Category: Statistics

J Orthop Surg Res. 2025 Jul 12;20(1):644. doi: 10.1186/s13018-025-06054-x.

ABSTRACT

BACKGROUND: Early physical therapy (PT) following ACL reconstruction is widely advocated for optimizing post-operative recovery. However, its impact on functional recovery, proprioception, return-to-sport (RTS) rates, and graft integrity remains debated. This study aims to evaluate whether early PT initiation enhances functional and proprioceptive outcomes without compromising knee stability.

OBJECTIVES: To compare the effects of early (≤ 2 weeks) vs. delayed (≥ 4 weeks) PT initiation on functional recovery, proprioception, RTS success, and graft integrity following ACL reconstruction.

METHODS: A cross-sectional study included 132 participants (n = 66 per group) who were evaluated using standardized assessments, including IKDC scores, quadriceps strength (hand-held dynamometer), knee range of motion (digital inclinometer), proprioception (joint position sense error, Y-Balance Test, and postural stability via force platform), RTS success, and graft integrity (Lachman and Pivot-Shift tests). All outcome measures were assessed between 6 and 12 months post-operatively during routine clinical follow-up, providing a standardized timeframe for evaluating recovery and RTS readiness.

RESULTS: The early PT group demonstrated significantly higher IKDC scores (85.60 ± 6.80 vs. 80.40 ± 7.30, p < 0.001), greater quadriceps strength (2.30 ± 0.40 vs. 2.00 ± 0.50 Nm/kg, p = 0.001), and improved knee ROM (135.20 ± 4.80° vs. 130.80 ± 5.20°, p < 0.001). The proprioceptive function was superior in early PT, with lower JPS error (p < 0.001), higher Y-Balance scores (p = 0.001), and greater postural stability (p < 0.001). RTS rates were higher in the early PT group (78.79% vs. 65.15%), but the difference was not statistically significant (p = 0.121). No significant differences were observed in graft integrity (p = 0.715) or knee stability tests (p > 0.05).

CONCLUSION: Early PT initiation significantly enhances functional recovery and proprioception without increasing the risk of graft failure or knee instability. These findings support the safety and efficacy of early rehabilitation in optimizing post-operative ACL recovery and RTS readiness.

PMID:40652287 | DOI:10.1186/s13018-025-06054-x

BMC Psychol. 2025 Jul 12;13(1):784. doi: 10.1186/s40359-025-03114-z.

ABSTRACT

BACKGROUND: In educational practice, the interaction between students’ learning behaviors and psychological states is crucial. Learning engagement reflects the degree of active participation in learning activities, academic self-efficacy embodies students’ confidence in their own learning abilities, and learning anxiety may affect students’ academic performance and mental health.

PURPOSE: This study aims to break through traditional linear thinking by using Latent Profile Analysis to identify heterogeneous groups of high school students in terms of learning engagement, reveal differences in their learning anxiety and nonlinear characteristics, and validate the differentiated mediating mechanism of academic self-efficacy between learning engagement and anxiety. It fills the theoretical gap from the perspective of group heterogeneity and provides a basis and support for constructing a learning psychological theory model and precise stratified intervention in educational practice.

METHODS: In this study, the method of cluster convenience sampling was adopted. Three ordinary high schools in a city of Hubei Province were selected, and students from six classes in each grade from the first year to the third year of senior high school were sampled as the research subjects. A total of 1,008 original questionnaires were obtained, and 936 valid questionnaires were collected. LPA was employed to identify the potential categories of high school students’ learning engagement and the impact of these categories on learning anxiety. Additionally, the mediating role of academic self-efficacy between different types of learning engagement and learning anxiety was examined based on the classification results. Furthermore, a generalized additive mixed model was used to analyze the linear relationships between different types of learning engagement, academic self-efficacy, and learning anxiety.

RESULTS: Learning engagement can be categorized into four types, among which students with “High Vigor-High Dedication-High Absorption” type exhibit the highest levels of learning anxiety. Academic self-efficacy plays a mediating role between various types of learning engagement and learning anxiety. Moreover, for students with “Medium Vigor-Low Dedication-High Absorption” type, as well as those with “Low Vigor-Medium Dedication-Medium Absorption” type, there exists a non-linear relationship between learning engagement and both academic self-efficacy and learning anxiety.

CONCLUSIONS: This study reveals the heterogeneous characteristics of learning engagement and its differentiated impact on learning anxiety. Furthermore, the study finds that the relationship between learning engagement types and self-efficacy and learning anxiety exhibits a nonlinear characteristic with a turning point, breaking through the traditional assumption of a linear relationship and revealing the possible existence of a ‘threshold effect’ in changes in learning engagement levels.

IMPLICATIONS: This study divides high school students’ learning engagement into four potential categories through LPA, breaking away from traditional single-dimensional or dichotomous research perspectives and providing categorical empirical evidence for learning engagement theory, which fills a gap in the sufficient segmentation of groups with moderate engagement levels.

PMID:40652283 | DOI:10.1186/s40359-025-03114-z

J Health Popul Nutr. 2025 Jul 12;44(1):251. doi: 10.1186/s41043-025-01007-w.

ABSTRACT

BACKGROUND: Aging is closely linked to chronic diseases, and gut microbiota plays a significant role in this process. The Dietary Index for Gut Microbiota (DI-GM), a novel tool reflecting the potential impact of diet on gut microbiota diversity, has an unclear association with biological aging. This study aimed to evaluate the association between DI-GM and phenotypic age acceleration (PAA), revealing the potential regulatory effect of diet on aging.

METHODS: Data from 29,435 participants in NHANES 1999-2018 were analyzed using multivariable regression models to assess the association between DI-GM scores and PAA. Phenotypic age was estimated from 10 physiological indicators, with PAA defined as a positive age acceleration residual (ACR). DI-GM was constructed from 14 dietary components; higher scores indicate greater potential benefits to gut microbiota.

RESULTS: Higher DI-GM scores were significantly associated with a lower risk of PAA. After adjusting for covariates, each 1-point increase in DI-GM was linked to a 7% reduction in PAA risk (OR = 0.93, 95% CI = 0.91-0.95, P < 0.001) and a decrease of 0.33 in ACR (β = -0.33, 95% CI = -0.39 to -0.26, P < 0.001). Subgroup and sensitivity analyses confirmed these findings.

CONCLUSIONS: Higher DI-GM scores are significantly associated with reduced phenotypic age acceleration. Dietary improvements that promote gut microbiota health may effectively delay aging, providing scientific evidence for dietary interventions aimed at healthy aging.

PMID:40652280 | DOI:10.1186/s41043-025-01007-w

J Health Popul Nutr. 2025 Jul 12;44(1):250. doi: 10.1186/s41043-025-01005-y.

ABSTRACT

BACKGROUND: Sarcopenia is a progressive muscle disease associated with loss of muscle mass, strength and function. Previous studies have shown that folate and muscle function are related, but the effect of body folate status on muscle mass is unknown. This study aimed to investigate the relationship between different forms of folate and muscle mass.

METHODS: This cross-sectional study analyzed data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Data on body folate (5-Methyl-tetrahydrofolate (5MTHF), serum total folate, and RBC folate), muscle mass (quantified by appendicular skeletal muscle mass index, ASMI), and covariates were extracted and analyzed. To examine the relationship between folate status and ASMI, weighted multivariable linear regression analyses and smooth curve fittings were performed, followed by subgroup analysis stratified by age, gender, and race. Threshold effect analysis was conducted when a nonlinearity relationship was detected.

RESULTS: A total of 13,850 participants were included in the final analysis. RBC folate was positively associated with ASMI in all three models. Serum total folate and 5MTHF were negatively associated with ASMI in unadjusted and partially adjusted model, but not in fully adjusted model. When stratified by age, gender, and race, we observed positive associations between RBC folate and ASMI in 20-40 years old participants, men, Mexican/Hispanic, Non-Hispanic Black, and Other Race. Smooth curve fitting demonstrated a nonlinear relationship between RBC folate and ASMI, with the inflection point identified at 512 ng/mL. Stratified by age, gender, and race, nonlinear relationships remained in 20-40 years old participants, Men, Non-Hispanic Black and Other Race, with inflection points identified at 468 ng/mL, 547 ng/mL, 400 ng/mL, and 494 ng/mL, respectively.

CONCLUSION: These findings suggested folate deficiency might play a role in muscle loss, and maintenance of RBC folate above 512 ng/mL might be helpful to the prevention and treatment of sarcopenia.

PMID:40652276 | DOI:10.1186/s41043-025-01005-y

BMC Palliat Care. 2025 Jul 12;24(1):197. doi: 10.1186/s12904-025-01840-0.

ABSTRACT

BACKGROUND: Significant knowledge gaps persist in understanding how to support patients receiving palliative and end-of-life care (PEoLC) who wish to die at home. This study aimed to identify factors associated with remaining at home and home death for patients receiving PEoLC.

METHODS: A sequential mixed-methods explanatory study (QUANT + QUAL) was conducted. Administrative data from a not-for-profit at-home palliative care organization in Québec Canada from 2015 to 2024 (n = 5931) and 73 semi-structured interviews with patients receiving PEoLC, caregivers, service providers and decision-makers were collected. Logistic and Cox regression models were completed for the quantitative data analysis. Content analysis was used for the qualitative data analysis. Data integration occurred following the quantitative analyses.

RESULTS: The mean age of patients requiring PEoLC was 77.97 (SD: 13.70) years. The sample included 50.3% men and 49.7% women. One quarter (25.8%) of patients receiving PEoLC lived alone. Most patients (93.5%) had cancer. Home death occurred in almost 30% of cases. Over 95% of deaths occurred within 365 days following admission to the at-home palliative care organization. Access to respite care (adjusted odds ratio: 2.699, p < 0.001), female sex, living alone, having been hospitalized, receiving psychological care, and volunteer and transportation support were associated with remaining at home and home deaths for patients receiving PEoLC. The interviews highlighted the importance of respecting the patients’ wishes related to end of life and home death. All participants described several challenges to access timely and reliable services following the pandemic. Timely access to home care, nursing and hygiene and a palliative care approach facilitated remaining at home and home death for patients receiving PEoLC.

CONCLUSIONS: Respite care more than doubles the odds of remaining at home and home death. Timely access to services that include home care, nursing care and hygiene and a palliative care approach is essential to support patients receiving PEoLC who wish to die at home. Stabilizing staffing of home care teams, standardizing PEoLC services offered across community health centers in the province, and optimal use of nurse practitioners would improve services offered to patients receiving PEoLC and their caregivers.

PMID:40652268 | DOI:10.1186/s12904-025-01840-0

J Health Popul Nutr. 2025 Jul 12;44(1):252. doi: 10.1186/s41043-025-01006-x.

ABSTRACT

BACKGROUND: Cancer remains the foremost cause of mortality worldwide. Additionally, malnutrition frequently occurs among cancer patients and constitutes a significant factor contributing to adverse clinical outcomes and poor prognosis in this population. The present systematic review and meta-analysis study aimed to evaluate the prevalence of severe malnutrition in cancer patients.

METHOD: This study was conducted based on data extracted from previous published studies reporting the prevalence of malnutrition in cancer patients. Statistical analysis of collected data was performed using Comprehensive Meta-Analysis software (v.2). Systematic searching was applied based on MeSH keywords in medical databases of ScienceDirect, Embase, Scopus, PubMed, Web of Science (WoS), MagIran, SID, and Google Scholar (by December 2024). Following the elimination of duplicate articles, further evaluation was applied through the assessment of Titles and Abstract. Then, the eligibility assessment was performed based on the inclusion and exclusion criteria by two reviewers, independently. The information extracted from Citation Management Software of EndNote was also added. In order to achieve the highest number of eligible articles, the references of all relevant studies were reviewed, manually.

RESULTS: Totally, 19 eligible studies were selected for data extraction and meta-analysis. According to the Random Effect Model, the prevalence of severe malnutrition among cancer patients was reported 19.3% (95% CI: 14.1-25.9%). Also, the results of meta-regression examining the effective factors on heterogeneity, it was found that the rate of malnutrition in cancer patients decreases with sample size, year of study, and the age of cancer patients (p < 0.05).

CONCLUSION: Malnutrition is a common phenomenon in cancer patients. Continuous monitoring of nutritional status in cancer patients and associated economic and social factors are critical objectives during cancer therapies. According to the results of the present study, cancer therapy should be applied parallel to examination and attention to nutritional status in cancer patients.

PMID:40652267 | DOI:10.1186/s41043-025-01006-x

J Med Case Rep. 2025 Jul 12;19(1):338. doi: 10.1186/s13256-025-05355-3.

ABSTRACT

BACKGROUND: Congenital hyperinsulinism is a rare disorder characterized by inappropriate insulin secretion, leading to persistent hypoglycemia. One genetic subtype, hyperinsulinism-hyperammonemia syndrome, results from activating mutations in the GLUD1 gene. This study aimed to describe the clinical spectrum, genetic variants, and outcomes of patients with GLUD1-related hyperinsulinism-hyperammonemia syndrome treated at a tertiary care center in Saudi Arabia.

METHODS: This retrospective case series included five patients of Saudi ethnicity diagnosed with GLUD1-associated hyperinsulinism-hyperammonemia syndrome between September and November 2023 at King Faisal Specialist Hospital and Research Centre. Clinical, biochemical, imaging, and genetic data were collected from medical records. Descriptive statistics were used to summarize the findings.

RESULTS: All five patients (four pediatric, one adult) presented with hypoglycemia, elevated insulin levels, and persistent hyperammonemia. Genetic testing confirmed GLUD1 mutations in all cases, with two patients sharing the c.1493C > T (p.Ser498Leu) variant. Diazoxide therapy effectively controlled hypoglycemia in most patients. Two patients experienced significant neurological complications, including seizures and developmental delay. One adult patient underwent pancreatectomy with improvement in hypoglycemia control but retained chronic neurological sequelae. Brain magnetic resonance imaging abnormalities and secondary genetic variants were identified in two cases.

CONCLUSION: GLUD1-related hyperinsulinism-hyperammonemia syndrome presents with a wide clinical spectrum, often with early onset and risk of neurological impairment if not promptly treated. Early diagnosis and individualized management-including genetic testing and diazoxide therapy-are essential to prevent irreversible complications. Further multicenter studies are warranted to better understand long-term outcomes in affected populations.

PMID:40652260 | DOI:10.1186/s13256-025-05355-3

BMC Public Health. 2025 Jul 12;25(1):2439. doi: 10.1186/s12889-025-23625-z.

ABSTRACT

BACKGROUND: Burden of disease estimation and the attribution to risk factors are commonly done on national or regional scale. This research proposes a novel approach, where air pollution-related mortality in Belgium was estimated locally, and compares the results to those of the common ‘global’ approach.

METHODS: In the local approach, mortality attributable to long-term exposure to particulate matter < 2.5 μm (PM_2.5) and nitrogen dioxide (NO₂) is derived at the level of census tracts. Relying on a statistical concentration-response function suggests potential bias when applied to such small scale. Therefore, the local method is validated by comparing aggregated results to estimates derived with a global approach. In a sensitivity analysis, the difference between the global and local approach is compared to the impact of other methodological choices and sources of uncertainty.

RESULTS: The local method estimates (95% confidence interval) 12,276 (6,695; 17,826) deaths for PM_2.5 and 7,944 (4,725; 11,181) for NO₂ in Belgium. For both pollutants, these national estimates never deviate more than 2% from those obtained with the global method, and never more than 4% in the individual provinces. The sensitivity analysis demonstrates the concentration-response function as having the largest contribution to overall uncertainty, while the global-local discrepancy is slightly larger compared to the exposure uncertainty.

CONCLUSIONS: Aggregated local burden estimates prove to be accurate compared to the global approach. This means the local method shows potential for comparing areas and population groups at subnational level, where estimates can be generated in a flexible manner depending on research or policy needs.

PMID:40652258 | DOI:10.1186/s12889-025-23625-z

Parasit Vectors. 2025 Jul 12;18(1):281. doi: 10.1186/s13071-025-06926-5.

ABSTRACT

BACKGROUND: The two intestinal protozoan parasites Giardia duodenalis and Cryptosporidium parvum cause infections in a wide spectrum of vertebrates and have also been shown to infect suitable hosts simultaneously. To investigate potential effects between these parasites and on host cells, a co-infection model with IPEC-J2 cells was established.

METHODS: Optimal infection conditions and several infection doses of both parasites were tested. The effect of Giardia growth medium on IPEC-J2 cells was analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction assay, while the effect of different infection doses of each parasite on host cell viability was investigated by CellTiter Blue cell viability assay. For co-infection, IPEC-J2 cells were first infected with C. parvum sporozoites, and 3.5 h later, G. duodenalis trophozoites were added. Parasite propagation during single infection and co-infection were analyzed by quantitative real-time polymerase chain reaction (qPCR) as well as immunofluorescent staining.

RESULTS: The infection with C. parvum sporozoites had no significant impact on cell viability, while G. duodenalis trophozoites affected cell culture in a dose dependent manner. The amount of gene copies of C. parvum in single and co-infected cells did not differ significantly, while statistically higher amounts of G. duodenalis gene copies in co-infected cell cultures were identified.

CONCLUSIONS: In this study, single infections and co-infections of IPEC-J2 cells with C. parvum and G. duodenalis were established and optimized over a period of 72 h.

PMID:40652254 | DOI:10.1186/s13071-025-06926-5

J Health Popul Nutr. 2025 Jul 12;44(1):253. doi: 10.1186/s41043-025-00959-3.

ABSTRACT

BACKGROUND: Infants categorized as large for gestational age (LGA) or with macrosomia face an increased risk of adverse pregnancy outcomes and metabolic syndrome. However, the epidemiological characteristics of LGA and macrosomia are not well understood. This study aims to describe these characteristics in detail.

METHODS: Descriptive statistical methods were employed to analyze the prevalence of large for gestational age (LGA) and macrosomia, as well as their distribution from 2014 to 2021, using data from the Guangdong Women and Children Health Information System. Retrospective data on birthweight, gender, method of delivery, maternal age, and household registration were collected. Additionally, the correlation between prevalence rates and gross domestic product (GDP) per capita was assessed.

RESULTS: The study included data from 12,992,558 singleton live births for LGA and 12,999,759 for macrosomia. The overall prevalence of LGA and macrosomia in southern China between 2014 and 2021 was 8.59% and 2.33%, respectively. During the study period, the prevalence of LGA in preterm infants (13.64%) was significantly higher than in full-term infants (8.34%), while macrosomia occurred more frequently in full-term infants (2.43%) and male infants (2.98%). The prevalence of LGA and macrosomia in winter was 9.94% and 2.59%, respectively, much higher than in other seasons. Additionally, the rate of LGA and macrosomia among infants born to mothers of advanced maternal age (≥ 35 years) was 13.52% and 3.57%, significantly higher than the 7.79% and 2.17% observed among those born to mothers younger than 35 years. Furthermore, the nine cities in the Pearl River Delta region accounted for the majority of LGA and macrosomia cases in southern China from 2014 to 2021.

CONCLUSIONS: Between 2014 and 2021, the overall birth rate in southern China showed a declining trend, while the prevalence of large for gestational age (LGA) and macrosomia increased. The liberalization of China’s birth policy, coupled with the rise in advanced maternal and paternal ages, contributed to the higher rates of LGA and macrosomia. Additionally, most LGA infants may be born at an earlier gestational age. LGA and macrosomia are more commonly observed in winter, with birth peaks occurring at the beginning of the following year.

PMID:40652252 | DOI:10.1186/s41043-025-00959-3