Category: Statistics

J Burn Care Res. 2025 Jul 13:iraf137. doi: 10.1093/jbcr/iraf137. Online ahead of print.

ABSTRACT

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin (Hb), vaso-occlusive crises, and hemolytic anemia. Hydroxyurea has been proven effective in managing SCD but is associated with non-healing skin ulcers. Additionally, its effects on wound healing in burn patients remain unclear. This study investigates the role of hydroxyurea in mortality, wound infection, wound disruption, and sepsis among SCD patients with burn injuries. Using the TriNetX database, cohorts were identified based on ICD-10 codes for adult patients aged 18 years or older diagnosed with SCD, previous burn injury, and hydroxyurea use. Propensity score matching was performed for demographics (age, sex, race, ethnicity), comorbidities that affect wound healing, and clinical variables (burn severity and SCD severity). Mortality, wound infection, wound disruption, and sepsis were assessed at 30 days, three months, and six months post-burn injury. Statistical methods such as chi-square analysis and risk ratio were used, with a statistical significance at p<.05. Hydroxyurea cohort had significantly higher risk for wound healing outcomes such as wound disruption, wound infection, and recurrent sepsis at each time outcome. However, hydroxyurea cohort had significantly lower risk of mortality compared to control group at each time outcome. This study highlights the need of considering hydroxyurea’s impact on wound healing when developing treatments for SCD patients with burn injury. Further research is needed to investigate its mechanism in wound healing processes and develop safer treatment alternatives.

PMID:40652301 | DOI:10.1093/jbcr/iraf137

J Burn Care Res. 2025 Jul 13:iraf130. doi: 10.1093/jbcr/iraf130. Online ahead of print.

ABSTRACT

Patients with severe burns are more vulnerable to infection, sepsis, and death. With heavy use of antimicrobials, changes in burn wound microbial and antibiotic resistance patterns have been reported; however, the literature remains scarce. This study assessed wound colonization trends in first positive cultures in our burn unit over the last decade. This is a retrospective cohort study including all patients admitted to our burn unit from July 2013 to June 2023. Demographics, total burn surface area (TBSA), injury mechanism and admission information were obtained. Wound culture information including date of positive cultures, type of organisms, and antibiotic susceptibility data was also collected. Patients were stratified based on TBSA as small (<10%), moderate (10-19.9%), and severe burns (≥20%). Descriptive statistics were obtained. Generalized linear models were fit to assess the trends of positive cultures over time for the three TBSA strata. A total of 2755 patients were included; median age was 38 years, 72.2% were male; 74.1%, 15.9%, and 10.1% presented with small, moderate, and severe burns, respectively. Wound cultures on initial presentation were performed in 40.3% of our population with 600 cases having positive first cultures; 84.7% grew Gram positive, 35.7% Gram negative, and 9.7% fungal organisms. Data showed an increase in Gram positive and fungal species over the study period in first positive cultures of severe burn patients. We also found increasing rates of resistance for several antibiotics, including erythromycin, oxacillin, and vancomycin. Future studies are warranted to evaluate changes in microorganism growth throughout the hospital course of severe burn patients.

PMID:40652297 | DOI:10.1093/jbcr/iraf130

J Cannabis Res. 2025 Jul 12;7(1):43. doi: 10.1186/s42238-025-00307-6.

ABSTRACT

INTRODUCTION: The use of medicinal cannabis is increasing worldwide and has applications in managing a wide range of conditions, including neurological, rheumatological, and gastrointestinal diseases. Despite its growing prevalence, there are limited data on patterns of cannabis prescription across varying disease groups and demographic subgroups.

METHODS: This retrospective observational cohort study analysed cannabis usage patterns among 263 patients from the cannabis user clinic at Rabin Medical center (RMC), a tertiary hospital in Israel. To minimise the inclusion of recreational cannabis users, only patients aged 30 years and older were included. Patients were categorised into three groups based on their primary medical condition: neurological (n = 63), rheumatological (n = 106), and gastrointestinal (n = 94). Data collected included: demographic information, cannabis dosage, Tetrahydrocannabinol (THC) content, cultivated variety preference (sativa vs. Indica), and method of consumption (smoking vs. oil). Statistical analyses were conducted using ANOVA, Kruskal-Wallis, chi-square, and t-tests to compare cannabis prescription patterns between disease and demographic groups.

RESULTS: Significant differences in cannabis prescription patterns were observed across disease groups. Patients with gastrointestinal conditions were prescribed the highest mean monthly cannabis dose (22.26 ± 13.60 g), while those with neurological conditions had the highest oil consumption (31.75%). Sex-based differences were notable, with male patients being prescribed significantly higher doses of cannabis (25.48 ± 15.15 g) and higher THC content (14 ± 6.56%) compared to female patients (17.32 ± 9.93 g; THC: 11.39 ± 6.48%).

DISCUSSION: The study highlights variations in cannabis prescription patterns based on both medical conditions and demographic factors. Male patients received higher doses and THC-rich formulations, while patients with gastrointestinal conditions had the highest cannabis prescription overall. These findings suggest the need for individualised cannabis therapy based on patient characteristics and the specific condition being treated.

CONCLUSION: Medicinal cannabis usage patterns vary significantly across disease and demographic groups. Personalised cannabis treatment plans, informed by both clinical and demographic factors, are essential to optimising patient outcomes. Further research is needed to develop more precise guidelines for prescribing medicinal cannabis.

PMID:40652292 | DOI:10.1186/s42238-025-00307-6

BMC Nutr. 2025 Jul 12;11(1):138. doi: 10.1186/s40795-025-01115-0.

ABSTRACT

BACKGROUND: The global prevalence of type 1 diabetes mellitus (T1DM) is steadily increasing, particularly among children and young adults. Health-related myths can significantly influence patients’ dietary behaviors and treatment adherence, thereby compromising disease management and metabolic outcomes.

METHODS: This cross-sectional study included 190 adolescents and young adults with T1DM attending a pediatric endocrinology outpatient clinic. Data on demographics, BMI, HbA1c values, and nutrition-related myths were collected through face-to-face interviews. Statistical analyses, including chi-square tests and Spearman correlation coefficients, were performed using SPSS 22.0 software. Logistic regression analysis was conducted to identify independent predictors of metabolic control status (p < 0.05).

RESULTS: Participants had a mean diabetes duration of 7.5 ± 4.63 years, with a mean HbA1c of 7.9 ± 1.44%. Approximately 27.0% of adolescents and 20.0% of young adults were overweight or obese. Only 29.0% of individuals had good metabolic control (HbA1c <%7), while 71.0% had HbA1c ≥ 7. An increase in diabetes duration was found to elevate the risk of poor metabolic control by 1.107 times, whereas a higher total number of answers was associated with a 0.696-fold decrease in this risk (p < 0.05).

CONCLUSION: Improved knowledge about nutrition myths is associated with better metabolic control among adolescents and young adults with T1DM. Structured education programs tailored to this population may contribute to improved glycemic outcomes. A multidisciplinary team approach is essential to effectively deliver educational content and reinforce evidence-based dietary practices.

PMID:40652289 | DOI:10.1186/s40795-025-01115-0

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