Category: Statistics

J Crit Care. 2026 May 23;95:155617. doi: 10.1016/j.jcrc.2026.155617. Online ahead of print.

ABSTRACT

Ketamine has been shown to possess unique pharmacologic properties that make it an appealing adjunctive sedative for critically ill patients; however, its overall impact on key intensive care unit (ICU) outcomes remains uncertain. As such, this systematic review and meta-analysis was conducted to evaluate whether intravenous ketamine-based sedation improves mechanical ventilation duration (MVD), ICU length of stay (LOS), and delirium incidence in ICU patients compared with standard analgosedation. Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included randomized or prospective controlled adult ICU trials comparing continuous intravenous ketamine or esketamine infusions with standard sedation regimens. Pooled mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Six studies comprising 903 ICU patients met inclusion criteria. MVD was reported in all six studies; ICU LOS was reported in five studies and delirium was reported in two studies. Ketamine-based sedation was associated with a significant reduction in ICU LOS and a significant decrease in delirium incidence (MD: -0.86; 95% CI: -1.51, -0.22 and OR: 0.55; 95% CI: 0.43-0.72, respectively). Although MVD trended shorter in the ketamine group, this difference did not reach statistical significance (MD: -0.30; 95% CI: -1.53, 0.92). These results support consideration of ketamine as an adjunct in multimodal ICU sedation strategies; however, the effect on ventilation duration remains uncertain. While this study’s findings offer valuable comprehensive evaluations, further large-scale trials are needed to optimize dosing and confirm long-term benefits.

PMID:42177858 | DOI:10.1016/j.jcrc.2026.155617

J Pharm Biomed Anal. 2026 May 14;279:117560. doi: 10.1016/j.jpba.2026.117560. Online ahead of print.

ABSTRACT

Adherence to hypertension treatment is crucial for therapeutic success, as noncompliance adversely affects quality of life and healthcare costs. Assessing adherence directly through plasma drug concentrations is particularly effective for patients with complex medication regimens. This study aimed to develop and validate an LC-MS/MS method for quantifying five antihypertensive drugs in dried capillary plasma obtained via a plasma separation device. The process involved incubating three 6 mm discs in 150 µL of 0.1% bovine serum albumin, followed by chloride analysis of a 20 µL aliquot after 45 min. The residual volume was precipitated using 25% trichloroacetic acid, then mixed with 500 µL methanol containing internal standards (losartan-D4 and atenolol-D7). The extract was dried, reconstituted with methanol, and combined with the supernatant from protein precipitation for analysis. An octadecylsilic column and gradient elution with 0.1% formic acid in water and acetonitrile were used, with positive electrospray ionization except for hydrochlorothiazide. The analytical run time was eight minutes, exhibiting linear ranges from 0.5 to 200 ng/mL for amlodipine and losartan and 5-2000 ng/mL for atenolol, hydrochlorothiazide, and losartan, with r² > 0.99 and 1/x weighting. Precision and accuracy were acceptable, with CV% ranging from 4.3% to 14.5% and accuracy from 86% to 112%, while extraction yields were between 75% and 101%. The analytes were stable at 23 ºC for 21 days in DPS samples. Comparison of drug concentrations in DPS and fresh plasma samples from 72 patients demonstrated high correlation (r = 0.93-0.98), indicating reliability in assessing therapy adherence. Lower concentrations of amlodipine, hydrochlorothiazide, and losartan were observed in patients exhibiting poor adherence (n = 21) compared to adherent patients (n = 51) with statistical significance (p < 0.05). The method is promising for assessing antihypertensive adherence using dried plasma spots.

PMID:42177855 | DOI:10.1016/j.jpba.2026.117560

Accid Anal Prev. 2026 May 24;234:108595. doi: 10.1016/j.aap.2026.108595. Online ahead of print.

ABSTRACT

Aggressive lane-changing behavior on highways can induce sharp lateral movements and significant speed variations, posing considerable traffic safety risks. Maximum lateral velocity effectively reflects both the vehicle’s lateral motion and the intensity of the driver’s lane-change maneuver, making it a key metric for analyzing lane-changing behavior. In this study, 1,646 lane-changing events were extracted from the real-world vehicle trajectory collected by CQSkyEyes, and their basic characteristics were analyzed using descriptive statistics. The Bayesian model was developed to examine how lane-change intensity varies under different environmental and driving conditions. The results indicate that under complex weather conditions, drivers tend to adopt more conservative lane-changing strategies, reflected in reduced maximum lateral velocity, especially when facing hazardous time-to-collision (TTC) levels. Moreover, lane change behavior is shaped by surrounding-vehicle interaction metrics; notably, the approach of a vehicle in the target lane increases the likelihood of aggressive maneuvers. These findings highlight maximum lateral velocity as a robust quantitative indicator of driver behavior, offering actionable implications for traffic safety management and autonomous driving system design.

PMID:42177847 | DOI:10.1016/j.aap.2026.108595

Food Chem. 2026 May 21;519:149758. doi: 10.1016/j.foodchem.2026.149758. Online ahead of print.

ABSTRACT

Meeting the food industry’s demand for safe, sustainable bioactive extraction, this research proposed an innovative “Parameter-Component” correlation strategy to clarify the mechanism of green extraction, using mechanochemical-assisted extraction (MCAE) of ginsenosides as a case. Via UPLC-Q-TOF-MS/MS, 92 ginsenosides were identified from ginseng. Deconstruction of key MCAE variables (i.e., particle size, pH, temperature), combined with untargeted metabolomics, multivariate statistical analysis, and quantitative validation of critical saponins, revealed a synergistic action of mechanical forces and chemical auxiliaries. This dual intervention disrupts cell walls efficiently while minimizing the degradation of heat-labile components. Different structured saponins showed specific parameter responses. MCAE at 25-40 °C balanced prototype ginsenoside dissolution and malonylated ginsenoside retention; composite processes (MCAE-HRE, MCAE-UAE) optimized functional component yield and production sustainability. This strategy provides a scientific basis for high-quality food-relevant extracts production and a scalable mechanistic study method.

PMID:42177844 | DOI:10.1016/j.foodchem.2026.149758

West Afr J Med. 2026 Apr 30;43(1):58-69.

ABSTRACT

BACKGROUND: Chronic heart failure is an increasing cause of morbidity and mortality across sub-Saharan Africa, yet contemporary data from large African cohorts remain limited.

OBJECTIVES: To characterise the clinical profile, management, and short-term outcomes of patients with chronic HF enrolled in the Ibadan Heart Failure Project.

METHODS: The Ibadan Heart Failure Project is a real-life, pragmatic, prospective, hospital-based cohort of adults with chronic heart failure being conducted at University College Hospital, Ibadan, Nigeria. The present report is based on participants recruited between September 1, 2016, and December 31, 2022. Baseline sociodemographic, clinical, and echocardiographic data were obtained, and participants were followed for six months. The primary outcomes were all-cause mortality and hospital readmission.

RESULTS: Among 1,290 patients (mean age 56.7 ± 15.4 years; 55.8% men), hypertensive heart disease was the leading cause, followed by dilated cardiomyopathy and rheumatic heart disease. Women were younger and more likely to have preserved or mildly reduced ejection fraction. The use of sodium-glucose cotransporter-2 inhibitors (3.3%) was low. The cumulative incidence of readmission, death, and a composite of these events at six months was 4.9%, 12.9%, and 17.8%, respectively. The use of beta blockers was associated with 43% reduction in the risk of readmission (HR-0.57, 95%CI-0.33-0.97), while the use of renin -angiotensin-aldosterone axis inhibitors was associated with 62% and 46% reduction in the risk of death and composite of readmission and death, respectively. A unit increase in serum creatinine is associated with 11% and 32% increase in readmission and death, respectively (HR-1.11, 95%CI-1.00-1.23 and HR-1.32, 95% CI-1.21-1.45, respectively) In addition, a unit increase in tricuspid annular plane systolic excursion is associated 64% and 53% lower risk of death and composite of readmission and death, respectively. (HR-0.36, 95%CI-0.22-0.60, HR-0.47, 95%CI-0.30-0.73 respectively). No significant sex or age-related differences were observed in adjusted risks of hospitalization or death.

CONCLUSIONS: Hypertensive heart disease remains the predominant cause of chronic heart failure in Nigeria. Despite similar short-term outcomes across sexes, suboptimal use of newer evidence-based therapies underscores the need for system-level interventions to improve HF care in sub-Saharan Africa.

PMID:42177830

West Afr J Med. 2026 Apr 30;43(1):42-52.

ABSTRACT

BACKGROUND: Sexual and Reproductive Health (SRH) literacy influences young people’s health behaviours and outcomes. Mobile health (mHealth) technologies are potential tools for the delivery of health education and services, but evidence on their effectiveness in strengthening SRH literacy is limited in the study setting. This study assessed the effect of an mHealth intervention on SRH literacy and service utilisation among in-school young people in Osun State, Nigeria.

METHODS: A quasi-experimental design was employed among undergraduate students aged 18 – 24 years in two tertiary institutions in Osun State. Participants were allocated by institution into intervention (n = 60) and control (n = 60) groups. The intervention group received a six-week mHealth SRH literacy programme delivered through a mobile application. Data was collected at baseline and post-intervention. Paired t-tests, analysis of covariance and regression analyses were done.

RESULTS: Post-intervention, the intervention group demonstrated a significant increase in mean SRH literacy scores compared with baseline (p = 0.018). The post-test SRH literacy scores were significantly higher in the intervention group than in the control group (p = 0.002), with a large effect size (partial η² = 0.84). The mHealth intervention independently increased the odds of good SRH literacy (AOR = 3.69; 95% CI: 1.54 – 8.86), SRH service utilisation (AOR = 6.25; 95% CI: 1.29-30.16), and the intention to use SRH services in the future (AOR = 2.86; 95% CI: 1.03 – 7.95).

CONCLUSION: The mHealth-based intervention significantly improved SRH literacy and service utilisation among young people. The deployment of mHealth interventions to strengthen health literacy competencies in the study setting should be considered.

PMID:42177811

West Afr J Med. 2026 Apr 30;43(1):35-41.

ABSTRACT

BACKGROUND: Asthma management prioritises symptom control, typically assessed using standardized questionnaires. However, comparative data on their performance and agreement remain scarce in Sub-Saharan Africa.

METHODS: In a cross-sectional study of 100 adults [79% females, mean age 38.1±14.6 years] with physician-diagnosed asthma at a Nigerian tertiary hospital, asthma control was evaluated using Global Initiative for Asthma (GINA), Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ-7), Royal Society of Physicians 3 Questions (RCP-3Qs) and Asthma Therapy Assessment Questionnaire (ATAQ). Agreement was measured with Cohen’s kappa statistics. Diagnostic accuracy for GINA-defined well-controlled asthma was analysed using ROC-derived thresholds, with GINA serving as the reference standard to assess the performance of ACT, ACQ, RCP-3Qs, and ATAQ.

RESULTS: The level of controlled asthma ranged from 73% to 83% across tools. Agreement among control tools was low; GINA showed slight agreement with others (κ = 0.018-0.107), while ACT and ACQ had moderate agreement (κ = 0.546). ACT, ACQ, and RCP-3Qs demonstrated strong diagnostic accuracy for identifying GINA-defined well-controlled asthma (AUC 0.90; 95% CI: ACT 0.76-0.95; ACQ 0.75-0.94; RCP-3Qs 0.78-0.92), whereas ATAQ performed poorly (AUC 0.5; 95% CI: 0.29-0.59). At pre-specified thresholds of >20, ≤1.57, ≤1 and 0.5, the specificity of ACT, ACQ, RCP-3Qs, and ATAQ was 92.6%, 70.4%, 70.4%, and 85.2%, respectively; while sensitivity was 73.7%, 94.7%, 100%, and 26.3%.

CONCLUSION: ACT, ACQ, and RCP-3Q effectively identified GINA-defined well-controlled asthma, while ATAQ showed poor diagnostic value. Low agreement among the tools suggests they are not interchangeable for assessing asthma control.

PMID:42177808

West Afr J Med. 2026 Apr 30;43(1):29-34.

ABSTRACT

BACKGROUND: Patient satisfaction is the extent to which a healthcare facility fulfils patients’ expectations. It is a critical and integral part of patient-oriented healthcare, serving as a key indicator for measuring the quality of care provided to patients. Assessing patients’ satisfaction with care is a way of obtaining feedback from patients, which can be a measure of the effectiveness of healthcare services. This study aimed to assess the level of patient satisfaction with services received at the Bingham University Teaching Hospital in Jos, Plateau State, to improve healthcare services.

METHODS: The study was a descriptive, cross-sectional study conducted in the Bingham University Teaching Hospital (BHUTH). The BHUTH is a private tertiary hospital located in Plateau State’s capital city of Jos, the North-central region of Nigeria. Participants were selected conveniently from the outpatient clinics and wards. The data was collected using the Long-form Patient Satisfaction Questionnaire (PSQ-III) and included the participants’ sociodemographic characteristics. There are seven domains in the PSQ-III, namely General satisfaction, Technical quality, Interpersonal care, Communication, Financial aspects, Time spent with the doctor, and Access/availability/convenience. Data collected was analyzed using IBM SPSS Statistics for Windows, version 27.

RESULTS: There were 236 respondents. A little more than half (51.7%) of the patients were in the 18 – 39 years age group, and more (59.7%) were females. A majority (62.7%) of the responders had attained a tertiary level of education. The overall patient satisfaction rate was 67.6%. Only 52.5% of patients reported having a high general satisfaction, 56.4% were highly satisfied with the financial aspects of healthcare services, and 86.0% had high satisfaction with the communication.

CONCLUSION: This study has revealed an overall average patient satisfaction. Among the domains of satisfaction assessed, communication had the highest rate of satisfaction, and the financial aspect of healthcare services was among the lowest rates of patient satisfaction. These findings can help prioritize strategies for improving healthcare services.

PMID:42177807

Matern Child Nutr. 2026 Jul;22(3):e70203. doi: 10.1111/mcn.70203.

ABSTRACT

Achieving good treatment coverage and outcomes for acutely malnourished children is challenging in resource limited and remote settings. Inclusion of treatment within integrated community case management (iCCM) programmes has shown promise, but evidence is limited. We conducted a cluster randomised controlled trial in rural villages within the districts of Hargeisa, Gabiley, and Faraweyne in Somaliland. We compared treatment coverage and outcomes between 18 villages implementing iCCM, where cases of malnutrition (mid-upper arm circumference (MUAC) < 12.5 cm and/or oedema) were referred to MCH clinics, and 19 villages implementing iCCM +, where malnutrition treatment was provided by family health workers (FHW) at village level. Coverage was measured in a closed household cohort at baseline and after 6 months of intervention. Treatment outcomes were determined in an open cohort of cases that were identified by the iCCM FHW and followed up on each month. The prevalence of acute malnutrition diagnosed using MUAC was four-fold lower compared to that diagnosed using weight-for-height z-scores (WHZ) (3% vs. 13%). This larger than expected difference resulted in the study being underpowered. Treatment coverage was 27% and 23% in the control and intervention arms at baseline and increased sharply in the intervention arm with an adjusted difference of 20 percentage points. However, the improvement was not statistically significant (adjusted OR 2.55 (95% CI 0.4, 18.8) p = 0.344). Cases were more likely to start treatment in the intervention arm (difference 71.9% (95% CI 58.1, 85.7) p < 0.001), but relapse and non-response were more frequent (p = 0.041 & p = 0.004). Over diagnosis of acute malnutrition by FHW was high, with 67.4% and 77.4% of cases being misdiagnosed in the control and intervention arm, respectively. While the integration of malnutrition treatment with iCCM shows potential for improving treatment coverage in some contexts, careful consideration should be given to the level of training and supervision required. TRIAL REGISTRATION: ISRCTN31437934. Registered 3/10/2023.

PMID:42177798 | DOI:10.1111/mcn.70203

Int J Epidemiol. 2026 Apr 17;55(3):dyag060. doi: 10.1093/ije/dyag060.

ABSTRACT

BACKGROUND: Exposure to heat and cold are associated with adverse birth outcomes, but whether ambient temperature affects embryonic and early fetal development remains unclear. We aimed to examine the association between ambient temperature exposure during early pregnancy and crown-rump length (CRL).

METHODS: Data from the Generation R Next Study (2017-2021) were analysed, with findings replicated in the Generation R Study (2002-2006), both population-based cohorts based in Rotterdam, The Netherlands. Weekly mean temperatures were modeled from the last menstrual period onward at a spatial resolution of 100 × 100 m by using the UrbClim™ model. The CRL was measured via 2D ultrasound at approximately 8, 10, and 12 weeks’ gestation in pregnancies with regular menstrual cycles. Distributed lag nonlinear models were applied.

RESULTS: In Generation R Next (N = 1378; mean maternal age 31.9 years), higher temperatures during the first 9 weeks were associated with a smaller CRL at 12 weeks {e.g. -7.2 mm [95% confidence interval (CI) -12.0, -2.3] at 19.2 vs 9.0°C during weeks 1-6}. Colder exposures during the first 11 weeks were also associated with a smaller CRL [-7.6 mm (95% CI -11.9, -3.3) at 3.6 vs 9.0°C during weeks 1-11]. No associations were observed for CRL at 8 or 10 weeks. Similar associations with cold, but not heat, were observed in the replication cohort (N = 1520).

CONCLUSION: Moderate cold and heat exposure during early pregnancy may affect fetal development as early as the first trimester. These findings indicate that early gestational development may be sensitive to ambient temperature and, as environmental conditions shift, may have potential clinical implications for birth outcomes and long-term health.

PMID:42177794 | DOI:10.1093/ije/dyag060