Category: Statistics

Adv Neonatal Care. 2025 Sep 10. doi: 10.1097/ANC.0000000000001297. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal anxiety and self-efficacy may significantly impact breastfeeding success. Understanding the relationship between these psychological factors and breastfeeding outcomes can help develop targeted interventions to support mothers in the neonatal intensive care unit (NICU).

PURPOSE: This study aimed to evaluate the relationship between breastfeeding self-efficacy and anxiety levels on the success of breastfeeding among mothers with infants staying in the NICU.

METHODS: A descriptive and cross-sectional study was conducted in a private hospital from May 2018 to February 2019 in Turkey. The inclusion criteria for the study were as follows: mothers over 18 years old who had a live birth at 34 weeks or above without any breastfeeding hindrances such as cleft lip or palate and infants who were not discharged within the first 24 hours after birth, had no congenital anomalies, and did not undergo any surgical procedures. Data were collected with the Breastfeeding Self-Efficacy Scale and the State-Trait and Anxiety Inventory. LATCH Breastfeeding Assessment Tool was used as a measure of breastfeeding success.

RESULTS: The study involved 83 mothers and 83 infants. Breastfeeding self-efficacy had a statistically significant relationship on maternal success in terms of breastfeeding the infant for the first time (P< .001) and 24 hours after the initial feeding (P< .001). However, state and trait anxiety had no statistically significant effect on breastfeeding success (P> .05).

IMPLICATIONS FOR PRACTICE AND RESEARCH: Interventions should be planned to increase maternal feelings of breastfeeding self-efficacy to support breastfeeding by the hospital staff to ensure success in the immediate postnatal period.

PMID:40938589 | DOI:10.1097/ANC.0000000000001297

Vascular. 2025 Sep 12:17085381251379846. doi: 10.1177/17085381251379846. Online ahead of print.

ABSTRACT

ObjectivesRuptured abdominal aortic aneurysm (RAAA) is a life-threatening vascular emergency with high mortality rate despite advances in surgical and endovascular techniques. This study evaluates the impact of internal iliac artery interventions on short-term (30-day) and long-term (up to 6564 days) mortality and intestinal ischemia in patients undergoing endovascular aneurysm repair (EVAR) for RAAA.MethodsA retrospective analysis of 4274 patients who underwent emergent EVAR for RAAA between 2004 and 2022 was conducted using the Vascular Quality Initiative (VQI) database. Patients were stratified into four groups based on the type of internal iliac intervention: no intervention, revascularization of at least one internal iliac artery, occlusion of both internal iliac arteries, and occlusion of one internal iliac artery. Mortality and intestinal ischemic outcomes were compared using chi-square tests, and logistic regression models were used to identify significant predictors.ResultsNo statistically significant differences in short-term (p = .5638) or long-term mortality (p = .5776) were observed between groups. Group 3 (occlusion of both internal iliac arteries) had the highest rates of intestinal ischemia (11.36%) and 30-day mortality (31.11%), though these differences were not statistically significant. Intestinal ischemia increased the odds of long-term mortality by 2.82 times (p < .001). Advanced age and preoperative creatinine levels were strong predictors of mortality: each additional year of age increased the odds of death by 7% (p < .0001), and the presence of COPD raised the odds of long-term mortality by 51% (p < .001). Prolonged procedure time and blood loss were also associated with higher risks of both long-term mortality and intestinal ischemia.ConclusionsThe type of internal iliac intervention did not significantly affect short-term or long-term mortality, but mitigating intraoperative factors such as prolonged procedure time and excessive blood loss is critical for improving short-term survival and reducing the risk of intestinal ischemia. Managing chronic conditions like COPD and optimizing renal function are essential to improving long-term outcomes, especially in high-risk patients with advanced age and systemic disease.

PMID:40938585 | DOI:10.1177/17085381251379846

Environ Sci Pollut Res Int. 2025 Sep 12. doi: 10.1007/s11356-025-36928-w. Online ahead of print.

ABSTRACT

The overarching goals of this work is to explore best practices for micro-scale modeling of a real case, identify relevant phenomena by using high-resolution modeling, and to explore their implications for public health, and climate resilience strategies in Hampton Roads, VA, USA. This project employs the Weather Research and Forecasting (WRF) model to conduct a comprehensive study of Hampton Roads, utilizing a coupled mesoscale to microscale modeling capable of resolving boundary layer turbulence. This study has three primary objectives: (1) to establish the optimal mesoscale to Large-Eddy Simulation (LES) configurations for complex geographical regions such as the Hampton Roads (HR) domain and address challenges inherent to multi-scale modeling; (2) as a demonstration, to identify extreme heat episodes and urban heat islands within the study area; and (3) to explore the correlation between these heat islands and the socio-economic characteristics of HR neighborhoods. Model performance was evaluated using observational data, applying standard statistical metrics such as correlation coefficient, mean bias, and root mean square error to select the most realistic model configuration. Similar statistical methods were used to assess the relationship between heat exposure and socio-economic factors. We also introduce a new metric, cooling energy demand, to quantify the potential economic burden of extreme heat. The Results show that lower-income communities are disproportionately exposed to higher heat levels and face greater cooling energy demands compared to rural areas. In addition, through extensive testing, we identified the cell-perturbation method as an effective approach for producing physically realistic LES simulations validated against observations. Future work will extend this approach to neighborhood-scale air quality modeling to develop a more comprehensive understanding of environmental stressors and support targeted climate resilience strategies for vulnerable communities.

PMID:40938554 | DOI:10.1007/s11356-025-36928-w

Cardiovasc Drugs Ther. 2025 Sep 12. doi: 10.1007/s10557-025-07757-3. Online ahead of print.

ABSTRACT

PURPOSE: To compare the effectiveness of tirzepatide (a dual GLP-1/GIP receptor agonist) versus semaglutide (a GLP-1 receptor agonist) in improving postoperative outcomes among patients with type 2 diabetes mellitus (T2DM) undergoing coronary artery bypass grafting (CABG).

METHODS: We conducted a retrospective analysis using the TriNetX global research network, identifying 226,742 adults with T2DM who underwent isolated CABG between 2022 and 2024. Among these, 3,669 received tirzepatide and 19,521 received semaglutide. After 1:1 propensity score matching, 3,667 matched pairs were analyzed. Primary outcomes included cerebrovascular and cardiovascular events, postoperative complications, healthcare utilization, and all-cause mortality, assessed at 6-month and 3-year intervals. P-values were adjusted for multiple testing using the Benjamini-Hochberg procedure.

RESULTS: Tirzepatide was associated with significantly lower risks of cerebrovascular events at both follow-up points, including reduced incidence of cerebrovascular disease (11.8% vs. 17.5%; HR = 0.831), cerebral infarction (4.6% vs. 7.3%; HR = 0.788), and cerebral occlusion without infarction (6.8% vs. 10.4%; HR = 0.838)-all of which remained statistically significant after multiple comparison correction (adjusted p = 0.0024). Cardiovascular outcomes also favored tirzepatide, with significant reductions in major adverse cardiovascular events (MACE) (39.7% vs. 49.5%; HR = 0.911), myocardial infarction (7.0% vs. 10.8%; HR = 0.838), and acute coronary disease (1.1% vs 2.3%; HR = 0.691); several of these remained significant after correction at both timepoints. While tirzepatide was associated with lower rates of surgical site infection, venous thrombosis, and CABG-specific complications, only venous thrombosis remained statistically significant after adjustment (adjusted p = 0.021). Additionally, tirzepatide users had reduced healthcare utilization and lower all-cause mortality, with 3-year readmission (16.4% vs. 23.4%; HR = 0.871) and mortality (1.9% vs. 4.7%; HR = 0.595) both remaining significant after adjustment (adjusted p = 0.002). Kaplan-Meier analysis confirmed sustained survival benefit.

CONCLUSION: In patients with T2DM undergoing CABG, tirzepatide was associated with improved cerebrovascular and cardiovascular outcomes, reduced venous thrombotic complications, and lower long-term mortality and healthcare utilization compared to semaglutide. These findings support the therapeutic potential of dual GLP-1/GIP receptor agonism in high-risk post-CABG populations.

PMID:40938549 | DOI:10.1007/s10557-025-07757-3

Indian J Gastroenterol. 2025 Sep 12. doi: 10.1007/s12664-025-01849-6. Online ahead of print.

ABSTRACT

BACKGROUND: Acute pancreatitis (AP) is a common gastrointestinal emergency with variable clinical course. Early identification of severe AP (SAP) is crucial for optimizing patient management. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has been implicated in various metabolic disorders, but its role in predicting AP severity remains underexplored.

METHODS: In this single-center, prospective study, 138 patients diagnosed with AP were enrolled between January 2022 and December 2024. The severity of AP was classified as per the Revised Atlanta Classification. TyG index was calculated at admission and compared with established severity scores, including the computed tomography severity index (CTSI) and bedside index of severe acute pancreatitis (BISAP). Statistical analyses were performed to assess the correlation of TyG index with disease severity, hospital stay, intensive care unit (ICU) admission and mortality.

RESULTS: Among the enrolled patients, 17% developed SAP. The mean TyG index was significantly higher in the SAP group compared to the non-SAP group (5.01 ± 0.33 vs. 4.69 ± 0.22, p < 0.001). Higher TyG index values correlated with prolonged hospital stay (p = 0.009), increased ICU admissions (p < 0.001) and greater mortality (p = 0.004). The predictive accuracy of the TyG index for SAP, as assessed by the area under the curve (AUC), was 0.902, higher than BISAP 0.696 and CTSI 0.751.

CONCLUSION: The TyG index is a simple and accessible biomarker that correlates with AP severity and prognosis. Its predictive value is higher than BISAP and CTSI.

PMID:40938547 | DOI:10.1007/s12664-025-01849-6

Med Biol Eng Comput. 2025 Sep 12. doi: 10.1007/s11517-025-03424-9. Online ahead of print.

ABSTRACT

Middle-aged people generally experience greater work pressure but higher health risks. However, the existing EEG-based cognitive load monitoring research has paid less attention to this segment of the population. We investigated high temporal resolution decoding of cognitive load from EEG signals in middle-aged individuals during inhibition and updating tasks. In this paper, we employed publicly available EEG data from Multi-Source Interference Task (MSIT) and Sternberg Memory Task (STMT) paradigms to examine variations in brain activation modes and cognitive load under low and high cognitive demands. This analysis was conducted using time courses of event-related potential (ERP) scalp maps. To validate the effect of the method, we conducted multivariate pattern recognition and statistics analysis. The point-by-point classification accuracy sequences obtained from decoding were assessed for significance above chance levels using one-tailed t-tests, with corrections for multiple comparisons made via the false discovery rate (FDR) method. After comparative analysis, we found that the decoder was more effective in categorizing different tasks, while the MSIT was better than STMT’s in categorizing cognitive loads. In addition, we also analyzed the spatio-temporal properties of brain activation under different conditions, which is instrumental in developing more powerful classifiers. Additionally, group-level statistical comparisons were performed to explore how AD risk may influence cognitive load decodings. The study results show that this program is feasible and can be used in the future to monitor the workload of high-risk job operators in real time and longitudinal observation in medical diagnostics.

PMID:40938543 | DOI:10.1007/s11517-025-03424-9

Arch Osteoporos. 2025 Sep 12;20(1):125. doi: 10.1007/s11657-025-01606-4.

ABSTRACT

This retrospective cohort found that osteoporosis (defined by T-score) or FRAX score is linked to a higher risk of non-fatal stroke. Additionally, a high FRAX score combined with T-score increases the risk of both major adverse cardiovascular events (MACE) and non-fatal stroke.

PURPOSE: This study examined the relationship between osteoporosis and major adverse cardiovascular events (MACE) in Thai older adults and evaluated the predictive capacity of the FRAX score for cardiovascular risk.

METHODS: A retrospective cohort study followed 348 individuals aged 60-75 Years for over 13 years (2005-2021) after their initial bone mineral density (BMD) assessment. Osteoporosis was defined by BMD T-scores ≤ -2.5 at the lumbar spine or femoral neck, or fragility fracture. High hip fracture risk was defined as a FRAX score ≥ 3%. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (3P-MACE). Cox proportional hazards models were used to calculate hazard ratios (HR). Statistical significance was set at p < 0.05.

RESULTS: While overall MACE was not significantly higher in the osteoporosis group, the stroke findings were increased (adjusted HR 2.46, 95% CI 1.12-5.39, p = 0.024). Utilizing FRAX score in conjunction with T-scores (FRAX-T ≥ 3%) was independently associated with an elevated risk of 3P-MACE (adjusted HR 1.88, 95% CI 1.05-3.38, p = 0.034) as well as non-fatal stroke risk (adjusted HR 3.04, 95% CI 1.38-6.69, p = 0.006).

CONCLUSIONS: Osteoporosis demonstrates a significant association with increased stroke risk in Thai older adults. Utilizing FRAX-T may improve cardiovascular risk stratification. Further large-scale prospective studies are needed to elucidate the underlying mechanisms and establish a definitive link between osteoporosis and broader cardiovascular outcomes in this population.

PMID:40938492 | DOI:10.1007/s11657-025-01606-4

AIDS Behav. 2025 Sep 12. doi: 10.1007/s10461-025-04851-3. Online ahead of print.

ABSTRACT

Prospective memory (PM) deficits are common among people with HIV (PWH) and are linked to poor clinical outcomes. Risk factors for PM deficits in PWH are poorly understood. While cannabis use is associated with worse PM in people without HIV, it is unclear whether this association generalizes to PWH. Three hundred and seven PWH (79% with regular cannabis use) completed the Memory for Intentions Test (MIST). Associations between regular use (vs. no/minimal lifetime use) and MIST score were evaluated. Among participants with regular use, bivariate associations were evaluated between MIST score and self-reported cumulative 30-day THC dose, use frequency, duration of heaviest lifetime use, age of first use, and use motivation (predominantly-recreational, predominantly-therapeutic, or combined). Confounding was addressed with linear regressions adjusted for age and Wechsler Test of Adult Reading. Cannabis use (vs. non-use) was not significantly associated with MIST score in unadjusted or adjusted models (β = – 0.04, 95% CI = – 0.29, 0.21, p = 0.74). After confounder adjustment, no associations between cannabis variables and MIST score reached statistical significance. The largest (albeit nonsignificant) effect in adjusted models was found for use motivation: participants with combined use showed better MIST performance vs. predominantly-recreational use (β = 0.28, 95% – 0.02, 0.57, p = 0.067). Participants reporting predominantly-therapeutic use vs. predominantly-recreational use performed similarly (β = 0.03, 95% CI = – 0.30, 0.37, p = 0.85). PM was not significantly associated with cannabis use in PWH. Associations between motivation for use and PM in PWH warrant further investigation.

PMID:40938490 | DOI:10.1007/s10461-025-04851-3

AIDS Behav. 2025 Sep 12. doi: 10.1007/s10461-025-04870-0. Online ahead of print.

ABSTRACT

Georgia has one of the highest HIV diagnosis rates in the U.S., yet only 33% of Pre-Exposure Prophylaxis (PrEP) users in the Deep South live there. This study aims to determine the potential mediational role of internalized homonegativity and attitudes towards PrEP between gay community connectedness and PrEP use among men who have sex with men (MSM) living in Georgia. Participants (N = 121) completed an online survey in June 2020. PrEP use (yes/no) was defined by the question “the last time you had sex, were you taking PrEP, like Truvada?” The study also used the “8-item Identification and Involvement with the Gay Community scale”, “9-item internalized homophobia scale”, and a “3-item PrEP attitude scale”. Path analysis was performed using Stata 17.0. After adjusting for sociodemographic characteristics, positive associations were observed between attitudes towards PrEP and PrEP use (β = 0.11; p = < 0.001), and gay community connectedness (GCC) and PrEP attitudes (β = 0.17, p < 0.001). Conversely, negative associations were found between GCC and internalized homonegativity (β=-0.71, p < 0.001), and internalized homonegativity and PrEP use (β=-.01, p = 0.031). GCC was not significantly associated with PrEP use (β=-.01; p = 0.196). However, the indirect effects of GCC on PrEP use through PrEP attitudes (β = 0.01, p < 0.001) and internalized homonegativity (β = 0.02, p = 0.041) were statistically significant. These findings indicate that PrEP attitudes and internalized homonegativity mediate the relationship between GCC and PrEP use among MSM. Thus, improving attitudes toward PrEP and reducing internalized homonegativity through fostering GCC among MSM may improve PrEP use and persistence.

PMID:40938489 | DOI:10.1007/s10461-025-04870-0

Bull Math Biol. 2025 Sep 12;87(10):149. doi: 10.1007/s11538-025-01514-1.

ABSTRACT

Human behavior plays a pivotal role in mitigating the global spread of infectious diseases, rendering it an indispensable characteristic of effective disease control efforts. While prior research has examined behavioral changes in disease control either through the force of infection or prevalence-based recruitment, the combined effects of these approaches remain largely unexplored. To bridge this gap, we develop a mathematical model that integrates behavioral modifications from both perspectives, with a focus on resource-limited settings-a critical factor for managing re-emerging diseases. Our analytical results indicate that disease dynamics are influenced not only by the basic reproduction number ( R 0 ) but also regulated by a threshold value ( R c ), which can lead to disease persistence through backward bifurcation. The model reveals a complex dynamic view, highlighting the intricate role of behavioral modifications in suppressing multiple waves of infection. To optimize behavioral strategies, we introduce a contour-area optimization method to identify the most effective responses. Using real-world data from the Monkeypox outbreaks in the United States of America. and the Democratic Republic of Congo (spanning January 7 to August 13, 2024), we estimated critical parameters for both regions. The results highlight a significant reduction in R 0 when behavioral interventions targeted both transmission pathways, compared to focusing solely on one. Furthermore, we provide short- and long-term forecasts of the effects of these interventions, offering actionable insights for resource-constrained countries. This research underscores the importance of behavioral adaptations in strengthening disease control measures and advancing sustainable public health efforts, even in regions with sparse resources.

PMID:40938458 | DOI:10.1007/s11538-025-01514-1