Category: Statistics

JMIR Hum Factors. 2025 Sep 9;12:e69934. doi: 10.2196/69934.

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide, yet first responder apps can significantly improve outcomes by mobilizing citizens to perform cardiopulmonary resuscitation before professional help arrives. Despite their importance, limited research has examined the psychological and behavioral factors that influence individuals’ willingness to adopt these apps.

OBJECTIVE: Given that first responder app use involves elements of both technology adoption and preventive health behavior, it is essential to examine this behavior from multiple theoretical perspectives. Building on the unified theory of acceptance and use of technology (UTAUT) and health belief model (HBM), this study therefore developed an integrative framework to explain which behavioral determinants and demographic and health-related factors drive an individual’s willingness to install a first responder app for OHCA.

METHODS: We conducted a web-based cross-sectional survey (N=3660; mean age 49.95, SD 16.75 years; n=1909, 52.2% women) in June 2024 among Belgian adults. Behavioral determinants (UTAUT and HBM constructs), demographic (eg, age), and health-related (eg, cardiopulmonary resuscitation training experience) variables were measured using (multi-item) scales. Willingness to install the app served as the outcome variable. We developed a structural equation model using the Lavaan package in R and specified regression paths, on the one hand, between the behavioral determinants and willingness to install the app, and on the other hand, between the demographic and health-related factors and the behavioral determinants. Additionally, we conducted multiple group analyses to examine the moderating role of demographic and health-related factors on the relationships between the behavioral determinants and the willingness to install the app.

RESULTS: Our results revealed that 2 UTAUT variables (ie, facilitating conditions: β=.07; P=.003 and social influence: β=.16; P<.001) and 3 HBM variables (ie, perceived susceptibility: β=.06; P=.003, perceived barriers: β=-.29; P<.001, and perceived benefits: β=.38; P<.001) were associated with willingness to install a first responder app for OHCA. Additionally, most demographic and health-related factors were indirectly related to willingness via behavioral determinants, with age being the sole moderator. Specifically, a negative association between perceived severity and willingness was only observed among older adults. In addition, the positive relationship between perceived benefits and willingness was stronger for older adults compared to younger ones.

CONCLUSIONS: Overall, the results of this study have both theoretical and practical implications. Theoretically, this study finds its relevance in extending the UTAUT and HBM to altruistic mobile health apps and advancing our understanding of technology adoption in health contexts. Practically, the study’s findings could inform real-life health campaigns aimed at enhancing citizen participation in first responder systems.

PMID:40924999 | DOI:10.2196/69934

J Pediatr Hematol Oncol. 2025 Sep 8. doi: 10.1097/MPH.0000000000003124. Online ahead of print.

ABSTRACT

BACKGROUND: Rhabdomyosarcoma (RMS) typically responds well to a combination of treatments with favorable prognosis in children 1 to 9 years old. However, infants may fare worse due to receiving less aggressive local therapy for concerns about long-term effects of surgery/radiation. This study investigates the clinical characteristics, treatment approach, and survival outcomes of RMS in children under 2.

METHODS: We reviewed retrospectively children younger than 2 years with newly diagnosed RMS treated from January 2002 until December 2022 at King Hussein Cancer Center. Demographics, clinical characteristics, and outcomes were analyzed. Statistical analysis included descriptive statistics and survival analysis using Kaplan-Meier methods. All cases were reviewed in a multidisciplinary clinic comprising experienced radiotherapists and surgeons.

RESULTS: We identified 34 cases of RMS in patients younger than 2 years at diagnosis. The median age was 13 months, with 70.6% males. The most common tumor site was bladder/prostate (N=13, 38%), followed by orbit (N=5, 14.7%), the predominant subtype was embryonal (N=30). Risk-stratification categorized 17.6% as low-risk and 79.4% as intermediate-risk. Twenty-five patients had tumors >5 cm, with metastasis in 6 (17.6%). All patients received neo-adjuvant chemotherapy, local control was by radiotherapy only (n=12, 35.3%), combined surgery and radiotherapy (n=11, 32.4%), or surgery alone (n=3, 8.8%). The 5-year event-free and overall survival rates were 55.1% and 57.5%, respectively. Fourteen patients experienced relapse/progression, with local relapse the most common pattern. TNM stage, clinical group, metastasis at diagnosis, and radiotherapy use significantly impacted survival.

CONCLUSIONS: Children under 2 years of age with RMS face significant challenges, with high local recurrence rates and suboptimal survival outcomes compared with older pediatric patients. Our findings highlight the need for tailored treatment approaches that balance effective local control with minimizing long-term toxicity.

PMID:40924982 | DOI:10.1097/MPH.0000000000003124

JCO Glob Oncol. 2025 May;11:e2500150. doi: 10.1200/GO-25-00150. Epub 2025 Sep 9.

ABSTRACT

PURPOSE: Expanding high-risk human papillomavirus (HPV) vaccine coverage in resource-constrained settings is critical to bridging the cervical cancer gap and achieving the global action plan for elimination. Mobile health (mHealth) technology via short message services (SMS) has the potential to improve HPV vaccination uptake. The mHealth-HPVac study evaluated the effectiveness of mHealth interventions in increasing HPV vaccine uptake among mothers of unvaccinated girls aged 9-14 years in Lagos, Nigeria.

METHODS: A randomized controlled trial was conducted at the Lagos University Teaching Hospital between June 2024 and March 2025. We randomly assigned n = 180 eligible mothers to either a text message (intervention) or a usual care (control) arm. The primary analysis was conducted using the intention-to-treat principle. Bivariable and multivariable logistic regression models were performed to compare HPV vaccination uptake between the two arms, adjusting for potential confounders using odds ratios (ORs) and 95% CIs.

RESULTS: mHealth intervention significantly increased HPV vaccination uptake among mothers of vaccine-eligible girls (adjusted odds ratio [adj OR], 3.05 [95% CI, 1.61 to 5.77]; P = .001). Higher education level was also significantly associated with increased vaccine uptake (adj OR, 3.35 [95% CI, 1.77 to 6.33]; P < .001). There were no significant interaction effects by baseline characteristics on the association between mHealth intervention and HPV vaccine uptake.

CONCLUSION: The study showed that mHealth interventions significantly improve HPV vaccine uptake. Integrating mHealth strategies into routine immunization programs could be a scalable and cost-effective approach to increasing HPV vaccination coverage. However, future multicenter studies should consider using cluster randomization at the facility level to better optimize mobile interventions for diverse populations, identify the key drivers of successful SMS-based mHealth interventions, and gain deeper insights into the complex barriers to HPV vaccination uptake.

PMID:40924973 | DOI:10.1200/GO-25-00150

Neurol Neuroimmunol Neuroinflamm. 2025 Nov;12(6):e200472. doi: 10.1212/NXI.0000000000200472. Epub 2025 Sep 9.

ABSTRACT

BACKGROUND AND OBJECTIVES: Myelitis is a relatively common clinical entity for neurologists, with diverse underlying causes. The aim of this study was to describe the incidence of myelitis, its causes, clinical presentation, and factors predicting functional outcomes and relapses.

METHODS: Using the Swedish National Patient Registry, we identified all adult patients in Stockholm County between 2008 and 2018 using International Classification of Diseases, 10th Edition (ICD-10) codes likely to include myelitis. We collected medical records and classified patients using a modification of the 2002 Transverse Myelitis Consortium Group criteria. Long-term follow-up data were collected for patients not diagnosed with multiple sclerosis (MS) or neuromyelitis optica spectrum disorder as a result of the initial myelitis.

RESULTS: We identified 2,321 individuals, of whom 461 were patients with myelitis. The crude mean incidence of all-cause myelitis was 24.9 (95% CI 16.7-33.9) cases per million person-years, of which idiopathic myelitis had an incidence of 8.0 (95% CI 3.8-12.1) cases per million person-years. Partial myelitis was found in 80% of patients. Poor functional outcome was found in 11% of the cohort and correlated, in a multivariate logistic model, with age older than 50 years (OR 4.26, 95% CI 1.75-10.40), transverse spinal cord lesions (odds ratio [OR] 6.85, 95% CI 2.68-17.52), elevated CSF count of polymorphonuclear cells (OR 6.09, 95% CI 1.56-23.72), and elevated CSF/serum albumin ratio (OR 3.17, 95% CI 1.23-8.17). The median follow-up time was 5.4 years. Relapses occurred in 27% of patients with idiopathic myelitis and 72% of patients with unspecified demyelinating disease of the CNS. An increased relapse rate after idiopathic myelitis was found to be associated, in a multivariate model, with the presence of oligoclonal bands (incidence rate ratio [IRR] 4.47, 95% CI 1.70-11.73), transverse spinal cord lesions (IRR 2.81, 95% CI 1.11-7.12), and multifocal spinal cord lesions (IRR 2.82, 95% CI 1.03-7.69). Around half (48%) of all patients with myelitis received MS diagnosis during the study period.

DISCUSSION: This large population-wide study describes a relatively high incidence of myelitis and low risk of relapses after idiopathic myelitis. A complete diagnostic workup of myelitis, including MRI of the entire CNS and collection of CSF, is essential in evaluating underlying causes and prognosis.

PMID:40924956 | DOI:10.1212/NXI.0000000000200472

Crit Rev Food Sci Nutr. 2025 Sep 9:1-25. doi: 10.1080/10408398.2025.2555425. Online ahead of print.

ABSTRACT

Wheat, a significant source of protein, can also induce various wheat-related allergic reactions (WRARs). Statistical data show significant spatiotemporal and geographical variations in the prevalence of WRARs. Studies reveal that hexaploid wheat exhibits notably higher allergenicity. Early childhood is associated with a higher prevalence rate, although some symptoms may alleviate or disappear with age. Additionally, living environments and certain allergic diseases influence the prevalence of WRARs, potentially related to dietary patterns, microbial exposure, and immune regulation. Among methods to reduce wheat protein allergenicity, biological modification is preferred over physical processing and chemical modification. Fermentation and enzymatic treatment are currently mainstream choices, while gene editing holds the most promise for a definitive solution to WRARs. Unfortunately, no effective alternative to a gluten-free diet currently exists as a treatment measure. This article aims to review the prevalence of WRARs and the factors influencing their occurrence, summarize the various methods employed to reduce wheat allergenicity, and offer insights for the development of low-allergenicity wheat products and potential treatments for WRARs.

PMID:40924933 | DOI:10.1080/10408398.2025.2555425

BJS Open. 2025 Sep 8;9(5):zraf101. doi: 10.1093/bjsopen/zraf101.

ABSTRACT

BACKGROUND: Intraoperative autotransfusion remains underutilized in high-risk haemorrhagic oncological procedures, particularly in liver transplantation for hepatocellular carcinoma. This is because of the theoretical risk of tumour cell reinfusion and dissemination, potentially leading to reduced recurrence-free survival. The aim of this study was to evaluate the impact of intraoperative autotransfusion on recurrence-free survival during liver transplantation for hepatocellular carcinoma.

METHODS: This was a retrospective study of patients receiving liver transplantation for hepatocellular carcinoma with or without intraoperative autotransfusion between 1 January 2011 and 1 January 2020 at five French hospitals, of which one used autotransfusion and four did not. Propensity score matching was used to match the cohorts with and without autotransfusion. The primary endpoint was 5-year recurrence-free survival.

RESULTS: Some 113 patients in the study cohort (autotransfusion) were compared with 441 patients in the control cohort. The median volume of autotransfused blood was 1500 ml. Median follow-up was 84.6 months. There was no significant difference in 5-year recurrence-free survival between the cohorts (69.7% in control cohort versus 66.3% in study cohort; P = 0.241). After matching patients based on oncological criteria, the difference remained non-significant, with a 5-year recurrence-free survival rate of 67.1% in the study cohort and 77.6% in the control cohort (P = 0.174).

CONCLUSION: The use of autotransfusion during liver transplantation for hepatocellular carcinoma was not associated with recurrence-free survival.

PMID:40924885 | DOI:10.1093/bjsopen/zraf101

Menopause. 2025 Sep 9. doi: 10.1097/GME.0000000000002661. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate depression in postmenopausal women and to explore the relationship between age at menopause, hormone therapy, and depression, while also identifying potential mediators that may explain these associations.

METHODS: This cross-sectional study analyzed data from National Health and Nutrition Examination Survey (NHANES) (2005-2020) for women older than 60 years who completed the Patient Health Questionnaire 9 (PHQ-9) depression questionnaire (n=7,027). Exposures included age at menopause and self-reported hormone therapy; the outcome was depression severity (PHQ-9 ≥10). Covariates included sociodemographics, body mass index, medical conditions, and biomarkers (C-reactive protein, homeostatic model assessment of insulin resistance). Survey-weighted logistic regression, Bayesian modeling, and causal mediation analysis were used. Missing data were handled with multiple imputation and inverse probability weighting. Analyses were conducted with R software, with P<0.05 considered significant.

RESULTS: In this NHANES sample of postmenopausal women older than 60 years, earlier age at menopause was associated with depression (P<0.0001). Hormone therapy did not show a significant association with depression (OR=0.58, 95% CI: 0.23-1.4), while higher education levels were protective (college degree: OR=0.89, 95% CI: 0.85-0.92, P<0.001). C-reactive protein and homeostatic model assessment of insulin resistance partially accounts for the statistical association between menopause and depression (P<0.0001).

CONCLUSION: Age at menopause is inversely associated with depression in women older than 60 years. This relationship is statistically accounted for by the role of inflammation and insulin resistance. Self-reported hormone therapy is not associated with depression in postmenopausal women.

PMID:40924884 | DOI:10.1097/GME.0000000000002661

Menopause. 2025 Sep 9. doi: 10.1097/GME.0000000000002638. Online ahead of print.

ABSTRACT

OBJECTIVE: Our study aimed to compare premenopausal and postmenopausal women in terms of choroidal thickness and choroidal vascularity index.

METHODS: This cross-sectional study included 96 eyes of 96 participants, comprising 48 premenopausal and 48 postmenopausal women. Enhanced depth image optical coherence tomography (EDI-OCT) was used to visualize the choroid. Choroidal thickness measurements were performed at three points, including the subfoveal region (subfoveal choroidal thickness [SFCT]), 1500 μm nasal to the fovea (nasal choroidal thickness [NCT]), and 1500 μm temporal to the fovea (temporal choroidal thickness [TCT]) from EDI-OCT images. The choroidal vascularity index (CVI), total choroidal area (TCA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 3000 μm area by the binarization technique via ImageJ software. Measurements of premenopausal and postmenopausal women were compared after adjusting for age.

RESULTS: The comparison of axial length, spherical equivalent, and body mass index values revealed no significant differences (P>0.05 for all). SCFT, NCT, TCT, LA, and TCA values were statistically significantly lower after adjusting for age in the postmenopausal group compared with the premenopausal group (P=0.002, 0.020, 0.004, 0.020, 0.043) respectively. There was no statistically significant difference in SA and CVI values (P>0.05 for all).

CONCLUSION: The decreased choroidal thickness in postmenopausal women likely resulted from the reduction in the vascular component of the choroid, while the stromal component remained unchanged. Further prospective long-term studies are needed to evaluate women before and during menopause to investigate the relationship between choroidal vascular structure and the risk of ischemic vascular diseases.

PMID:40924883 | DOI:10.1097/GME.0000000000002638

Brain. 2025 Sep 9:awaf317. doi: 10.1093/brain/awaf317. Online ahead of print.

ABSTRACT

The lateral prefrontal cortex (LPFC) serves as a critical hub for higher-order cognitive and executive functions in the human brain, coordinating brain networks whose disruption has been implicated in many neurological and psychiatric disorders. While transcranial brain stimulation treatments often target the LPFC, our current understanding of connectivity profiles guiding these interventions based on electrophysiology remains limited. Here, we present a high-resolution probabilistic map of bidirectional effective connectivity between the LPFC and widespread cortical and subcortical regions. This map is derived from intracranial evoked potential analysis of 48,797 intracranial direct electrical stimulation runs across 759 implantations in 724 patients with refractory epilepsy (368 male, 354 female, two unspecified; mean age 24±13.5 years). We mapped probabilistic connectivity between brain parcels with adaptive resolution – higher resolution in the LPFC in the hemisphere of interest and lower elsewhere – maintaining statistical power while achieving 95% average confidence interval of ∼0.03 for connectivity probability estimates. In addition, the significance threshold (p-value) for probabilistic connectivity was obtained from surrogate distributions. Overall, we observed remarkable symmetry between afferent and efferent connectivity patterns of the LPFC, with a slight preference for efferent connections (mean slope = 0.92±0.09, mean R² = 0.93±0.025). For example, connections between the inferior frontal gyrus (IFG) and anterior cingulate showed notable directional asymmetry. The IFG strongly projected to most brain networks compared to other LPFC regions, with the strongest connectivity to the ventral attention network (0.26±0.01 compared to values between 0.15 and 0.21 in other LPFC regions). Posterior DLPFC demonstrated stronger connectivity to brain networks compared to anterior DLPFC regions (eg. 0.21±0.01 vs 0.15±0.01 for connectivity to ventral attention network), with the exception of the limbic cortex. All LPFC subregions strongly projected to the fronto-parietal (greater than 0.17) and ventral attention (greater than 0.15) networks, with moderate connections to the default network (between 0.1 and 0.15, with the maximum corresponding to superior DLPFC). Finally, latency analysis suggested that the left LPFC’s influence on ipsilateral emotion-related regions is primarily polysynaptic, with particularly strong pathways from IFG to amygdala (0.16±0.02) and hippocampus (0.12±0.01). Taken together, these comprehensive connectivity maps provide a new detailed electrophysiological foundation for understanding the functional anatomy of LPFC and guiding targeted brain stimulation protocols.

PMID:40924875 | DOI:10.1093/brain/awaf317

Menopause. 2025 Sep 9. doi: 10.1097/GME.0000000000002639. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to examine the relationship between vaginal aging and sexual quality of life in postmenopausal women.

METHODS: A descriptive, cross-sectional study was conducted with 210 postmenopausal women aged 45 to 59 years. Data were collected using a Personal Information Form, the Daily Effects of Vaginal Aging Scale, and the Sexual Quality of Life Scale. Descriptive statistics, Pearson correlation analysis, and multiple regression analysis were used to analyze the data.

RESULTS: A statistically significant negative correlation was found between vaginal aging and sexual quality of life (r=-0.533, P<0.001). A one-unit increase in vaginal aging was associated with a 0.506-unit decrease in sexual quality of life score (B=-0.506, P<0.001).

CONCLUSIONS: Vaginal aging was significantly associated with lower sexual quality of life in postmenopausal women. These findings suggest that addressing vaginal aging may contribute to enhancing sexual well-being in this population.

PMID:40924870 | DOI:10.1097/GME.0000000000002639