Category: Statistics

Malar J. 2025 Sep 23;24(1):288. doi: 10.1186/s12936-025-05588-z.

ABSTRACT

BACKGROUND: The World Health Organization malaria burden estimates produced from incomplete clinical case reporting and often outdated household asymptomatic parasitaemia surveys in children < 5 years old, are unreliable. Surveillance target groups need to be expanded in line with the epidemiological shift in malaria-eliminating countries towards adults, and particularly men. Furthermore, new tools that can provide granular and timely data, critical to understanding geographic heterogeneity and enabling timely decision-making at the operational level, are needed. This prospective study aimed to demonstrate that blood donor malaria screening could serve as a time-sensitive complementary source of highly detailed malaria surveillance data.

METHODS: Consecutive blood donations received from 16 August 2023 to 31 August 2024 at the Ouagadougou and Bobo-Dioulasso Regional Blood Transfusion Centres in Burkina Faso, covering 5 of 13 regions, were screened for malaria using the Sysmex XN-31 automated analyser. XN-31 results, donor age, sex, place of residence, collection date, were analysed using descriptive statistics, chi-squared, and logistic regression tests. Seasonal malaria patterns were compared with publicly available rainfall data.

RESULTS: Donor malaria prevalence was 5.91% (3164/53575) overall. Key predictors of malaria identified were age ≤ 30 years (odds ratio (OR) 2.85, p < 0.001), male sex (OR 1.47, p < 0.001) and rural residency (OR 2.40, p < 0.001), with regional location having a strong influence on the latter. Strong seasonal variability, mirroring that of rainfall with a 3-month lag, was observed with different peak periods and rate of change over time at provincial level. Hot-spots were observed within both Bobo-Dioulasso and Ouagadougou. There were no age or sex-based differences in parasite density or gametocyte carriage, and both measures were directly proportional to malaria prevalence. Only males showed striking seasonal variability in gametocyte carriage (low season 1.39%, 14/1006; high season 4.42%, 66/1494; p < 0.001).

CONCLUSIONS: The large data set and spatiotemporal malaria prevalence information, not possible with episodic household malaria surveys, facilitated highly granular analysis and demonstrated the potential to provide dynamic real-time information on the malaria burden using automated XN-31 blood donor malaria screening.

PMID:40988020 | DOI:10.1186/s12936-025-05588-z

Cardiovasc Diabetol. 2025 Sep 23;24(1):365. doi: 10.1186/s12933-025-02936-w.

ABSTRACT

BACKGROUND: Combination therapy is gaining attention in type 2 diabetes management due to its potential to reach glycaemic goals within a shorter period. However, the long-term comparative cardiorenal effectiveness of fixed- versus loose-dose combinations remains unclear. This study aimed to assess whether oral antidiabetic fixed-dose combination (FDC) therapy is associated with improved cardiorenal outcomes in adults with type 2 diabetes compared with loose-dose combination (LDC) therapy. A secondary objective was to evaluate the mediating role of medication adherence in these associations.

METHODS: This population-based, new-user, active-comparator cohort study used Swedish national registers. Propensity score matching without replacement was applied. Study outcomes included acute myocardial infarction, atrial fibrillation, unstable angina, heart failure, ischaemic stroke, and eGFR < 30 ml/min/1.73m². Associations with cardiorenal outcomes were assessed using Cox regression. Adherence was defined as the proportion of days covered > 80% during the first year.

RESULTS: The median follow-up time was 4.0 years for cardiovascular outcomes and 3.8 years for kidney outcomes. In the matched cohort (mean age 62 years; 67% male), FDC users had higher treatment adherence (68.6 vs. 46.5%). FDC was associated with a lower rate of heart failure (HR = 0.88; 95% CI 0.79, 0.99), with adherence mediating 47% of this association. In people aged ≥ 65 years, FDC was associated with a lower rate of heart failure (HR = 0.79; 95% CI 0.69, 0.91). The observed association was attenuated with further matching for diabetes duration or when drugs were matched at the ATC code level. No associations between FDC use and other outcomes were identified.

CONCLUSIONS: FDC therapy in people with type 2 diabetes was associated with a lower rate of heart failure, particularly in older adults. Higher medication adherence appeared to mediate nearly half of this association.

PMID:40988019 | DOI:10.1186/s12933-025-02936-w

Cardiovasc Diabetol. 2025 Sep 23;24(1):366. doi: 10.1186/s12933-025-02921-3.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index, as a measure of insulin resistance, has been confirmed to be associated with adverse clinical outcomes. The new composite indicator, TyG-A body type index (TyG-ABSI), by integrating the TyG index and the A body type index, has demonstrated superior efficacy in predicting the risk of cardiovascular death in the general population compared to traditional indicators. This study aims to deeply explore the association between TyG-ABSI and all-cause mortality and CVD mortality in the population with cardiovascular kidney-metabolic syndrome (CKM) stages 0-3. The analysis will be conducted from multiple dimensions such as the intensity of indicator correlation and potential influencing mechanisms, in order to comprehensively reveal the relationship between the two.

RESULTS: We analyzed data from 13,480 participants in the NHANES cohort (1999-2018) using Cox proportional hazards models and restricted cubic spline functions. The results indicated that elevated TyG-ABSI values were independently associated with a higher risk of all-cause mortality (HR = 1.226, 95% CI 1.104-1.361) and cardiovascular mortality (HR = 1.377, 95% CI 1.149-1.651). Time-dependent receiver operating characteristic (ROC) curves and concordance index evaluations demonstrated that TyG-ABSI yielded more accurate long-term prognostic performance than other TyG-derived metrics. The area under the curve (AUC) of this indicator reached 0.688-0.708 in the prediction of all-cause mortality risk over 5-15 years, and 0.696-0.739 in the prediction of cardiovascular mortality risk. External validation using CHARLS data confirmed the robustness of these findings in predicting all-cause mortality.

CONCLUSIONS: Among individuals with CKM stages 0-3, TyG-ABSI demonstrates a stronger association with mortality risk and superior predictive ability compared with other TyG-derived metrics. Its performance suggests a potential role in capturing variations across diverse clinical subgroups, and informing optimal timing for preventive interventions.

PMID:40988017 | DOI:10.1186/s12933-025-02921-3

BMC Oral Health. 2025 Sep 23;25(1):1417. doi: 10.1186/s12903-025-06944-w.

ABSTRACT

BACKGROUND: Pediatric dentists can play a crucial role in detecting, referring, counselling, and treating patients with obstructive sleep apnea (OSA). Understanding their knowledge and attitudes towards OSA is crucial for effective healthcare delivery.

OBJECTIVE: This study aimed to assess the knowledge, attitude, and practice of pediatric dentists in Egypt toward obstructive sleep apnea in children.

METHODS: This cross-sectional study used a web-based structured questionnaire generated via Google Forms based on a previously validated questionnaire. The link for the questionnaire was circulated to participants through emails and professional group forums. The questionnaire comprised an introductory paragraph and four sections: demographic, knowledge, attitude, and practice for data collection.

RESULTS: A total of 362 pediatric dentists participated in this online survey. Adequate knowledge was detected in 310 (85.64%) pediatric dentists, and 343 (94.75%) demonstrated a positive attitude toward OSA. In contrast, inadequate practices were observed in 274 (75.69%) pediatric dentists. Concerning the correlation between the knowledge, attitude, and practice and demographic data, a weak negative correlation with statistical significance (p-value = 0.047186) was detected between practice and age. A weak positive correlation was also detected between knowledge and years of experience, with a statistical significance (p-value = 0.011848).

CONCLUSIONS: Pediatric dentists in Egypt seem to have adequate knowledge and a positive attitude toward different domains of pediatric OSA, but their practice was inadequate. Participants’ knowledge showed a weak favourable correlation with years of experience; meanwhile, their practice has an adverse weak relationship with age.

TRIAL REGISTRATION: The current study was registered on May 6, 2025, with the identifier number NCT06970873 on clinicaltrials.gov.

PMID:40988011 | DOI:10.1186/s12903-025-06944-w

Int J Behav Med. 2025 Sep 23. doi: 10.1007/s12529-025-10397-4. Online ahead of print.

ABSTRACT

PURPOSE: Depression is the second most prevalent mental disease among adolescents, yet only a small percentage seek or receive treatment for the disease. Physical activity (PA) interventions hold promise as an alternative or adjunct to clinical treatment for depression. However, previous studies have been inconsistent regarding the relationship between PA and depressive symptoms in children and adolescents. The purpose of this study was to assess the effect of PA intervention on depressive symptoms in children and adolescents through a meta-analysis.

METHODS: Literature from 10 electronic databases and 4 registries was systematically searched. Combined estimates (standardized mean difference, SMD) and 95% CIs were calculated using a random-effects model to assess the effect of PA on depressive symptoms in adolescents. Relevant subgroup analyses and sensitivity analyses were also performed.

RESULTS: Results showed that PA improved depressive symptoms in children and adolescents (SMD = -0.707, 95% CI: -0.901 to -0.514). Subgroup analyses showed that PA improved adolescent depressive symptoms in different regions, different types of PA, moderate- to vigorous-intensity PA, different single-session time PA, different frequency PA, and different duration PA.

CONCLUSIONS: PA interventions could be used to reduce depressive symptoms in children and adolescents. A mixed program and vigorous-intensity PA intervention was the most effective in improving depressive symptoms in children and adolescents. The selection of a 4 to 8-week, no less than 4 times per week, single-session PA program of no more than 30 min may yield desirable results.

PMID:40987974 | DOI:10.1007/s12529-025-10397-4

J Imaging Inform Med. 2025 Sep 23. doi: 10.1007/s10278-025-01536-0. Online ahead of print.

ABSTRACT

The potential of deep learning for medical imaging is often constrained by limited data availability. Generative models can unlock this potential by generating synthetic data that reproduces the statistical properties of real data while being more accessible for sharing. In this study, we investigated the influence of training set size on the performance of a state-of-the-art generative adversarial network, the StyleGAN2-ADA, trained on a cohort of 3,227 subjects from the OpenBHB dataset to generate 2D slices of brain MR images from healthy subjects. The quality of the synthetic images was assessed through qualitative evaluations and state-of-the-art quantitative metrics, which are provided in a publicly accessible repository. Our results demonstrate that StyleGAN2-ADA generates realistic and high-quality images, deceiving even expert radiologists while preserving privacy, as it did not memorize training images. Notably, increasing the training set size led to slight improvements in fidelity metrics. However, training set size had no noticeable impact on diversity metrics, highlighting the persistent limitation of mode collapse. Furthermore, we observed that diversity metrics, such as coverage and β-recall, are highly sensitive to the number of synthetic images used in their computation, leading to inflated values when synthetic data significantly outnumber real ones. These findings underscore the need to carefully interpret diversity metrics and the importance of employing complementary evaluation strategies for robust assessment. Overall, while StyleGAN2-ADA shows promise as a tool for generating privacy-preserving synthetic medical images, overcoming diversity limitations will require exploring alternative generative architectures or incorporating additional regularization techniques.

PMID:40987961 | DOI:10.1007/s10278-025-01536-0

Diabetologia. 2025 Sep 24. doi: 10.1007/s00125-025-06546-9. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this work was to investigate tissue-specific insulin resistance in South Asian and Nordic women with previous gestational diabetes mellitus (pGDM) and to evaluate potential ethnic differences contributing to type 2 diabetes risk.

METHODS: A cross-sectional study using a two-step hyperinsulinaemic-euglycaemic clamp with a glucose tracer was conducted to assess insulin sensitivity in muscle, liver and adipose tissue in 19 South Asian and 16 Nordic women with pGDM and prediabetes (impaired glucose tolerance and/or impaired fasting glucose), along with 16 ethnicity-specific control women. We assessed inflammation and mitochondrial genes by mRNA sequencing of adipose tissue.

RESULTS: Both South Asian and Nordic women with pGDM showed reduced total glucose disposal (mainly due to muscle insulin resistance) and hyperinsulinaemia compared with the control group. Endogenous glucose production (mainly due to hepatic insulin resistance) was elevated in Nordics with pGDM, while South Asians with pGDM showed pronounced adipose tissue insulin resistance (reduced suppression of glycerol during clamp). mRNA sequencing of adipose tissue indicated increased tissue inflammation in South Asian women compared with Nordic women with pGDM. Furthermore, we observed a differential response to hyperinsulinaemia in South Asians vs Nordics related to mitochondrial mRNA, such as thymidine kinase 2 (TK2). Correlations between adiposity markers and insulin sensitivity also differed by ethnicity, suggesting that the pathways leading to type 2 diabetes may vary across populations.

CONCLUSIONS/INTERPRETATION: South Asian and Nordic women with pGDM exhibited differences in insulin resistance profiles, with South Asians showing greater adipose tissue insulin resistance and inflammation.

PMID:40987939 | DOI:10.1007/s00125-025-06546-9

J Environ Manage. 2025 Sep 22;394:127411. doi: 10.1016/j.jenvman.2025.127411. Online ahead of print.

ABSTRACT

Sustainable development remains a critical priority under the United Nations 2030 Agenda, and the G7 economies-Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States-play a pivotal role due to their economic influence, technological leadership, and environmental responsibility. This study investigates the long-run determinants of sustainable development in the G7 from 1995 to 2022, using the Sustainable Development Index (SDG) as the dependent variable. Six explanatory factors are considered: artificial intelligence adoption (AI), women’s entrepreneurship (FEM), technological intensity (TEC), global warming (SUR), income inequality (INI), and unemployment (UNM). The empirical strategy employs Fixed Effects estimation with Driscoll-Kraay standard errors, validated through the Hausman test, and complemented with Augmented Mean Group (AMG) and Common Correlated Effects Mean Group (CCEMG) estimators for robustness against cross-sectional dependence and slope heterogeneity. The results reveal that AI exhibits a negative association with the SDG index under the baseline model, underscoring the risks of digital transformation without inclusive policies, though AMG suggests a potential positive effect under heterogeneous country conditions. Women’s entrepreneurship, while positively signed, is statistically insignificant, indicating persistent structural barriers in the G7. Technological intensity consistently demonstrates a positive and significant impact, highlighting the role of advanced industrial innovation in driving sustainability. Rising surface temperatures exert a weakly negative effect, reaffirming climate change as a threat to long-term development. Income inequality remains statistically insignificant but directionally adverse. Unemployment shows a strong and positive association across all estimators, reflecting structural labor market adjustments during the transition toward greener and more sustainable sectors. This study contributes to the literature by integrating digital, social, economic, and environmental dimensions within a robust econometric framework tailored for high-income economies. Policy recommendations emphasize inclusive digital transformation, stronger support for women-led enterprises, investment in clean technologies, proactive climate action, and labor market policies that align green transitions with social equity.

PMID:40986962 | DOI:10.1016/j.jenvman.2025.127411

J Environ Manage. 2025 Sep 22;394:127366. doi: 10.1016/j.jenvman.2025.127366. Online ahead of print.

ABSTRACT

Negative developments such as excessive resource consumption and accelerated environmental degradation in recent years have prompted European countries and institutions to adopt the circular economy model instead of the linear economy model. This study examines the relationship between circular economy indicators and gross domestic product, and by so doing, analyzes the impact of the circular economy on achieving sustainable development. To holistically demonstrate the direct and indirect benefits of “becoming circular,” the statistical indicators used were those established within the framework developed by the European Commission for monitoring the circular economy. Thus, the core elements of the circular economy could be monitored through these indicators. A total of 25 European countries were analyzed over the period from 2005 to 2023. The analysis employs panel data econometrics, and the model was estimated using Driscoll-Kraay estimators. This method provides robust estimators in the presence of heteroskedasticity, autocorrelation, and cross-sectional dependence. The results of the study show that measures related to the circular economy have a direct impact on economic growth.

PMID:40986959 | DOI:10.1016/j.jenvman.2025.127366

Diving Hyperb Med. 2025 Sep 30;55(3):212-219. doi: 10.28920/dhm55.3.212-219.

ABSTRACT

INTRODUCTION: Diving necessitates significant physiological adaptations, particularly within the cardiopulmonary system. Resting electrocardiograms (ECGs) are widely used in fitness to dive assessments, but their effectiveness in healthy young divers remains unclear. This study assessed the impact of applying sports medicine ECG criteria compared to traditional clinical standards, aiming to reduce (unnecessary) referrals to a cardiologist without compromising diver safety.

METHODS: In this retrospective study covering 10 years, ECGs from Royal Netherlands Navy divers were analysed. Abnormal ECGs identified by clinical criteria between 2010 and 2019 were re-evaluated using international sports medicine ECG criteria. A control group of normal ECGs was matched based on demographic factors. Statistical analyses were performed using Pearson’s chi-squared and Fisher’s exact test, with significance set at P < 0.05.

RESULTS: Of a total of 3,020 ECGs, 156 were classified as abnormal by clinical criteria. Reassessment using sports medicine standards reduced the number requiring further investigation by 85.9%. In the control group, 1.0% of previously unremarkable ECGs were identified as requiring further investigation upon reassessment. Conduction disorders and rhythm disturbances were the most common findings.

CONCLUSIONS: The findings of this study suggest that the application of sports medicine ECG interpretation criteria effectively reduces the number of ECGs requiring further investigation, thereby minimising referrals and associated costs. These results advocate for a re-evaluation of routine ECG screening practices in fitness to dive assessments in military divers, promoting a more tailored approach for this specific group.

PMID:40986920 | DOI:10.28920/dhm55.3.212-219