Category: Statistics

JMIR Res Protoc. 2025 Nov 28;14:e75199. doi: 10.2196/75199.

ABSTRACT

BACKGROUND: The COVID-19 pandemic impacted trust in public health, medical care, scientific, and governmental institutions; this influenced health, health-seeking behaviors, and adherence to public health measures. Understanding how trust evolves is necessary for informing future public health crisis management and strategies. Rebuilding public trust is key to pandemic preparedness worldwide. This research protocol examines these trust dynamics, their determinants, and their implications.

OBJECTIVE: This study aimed to investigate the evolution of public trust in scientists, public health and medical care institutions, governments, and social and personal networks during the COVID-19 pandemic. It sought to identify key factors contributing to trust maintenance or erosion, particularly in marginalized and minority communities, and understand the impact of trust level on public health adherence.

METHODS: A sequential, explanatory mixed methods approach was implemented, consisting of an initial quantitative survey followed by qualitative interviews. The nationwide representative survey included 5607 Canadian residents as of May 2024. The questionnaire assessed trust in 6 key trust sources before and during the pandemic: provincial and federal governments, public health authorities, medical care providers, health scientists, and social and personal networks. To complement, 41 qualitative interviews were conducted to understand participants’ lived experiences, perceptions, and how trust played into both. Data have been analyzed using quantitative statistical techniques and qualitative phenomenological analysis, and the results have been integrated to derive comprehensive insights. All phases of data collection and analysis were finalized by early 2025. The project then advanced to paper preparation, dissemination at national conferences, and knowledge-translation activities, including the report development and public-facing outputs, scheduled for completion in end-2025.

RESULTS: This Canadian survey included participants from all 10 provinces and 2 territories; the provinces and territories’ samples matched the proportions of each in the overall Canadian population. Age and sex or gender were well distributed across the sample. Additionally, 18.6% (1040/5607) identified as an ethnic minority, 12.7% (710/5607) identified as Indigenous, including 7.2% (403/5607) First Nations, 4.8% (270/5607) Métis, and 0.4% (25/5607) Inuit. Fifty-five percent (3094/5607, 55.2%) had received at least 1 dose and planned to stay up to date with booster recommendations, while 36.6% (2052/5607) were vaccinated but did not intend to receive additional doses. A small percentage, 0.7% (39/5607), had not yet been vaccinated but were open to it, whereas 6.4% (359/5607) had not received a vaccine and did not plan to take a vaccine.

CONCLUSIONS: The COVID-19 pandemic has underscored the critical role of trust in public health behavior and crisis response. This study explores how consistent, transparent communication and equity-driven policies may contribute to maintaining public trust, particularly among marginalized communities. By examining trust dynamics and identifying potential disparities, this study aims to inform evidence-based public health strategies and improve preparedness for future health emergencies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75199.

PMID:41313631 | DOI:10.2196/75199

JMIR Res Protoc. 2025 Nov 28;14:e77521. doi: 10.2196/77521.

ABSTRACT

BACKGROUND: The COVID-19 pandemic challenged families, youth, and frontline workers, including childcare providers. Studying lived experiences before, during, and near the pandemic’s end from multiple perspectives provides a more holistic and deeper understanding of its effects and impacts.

OBJECTIVE: This study investigated how parental, childcare provider, and youth stress, mental health, and role overload relate to individual coping and family functioning, as well as vaccine attitudes and uptake patterns among youth, parents, and childcare providers. Information learned from this investigation will inform policy and messaging for future public health crises.

METHODS: This study is an explanatory sequential mixed methods study designed to capture the voices of parents of children younger than 18 years of age, childcare providers, and youth aged 12-17 years through surveys and interviews. This retrospective cross-sectional study began with a web-based survey that included demographic questions and validated scales to assess personal well-being, household and family dynamics, behavioral problems, and vaccination-related perceptions, attitudes, and behaviors. Open-ended responses about pandemic experiences for themselves and their families were included. A subsample of parents, youth, and childcare providers was selected for in-depth interviews about their pandemic-related experiences. Descriptive statistics were used to summarize demographic characteristics, and internal consistency was assessed for all survey measures using Cronbach α. Future studies will use inferential statistical techniques to analyze survey measures, thematic analysis for open-ended survey responses and interview data, and mixed methods data integration to synthesize quantitative and qualitative findings.

RESULTS: Data collection for the study began in August 2022 and finished in August 2023. Data analysis is currently in progress to address research questions, and study preparation and dissemination efforts are underway. A total of 506 adults and 93 youths answered a study survey, and 45 adults and 21 youths completed in-depth interviews. Among the 506 adults, 166 were childcare providers. The adult sample had a mean age of 42.8 (SD 9.15) years and was predominantly female (467/506, 92.3%), with 9.7% (49/506) identifying as Black, 4.7% (24/506) as Hispanic, and 81.2% (411/506) being parents of children aged 17 years or younger. The youth sample had a mean age of 14.5 (SD 1.63) years, and 55.9% (52/93) were female, 6.4% (6/93) were Black, and 17.2% (16/93) were Hispanic. Several dyads and triads participated. The sample included 42 parent-child dyads, 3 parent-parent dyads, 2 parent-parent-child triads, and 21 parent-child-child triads.

CONCLUSIONS: These data will be used to understand the diverse experiences of families, youth, and childcare providers during and after the COVID-19 pandemic. This includes successful and unsuccessful adaptations, responses to policies and mandates, and the unmet needs for health messaging, programs, policies, and services. This research aims to guide the development of effective policies and public health communication, fostering scalable and sustainable messaging resources.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/77521.

PMID:41313626 | DOI:10.2196/77521

JMIR Res Protoc. 2025 Nov 28;14:e77944. doi: 10.2196/77944.

ABSTRACT

BACKGROUND: Driving performance involves multiple underlying components of psychomotor functioning, such as attention, executive functions, and vehicle control. While the effects of acute medical marijuana and prescription opioid intoxication are known, how long-term use of medical marijuana under real-world conditions affects driving performance is unknown. Additionally, there are numerous ongoing physical and cognitive changes that affect driving performance with age. Given the proliferation of medical marijuana and prescription opioid use in adults aged 50 years and older, the prevalence of polypharmacy, and declining functional abilities, it is imperative to understand the long-term effects of daily medical marijuana use. Further, we need to understand how co-occurring use of medical marijuana and prescription opioids, in the presence of comorbidities such as chronic pain, affects real-world driving outcomes.

OBJECTIVE: This study aims to document the observational trial protocol. The primary goal of this study is to identify the effects of daily long-term (ie, use for >12 months daily or most days of the week) medical marijuana use on driving performance outcomes using an open-road driving performance task under real-world conditions in adults aged 50 years and older who endorse chronic or severe nonmalignant pain and to examine the combined effect of daily long-term medical marijuana use and prescription opioid use on driving outcomes. A secondary goal is to qualitatively explore self-regulation of medical marijuana and prescription opioid use in this population.

METHODS: We plan to test medical marijuana use as the exposure variable in adults aged 50 years and older on an open-road driving task performance as the primary outcome. The study will detail tetrahydrocannabinol exposure through ecological momentary assessment and urinalysis and will compare performance with a race-sex-matched group of non-marijuana users.

RESULTS: This study is funded by a grant from the National Institute on Drug Abuse (5R01DA057965). Recruitment began on May 19, 2025. As of November 2025, a total of 30 participants had been enrolled. Recruitment is anticipated to be completed by 2029. Publication of the complete results and data from this study is expected by 2030.

CONCLUSIONS: Data from this study will identify the effects of long-term medical marijuana use and the combined effect of that use with prescription opioids to develop risk screening protocols and intervention targets for this population. The development and dissemination of screening and intervention guidelines will be the next step in this work.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06995937; https://www.clinicaltrials.gov/study/NCT06995937.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/77944.

PMID:41313623 | DOI:10.2196/77944

J Integr Complement Med. 2025 Nov 21. doi: 10.1177/27683605251399059. Online ahead of print.

ABSTRACT

Objective: The primary goal of treatment for endometriosis (EMS), where pelvic pain is the most significant symptom, is the symptom alleviation. Medical treatment is typically employed until menopause or until pregnancy is desired. The primary outcome of this randomized controlled trial was the reduction in pelvic pain intensity as measured by the visual analog scale (VAS). Secondary outcomes included quality-of-life (QoL) parameters assessed using the short form 36 (SF-36) subscales. Therefore, this study aimed to evaluate the effectiveness of emotional freedom techniques (EFTs) in women experiencing pelvic pain due to EMS. Method: The research was conducted using a parallel-group, randomized controlled design. The EFT group received two EFT sessions (45-60 min each) once a month together with affirmation practices lasting 10-15 min at least twice a week. Control group participants performed breathing exercises parallel to the intervention group. Data were collected from 64 women (intervention: 32 and control: 32) presenting with pelvic pain complaints at the Gynecology Clinic of Trakya University between May 24, 2024 and October 27, 2024. Assessments were performed using the VAS and the SF-36-short form. Mixed-model analysis of variance was utilized to analyze the effects of time, group, and the time × group interaction. Statistical significance was set at p ≤ 0.05. Results: Compared with the control group, the EFT group showed a significant reduction in mean VAS pain scores (baseline: 7.34 ± 0.90; 1st month: 6.46 ± 0.67; 2nd month: 4.68 ± 0.53) (interaction η² = 0.323, p < 0.001). Improvements were also observed in SF-36 subscales, including physical functioning, emotional role functioning, vitality, mental health, social functioning, and pain (all p < 0.05), suggesting that EFT may reduce pelvic pain and improve the QoL. Conclusion: EFT was associated with reductions in pelvic pain intensity (the primary outcome) and improvements in multiple dimensions of the QoL among women with EMS-related pelvic pain. These findings suggest that EFT may be a beneficial complementary intervention for managing EMS symptoms.

PMID:41313614 | DOI:10.1177/27683605251399059

J Integr Complement Med. 2025 Nov 21. doi: 10.1177/27683605251392469. Online ahead of print.

ABSTRACT

Background: Systematic studies and follow-up evaluation of the effects and duration of Baduanjin exercises are still lacking. This study used a meta-analysis to systematically evaluate the effectiveness and safety of long-term cardiac rehabilitation using Baduanjin exercise in patients with chronic heart failure (CHF). Methods: Eight databases were searched up to June 2, 2025. Two reviewers independently screened the included titles, then extracted trial and patient characteristics and outcome data and assessed the risk of bias. The meta-analysis was performed using Stata software 17.0, with cardiac function, exercise capacity, and quality of life pooled as either short-term (12 weeks) or long-term follow-up. Changes in left ventricular ejection fraction, depression, readmission rate, and efficiency rate were also analyzed. Results: A total of 21 randomized controlled trials involving 1594 patients (805 in the intervention group and 789 in the control group) were included in the meta-analysis. The results showed that long-term Baduanjin exercise was associated with indices of cardiac function and favorable improvements in overall quality of life (mean difference [MD] = -1.33; 95% confidence interval [CI]: -1.65 to -1.00; p < 0.00001), left ventricular ejection fraction (MD = 0.46; 95% CI: 0.21-0.71; p < 0.00001), exercise capacity (MD = 1.10; 95% CI: 0.72-1.48; p < 0.00001), depression (MD = –0.61; 95% CI: -0.94 to -0.29; p = 0.00;), and efficiency rate (OR = 3.19; 95% CI: 2.04-4.98; p < 0.00001). The improvements in cardiac function, quality of life, and exercise capacity were more pronounced with long-term Baduanjin exercise than with short-term exercise. These changes were not statistically significant (risk ratio = 0.31; 95% CI: 0.09-1.07; p = 0.06), although there was a trend toward an improvement. Analysis of the safety data indicated no serious adverse events. Conclusions: Long-term Baduanjin exercise may improve quality of life, exercise capacity, and psychological well-being in patients with CHF. This finding indicates it may have potential as an effective component of cardiac rehabilitation, although further rigorous studies are needed to confirm these benefits.

PMID:41313613 | DOI:10.1177/27683605251392469

Cancer Control. 2025 Jan-Dec;32:10732748251404662. doi: 10.1177/10732748251404662. Epub 2025 Nov 28.

ABSTRACT

IntroductionThis study examined the association between social determinants of health (SDHs) and cancer incidence in a nationally representative Chinese cohort.MethodsWe conducted a prospective cohort study using data from 12,335 participants in the China Health and Retirement Longitudinal Study (2011-2020). SDHs scores reflected favorable social conditions. Cox proportional hazards models estimated cancer risk across SDHs levels, with subgroup and sensitivity analyses.ResultsHigher SDHs scores were associated with a lower cancer risk (HR 0.69, 95% CI 0.51-0.95), particularly among men (HR 0.60, 95% CI 0.39-0.92), rural residents (HR 0.54, 95% CI 0.33-0.87), and individuals who smoked (HR 0.59, 95% CI 0.37-0.95) or drank alcohol (HR 0.47, 95% CI 0.27-0.82). No significant association was observed in participants with hypertension (HR 0.74, 95% CI 0.44-1.24) or hyperlipidemia (HR 0.85, 95% CI 0.33-2.18).ConclusionsFavorable social conditions were linked to reduced cancer risk, emphasizing the need to improve social environments alongside lifestyle interventions.

PMID:41313611 | DOI:10.1177/10732748251404662

Brief Bioinform. 2025 Nov 1;26(6):bbaf616. doi: 10.1093/bib/bbaf616.

ABSTRACT

Deep learning has significantly enhanced protein structure prediction, and AlphaFold2 marked a particular milestone among these methods for predicting protein monomer and complex structures. The AlphaFold3 represents a pivotal further advancement in biomolecular structure prediction, extending beyond proteins to model diverse assemblies. Despite attracting a huge number of users, there is still an absence of third-party benchmarks to fairly demonstrate the performance of the AlphaFold3. In this work, we benchmark AlphaFold3’s performance across nine datasets, protein monomers, orphan proteins, alternative conformations, protein multimers, peptide-protein complexes, antigen-antibody complexes, RNA, RNA multimers, and protein-nucleic acid complexes, compared to AlphaFold2, AlphaFold-Multimer, and RoseTTAFoldNA, RhoFold+, NuFold and trRosettaRNA. For protein monomers, AlphaFold3 demonstrates improved local structural accuracy over AlphaFold2, though global accuracy gains are limited. In modeling general protein complexes, AlphaFold3 surpasses AlphaFold-Multimer in local structural prediction. For peptide-protein complexes, their performances are nearly indistinguishable, whereas on antigen-antibody complexes, AlphaFold3 is significantly superior. AlphaFold3 shows substantial superiority over RoseTTAFoldNA in protein-nucleic acid predictions, with significant gains in TM-score, local distance difference test scores, and interaction network fidelity scores, whereas for RNA multimers its advantage is limited to significant gains in local distance difference test scores. For RNA monomers, trRosettaRNA achieves higher global prediction accuracy. These results highlight AlphaFold3’s ability to predict both structural detail and interactions, positioning it as a versatile tool for diverse biomolecular systems and suggesting promising applications in structural biology and molecular interaction research, while at the same time highlighting areas ripe for continuing improvements in performance.

PMID:41313605 | DOI:10.1093/bib/bbaf616

Oper Neurosurg. 2025 Nov 28. doi: 10.1227/ons.0000000000001830. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Large anterior skull base meningiomas are common and challenging brain tumors to resect. This study evaluates the role of the frontal, bifrontal, and pterional craniotomies on outcomes after resection.

METHODS: This is a retrospective study of patients with large anterior skull base operated on at our institution between 2010 and 2024 using the frontal, bifrontal, and pterional approaches. All patients were 18 years or older and had ≥1 year of clinical follow-up data. Propensity-score matching (PSM) with a one-to-many nearest neighbor matching algorithm was used to achieve 3 groups of similar patients, based on size, grade, and preoperative Karnofsky Performance Status. The Shapiro-Wilk test, paired T-test, analysis of variance, and Tukey test were used to establish statistical significance. Pearson R was used to evaluate PSM success, with the log-rank test used within Kaplan-Meier analysis and multiple-linear regressions performed to evaluate predictors of outcomes.

RESULTS: In total, 337 patients (140M, 197F) were included, with 80, 189, and 68 patients undergoing bifrontal, frontal, and pterional craniotomies, respectively. Patients in the bifrontal group presented with significantly higher tumor size (5.46 cm, P = .0021) and lower mean preoperative Karnofsky Performance Status (71.15, P = .0059), while patients in the frontal group reported a significantly higher tumor grade vs other groups (1.65, P = .0025). After PSM, the bifrontal group reported a significantly higher frequency of medical (25.0%, P < .0001) and surgical (22.5%, P < .0001) complications, alongside significantly worse cosmetic outcomes (6.25%, P = .0054) vs other groups. Kaplan-Meier analysis showed a significantly higher rate of minor complications in the bifrontal group (P = .0497), alongside reduced progression-free survival in the frontal group (P = .0048). Regression analyses revealed olfactory groove meningiomas and subtotal resections predicted worse outcomes for the pterional and frontal approaches, respectively.

CONCLUSION: The findings suggest significant difference in baseline characteristics and operative outcomes across the 3 groups, highlighting predictive factors and risk profiles that neurosurgeons can include in perioperative planning.

PMID:41313593 | DOI:10.1227/ons.0000000000001830

Foodborne Pathog Dis. 2025 Nov 21. doi: 10.1177/15353141251394945. Online ahead of print.

ABSTRACT

Camel milk is an essential nutritional resource in arid and semiarid regions and has been gaining commercial importance, particularly in the Middle East. Concerns over mycotoxin contamination, particularly aflatoxins (AFs), pose potential health risks and may affect milk quality. Understanding the role of feeding systems on the occurrence of AFs and on milk quality is vital for safeguarding public health and improving dairy industry practices. This study aimed to evaluate the impact of different feeding systems on the chemical and microbiological quality of camel milk and to detect aflatoxin M1 (AFM1) in milk and AF B1 (AFB1) in camel feed. A total of 80 samples were collected from 40 camels across Riyadh and Dammam, Saudi Arabia, between March and May 2024. Camels were divided into two groups based on feeding systems: natural grazing (grasses and legumes) and semi-intensive farm-based feeding (concentrates). Milk samples were analyzed for chemical composition and microbiological quality. Statistical comparisons were made between groups. AFB1 was detected in 1 (5%) of the natural grazing feed samples and in 3 (15%) of the farm-based feed samples; all values were below the Saudi national MRL for AFM1 in milk (0.5 μg/kg), as well as the stricter European Union’s limit of 0.05 μg/kg and the Codex Alimentarius standard of 0.5 μg/kg. AFM1 was below the detection limit in all samples, and consequently, no significant differences between feeding systems could be observed. There was no significant difference in AFM1 levels between the two feeding systems. However, milk from naturally grazed camels exhibited significantly lower microbial counts. Samples from Riyadh showed no AF contamination. The absence of AFM1 in all milk samples suggests minimal public health risk. However, higher AFB1 occurrence in farm-based feed underscores the need for stringent feed monitoring. These findings inform management practices to enhance milk safety in camel dairy systems.

PMID:41313587 | DOI:10.1177/15353141251394945

J Magn Reson Imaging. 2025 Nov 28. doi: 10.1002/jmri.70176. Online ahead of print.

ABSTRACT

BACKGROUND: MRI contrast agents enhance lesion characterization by altering tissue relaxation properties. However, quantitative assessment of contrast enhancement is limited by variability in contrast administration parameters, and lack of efficient and precise contrast concentration independent relaxivity (r₁, r₂) measurement techniques. MR Fingerprinting (MRF) rapidly, simultaneously and accurately measures T₁ and T₂, enabling for the first time efficient clinical estimation of relaxivity ratios (r₁/r₂).

PURPOSE: To introduce an MRF-derived delta-relaxometry method for mapping contrast-specific relaxivity ratios (r₁/r₂) by accurately measuring ΔR₁/ΔR₂. We hypothesize that delta-relaxometry ratios offer dose-independent, reproducible measures of tissue enhancement, with potential advantages over conventional contrast-enhanced MRI.

STUDY TYPE: Prospective, observational.

POPULATION: Phantom studies and 29 patients (15 glioblastoma, 14 brain metastases).

FIELD STRENGTH/SEQUENCE: 3 T; pre- and post-contrast 3D whole-brain MR Fingerprinting.

ASSESSMENT: Mathematical derivations established a relationship between ΔR₁/ΔR₂ and r₁/r₂. Phantom studies assessed the concentration-dependency of ΔR₁/ΔR₂ compared to ΔT₁ and ΔT₂. Reproducibility was assessed by the inter-subject coefficient of variation (CoV). In vivo tumor type differentiation was assessed with whole-lesion histograms.

STATISTICAL TEST: Coefficient of variation; coefficient of determination; Mann-Whitney U tests with Benjamini-Hochberg correction.

RESULTS: ΔR₁/ΔR₂ is theoretically equivalent to r₁/r₂, showing contrast-dose independence in phantom studies. ΔR₁/ΔR₂ showed no dependence on injected dose or timing (p > 0.05), unlike ΔT₁ and ΔT₂. Delta-relaxometry ratios were highly reproducible, selectively elevated in tumors versus normal tissue, and showed a difference between tumor core and edema (p < 0.05). ΔR₁/ΔR₂ showed higher intra-subject reproducibility (median CoV: GBM = 27.3%, MET = 22.0%) as compared to ΔT₁ (GBM = 57.1%, MET = 106.2%; p < 0.001). Whole-lesion histogram analysis of delta-relaxometry ratios demonstrated GBM versus metastasis differentiation (p < 0.05). “DATA” CONCLUSIONS: In this proof-of-concept study, MRF-derived ΔR₁/ΔR₂ ratios show potential for reproducible, clinically feasible, dose-independent relaxivity quantification. Delta-relaxometry ratios may offer a novel approach to tissue characterization with minimal background enhancement, distinct from perfusion imaging. Our results suggest delta-relaxometry as a tumor imaging marker worthy of further investigation.

EVIDENCE LEVEL: 3 (retrospective cohort study with imperfectly applied reference standard).

TECHNOLOGY EFFICACY: 1 (feasibility study with quantitative assessment, requires a comparison with standard of care).

PMID:41313583 | DOI:10.1002/jmri.70176