Category: Statistics

Reumatismo. 2025 Sep 25. doi: 10.4081/reumatismo.2025.1773. Online ahead of print.

ABSTRACT

OBJECTIVE: Systemic sclerosis (SSc) is a multisystem autoimmune disease of heterogeneous pathogenesis, including vascular, immunologic, genetic, epigenetic, and environmental factors. Progressive fibrosis is the hallmark of SSc. Intense research has been conducted to unveil new tools for early diagnosis and management, thus reducing morbidity and mortality. miR-21 has recently been considered to play an important role in the fibrosis of SSc. The objective of this study was to evaluate miR-21 levels in SSc patients and study its correlation to the extent of skin fibrosis and association with various clinical characteristics.

METHODS: A total of 25 patients with SSc who fulfilled the American College of Rheumatology/European Alliance of Associations for Rheumatology 2013 classification criteria, as well as 25 controls, were enrolled in a cross-sectional study. The extent of skin fibrosis was evaluated using the modified Rodnan skin score, and disease severity was assessed using the Medsger severity score. The levels of miR-21 were measured by quantitative real-time polymerase chain reaction. The 2-ΔΔCt method was used for analysis. SSc patients affected by diabetes mellitus, hypertension, renal impairment, heart disease, malignancy, other autoimmune diseases, or a history of serious acute infection within 6 weeks were excluded.

RESULTS: There was a high statistically significant difference in miR-21 levels between cases and controls (p<0.001). At a cut-off level of 2.55, miR21 could discriminate between SSc patients and controls with sensitivity and specificity. There was no significant correlation between miR-21 levels and the degree of skin fibrosis. There was a significant positive association between miR-21 levels and the presence of arthritis in SSc patients (p=0.007).

CONCLUSIONS: miR-21 was suggested as a robust diagnostic biomarker in SSc with exceptional superiority over the traditionally utilized antibodies. Additionally, due to its association with arthritis, it is supposed to play a proinflammatory role in addition to its pronounced profibrotic effects. Interestingly, the profibrotic miR-21 may not reflect the extent of skin fibrosis.

PMID:41025207 | DOI:10.4081/reumatismo.2025.1773

Disaster Med Public Health Prep. 2025 Sep 30;19:e283. doi: 10.1017/dmp.2025.10193.

ABSTRACT

The Flint water crisis was a lead-in-water disaster that occurred in Flint, Michigan. The Center for Children’s Integrated Services Assessment Center (CISAC) was established to provide neuropsychological assessments and recommendations for exposed children. Our objective was to describe the implementation of the CISAC and report the clinical diagnoses of the first cohort of children who received comprehensive assessments. The CISAC’s eligibility criteria were broad and allowed referrals from physicians, schools, community organizations, and parents. A cross-sectional, descriptive analysis was conducted for 376 children who received initial neurodevelopmental assessments. About 60% of assessed children (ages 3-18) were diagnosed with ADHD, and 70% were diagnosed with ≥2 conditions. Most (96.8%) children received recommendations for new or continued educational, medical, and mental health services. Recognizing the implications of lead exposure and community-wide trauma on neuropsychological trajectories, the CISAC provides longitudinal assessments, secondary prevention efforts to mitigate potential sequelae, and trauma-informed treatment.

PMID:41025206 | DOI:10.1017/dmp.2025.10193

Geospat Health. 2025 Jul 7;20(2). doi: 10.4081/gh.2025.1408. Epub 2025 Sep 29.

ABSTRACT

An important area of use of the geographic information systems in health is the organization of Emergency Medical Services (EMS). In this study, the EMS application offered in Turkey’s 81 provinces, in particular, Istanbul metropolis, which has the highest population in the country, was examined with a statistical approach. It was determined that the correlation level between the number of EMS stations and the population of the 39 districts of Istanbul was higher compared to the land area and population density; the number of EMS stations in the Fatih District was significantly greater than the median value of the number of EMS stations in all districts of Istanbul. It was determined that the number of EMS stations, ambulances, and hospitals in Istanbul is significantly greater than the median value of all provinces in Turkey; the population density per hospital and EMS station in Istanbul is significantly greater than the median value of all provinces, and the area value is smaller than the median value of all provinces. Ambulance response time, hospital transfer time and reasons for delays at these stages were questioned through a survey. The most common reasons for delay were traffic congestion, followed by the few and far distances of ambulance stations. Considering the problems arising from the geographical location of EMS stations and hospitals, it is expected that taking population density into account when planning EMS station distribution would contribute to increased efficiency in EMS and equality in access to services.

PMID:41025202 | DOI:10.4081/gh.2025.1408

Ann Agric Environ Med. 2025 Sep 18;32(3):411-417. doi: 10.26444/aaem/204854. Epub 2025 Jun 4.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Health behaviour is a set of activities that affect an individual’s well-being and attitude toward health. These behaviours are shaped by socio-demographic characteristics, social circumstances, cultural background, personality traits, and the mass media. The health of an individual is largely determined, among other factors, by his/her actions, decisions, and the resulting outcomes. The health locus of control affects an individual’s adherence to health-related recommendations. The aim of the study is to examine the association between the health locus of control and declared health behaviours in Polish women in the setting of breast cancer prevention.

MATERIAL AND METHODS: The study included 407 women between the age of 45 and 69 years (mean: 54.86, SD: 6.718), selected using convenience sampling. The research was conducted at the Medical University of Warsaw between March 2021 – May 2022, using convenience sampling. The research tool was a survey consisting of an author-designed questionnaire, the Multidimensional Health Locus of Control Scale, and the Health Behaviour Inventory Correlation analysis between scales from HBI questionnaire and scales from MHLC-B questionnaire was conducted.

RESULTS: Correlation analysis showed that the internal health locus of control was positively correlated with healthy nutrition habits, preventive behaviours, and positive adjustment. Additionally, the external health locus of control was also positively correlated with preventive behaviours, positive adjustments, and health-promoting practices. In contrast, a higher belief in the influence of chance was inversely correlated with healthy nutrition habits and positive adjustment.

CONCLUSIONS: Psychological factors influencing women’s attitudes towards preventive behaviours can help in the planning of preventive measures. An increase in the internal health locus of control may translate into a higher participation rate in population-based screening programmes.

PMID:41025188 | DOI:10.26444/aaem/204854

Ann Agric Environ Med. 2025 Sep 18;32(3):398-44. doi: 10.26444/aaem/196268. Epub 2024 Dec 17.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Hiking is becoming an increasingly popular leisure activity, practised due to its benefits, often regardless of people’s exercise capacity and Body Mass Index (BMI) values. The aim of the study was to investigate the relationship between the level of daily physical activity and BMI, as well as the incidence and severity of injuries experienced during hiking.

MATERIAL AND METHODS: A total of 230 individuals fulfilled completed questionnaire forms. Questionnaires were distributed via Google form between 15 January 2021 and 23 February 2021. A modified Global Physical Activity Questionnaire (GPAQ) and BMI values were used to check how the hikers’ health and physical condition influenced the incidence and severity of trauma while hiking. 162 mountain hikers were included in the final analysis.

RESULTS: Using independence tests, it was shown that in the cases there was no relation between the created BMI categories and the occurrence of injury (p-value=0.708), or between physical activity groups and the occurrence of injury (p-value=1). The results also showed no statistically significant correlation between the severity of the injury sustained during hiking, or both daily physical activity level (p-value=0.754) and BMI value (p-value=0.854).

CONCLUSIONS: The study might indicate that proper, adjusted hiking could be the correct way of spending free time, regardless of pre-existing levels of physical activity and/or BMI.

PMID:41025186 | DOI:10.26444/aaem/196268

Ann Agric Environ Med. 2025 Sep 18;32(3):383-390. doi: 10.26444/aaem/208382. Epub 2025 Aug 6.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Menstrual poverty lies at the intersection of poverty, sustainability, reproductive rights, and gender inequality. The study investigates menstrual poverty among women affected by the 2023 earthquake in Turkey.

MATERIAL AND METHODS: A descriptive cross-sectional study was conducted between 24 April – 24 May 2023 with 400 women impacted by the earthquake. Data were collected via social media using a survey form. Chi-square tests, Bonferroni test, and binary logistic regression model were used for statistical analysis.

RESULTS: The mean age of participants was 27.27 ± 8.40 years; 69.5% had higher education, 57.0% lived in urban areas, and 90.5% had no chronic disease. A significant relationship was found between access to menstrual products and basic needs (clean water, toilet paper, soap, safe toilet access, and healthcare) during menstruation after the earthquake (p<0.05). A significant correlation was also observed between disruptions to the menstrual cycle and the following variables: lack of privacy, perception that lack of privacy affected menstruation, healthcare access, and difficulty obtaining menstrual products (p<0.05).

CONCLUSIONS: Most participants faced difficulties accessing menstrual products, water, hygiene supplies, privacy, and healthcare. Those living in tents or containers reported greater challenges. These barriers contributed to menstrual poverty and impacted women’s cycles. As menstrual health and hygiene are basic needs and human rights, menstrual poverty must be addressed globally.

PMID:41025184 | DOI:10.26444/aaem/208382

Ann Agric Environ Med. 2025 Sep 18;32(3):377-382. doi: 10.26444/aaem/207636. Epub 2025 Jul 8.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Learning effectiveness is a key element in the educational process that determines how effectively students can assimilate, store, and apply the knowledge acquired. There are many approaches and theories in the research literature exploring the different aspects of this process. Factors influencing learning effectiveness include learning style, motivation, learning techniques, and learning environment. Learning effectiveness also depends on individual student characteristics, including socio-demographic characteristics. The aim of the study is to verify the influence of socio-demographic characteristics on the assessment of the effectiveness of medical simulation as a learning method, using the standardised EPQ tool.

MATERIAL AND METHODS: The study was conducted between 2023-2024 among 306 nursing students by means of a diagnostic survey, using the survey instrument EPQ.

RESULTS: The surveyed students rated the educational techniques best in terms of collaboration. Statistical analysis showed a weak negative correlation between age and the evaluation of active learning, expectations, and the overall evaluation of educational techniques. Statistically significant results were obtained in the correlation of place of residence with the evaluation of educational practices.

CONCLUSIONS: The study showed a general relationship of the influence of selected socio-demographic characteristics on the evaluation of educational practices in medical simulation. Despite the occurrence of a relationship, the age of the subjects did not determine the outcome of the simulation effectiveness evaluation. There is a lack of detailed research in the available literature on the influence of socio-demographic variables on the evaluation of medical simulation educational practices, which allowed the identification of a research gap (white gap).

PMID:41025183 | DOI:10.26444/aaem/207636

Phys Med. 2025 Sep 28;138:105186. doi: 10.1016/j.ejmp.2025.105186. Online ahead of print.

ABSTRACT

INTRODUCTION: Postmortem computed tomography (PMCT) is increasingly used in forensic investigations, offering a non-invasive and objective approach to estimating the postmortem interval (PMI). This study aimed to develop and externally validate radiomic models to distinguish deaths within versus beyond 24 h, using liver radiomic features from PMCT scans..

METHODS: A retrospective analysis was performed on 51 cadavers for model development and validated on 80 independent cases. In the training set, 173 PMCT scans across different PMIs were analyzed. The liver was manually segmented, and 40 radiomic features-statistical, morphological, and fractal-were extracted. Robustness to segmentation variability was assessed with autocontoured segmentations using the Intraclass Correlation Coefficient (ICC). PMI was dichotomized as ≤ 24 versus > 24 h. Univariate analyses identified predictive features, and logistic regression models were built from significant variables. Model performance was evaluated with receiver operating characteristic (ROC) curves, with sensitivity and specificity at the optimal threshold.

RESULTS: Four features were significantly associated with PMI, with liver skewness emerging as the most predictive (p = 9.13 × 10^-4) and robust (ICC = 0.75). A logistic regression model based on skewness achieved an AUC of 0.75 (95 % CI: 0.65-0.86) and 100 % specificity at the optimal threshold, reliably identifying deaths beyond 24 h. Adding a second feature did not improve performance (p = 0.54, DeLong test). External validation confirmed specificity of the skewness model (70 % at the optimal threshold).

CONCLUSION: Liver skewness extracted from PMCT shows potential as a biomarker for identifying deaths beyond 24 h, with performance confirmed on an independent cohort.

PMID:41022006 | DOI:10.1016/j.ejmp.2025.105186

Addict Behav. 2025 Sep 26;172:108504. doi: 10.1016/j.addbeh.2025.108504. Online ahead of print.

ABSTRACT

BACKGROUND: E-cigarette use has grown in popularity and is independently associated with alcohol use and mental health (anxiety/depression), but the interactions between alcohol and anxiety/depression with e-cigarette use have not been examined. We examined whether anxiety/depression would influence the association of both alcohol use frequency and heavy episodic drinking (HED) with e-cigarette use frequency, hypothesizing that alcohol use would be more strongly related to e-cigarette use among those with current anxiety/depression.

METHODS: N = 11,006 adults (55 % female; 71 % non-Hispanic White, M age = 42) completed assessments of demographics, past 30-day e-cigarette and alcohol use, and current symptoms of anxiety and depression. Regression models including past 30-day e-cigarette users only (N = 2,395) examined the moderating effects of anxiety/depression (yes/no) on the alcohol-e-cigarette frequency relationship, examining alcohol use frequency and HED separately.

RESULTS: More than one-fifth (21.7 %) of the total sample reported any past 30-day e-cigarette use. Among e-cigarette users, past 30-day alcohol use frequency was associated with e-cigarette use frequency but did not significantly differ by mental health status (IRR = 1.02, 95 % 1.01, 1.02). HED was not associated with e-cigarette use frequency, regardless of mental health status (IRR = 1.02; 95 % CI: 0.93, 1.11).

CONCLUSION: The relationship between current alcohol use and e-cigarette use frequency was not statistically different between individuals who endorsed current anxiety and/or depression vs. those who did not. Findings support the need to consider other substance use within e-cigarette smoking prevention and cessation efforts. Additional longitudinal research is needed to infer directionality and causality.

PMID:41021996 | DOI:10.1016/j.addbeh.2025.108504

Comput Methods Programs Biomed. 2025 Sep 25;273:109081. doi: 10.1016/j.cmpb.2025.109081. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cutaneous melanoma remains the most lethal form of skin cancer. Although incurable at advanced stages, if diagnosed at an early, localized stage, the five-year survival rate is remarkably high. Recent advancements in artificial intelligence have paved the way for early skin lesion diagnosis, leveraging digital imaging processes into effective solutions. Most of these, however, use Machine Learning and Deep Learning techniques compartmentalized, without combining the produced predictions.

METHODS: This paper introduces MultiExCam, a novel multi approach and explainable architecture for skin cancer detection that integrates both machine and deep learning. Three heterogeneous data from three different techniques are used: dermatoscopic images, features extracted from deep learning techniques, and hand-crafted statistical features. A convolutional neural network is used for both deep feature extraction and initial classification, with the extracted features being combined with handcrafted ones to train four additional machine learning models. An advanced ensemble model, implemented as a Feed Forward Neural Network with gating and attention mechanism, produces the final classification. To enhance interpretability, the architecture employs GradCAM for visualizing critical regions in input images and SHAP for evaluating the contribution of individual features to predictions.

RESULTS: MultiExCam demonstrates robust performance across three diverse datasets (HAM10000, ISIC, MED-NODE), achieving AUC scores of 97%, 91%, and 98% respectively, with corresponding F1-scores of 92%, 87%, and 94%. Comprehensive ablation studies validate the importance of the preprocessing pipeline and ensemble integration, with the hybrid approach consistently outperforming baseline deep learning models by 1-3 percentage points. Unlike existing compartmentalized hybrid solutions, MultiExCam’s adaptive ensemble architecture learns personalized decision strategies for individual lesions, mimicking expert dermatological workflows that integrate multiple evidence sources. The explainability analysis reveals clinically meaningful activation patterns corresponding to established diagnostic criteria including asymmetry, border irregularity, and color variation.

CONCLUSION: MultiExCam establishes a new paradigm for AI-assisted dermatological diagnosis by demonstrating that true hybrid integration of deep learning and machine learning, combined with comprehensive explainability techniques, can achieve both superior diagnostic performance and clinical interpretability. The architecture’s ability to provide accurate classifications while explaining prediction rationale addresses critical requirements for medical AI adoption, offering a promising foundation for clinical decision support systems in melanoma detection.

PMID:41021995 | DOI:10.1016/j.cmpb.2025.109081