Category: Statistics

Womens Health (Lond). 2025 Jan-Dec;21:17455057251347081. doi: 10.1177/17455057251347081. Epub 2025 Jun 24.

ABSTRACT

BACKGROUND: Balochistan, Pakistan’s most economically and health system-deprived province, hosts a significant portion of the Afghan refugee population. The province’s already fragile healthcare infrastructure faces additional strain due to the refugees.

OBJECTIVE: This study aimed to investigate the barriers to antenatal and intrapartum care seeking among Afghan refugee women in Balochistan during the Coronavirus disease 2019 (COVID-19) pandemic.

DESIGN: This study employed a cross-sectional survey approach to assess antenatal and intrapartum care-seeking behavior among Afghan refugee women residing in Balochistan, Pakistan. The study focused on refugee women living in Kharotabad Union Council in Quetta city to understand their barriers to accessing maternal healthcare services.

METHODS: The survey focused on antenatal and childbirth care-seeking behaviors among married women of reproductive age (MWRA) with at least one child aged 12-23 months born during the first four waves of COVID-19 in Pakistan.

RESULTS: Of 480 MWRAs, only 36.9% sought antenatal care (ANC); only 13.1% received at least four ANC visits. Furthermore, only 38.8% of MWRA had skilled birth attendance. Only 32.9% of MWRAs received at least one ANC and had skilled birth attendance (i.e., comprehensive care). Accessing comprehensive care was associated with maternal age less than 25 years (adjusted odds ratio (OR): 0.40; 95% confidence interval (CI): 0.21, 0.78), Tajik ethnicity (adjusted OR: 0.40; 95% CI: 0.23, 0.70) and large family size (adjusted OR: 0.58; 95% CI: 0.37, 0.93). Predictors of poor access were concern related to documentation of the refugee women they faced (adjusted OR: 1.52; 95% CI: 1.00, 2.34), women with no one at household to accompany them at health facility (adjusted OR: 1.75; 95% CI: 1.13, 2.70), myths and misconceptions related to available care (adjusted OR: 1.89; 95% CI: 1.18, 3.02), and the transport availability (adjusted OR: 1.76; 95% CI: 1.12, 2.77). Concerns related to COVID-19 had no association.

CONCLUSION: The study highlights the barriers to maternal, neonatal and child health service utilization among Afghan refugee women in Balochistan. Tailoring healthcare services to consider age, ethnicity, cultural dynamics, and system constraints is crucial for improving access.

PMID:40554753 | DOI:10.1177/17455057251347081

PLoS Comput Biol. 2025 Jun 24;21(6):e1013202. doi: 10.1371/journal.pcbi.1013202. Online ahead of print.

ABSTRACT

Phenotypic plasticity contributes significantly to treatment failure in many cancers. Despite the increased prevalence of experimental studies that interrogate this phenomenon, there remains a lack of applicable quantitative tools to characterise data, and importantly to distinguish between resistance as a discrete phenotype and a continuous distribution of phenotypes. To address this, we develop a stochastic individual-based model of plastic phenotype adaptation through a continuously-structured phenotype space in low-cell-count proliferation assays. That our model corresponds probabilistically to common partial differential equation models of resistance allows us to formulate a likelihood that captures the intrinsic noise ubiquitous to such experiments. We apply our framework to assess the identifiability of key model parameters in several population-level data collection regimes; in particular, parameters relating to the adaptation velocity and cell-to-cell heterogeneity. Significantly, we find that cell-to-cell heterogeneity is practically non-identifiable from both cell count and proliferation marker data, implying that population-level behaviours may be well characterised by homogeneous ordinary differential equation models. Additionally, we demonstrate that population-level data are insufficient to distinguish resistance as a discrete phenotype from a continuous distribution of phenotypes. Our results inform the design of both future experiments and future quantitative analyses that probe phenotypic plasticity in cancer.

PMID:40554749 | DOI:10.1371/journal.pcbi.1013202

Womens Health (Lond). 2025 Jan-Dec;21:17455057251341999. doi: 10.1177/17455057251341999. Epub 2025 Jun 24.

ABSTRACT

BACKGROUND: Prospective nutritional and physical activity data are lacking throughout preconception and pregnancy.

OBJECTIVES: To evaluate (1) intakes of energy, macronutrients and micronutrients, diet quality and physical activity levels in preconception and in each trimester of pregnancy and (2) adherence to recommendations.

DESIGN: Prospective study.

METHODS: Ninety individuals planning a pregnancy in the next year (Quebec, Canada) took part in four online assessments that occurred before conception and during each trimester of pregnancy (T1, T2 and T3). At each assessment, dietary intakes were derived from at least two web-based 24-h recalls, and supplements use was obtained from a web questionnaire. Diet quality was measured via the Healthy Eating Food Index 2019. Physical activity levels were evaluated with the International Physical Activity Questionnaire and the Pregnancy Physical Activity Questionnaire.

RESULTS: Preconceptionally, participants (30.5 ± 3.6 years) had a mean body mass index of 23.5 ± 3.4 kg/m². Energy intakes (kcal/day) increased over time (preconception: 2172 ± 457; T1: 2284 ± 557; T2: 2382 ± 501; T3: 2434 ± 549; p < 0.0001), while Healthy Eating Food Index 2019 total score remained stable (p = 0.10). Although dietary fiber intake (g/day) increased from preconception to T3 (preconception: 23 ± 9; T1: 25 ± 9; T2: 26 ± 10; T3: 27 ± 9; p < 0.0001), more than 80% of individuals had daily dietary fiber intakes below 14 g/1000 kcal at each assessment. From preconception to T3, total intakes (foods + supplements) increased for iron, folate and vitamin D (p < 0.01), especially from preconception to T1. These intakes came mainly from dietary supplements and met recommendations for most individuals (>52%) at each assessment. Physical activity levels (METs – min/week) decreased from preconception to T3 (preconception: 1754 ± 1431; T1: 1518 ± 1124; T2: 1562 ± 1214; T3: 1258 ± 1218; p < 0.0001), whereas most individuals (64%-82%) complied with the physical activity recommendations at each assessment.

CONCLUSION: Changes in dietary intakes and physical activity levels are observed from preconception to the end of pregnancy. The recommendations are met for most individuals, except for dietary fiber intakes. These results need to be confirmed in a larger, more heterogeneous sample.

PMID:40554727 | DOI:10.1177/17455057251341999

J Can Dent Assoc. 2025 Feb;91:p2.

ABSTRACT

PURPOSE: A specialized temporomandibular joint (TMJ) dental clinic was created at the Centre hospitalier universitaire (CHU) Sainte-Justine to optimize care of patients with juvenile idiopathic arthritis (JIA). In this article, we characteristics of patients with JIA and the resources available in Canadian pediatric hospitals for JIA patients with TMJ involvement.

METHODS: To determine patient characteristics, we compiled retrospective data on patients seen at the TMJ clinic. Regarding resources available for patients with JIA, we sent questionnaires to the departments of rheumatology and dentistry of 13 Canadian pediatric hospitals.

RESULTS: Of the 86 JIA patients included in our study, 42% (95% confidence interval 32-52%) had TMJ involvement. Panoramic radiography was the imaging prescribed most often for patients with JIA (91%) and frequency of follow up was most often every 6 months. In the second part of the study, 7 hospitals were included; 2 had a specialized TMJ clinic. In many cases, reports of types of imaging and available dental specialists differed between the rheumatology and dentistry questionnaires for the same hospital.

CONCLUSION: Few Canadian pediatric hospitals have a specialized TMJ clinic for JIA, and there seems to be a gap in the knowledge of primary care physicians regarding TMJ diagnosis and the management of patients with JIA.

PMID:40554705

J Nurs Res. 2025 Jun 25. doi: 10.1097/jnr.0000000000000688. Online ahead of print.

ABSTRACT

BACKGROUND: Work engagement in nurses is influenced by a variety of factors, with compassion fatigue identified as a negative predictor and resilience identified as a positive predictor. Although mindful self-care (MSC) may influence work engagement, this potential relationship has not been validated in the literature.

PURPOSE: This study was designed to examine the relationship between MSC and work engagement in a sample population of nurses in Israel and to investigate the potential mediating effects of compassion fatigue, resilience, and internal health locus of control (IHLC) on this relationship.

METHODS: A quantitative cross-sectional study design was used, and data were collected from 845 nurses working in different clinical settings in Israel. A self-administered questionnaire was administered online between March and June 2023 to assess MSC, compassion fatigue, resilience, IHLC, and work engagement. A hypothesized model based on the Job Demands-Resources Theory was proposed. Descriptive statistics and path analysis were utilized in data analysis.

RESULTS: The proposed model demonstrated a good fit with the empirical data, explaining 17.2% of the variance in work engagement. Direct relationships were identified between work engagement and, respectively, MSC, compassion fatigue, resilience, and IHLC (β=-0.131, p < .01; β=0.011, p < .01; β=0.116, p < .05; β=0.280, p < .01, respectively). The relationship between MSC and work engagement was shown to be mediated by compassion fatigue and resilience (β=0.068, p < .01), while compassion fatigue was shown to partially mediate the relationship between MSC and resilience (β=0.025, p <01). IHLC was not found to be significantly associated with work engagement.

CONCLUSIONS: MSC is a significant predictor of work engagement among nurses. Practicing MSC increases personal resilience and prevents compassion fatigue, leading to higher work engagement. Thus, we recommend nurse managers promote the regular practice of MSC, along with traditional self-care behaviors, among nurses to improve work engagement.

PMID:40554680 | DOI:10.1097/jnr.0000000000000688

Oncologist. 2025 Jun 24:oyaf193. doi: 10.1093/oncolo/oyaf193. Online ahead of print.

ABSTRACT

PURPOSE: Synovial sarcoma (SS) is aggressive with poor outcomes. Cellular therapies are now FDA approved for advanced disease, but are restricted to certain HLA-A*02 alleles. We estimate eligibility to cellular therapies by race and ethnicity.

MATERIALS AND METHODS: Demographic and clinical features of SS cases from 2001 to 2020 were obtained from the United States Cancer Statistics (USCS; NPCR-SEER). Survival analyses were performed overall and by races/ethnicity. The proportion eligible for cellular therapy was estimated by races/ethnicity using previously published data on HLA-A*02 status and MAGE-A4 positivity.

RESULTS: From 2001 to 2020, 10,605 patients (48% female, 64% Non-Hispanic White, 17% Hispanic) with SS were identified. The incidence rate was 1.5-1.8/million/person-years and was stable over time, corresponding to an average 530 new cases annually. The most common primary site was the extremity (n = 5,877; 58%), and most patients presented with localized disease (n = 5,753; 54%). The 5-year cause-specific survival was 60% across all races/ethnicities and 79% for localized, 57% for regional, 12% for distant disease. Differences by race and ethnicity were found in the proportions of patients expected to be eligible for HLA-restricted cellular therapies targeting MAGE-A4. People of European/European descent had the highest estimated proportion (25-39%), and people of Asian/Pacific Islander descent had the lowest (11-17%).

CONCLUSION: Engineered T-cells targeting MAGE-A4 have shown encouraging safety and efficacy in advanced SS; however, eligibility restrictions will lead to racial and ethnic disparities. HLA-independent solutions must be developed to counter disparities and ensure all patients have access.

PMID:40554677 | DOI:10.1093/oncolo/oyaf193

Oncologist. 2025 Jun 24:oyaf191. doi: 10.1093/oncolo/oyaf191. Online ahead of print.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD) is a major cause of cancer death. Traditional histopathological classification overlooks molecular heterogeneity, limiting personalized treatment. This study used multiomic data to define LUAD subtypes, assess prognostic significance, and analyze immune features, aiming to improve targeted therapy and clinical outcomes.

METHODS: This study used Consensus Clustering and Gap Statistics to analyze LUAD multiomic data, including mRNA, lncRNA, miRNA, DNA methylation, and mutations. Clustering was validated by silhouette plots and heatmaps. Molecular characterization involved regulon activity, immune and metabolic profiling. Functional assays (qPCR, WB, CCK-8, flow cytometry) assessed NDNF’s role in LUAD.

RESULTS: Two molecular LUAD subtypes showed distinct clustering and survival outcomes. One subtype had worse prognosis and unique immune features, including checkpoint expression and microenvironment differences. Gene signatures and metabolism varied by subtype. NDNF was downregulated in tumors; its overexpression suppressed LUAD cell viability and promoted apoptosis, suggesting tumor-suppressive function.

CONCLUSION: This study identifies two LUAD subtypes with distinct molecular and immune features linked to prognosis and therapy response. NDNF downregulation and its tumor-suppressive effects highlight its therapeutic potential. These findings support improved LUAD stratification and personalized treatment strategies.

IMPLICATIONS FOR PRACTICE: This study reveals two LUAD molecular subtypes with distinct prognoses and immune features, offering a basis for more precise treatment strategies. The identification of NDNF as a potential tumor suppressor suggests its value as both a biomarker and therapeutic target. These findings support improved LUAD stratification and personalized therapy.

PMID:40554675 | DOI:10.1093/oncolo/oyaf191

Oncologist. 2025 Jun 24:oyaf189. doi: 10.1093/oncolo/oyaf189. Online ahead of print.

ABSTRACT

BACKGROUND: Nab-paclitaxel is a standard second-line treatment for advanced gastric cancer, but the role of PD-1 inhibitors remains uncertain. This multicenter, randomized phase II trial evaluated the efficacy of nab-paclitaxel plus camrelizumab (Cam-NP) versus nab-paclitaxel alone (NP) in patients with advanced gastric adenocarcinoma resistant to prior treatment.

METHODS: Patients were randomized to receive either Cam-NP or NP until disease progression, intolerable toxicity, or consent withdrawal. The primary endpoint was the overall response rate (ORR), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and safety.

RESULTS: 61 patients were randomized, with 58 receiving treatments. At a median follow-up of 34.5 months, the Cam-NP group achieved a significantly higher ORR (33.3% vs. 10.7%; p = 0.039) and longer median PFS (5.62 vs. 4.21 months; p = 0.006). Median response duration also favored Cam-NP (4.64 vs. 2.96 months; p = 0.058). While the Cam-NP group showed a longer OS (9.8 vs. 7.2 months; p = 0.087), this was not statistically significant. The most common grade 3-4 adverse event was hematological toxicity.

CONCLUSIONS: Cam-NP significantly improved ORR and PFS compared to NP as a second-line treatment for advanced gastric adenocarcinoma. Larger studies and biomarker exploration are needed to validate these findings.

PMID:40554667 | DOI:10.1093/oncolo/oyaf189

Dtsch Arztebl Int. 2025 Sep 5;(Forthcoming):arztebl.m2025.0089. doi: 10.3238/arztebl.m2025.0089. Online ahead of print.

ABSTRACT

BACKGROUND: Both radical prostatectomy (RP) and radiotherapy (RT) are recommended as standard treatments for prostate cancer. The prospective comparisons available to date provide only limited information.

METHODS: We used data from the database of our university cancer center to compare the metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of all patients with prostate cancer who underwent either RP or RT in the period 2014-2024. Stage-, age-, and frailty-specific sensitivity analyses were carried out.

RESULTS: Of 2685 patients with prostate cancer, 1999 (74%) underwent RP and 686 (26%) underwent RT. The RP patients were younger (66 vs. 74 years); a higher percentage of the RP patients than of the RT patients had high-risk prostate cancer (60% vs. 43%), stage cT3 (47% vs. 9.6%), and stage cN1 (11 vs. 5.2%), while the RT patients more commonly had ECOG status 1-2 (16% vs. 6.7%; p<0.001 for all comparisons). Univariate analyses of MFS mostly favored RT, while univariate analyses of OS mostly favored RP. These differences, however, were no longer seen after adjustment for patient and tumor characteristics in multivariable Cox regression models, nor were they seen in sensitivity analyses of D’Amico risk groups, age categories, or ECOG status. Lastly, in 2:1 propensity-score-matched analyses, no differences between RP and RT were found in any of the oncological outcome measures (p≥0.15 for MFS, CSS, and OS).

CONCLUSION: The findings of this real-world study of prostate cancer patients who underwent either RP or RT suggest equally effective cancer control by the two methods when the statistical analysis is adjusted for patient and tumor characteristics. At present, patients with high-risk prostate cancer und unfavorable disease stages more commonly undergo RP.

PMID:40554664 | DOI:10.3238/arztebl.m2025.0089

Chaos. 2025 Jun 1;35(6):063137. doi: 10.1063/5.0230984.

ABSTRACT

We argue that a physics experiment with systems involving drifting parameters requires a paradigm shift: the measured signal, a curve, should be compared with a band resulting from simulations. Based on earlier theoretical results, an accurate description of drifting dissipative chaotic systems can only be given by following an ensemble of trajectories. After convergence to a time-dependent attractor (to the so-called snapshot attractor), the ensemble faithfully represents the dynamics. We point out that an experimentally measured signal should wander within the spread of the converged numerical ensemble, i.e., to behave as any of the ensemble members on the snapshot attractor. If that is the case, the model (a set of ordinary differential equations) used for the simulation can be considered credible. The transient period preceding the arrival to the attractor can be divided into two phases when using two initially localized ensembles. In the first one, a quick spread of the ensembles takes place, and a plume diagram evolves. The next, intermediate phase corresponds to a convergence of the no longer localized ensembles to the same unique time-dependent attractor and lasts approximately as long as the averages and other statistical moments of the two ensembles remain distinct.

PMID:40554584 | DOI:10.1063/5.0230984