Category: Statistics

Actas Esp Psiquiatr. 2025 May;53(3):557-569. doi: 10.62641/aep.v53i3.1788.

ABSTRACT

OBJECTIVE: Surgery, as the preferred option to extend the survival of breast cancer patients, has increasingly garnered attention for its impact on patients’ mental status and quality of life (QoL). Therefore, this study aimed to identify the factors affecting the QoL and mental status of breast cancer patients with schizophrenia, thus enabling subsequent interventions to improve their mental status and QoL.

METHODS: This study included 125 breast cancer patients with schizophrenia, and their mental status and QoL were analyzed before and after surgery. The mental status of these patients was assessed using the Symptom Checklist-90 (SCL-90), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to score their QoL. Baseline characteristics were recorded, including age, marital status, education level, and per capita monthly household income. The clinical and demographic data were statistically analyzed to identify factors affecting patients’ mental status and QoL.

RESULTS: We observed that the mental status and QoL of breast cancer patients with schizophrenia at preoperative and postoperative stages were influenced by marital status, education level, tumor stage, tumor size, and monthly family income. Additionally, the type of surgery was significantly associated with postoperative mental status and QoL and was found to be a predictor influencing the overall QoL. Furthermore, surgery had a positive impact on patients across different treatment stages.

CONCLUSION: The psychological state and QoL of breast cancer patients with schizophrenia are influenced by various factors at different stages of treatment (preoperative and postoperative). Surgery significantly improves the patients’ psychological state and QoL.

PMID:40356007 | DOI:10.62641/aep.v53i3.1788

Actas Esp Psiquiatr. 2025 May;53(3):494-503. doi: 10.62641/aep.v53i3.1892.

ABSTRACT

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) refers to a set of symptoms, such as an inability to sustain attention, hyperactivity, and impulsivity, with a prevalence of 2.0% for the general population. Approximately 2.7% of American medical students report having some form of disability, with ADHD emerging as the most frequently self-disclosed condition. Medical students with a positive ADHD Self-Report Scale (ASRS) score present more depression symptoms in comparison with those with a negative ASRS score. Previous studies suggest that a low amount of time spent in physical activity and a high amount of time spent in sedentary behavior were associated with mental disorders (e.g., anxiety and depression). However, information in the literature on this association with symptoms of ADHD is limited, particularly in medical students.

METHODS: In this cross-sectional study, we investigated a sample of medical students aged 18 years or older. Individuals diagnosed with ADHD were excluded. Participants completed an online survey, which included questions about demographic and academic experiences, the ADHD Self-Report Scale, the International Physical Activity Questionnaire (IPAQ), and the Beck Anxiety Inventory (BAI). Statistical analysis was conducted using the SPSS 22 program, with a significance threshold of p = 0.05.

RESULTS: Out of ninety-nine medical students included, forty individuals (40.4%), demonstrated positive ASRS scores, suggesting a risk for ADHD. After dividing the participants into groups according to their ASRS scores (negative or positive ASRS), the Mann-Whitney comparison revealed that the negative ASRS group exhibited lower daily screen time (9.0 vs 12.0 hours per day; p < 0.01) and reduced anxiety symptoms (8.0 vs 16.0 points; p < 0.01) compared to the positive ASRS group. Furthermore, the linear multiple regression analysis indicated that screen time was a predictor of the ASRS score.

CONCLUSION: In a sample of medical students, the current study showed a prevalence of 40.4% of positive ASRS. The results suggest that medical students with a positive ASRS score have higher screen time, as well as more symptoms of anxiety. In addition, we found that screen time was a significant predictor of scores in the ASRS.

PMID:40355994 | DOI:10.62641/aep.v53i3.1892

Alzheimers Dement. 2025 May;21(5):e70153. doi: 10.1002/alz.70153.

ABSTRACT

INTRODUCTION: The spatial heterogeneity of tau deposition is closely linked to clinical variants of Alzheimer’s disease (AD). Detecting these patterns in the preclinical stage is challenging, but second-generation tau tracers provide a unique opportunity to do so.

METHODS: We used independent component analysis (ICA) and tau positron emission tomography (PET) imaging with the 18F-MK6240 tracer in 590 cognitively healthy adults (mean age 66.58 ± 5.13 years, 340 females) to identify tau patterns in the preclinical stage.

RESULTS: Using all individuals, seven distinct patterns emerged, with medial temporal lobe (MTL) involvement associated with age, Aβ burden, apolipoprotein E (APOE) genotype, and plasma total tau. Bilateral amygdala-hippocampus tau deposition was associated negatively with memory (t = -2.64, p < 0.01), while broader neocortical patterns, especially asymmetric ones, were linked to deficits in language (t < -3.13, p < 0.002) and reasoning (t < -2.63, p < 0.01).

DISCUSSION: These findings advance our understanding of preclinical tau heterogeneity, offering new insights for early AD intervention.

HIGHLIGHTS: Seven tau deposition patterns were identified in preclinical stages of AD, including medial temporal lobe and asymmetric neocortical patterns. Medial temporal lobe patterns were strongly linked to age, APOE genotype, Aβ burden, and plasma total tau levels. Neocortical patterns, especially asymmetric ones, were linked to domain-specific cognitive deficits, notably in language and reasoning. This research highlights the potential of using tau deposition patterns for early detection and tailoring interventions in preclinical AD.

PMID:40355988 | DOI:10.1002/alz.70153

Implement Sci Commun. 2025 May 12;6(1):58. doi: 10.1186/s43058-025-00746-5.

ABSTRACT

BACKGROUND: Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.

METHODS: We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies – retraining health providers and fast tracking PrEP clients- to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.

RESULTS: We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.

CONCLUSIONS: A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.

PMID:40355972 | DOI:10.1186/s43058-025-00746-5

Orphanet J Rare Dis. 2025 May 12;20(1):224. doi: 10.1186/s13023-025-03583-w.

ABSTRACT

BACKGROUND: X-linked myotubular myopathy (XLMTM) is a rare, life-threatening congenital myopathy with multisystem involvement, which often includes the need for invasive ventilator support, gastrostomy tube feeding, and wheelchair use in approximately 80% of patients. The direct and indirect financial impact of extensive supportive care, as reported by caregivers of individuals with XLMTM, and the health-related quality of life (HRQoL) of caregivers has not been previously described. Here, we use a survey co-designed by patient advocates to provide objective information on the physical and financial challenges of caregiving for individuals with XLMTM.

METHODS: A real-world web-based survey was conducted in the United States between November 19, 2019, and January 23, 2020. The survey was developed in association with patient advocacy leaders from the XLMTM community, who were also caregivers of individuals with XLMTM. The survey included the EuroQol 5-dimension 5-level HRQoL instrument and visual analog scale, and a cost (direct and indirect medical costs) and healthcare resource questionnaire. The survey was shared among the XLMTM community by patient advocacy organizations. Caregivers who completed the survey and met the eligibility criteria were included. Descriptive statistics were conducted using Microsoft Excel.

RESULTS: Twenty-two caregiver respondents agreed to participate. All respondents completed the cost and health resource survey. Productivity loss varied between participants over the prior 12 months. Durable medical equipment expenses comprised most of the direct medical out-of-pocket costs. Non-medical expenditures (e.g. home and vehicle modifications) were higher than direct medical out-of-pocket costs. Twelve of the 22 respondents completed the HRQoL survey. The HRQoL domains most impacted were usual activities, anxiety/depression, and pain/discomfort.

CONCLUSIONS: Findings from this real-world survey of caregivers for individuals with XLMTM describe the caregiver experience, as well as the multifaceted impact of the disease on caregiver productivity loss, out-of-pocket expenses, and HRQoL. XLMTM comes with financial constraints and substantial impacts on caregivers’ physical and mental health. Understanding these gaps is crucial to support the caregivers who provide care for this medically fragile population.

PMID:40355957 | DOI:10.1186/s13023-025-03583-w

Breast Cancer Res. 2025 May 12;27(1):76. doi: 10.1186/s13058-025-02036-3.

ABSTRACT

BACKGROUND: Cancer-related fatigue (CRF) is a common symptom in breast cancer patients and survivors, which can substantially impair quality of life. Previous studies suggested that CRF may be associated with poorer survival outcomes, but had limited follow-up duration or insufficient adjustment for established prognostic factors. The aim of this analysis was to assess the prognostic value of CRF at the end of radiotherapy for overall survival in a cohort of women with breast cancer with a median follow-up time of 19 years.

METHODS: Data from the prospective ISE study, which enrolled women with non-metastatic breast cancer between 1998 and 2001, were analysed. Patients did not receive chemotherapy. A vital status follow-up was conducted in 2019. CRF was collected at the end of radiotherapy using the EORTC QLQ-C30 and classified using the threshold of clinical importance. Cox regression models adjusted for CRF, age, body mass index (BMI), tumour size, nodal involvement, grading and receptor status were calculated.

RESULTS: Of 437 patients with fatigue assessments, 164 (38%) reported CRF. During 10 years of follow-up, 25 patients without and 27 patients with CRF died. Tumour size, nodal involvement and age were statistically significantly associated with 10-year overall survival. For CRF, a statistically significant effect was observed for ≥ 5 years of follow-up (HR: 2.44), but not within the first 5 years of follow-up (HR: 1.26).

CONCLUSIONS: CRF assessments at the end of radiotherapy showed prognostic value for long-term survival beyond established factors and could potentially be used to identify patients that require monitoring in risk-adapted aftercare programmes in order to improve survival.

PMID:40355939 | DOI:10.1186/s13058-025-02036-3

J Transl Med. 2025 May 12;23(1):532. doi: 10.1186/s12967-025-06507-1.

ABSTRACT

BACKGROUND: Accurate assessment of expected survival in melanoma patients is crucial for treatment decisions. This study explores deep learning-based body composition analysis to predict overall survival (OS) using baseline Computed Tomography (CT) scans and identify fully volumetric, prognostic body composition features.

METHODS: A deep learning network segmented baseline abdomen and thorax CTs from a cohort of 495 patients. The Sarcopenia Index (SI), Myosteatosis Fat Index (MFI), and Visceral Fat Index (VFI) were derived and statistically assessed for prognosticating OS. External validation was performed with 428 patients.

RESULTS: SI was significantly associated with OS on both CT regions: abdomen (P ≤ 0.0001, HR: 0.36) and thorax (P ≤ 0.0001, HR: 0.27), with lower SI associated with prolonged survival. MFI was also associated with OS on abdomen (P ≤ 0.0001, HR: 1.16) and thorax CTs (P ≤ 0.0001, HR: 1.08), where higher MFI was linked to worse outcomes. Lastly, VFI was associated with OS on abdomen CTs (P ≤ 0.001, HR: 1.90), with higher VFI linked to poor outcomes. External validation replicated these results.

CONCLUSIONS: SI, MFI, and VFI showed substantial potential as prognostic factors for OS in malignant melanoma patients. This approach leveraged existing CT scans without additional procedural or financial burdens, highlighting the seamless integration of DL-based body composition analysis into standard oncologic staging routines.

PMID:40355935 | DOI:10.1186/s12967-025-06507-1

Cardiovasc Diabetol. 2025 May 12;24(1):201. doi: 10.1186/s12933-025-02738-0.

ABSTRACT

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent clinical syndrome with high morbidity and mortality. Although HFpEF frequently coexists with cardiometabolic diseases, the causal mechanisms and potential mediators remain poorly understood.

OBJECTIVES: This study aimed to identify cardiometabolic risk factors specifically driving HFpEF and to determine their underlying circulating mediators.

METHODS: We used two-sample Mendelian Randomization (MR) to analyze the effects of obesity, Type 2 diabetes, hypertension, chronic kidney disease (CKD), and dyslipidemia on HFpEF and heart failure with reduced ejection fraction (HFrEF) in large European-ancestry GWAS datasets. We then performed mediation MR to identify plasma proteins and metabolites that mediate the transition from each cardiometabolic disease to HFpEF, respectively. We applied multivariable MR to assess the impact of risk confounding on the results. Bioinformatic analyses were conducted to delineate mechanisms.

RESULTS: Cardiometabolic diseases had heterogeneous effects on HFpEF and HFrEF. Obesity and type 2 diabetes showed adjusted causal effects with HFpEF, hypertension showed potential relevance to HFpEF, whereas dyslipidemia and CKD did not. MR analysis identified 5 proteins that mediate obesity to HFpEF; 5 proteins that mediate type 2 diabetes to HFpEF. Further mediation MR analysis of obesity and T2D on HFrEF revealed heterogeneity in circulating mediators between metabolic HFpEF and HFrEF. Comprehensive bioinformatics analyses showed that IL1R1, together with other proteins such as TP53 and FGF19, orchestrates the inflammatory and fibrotic processes underlying HFpEF.

CONCLUSIONS: These findings suggest that metabolic HFpEF has distinct etiological features compared with HFrEF and is driven by complex, condition-specific mediators. IL1R1 mediates HFpEF in multiple metabolic risk states, suggesting a potential therapeutic target. Further translational studies are warranted to evaluate anti-inflammatory strategies targeting IL1R1 in HFpEF.

PMID:40355922 | DOI:10.1186/s12933-025-02738-0

BMC Oral Health. 2025 May 12;25(1):712. doi: 10.1186/s12903-025-06083-2.

ABSTRACT

BACKGROUND: Maintaining good oral and dental hygiene is one of the most crucial components of a healthy lifestyle. Health education is implemented through various techniques, such as lectures, movie screenings, printed materials, etc. This study aimed to develop a multimedia teaching instrument for oral and dental health education and assess its effectiveness in raising teenagers’ knowledge and satisfaction.

METHODS: the research’s sample size included 70 teenagers, who were chosen randomly. The users were given access to the program before and after using the software, and its efficacy was assessed from their perspective using questionnaires. The data analysis was performed using descriptive statistics indices and analytical tests, SPSS version 26. A significance level of 0.05 was considered.

RESULTS: The average age and educational grade of software users were 14.49 years and 8.49 years, respectively. Before using the software, 67.76 ± 19.8% of the questions were answered correctly, while after using the software, 86.85 ± 10.21% of the questions had an accurate response. Before and after utilizing the program, there was an increase of 22.9 ± 17.8% in the mean correct response.

CONCLUSION: Useful training in the mentioned software, along with multimedia content and easy access of teenagers to the training, will facilitate and increase the speed of health education and reduce the time and cost of subsequent oral and dental health disorders.

PMID:40355920 | DOI:10.1186/s12903-025-06083-2

BMC Nurs. 2025 May 12;24(1):515. doi: 10.1186/s12912-025-03062-4.

ABSTRACT

BACKGROUND: Despite numerous shared health challenges during treatment and recovery, the interdependence of health between patients with colorectal cancer and their family caregivers remains underexplored. This study applied the actor-partner interdependence model (APIM) to examine this dyadic relationship.

METHODS: This descriptive correlational survey involved patients with colorectal cancer who visited the outpatient department for postoperative follow-up, along with their family caregivers. From 343 consenting participants, responses from 100 matched patient-caregiver pairs were analyzed. Data collection occurred at J Hospital from August 2023 to May 2024. Key variables included the psychological health and quality of life (QoL) of both patients and caregivers, patient self-care, and caregiver contribution to self-care. Statistical analysis was performed using Stata 16.1, with structural equation modeling.

RESULTS: The mean age of patients was 65.57 years; 51% were male, 66% had colon cancer, and 34% rectal cancer. The caregivers’ mean age was 56.11 years; 55% were female, and 66% were spouses. The analysis of actor effects showed that the psychological health and QoL of both patients and caregivers independently influenced their respective outcomes. The analysis of partner effects revealed mutual influences between the psychological health of patients and caregivers; moreover, the psychological health of caregivers impacted patients’ self-care. While there was a correlation between the QoL of patients and caregivers, it was not statistically significant in the structural equation modeling.

CONCLUSIONS: This study underscores the profound interdependence of health between patients with colorectal cancer and their caregivers, revealing significant mutual impacts on psychological health and, to a lesser extent, self-care. These insights suggest the need for targeted interventions to improve both patient recovery and caregiver support, even where some correlations lack statistical significance.

TRIAL REGISTRATION: Prospectively registered with the Clinical Research Information Service (CRIS) under the Clinical Trial Number KCT0008743 (Registration Date: 2023.08.25).

PMID:40355918 | DOI:10.1186/s12912-025-03062-4