Category: Statistics

Cancer Cell Int. 2024 Oct 26;24(1):350. doi: 10.1186/s12935-024-03543-7.

ABSTRACT

BACKGROUND: The tertiary lymphoid structures (TLSs) have an immunomodulatory function and have a positive impact on the survival outcomes of patients with oral squamous cell carcinoma (OSCC). However, there is a lack of standard approaches for quantifying TLSs and prognostic models using TLS-related genes (TLSRGs). These limitations limit the widespread use of TLSs in clinical practice.

METHODS: A convolutional neural network was used to automatically detect and quantify TLSs in HE-stained whole slide images. By employing bioinformatics and diverse statistical methods, this research created a prognostic model using TCGA cohorts and explored the connection between this model and immune infiltration. The expression levels of three TLSRGs in clinical specimens were detected by immunohistochemistry. To facilitate the assessment of individual prognostic outcomes, we further constructed a nomogram based on the risk score and other clinical factors.

RESULTS: TLSs were found to be an independent predictor of both overall survival (OS) and disease-free survival in OSCC patients. A larger proportion of the TLS area represented a better prognosis. After analysis, we identified 69 differentially expressed TLSRGs and selected three pivotal TLSRGs to construct the risk score model. This model emerged as a standalone predictor for OS and exhibited close associations with CD4 + T cells, CD8 + T cells, and macrophages. Immunohistochemistry revealed high expression levels of CCR7 and CXCR5 in TLS + OSCC samples, while CD86 was highly expressed in TLS- OSCC samples. The nomogram demonstrates excellent predictive ability for overall survival in OSCC patients.

CONCLUSIONS: This is the first prognostic nomogram based on TLSRGs, that can effectively predict survival outcomes and contribute to individual treatment strategies for OSCC patients.

PMID:39462422 | DOI:10.1186/s12935-024-03543-7

BMC Musculoskelet Disord. 2024 Oct 26;25(1):853. doi: 10.1186/s12891-024-07988-9.

ABSTRACT

OBJECTIVE: To improve hip flexor flexibility, the commonly used hip extension stretch focuses on advancing the pelvis forward in a half-kneeling position, targeting only hip extension. This study aimed to compare the effectiveness of this traditional stretch with a new technique incorporating posterior pelvic tilt.

METHODS: A randomized crossover clinical trial was conducted with in 26 healthy, physically active individuals (52 hips), aged 22.50 ± 4.10 years. Each participant performed both the hip extension stretch and the posterior pelvic tilt stretch (26 hips), with one technique applied to each limb: the posterior pelvic tilt stretch on one limb and the hip extension stretch on the other limb (26 hips). The reactive hip flexor test and active knee extension test were measured pre and post stretching techniques. A repeated measures ANOVA was performed to assess differences between groups.

RESULTS: There was a significant group-by-time interaction with a medium effect size for the variable related to reactive hip flexor force (F = 4.775, p = 0.034, η2p = 0.087). The posterior pelvic tilt stretch had a statistically significant mean difference of 4.85 N·m (p = 0.003; 95%CI: 1.74; 7.96) compared with the hip extension stretch (mean difference = 0.06 N·m (p = 0.969; 95%CI-3.05; 3.17). No significant differences were found for active knee extension (p > 0.05).

CONCLUSIONS: The results showed that the posterior pelvic tilt stretching technique was effective in reducing the hip reactive flexor force when compared to conventional hip extension stretch.

PMID:39462416 | DOI:10.1186/s12891-024-07988-9

BMC Health Serv Res. 2024 Oct 26;24(1):1286. doi: 10.1186/s12913-024-11758-7.

ABSTRACT

BACKGROUND: Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation.

METHODS: This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients.

RESULTS: Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model’s essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients.

CONCLUSIONS: This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely.

PMID:39462414 | DOI:10.1186/s12913-024-11758-7

Int J Equity Health. 2024 Oct 26;23(1):222. doi: 10.1186/s12939-024-02305-1.

ABSTRACT

BACKGROUND: While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.

METHODS: A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18-84 years old, 3,779 answered the survey during February-May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.

RESULTS: Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30-44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45-64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65-84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.

CONCLUSIONS: Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.

PMID:39462413 | DOI:10.1186/s12939-024-02305-1

BMC Womens Health. 2024 Oct 26;24(1):575. doi: 10.1186/s12905-024-03418-z.

ABSTRACT

OBJECTIVE: The primary goal of this study is to discern the optimal adjuvant treatment for patients diagnosed with bacterial vaginosis, focusing on reducing recurrence rates.

METHODS: This study is a double-blind clinical trial with no previous similar trials conducted to date. The study population consisted of non-pregnant, married women visiting teaching hospitals’ clinics in Mashhad, complaining of vaginal discharge. After informed consent and questionnaire completion, samples were obtained from vaginal discharge surrounding the cervix of clinically diagnosed bacterial vaginosis patients. Using Gram staining, a gold standard method for bacterial vaginosis diagnosis, samples were examined under a microscope according to the Nugent score. After initial treatment with metronidazole, patients were divided into two groups receiving either vaginal or oral probiotics.

RESULTS: Of the 55 participating women, 20 were in the vaginal probiotic group and 35 were in the oral probiotic group. No significant demographic or clinical differences existed between groups at baseline. The Nugent score decreased from 8.5 to 3 in the vaginal group and from 9 to 3 in the oral group, suggesting the effectiveness of both treatments. While the difference between groups was not statistically significant, each group showed significant improvements from their initial states (p-value < 0.001).

CONCLUSION: No significant difference was observed in the effectiveness of oral versus vaginal probiotics in reducing the recurrence of bacterial vaginosis after routine treatment. Therefore, the type of probiotic to be used could be chosen based on patient preference.

PMID:39462408 | DOI:10.1186/s12905-024-03418-z

BMC Oral Health. 2024 Oct 26;24(1):1292. doi: 10.1186/s12903-024-05087-8.

ABSTRACT

BACKGROUND: India bears the highest global burden of oral cancer, despite having an operational tobacco cessation framework. Occupational groups like solid waste management personnel face significant health challenges due to prevalent tobacco use, leading to oral potentially malignant lesions and oral cancer. Enhanced tobacco control strategies are essential for these groups.

METHODS: A pre-post interventional, community-based study enrolled 1200 municipal workers in Varanasi, India, from July 2022 to August 2023. 858 tobacco users underwent screening and were randomly assigned to one of three interventions: Very Brief Advice, Individual Behavioral Counseling, or Group Behavioral Therapy. Follow-up was conducted one year after the baseline interventions Effectiveness was measured by nicotine dependence reduction using the Fagerstrom Test for Nicotine Dependence (FTND) scores and cessation rates defined as at least 6-month abstinence. Appropriate statistical tests assessed the burden of tobacco use, oral potentially malignant lesions, and pre-post differences in FTND scores within and between groups. A p-value of < 0.05 was considered statistically significant.

RESULTS: Municipal workers exhibited a high prevalence (71.5%) of smokeless tobacco (SLT) use. One-third (32.9%) of the participants screened positive for oral potentially malignant lesions and oral cancer. Leukoplakia was the most common lesion. Screened positivity correlated with significant nicotine dependence. Among 494 follow-up participants, 47.1% reported a significant reduction in nicotine dependence across all intervention groups. Quade’s ANCOVA indicated significant differences in post-test FTND scores, with individual behavioral counselling showing the greatest reduction. However, no cessation was achieved in any group despite the significant decline in dependence.

CONCLUSION: Solid waste management personnel in Varanasi show heightened SLT use and associated oral potentially malignant lesions. The persistent tobacco use in these high-risk occupational populations undermines government tobacco control efforts and highlights the need for robust policy and implementation strategies. The study demonstrated a significant reduction in nicotine dependence following interventions, though tobacco cessation was not achieved. More frequent interventions and addressing quitting barriers-such as cultural norms, lack of awareness, easy accessibility, and adverse working conditions-are crucial. Developing a tailored workplace model to tackle tobacco use in occupational settings may facilitate cessation.

CLINICAL TRIAL REGISTRATION NUMBER: Trial registration Clinical Trials Registry India CTRI/2020/07/026479. Date of registration 10/07/2020.

PMID:39462398 | DOI:10.1186/s12903-024-05087-8

Lipids Health Dis. 2024 Oct 26;23(1):350. doi: 10.1186/s12944-024-02336-1.

ABSTRACT

BACKGROUND & AIMS: There is no consensus on whether it is worthwhile for young people to undergo lipid screening. An estimate of the national prevalence of lipid screening in this population can serve as a basic parameter in analyses of the utilization and cost-effectiveness of health care services. Previous studies were mostly based on electronic health records or insurance claims data or were restricted to adolescents at younger ages. This study aimed to investigate the prevalence of lipid screening and the factors associated with it in young people aged 16- to 21 years in the United States based on a nationally representative sample.

METHODS: A cross-sectional study of 16- to 21-year-old participants from the National Health and Nutrition Examination Survey (NHANES), 2013-March 2020 (four cycles), was conducted. The prevalence of lipid screening uptake was calculated for each cycle as well as for all four cycles combined, and the associations of lipid screening uptake with the covariates were analysed by logistic regression. An appropriate sample weight was incorporated into the analysis as recommended.

RESULTS: A total of 3,600 participants were included in the analysis, and 32.02% of them had ever received lipid screening at the time of the survey, with no statistically significant secular changes observed over the four cycles. Among the participants, 28.83% received lipid screening within the past 5 years. In multivariable regression analysis adjusted for all covariates, non-Hispanic black ethnicity (adjusted odds ratio [AOR]: 1.43), having health insurance (AOR: 1.54), obesity (AOR: 1.65) and sufficient physical activity (AOR: 1.36) were significantly associated with a greater chance of ever receiving lipid screening.

CONCLUSIONS: Nearly one-third of young people aged 16- to 21 years in the United States have received lipid screening. Ethnicity, health insurance, weight problems, and physical activity level were associated with the likelihood of lipid screening uptake. These findings could help people understand the current situation of lipid screening in young people in the United States and may serve as fundamental parameters in the assessment of the utilization and cost-effectiveness of related health care services.

PMID:39462389 | DOI:10.1186/s12944-024-02336-1

Lipids Health Dis. 2024 Oct 26;23(1):348. doi: 10.1186/s12944-024-02340-5.

ABSTRACT

BACKGROUND: Vegan and vegetarian dietary patterns are known to beneficially modulate risk factors for cardiovascular disease; however, the current literature does not differentiate between various plant-based diets. This study aimed to examine the association between various plant-based diets and plasma lipids and glycaemic indices compared to a regular meat-eating diet.

METHODS: A cross-sectional study of Australian adults (n = 230) aged 30-75yrs habitually consuming the following were recruited: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat-eater. Multivariable regression analysis was used to adjust for covariates.

RESULTS: Compared to regular meat-eaters, vegans had significantly lower total cholesterol (-0.77mmol/L,95% CI -1.15, -0.39, P < 0.001), low-density lipoprotein cholesterol (LDL-C, -0.71mmol/L, 95% CI -1.05, -0.38, P < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C, -0.75mmol/L, 95% CI -1.11, -0.39, P < 0.001), total cholesterol/HDL-C-ratio (-0.49mmol/L, 95% CI -0.87, -0.11, P = 0.012), fasting blood glucose (FBG, -0.29mmol/L, 95% CI -0.53, -0.06, P = 0.014), haemoglobin A1C (-1.85mmol/mol, 95% CI -3.00, -0.71, P = 0.002) and insulin (-1.76mU/L, 95% CI -3.26, -0.26, P = 0.021) concentrations. Semi-vegetarians had significantly lower LDL-C (-0.41mmol/L, 95% CI -0.74, -0.08, P = 0.041) and non-HDL-C (-0.40mmol/L, 95% CI -0.76, -0.05, P = 0.026) and lacto-ovo vegetarians had significantly lower FBG (-0.34mmol/L, 95% CI -0.56, -0.11, P = 0.003) compared to regular meat-eaters. There were no differences in HDL-C and triglycerides between plant-based and regular-meat diets.

CONCLUSIONS: Plasma lipaemic and glycaemic measures as a collective were more favourable among vegans, whereas among lacto-ovo vegetarians and semi-vegetarians, only some measures were favourable.

TRIAL REGISTRATION: ACTRN12621000743864. Date 6/11/2021.

PMID:39462384 | DOI:10.1186/s12944-024-02340-5

Health Qual Life Outcomes. 2024 Oct 26;22(1):92. doi: 10.1186/s12955-024-02304-4.

ABSTRACT

BACKGROUND: Mental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany.

METHODS: Using data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18-79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity.

RESULTS: Means of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups.

CONCLUSIONS: Both versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

PMID:39462382 | DOI:10.1186/s12955-024-02304-4

BMC Womens Health. 2024 Oct 26;24(1):573. doi: 10.1186/s12905-024-03411-6.

ABSTRACT

BACKGROUND: Breast cancer (BrCa) is one of the leading causes of cancer-related deaths. There are several factors for getting BrCa, including some changeable factors related to lifestyle like unhealthy dietary patterns, so modifying them can prevent one third of the complications and deaths caused by BrCa. Therefore, we decided to investigate the relationship between Healthy Beverage Index (HBI) and the risk of BrCa.

METHODS: In this hospital-based case-control study, 253 patients with BrCa and 267 non-BrCa controls were enrolled. Food consumption was recorded to calculate the HBI score using a semi-quantitative Food Frequency Questionnaire (FFQ). Additionally, by using binary logistic regression analysis with adjustment for confounders, the relationship between HBI and the risk of BrCa were assessed. HBI was established by Duffey et al. and is used to evaluate the overall quality of beverage intake and identify changes in consumption.

RESULTS: Mean ± SD of age and BMI of the study participants were 47.92 ± 10.33 years and 29.43 ± 5.51 kg/m², respectively. Patients with BrCa considerably outperformed controls in terms of waist circumference (WC), age at first pregnancy, history of abortion, and number of children(Pvalue < 0.05). Compared with those in the lowest quartile of HBI, subjects in the highest quartile had higher intake of energy, carbohydrate, protein, fat, fiber, sodium, potassium, calcium, magnesium, zinc, vitamin C, E, B9, fruits, vegetables, fish and nut as well as lower BMI and WC (Pvalue < 0.05). After adjustment for potential confounders, individuals in highest compared to lowest quartile of HBI had significantly lower risk of BrCa for total population (odds ratio (OR): 0.40; 95% confidence interval (95%CI): 0.21-0.76, Pvalue < 0.05), premenopausal (OR: 0.38; 95% CI: 0.16-0.92, Pvalue = 0.013), and postmenopausal (OR: 0.27; 95% CI: 0.10-0.78, Pvalue = 0.023).

CONCLUSION: Findings of this study suggested that higher HBI score decreased the risk of BrCa. However, further investigation is needed.

PMID:39462378 | DOI:10.1186/s12905-024-03411-6