sample of reproductive-aged women in the United States.

METHODS: This cross-sectional analysis used household population-based data from the National Survey of Family Growth (January 2022-December 2023) and was limited to women aged 21-49 years without a history of hysterectomy or cervical cancer (sample n=4,465). Survey weights and design variables were applied to generate nationally representative population frequencies and percentages of preference for HPV self-collection compared with clinician collection, and preference for collection location (ie, at home or in office).

RESULTS: Among eligible U.S. women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% expressed no preference. An estimated 41.7 million (71.5%) U.S. women aged 21-49 years were open to HPV self-collection (either preferring it or having no preference), including 9.7 million women who were underscreened or never screened. Among women who were open to HPV self-collection, more than half (52.1%) preferred self-collection at home, 14.7% preferred to do self-collection in a doctor’s office, and 33.2% had no preference for location. More underscreened or never-screened women preferred HPV self-collection (54.0%) and at-home collection (59.3%) compared with those who were up to date with screening (40.3% and 50.2%, respectively, P<.001). Preference for self-collection also varied by race and Hispanic origin, education, income, parity, sexual orientation, and prior experience of nonvoluntary vaginal intercourse.

CONCLUSION: In this nationally representative study, more than 7 in 10 U.S. women aged 21-49 years were open to HPV self-collection for cervical cancer screening, with more than half favoring at-home collection. Preference was higher among women who were not up to date with screening. These findings provide timely evidence to inform future policy decisions and implementation strategies to improve access to cervical cancer screening.

PMID:41380156 | DOI:10.1097/AOG.0000000000006147