Category: Statistics

J Reprod Infant Psychol. 2025 Dec 15:1-16. doi: 10.1080/02646838.2025.2599244. Online ahead of print.

ABSTRACT

BACKGROUND: India’s rising dependence on institutional childbirth through Caesarean sections has intensified both the health-related risks and the financial pressures experienced by women and their households. The escalating costs of Caesarean deliveries have become a significant source of out-of-pocket spending, with the burden falling most heavily on low-income families in Kerala.

OBJECTIVE: This study aims to identify the cognitive, emotional, and healthcare related predictors that influence women’s intentions to opt for elective Caesarean delivery. It seeks to understand the underlying factors that shape this preference, using the theory of planned behavior framework, which emphasizes the role of attitudes, subjective norms, and perceived behavioral control in shaping behavioral intentions.

METHODS: Using a cross-sectional design, a structured household survey was conducted among 1,030 married women in Kerala planning future pregnancies. The main outcome measured was their stated intention to opt for a Caesarean delivery in a subsequent birth. Key predictors included unmet health needs, childbirth-related knowledge, depression severity, attitudes, subjective norms, and perceived behavioral control. Binary logistic regression and propensity score matching (STATA 14.0; p < 0.05) were applied to identify statistically significant associations.

RESULTS: Greater childbirth-related knowledge significantly lowered the likelihood of intending to choose a Caesarean delivery (intermediate knowledge: OR = 0.167; good knowledge: OR = 0.297). Depression severity displayed a nonlinear relationship: moderately severe depression reduced the intention to opt for a C-section (OR = 0.140), whereas severe depression substantially increased it (OR = 4.357). The most influential predictor was unmet healthcare need (OR = 27.876), a result further supported by propensity score matching.

CONCLUSION: Women’s intentions to choose elective Caesarean delivery are strongly influenced by their level of knowledge, psychological well-being, and access to healthcare. Strategies that strengthen health literacy, bolster mental health support, and reduce healthcare barriers may help decrease unnecessary C-sections and enhance maternal health outcomes.

PMID:41392907 | DOI:10.1080/02646838.2025.2599244

Hypertension. 2025 Dec 15. doi: 10.1161/HYPERTENSIONAHA.125.25949. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension is a multifactorial disease influenced by sex hormones, with notable sex-specific differences in its development and progression. Extracellular vesicles have emerged as important mediators in hypertension pathophysiology. This study aimed to investigate sex-specific extracellular vesicle-derived microRNA and protein profiles in deoxycorticosterone acetate-salt-induced hypertension.

METHODS: Male and female C57BL/6J mice underwent deoxycorticosterone acetate-salt treatment, with blood pressure monitored via telemetry and cardiac function assessed using echocardiography and invasive hemodynamics. Extracellular vesicles from plasma and cerebrospinal fluid were isolated and analyzed for microRNA (high-throughput RNA sequencing) and protein (LC/ms) content. To determine the contribution of sex hormones, gonadectomy was performed before deoxycorticosterone acetate-salt exposure. Hypothalamic and plasma samples were then used to validate key molecular findings.

RESULTS: Deoxycorticosterone acetate-salt treatment caused more severe hypertension, cardiac dysfunction, and mortality in males compared with females. Gonadectomy reduced hypertension and mortality in males but exacerbated them in females, confirming the protective effect of estrogens and the deleterious influence of androgens. Sex-specific extracellular vesicle-derived microRNA and protein expression profiles were identified, revealing 10 key regulatory microRNAs and highlighting potential regulatory axes such as miR-125b-5p/ACE (angiotensin-converting enzyme) 2, miR-1a-3p/G6PD, miR-410-3p/AT₁R (angiotensin II type 1 receptor), and miR-378a-5p/IRAP. Gonadectomy altered expression patterns, supporting the hormone-dependent regulation of these microRNAs. Proteomic data showed renin-angiotensin system and diabetic cardiomyopathy pathway activation in hypertensive males. In silico and ex vivo analyses identified 25 microRNA-targeted genes, such as G6pdx and IRAP, reinforcing the role of sex hormone-sensitive microRNA-protein interactions.

CONCLUSIONS: This study highlights potential sex-specific microRNA networks in hypertension and proposes novel molecular targets for validation toward personalized, sex-tailored therapies.

PMID:41392884 | DOI:10.1161/HYPERTENSIONAHA.125.25949

Int J Gynaecol Obstet. 2025 Dec 15. doi: 10.1002/ijgo.70742. Online ahead of print.

ABSTRACT

OBJECTIVE: The main objective was to describe women with fibroids who were treated with ultrasound-guided high intensity focused ultrasound (USgHIFU) at the Chris Hani Baragwanath Academic Hospital (CHBAH) and to evaluate the outcomes at least 6 months after treatment.

METHODS: This was a cross-sectional study using retrospectively collected data of women treated between November 2015 and December 2018 with USgHIFU at CHBAH. A clinical database that was used at the USgHIFU clinic and medical files were reviewed. The following data were retrieved; demographic information, characteristics of the fibroid (size, number, position, magnetic resonance imaging [MRI] intensity), symptoms before and after the procedure. Variables are described using descriptive statistics and were compared using a McNemar’s chi2, t-test or Wilcoxon sign rank test.

RESULTS: The mean age, median body mass index (BMI) and median parity was 35 years (standard deviation [SD] ±5.43), BMI of 25.3 (interquartile range [IQR]: 22.31-29.05), parity 0 (IQR: 0-1; range: 0-6), respectively. The presenting symptoms were dysmenorrhea (85.41%), infertility (50.92%) and menorrhagia (67.69%). The proportion of dysmenorrhea decreased from 84.10% before treatment to 54.06% after treatment. Menorrhagia was reduced from 66.08% to 41.34%. The median size of fibroids changed from 38.00 to 26.88 cm³. These changes were statistically significant.

CONCLUSION: This is the first USgHIFU study that reports outcomes in a South African population. The treatment has resulted in a noticeable alleviation of symptoms and a measurable reduction in fibroid size and this was statistically significant and clinically relevant.

PMID:41392873 | DOI:10.1002/ijgo.70742

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1088-1094. doi: 10.14744/tjtes.2025.73730.

ABSTRACT

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are prevalent, particularly following athletic incidents. Most clinicians use MRI for diagnostic purposes and therapy assessment, but it can present challenges in terms of cost and accessibility. While ultrasound guidance (USG) is more readily available, it is inadequate for diagnosing ACL injury in isolation. Therefore, our study aimed to evaluate the effectiveness of sonoelastography, a novel method for assessing tendon injuries, in the context of anterior cruciate ligament (ACL) injuries.

METHODS: This study involved a cohort of 45 patients who fulfilled the designated inclusion criteria. We selected the patients from a cohort of 105 individuals who underwent anatomical ACL restoration at the orthopedics and traumatology clinic between 2017 and 2020. The clinical examination results and the stability and quality of the ACL in patients who underwent ACL reconstruction were compared with those from magnetic resonance imaging (MRI) and stress echo laxity (SEL) testing.

RESULTS: The study comprised 40 individuals with a mean age of 30.7+-1.4 years. The patients’ Lysholm scores exhibited consider-able enhancement post-operation, with a mean increase from 2.2+-0.9 pre-operation to 6.1+-1.6 post-operation. The Lachman, anterior drawer, and pivot-shift tests demonstrated improvements relative to the preoperative values. No substantial difference was observed in the single-leg hop test relative to the unaffected side. The SEL findings indicated that 15.6% of the healthy ACL instances were categorized as type 2a, 68.9% as type 2b, and 15.6% as type 3a. In the reconstructed ACL cohort, 17.8% were categorized as type 2a, 62.2% as type 2b, and 20% as type 3a. No substantial statistical difference was detected between the healthy ACL and the reconstructed ACL. No occurrences of type 3b or type 4 were identified in any of the patients.

CONCLUSION: We used SEL to find a torn ACL and check its stability and condition after the ligament was reconstructed with a graft. We utilize SEL, or stress sonoelastography, to monitor graft viability and evaluate the progression of ACL injuries. It is also beneficial in evaluating whether the restored ligament possesses a functional structure akin to that of a normal ligament. Moreover, considering its accessibility, cost-effectiveness, replicability, and patient preference, it may provide a more advantageous alternative to MRI.

PMID:41392848 | DOI:10.14744/tjtes.2025.73730

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1130-1136. doi: 10.14744/tjtes.2025.64744.

ABSTRACT

BACKGRUND: Acute appendicitis is an important clinical condition that usually occurs as a result of obstruction of the appendix lumen due to fecaloma or reactive lymphoid hyperplasia. However, rarely, various nonspecific and unusual pathologies can cause acute appendicitis or mimic this clinical condition. The aim of this study was to present patients who underwent surgery with a preliminary diagnosis of acute appendicitis and to determine the incidence of incidentally diagnosed nonspecific and unusual pathologies found during histopathological examination of the specimens.

METHODS: Data from 2633 patients who underwent appendectomy with a preliminary diagnosis of acute appendicitis in our clinic between January 2014 and June 2023 were retrospectively analyzed. Patients who underwent elective appendectomy in addition to other intra-abdominal operations were excluded. Specimens with unusual diagnoses were re-evaluated histopathologically. The data were analyzed statistically.

RESULTS: A total of 2633 patients were included in the study, 1617 (61.4%) male and 1016 (38.6%) female. The mean age was 11.32+-3.66 (range: 1-18) years. All patients underwent the standard appendectomy procedure. After histopathological examination, the specimens were detected to show inflamed appendicitis in 2150 cases (81.65%), perforated appendicitis in 162 cases (6.15%), fibrous obliteration in 104 cases (3.94%) and unusual histopathological findings in 57 cases (2.16%). Of the patients with unusual histopathological findings, 40 were female and 17 were male. Enterobius vermicularis was detected in 41 patients (1.55%), appendicular carcinoid tumor in 10 patients (0.4%) and serous appendicitis in 6 patients (0.2%). Microscopic findings of acute appendicitis were not observed in 35 of these patients.

CONCLUSION: Nonspecific and unusual histopathological findings are more common in childhood appendectomy specimens than in those from adults. Careful histopathological evaluation of appendix specimens will allow early diagnosis and treatment of these rarely seen pathologies.

PMID:41392845 | DOI:10.14744/tjtes.2025.64744

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1102-1108. doi: 10.14744/tjtes.2025.60464.

ABSTRACT

BACKGROUND: This study aimed to investigate the effects of the minimally invasive direct lateral approach, performed using standard hip surgery instruments, on operation duration, early postoperative pain, postoperative blood loss, and hospital stay in the treatment of femoral neck fractures with hemiarthroplasty (HA), compared with the standard Hardinge direct lateral approach (referred to in this study as the conventional group, CG).

METHODS: We retrospectively collected clinical data from the medical records of our hospital. Inclusion criteria were a diagnosis of femoral neck fracture resulting from low-energy trauma and treatment with HA surgery. Patients were divided into two groups based on the surgical approach: the conventional group (CG) and the mini-incision group (MG). Twenty-four patients comprised the MG (case group), while 18 patients were in the CG (control group). The average wait time for surgery was 3.8 days for the MG and 3.6 days for the CG. Statistical analyses were conducted to evaluate differences in postoperative pain scores, hospital stay, postoperative blood transfusion, operation duration, hemoglobin, and hematocrit levels between the groups.

RESULTS: There was no significant difference in age or gender distribution between the case and control groups (p>0.05). The average age of the mini-incision group was 83.8 years, while the average age of the CG was 86.9 years. In both groups, the fracture types were equally distributed between Garden type III and IV. However, the visual analog scale (VAS) scores on the first and third postoperative days were significantly lower in the case group than in the CG (p<0.05). Patients in the MG required significantly fewer postoperative blood transfusions compared to the control group. Hospitalization duration, as well as hemoglobin and hematocrit levels both preoperatively and at discharge, were comparable between the groups.

CONCLUSION: The data from this study indicate that the mini-incision technique is an effective and reliable method for treating femoral neck fractures. Compared with the conventional group, the minimally invasive direct lateral approach for femoral neck fractures significantly reduces early postoperative pain, results in less blood loss, offers better cosmetic outcomes, and maintains a similar length of hospital stay. Clinical studies with larger sample sizes and assessments of long-term postoperative outcomes are necessary.

PMID:41392844 | DOI:10.14744/tjtes.2025.60464

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1095-1101. doi: 10.14744/tjtes.2025.58436.

ABSTRACT

BACKGROUND: This study aimed to compare the long-term continence outcomes of patients who underwent surgical repair for obstetric anal sphincter injuries (OASIS) and non-OASIS, based on the Jorge Wexner score. Additionally, predictive factors associated with complete continence restoration versus persistent fecal incontinence were analyzed.

METHODS: A retrospective analysis was conducted on 13 patients treated surgically for anal sphincter injuries at Erciyes University Faculty of Medicine between 2016 and 2019, with a minimum follow-up duration of five years. Patients were categorized into obstetric (n=8) and non-obstetric (n=5) groups. Functional outcomes were assessed using the Jorge Wexner score at 6 months, 1 year, and 5 years postoperatively. Continuous variables were analyzed using the Mann-Whitney U test, categorical variables with Fisher’s exact test, longitudinal changes with the Friedman test, and potential predictors of full continence were assessed via binary logistic regression.

RESULTS: The non-OASIS group exhibited significantly higher mean age (p=0.045) and longer hospital stays (p=0.006) compared to the obstetric group. Perineal examination revealed more extensive tissue loss and contamination in non-OASIS cases, often requiring fecal diversion, whereas obstetric injuries were typically cleaner and linear in nature. Although higher Wexner scores were observed in the non-OASIS group at all time points, between-group differences were not statistically significant. Wexner scores varied significantly over time within the non-OASIS group (p=0.014) but not within the obstetric group (p=0.257). No individual factor showed a significant association with complete continence restoration. The logistic regression model was statistically significant overall (p=0.027), though none of the independent predictors reached significance.

CONCLUSION: Compared with obstetric injuries, non-OASIS cases tend to involve a more prolonged recovery course and longer hospitalization. These findings suggest a more complex clinical trajectory in non-OASIS patients.

PMID:41392843 | DOI:10.14744/tjtes.2025.58436

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1109-1118. doi: 10.14744/tjtes.2025.52643.

ABSTRACT

BACKGROUND: Hemorrhagic shock is a leading cause of preventable trauma deaths, particularly within the first hours following injury. Early identification of patients requiring massive transfusion or with high mortality risk is critical to optimizing trauma management. Early identification of massive transfusion needs supports timely blood product preparation. Likewise, predicting mortality risk early can influence therapeutic planning and clinical decisions. Numerous trauma and transfusion scoring systems have been developed to guide such early decisions; however, their comparative predictive performance remains unclear. This study aimed to evaluate the effectiveness of trauma and transfusion scoring systems in predicting massive transfusion requirements and in-hospital mortality within the first four hours of trauma.

METHODS: This retrospective study included 117 trauma patients who received at least one unit of red blood cell transfusion within the first four hours of admission to a tertiary care center between 2018 and 2022. Data on demographics, trauma mechanism, clinical and laboratory findings were collected. Each patient was evaluated using 16 trauma and transfusion scoring systems. Patients were categorized based on the need for massive transfusion, defined as receiving ≥5 units of blood products within four hours. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of each scoring system, and optimal cut-off values were determined using the Youden Index.

RESULTS: Massive transfusion was required in 23 patients (19.7%), with firearm injuries being the most common mechanism among these cases. All 16 scoring systems significantly differentiated patients with and without massive transfusion. The Shock Index demonstrated the highest predictive accuracy for massive transfusion (area under the curve [AUC]=0.911). For in-hospital mortality, all scoring systems except the Schreiber Score showed significant predictive ability. The Trauma Related Injury Severity Score (TRISS) achieved the highest predictive value for mortality (AUC=0.975). Several scoring systems required revised threshold values for optimal performance in this cohort, highlighting the need for population-specific calibration.

CONCLUSION: Early-phase application of trauma and transfusion scoring systems provides valuable insights for predicting clinical outcomes in trauma patients. Among the systems analyzed, the Shock Index was the most reliable predictor of massive transfusion. Separately, TRISS demonstrated superior accuracy in forecasting in-hospital mortality. These findings emphasize the importance of rapid, score-based assessment in early trauma care and support further validation of scoring systems across diverse patient populations.

PMID:41392841 | DOI:10.14744/tjtes.2025.52643

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1075-1081. doi: 10.14744/tjtes.2025.03388.

ABSTRACT

BACKGROUND: Pediatric femoral neck fractures (PFNFs) are rare but are associated with high complication rates due to the precarious vascularity of the femoral head. Cannulated screw fixation (CSF) is the most common surgical technique, though optimal strategies remain debated. The objective of this study was to evaluate the radiological and functional outcomes of proximal femoral neck fractures (PFNFs) treated with CSF and to identify predictors of postoperative complications.

METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5-18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet-Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.

RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.

CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.

PMID:41392836 | DOI:10.14744/tjtes.2025.03388

Riv Psichiatr. 2025 Oct-Dec;60(6):270-278. doi: 10.1708/4617.46260.

ABSTRACT

BACKGROUND: Mental pain (psychache) is a key risk factor for suicide, surpassing traditional constructs like depression and anxiety. While its correlation with suicidal ideation is well-established, few studies have evaluated its predictive value for actual suicide attempts in clinical populations. This study aimed to evaluate whether mental pain predicts short-term suicide attempts in a clinical sample, and to assess its potential role as a screening tool in suicide prevention.

METHODS: A longitudinal study on 179 psychiatric outpatients recruited at the University Hospital of Varese between 2020 and 2022. At baseline, participants completed the Psychache Scale (PAS), Beck Hopelessness Scale (BHS), Beck Depression Inventory-II (BDI-II), and Columbia Suicide Severity Scale (C-SSRS), among others. Sociodemographic, clinical, and laboratory data were also collected. Suicide attempts were tracked over a 12-month follow-up. Binary logistic regression was used to identify predictors of suicide attempts.

RESULTS: Twenty-six patients attempted suicide during follow-up, with 24 cases occurring within the first 6 months. Higher scores on the PAS, BHS, BDI-II, and Columbia Severity Rating Scale (C-SSRS) were significantly associated with increased suicide risk. In logistic regression, the PAS emerged as an independent predictor: each point increase corresponded to a 3.8% rise in suicide attempt probability (p=0.015). The BDI-II showed the strongest model fit (R2=0.169). Unemployment and history of substance abuse were also significantly associated with increased risk. No significant associations were found with routine laboratory parameters.

CONCLUSIONS: The PAS, alongside the BDI-II, BHS, and C-SSRS scales may serve as an effective tool for early suicide risk detection, especially in psychiatric and primary care settings. Mental pain appears to be a relevant short-term risk indicator, highlighting the need for targeted screening and prevention strategies. Further research should explore its application in general healthcare to enhance suicide prevention efforts.

PMID:41392811 | DOI:10.1708/4617.46260