Category: Statistics

J Orthop Surg Res. 2025 Jun 18;20(1):601. doi: 10.1186/s13018-025-06018-1.

ABSTRACT

BACKGROUND: In arthroscopic rotator cuff repair, satisfactory postoperative outcomes can be achieved by simplifying the surgical procedure and ensuring proper integration of the deep rotator cuff tissue with the footprint area for tendon reconstruction. The purpose of this study was to evaluate the short-term efficacy of arthroscopic spinal needle sutures for the repair of rotator cuff tears.

METHODS: This retrospective study included a cohort of 81 patients with rotator cuff tears who underwent arthroscopic suture repair using a spinal needle between January 2021 and March 2021, with a minimum follow-up duration of 27 months. Pre- and postoperative Constant-Murley Score (CMS), University of California-Los Angeles Shoulder Score (UCLASS), Visual Analog Scale (VAS) scores, and range of motion (ROM) measurements, including active forward flexion, abduction, and lateral rotation angles, were compared to assess shoulder anatomy, function, strength, and subjective patient satisfaction.

RESULTS: Statistically significant improvements were observed in CMS, UCLASS, VAS, and ROM postoperatively (P = 0.000). The excellent or good outcome rate was 81.48%. Age and preoperative ROM significantly influenced outcomes (P = 0.039 and P = 0.006), respectively, whereas gender and pain duration did not show a significant effect (P > 0.05). Patients older than 30 years demonstrated significantly better results (P < 0.001).

CONCLUSION: The use of a spinal needle for rotator cuff tear repair under direct arthroscopic visualization is a safe, efficient, and clinically effective technique.

LEVEL OF EVIDENCE: IV CLINICAL/CONTROLLED TRIALS: Not applicable.

PMID:40533792 | DOI:10.1186/s13018-025-06018-1

J Cardiothorac Surg. 2025 Jun 18;20(1):264. doi: 10.1186/s13019-025-03508-5.

ABSTRACT

OBJECTIVE: Non-small cell lung cancer (NSCLC) poses great mortality globally. Aberrant microRNA (miRNA/miR) expression is linked to the progression of many cancers. Herein, this study explored the association of miR-196b-5p in NSCLC tissues with the clinical features and prognosis of patients.

METHODS: Totally 166 NSCLC patients were retrospectively enrolled. Cancer and normal adjacent tissues (NAT) were attained for miR-196b-5p expression measurement. Clinical baseline data were attained, followed by the analysis of the relation of miR-196b-5p expression with clinical pathological features of NSCLC patients. The 3-year postoperative mortality risk was assessed in NSCLC patients with different miR-196b-5p levels, and independent risk factors (IRFs) for 3-year postoperative mortality were screened using Kaplan-Meier curves and Cox multivariate regression analysis.

RESULTS: miR-196b-5p levels were higher in cancer tissues than in NAT. Compared with stage I-II patients, miR-196b-5p in cancer tissues was upregulated in stage III patients. Patients with high/low miR-196b-5p expression showed statistically significant differences in age, capsule invasion, lymph node metastasis (LNM), maximum tumor diameter, and clinical staging. The survival and death groups were markedly different regarding age, capsule invasion, LNM, and clinical TNM staging. High miR-196b-5p expression in cancer tissues in NSCLC patients increased 3-year postoperative mortality risk. Age, clinical TNM stage, and miR-196b-5p expression in cancer tissues were IRFs for 3-year postoperative mortality in NSCLC patients.

CONCLUSION: High miR-196b-5p expression in cancer tissues of NSCLC patients was closely linked to capsule invasion, LNM, maximum tumor diameter, and clinical TNM stage and was an IRF for 3-year postoperative mortality in NSCLC patients.

PMID:40533790 | DOI:10.1186/s13019-025-03508-5

Int J Behav Nutr Phys Act. 2025 Jun 18;22(1):79. doi: 10.1186/s12966-025-01784-x.

ABSTRACT

BACKGROUND: Community-based overweight prevention programmes are widely implemented, however, little is known about their effectiveness after scale-up. This study examines the contribution of a scaled up community-based overweight prevention programme in the Netherlands: Healthy Youth, Healthy Future (JOGG) to children’s BMIz, adherence to fruit and/or vegetable consumption guidelines, and minutes of moderate to vigorous physical activity (MVPA) per week.

METHODS: In this observational study we used repeated cross-sectional data from 5 to 11- and 12-18-year-old participants in the annual Dutch national health survey (2006-2019) and applied two analytical methods for more robust inference. First, we applied linear mixed models to assess the association between JOGG exposure for at least 18 months (n = 1,008) vs. no exposure (n = 23,779) and the outcomes and assessed whether this association differed across subgroups defined by age, socioeconomic position (SEP), or migration background. Second, we compared outcome trends in JOGG and non-JOGG municipalities before and after implementation, using a difference-in-differences approach, to account for unobserved time-invariant confounders.

RESULTS: Results showed no significant association between JOGG exposure and BMIz or MVPA. However, JOGG exposure was associated with higher adherence to fruit and/or vegetable consumption guidelines in 12- to 18-year-olds (log odds 1.82, 95%CI 0.23, 3.41). We observed no differential associations across subgroups and no differences in outcome trends between JOGG and non-JOGG municipalities.

CONCLUSIONS: The scale up of JOGG in the Netherlands between 2010 and 2019 potentially contributed to higher fruit and vegetable consumption but not to BMIz or MVPA levels. Further examination of the implementation process may provide insight in underlying mechanisms and contribution of JOGG.

PMID:40533781 | DOI:10.1186/s12966-025-01784-x

Reprod Health. 2025 Jun 18;22(1):101. doi: 10.1186/s12978-025-02058-2.

ABSTRACT

BACKGROUND: Teenage pregnancy remains a pressing public health issue with profound effects on health, education, and socio-economic outcomes. Rural areas, such as parts of Teso, often face higher prevalence of teenage pregnancy due to socioeconomic challenges. This study aimed at determining the prevalence of teenage pregnancy and associated factors in Atutur sub-county, Kumi district.

METHODOLOGY: The authors employed a cross-sectional study design and sampled 444 teenage girls aged 13-19 years from 12 randomly selected villages in Atutur sub-county, Kumi district in April 2024. They were interviewed using structured researcher administered questionnaire. Data was collected using kobo collect tool, downloaded, cleaned and exported to SPPS version 27.0 for further management and analysis. Descriptive statistics was conducted to determine the prevalence of teenage pregnancy. After adjusting for covariates, multivariate analysis was conducted using modified Poisson regression to determine predictors of teenage pregnancy. Results were reported with a 95% confidence interval (CI) and factors whose CI did not contain a null (1.0), with p-value (P < 0.05) for adjusted PR, were considered statistically significant.

RESULTS: Of the 444 teenage girls, the mean age was 17 (standard deviation = 1.9) years. About one third of the participants, 132(29.7%) had ever conceived. Teenage girls in cohabitation were 3.0 times more likely to have conceived (aPR = 3.0, 95% CI: 2.23-4.10, P < 0.001) compared to those staying with their parents. Teenagers with both parents deceased were 1.9 times more likely to conceive (aPR = 1.9, 95% CI: 1.15-3.31, P = 0.032) compared to those whose parents were both alive. Teenage girls who were not satisfied with basic needs provided by parents were 3.3 times more likely to conceive (aPR = 3.3, 95% CI: 2.26-4.85, P < 0.001) compared to those satisfied with the basic needs provided by their parents.

CONCLUSION: Teenage pregnancy rates in Atutur sub-county Kumi district was higher than the national average, due to adverse socio-economic situation. Strengthening parental support of the girl child, with legal and community measures to reduce early marriages in rural settings may reduce teenage pregnancy. There is need to make deliberate efforts to provide socio-economic strengthening for the teenage girls to reduce their vulnerability.

PMID:40533780 | DOI:10.1186/s12978-025-02058-2

Cardiovasc Diabetol. 2025 Jun 18;24(1):258. doi: 10.1186/s12933-025-02808-3.

ABSTRACT

BACKGROUND: The diagnostic criteria for HFpEF remain inconsistently defined, further confounded by comorbidities such as obesity and type 2 diabetes mellitus (T2DM), which are thought to contribute to its pathogenesis via chronic pro-inflammatory mechanisms. This study aimed to evaluate the relationship between advanced cardiac magnetic resonance (CMR) imaging and pro-fibrotic and inflammatory serum biomarkers, assessing their potential to discriminate HFpEF from associated comorbid conditions.

METHODS: This was an exploratory analysis of a prospective cohort study of 35 obese/overweight participants (mean age 64 ± 8 years, 23% females), including 16 with T2DM, 13 with HFpEF (NYHA II-III) and T2DM, and 6 healthy controls. All subjects underwent comprehensive contrast-enhanced CMR at a 3 T scanner (Philips Ingenia, The Netherlands), including assessment of left ventricular and left atrial (LA) volumetry and function, myocardial perfusion reserve (MPR), and diffuse fibrosis imaging (ECV). Obtained serum biomarkers were Pentraxin-3, Galectin-3 and Interleukin-1 Receptor-Like 1 (IL1RL1). Statistical analyses included one-way ANOVA, Tukey test, Pearson’s correlation, regression and receiver operating characteristic analyses, and intra-class correlation.

RESULTS: In multivariable regression, impaired measures of LA structure and function emerged as the only independent discriminators of HFpEF, with LA maximum volume showing an OR of 1.13 (95% CI 1.05-1.28), reservoir strain of 0.71 (95% CI 0.44-0.89), conduit strain of 0.57 (95% CI 0.32-0.82) and booster strain of 0.70 (95% CI 0.48-0.89) per unit increase. No differences in MPR nor ECV were observed between the groups. While serum biomarkers Galectin-3 and Pentraxin-3 were significantly higher in HFpEF vs. obese controls (16.1 ng/ml ± 3.8 ng/ml vs. 10.6 ng/ml ± 3.7 ng/ml, p = 0.011, and 0.84 ng/ml ± 0.67 ng/ml vs. 0.21 ng/ml ± 0.05 ng/ml, p = 0.031, respectively), these biomarkers remained within normal limits and showed only moderate correlations with CMR metrics. Highest inter-study reproducibility was seen in MPR (ICC: 0.94), LA Reservoir Strain (ICC: 0.84) and serum biomarkers (ICC: 0.087-0.93).

CONCLUSION: CMR markers of diffuse fibrosis and microvascular dysfunction may not differentiate HFpEF from obese or diabetic controls. However, left atrial function assessment may evolve to be a reproducible and practical CMR marker, effectively distinguishing HFpEF independent of fibrotic remodeling.

PMID:40533773 | DOI:10.1186/s12933-025-02808-3

Ann Plast Surg. 2025 Jun 4. doi: 10.1097/SAP.0000000000004419. Online ahead of print.

ABSTRACT

BACKGROUND: Painful neuromas are common cause of residual limb pain following lower extremity amputation, yet its incidence in diabetic populations remains unestablished. While diabetes is thought to reduce neuroma risk due to impaired nerve regeneration, the role of metformin on this process remains unclear. This study aims to explore the association of diabetes severity and metformin therapy on painful neuroma formation following lower extremity amputations.

METHODS: This retrospective cohort study used TriNetX Research Network to identify adult patients (≥18 years) who underwent lower extremity amputation between January 2016 to February 2024. Patient cohorts were identified using International Classification of Disease-10 and Current Procedural Terminology codes. Patients were stratified by diabetic status, hemoglobin A1c levels, and metformin use. Propensity score matching was performed and adjusted for demographics, comorbidities, and medications. Risk differences, risk ratios, and odds ratios with corresponding 95% confidence intervals were calculated to quantify the association between the exposure and the outcome. Statistical significance was set at P < 0.05.

RESULTS: A total of 16,090 patients underwent lower extremity amputation, 9994 (62.1%) were diabetic, while 6096 (37.9%) were nondiabetic. The overall incidence of symptomatic neuromas was lower in diabetic patients (0.61%) compared to the nondiabetic group (1.67%). After propensity score matching, 5196 diabetic and 5104 nondiabetic amputees were identified. Diabetes was associated with a significant reduction in neuroma risk [risk difference of -0.893% (95% CI: -1.29% to -0.496%); P < 0.0001]. Patients using metformin at the time of surgery had a higher incidence of painful neuroma (0.718%) compared to nonusers (0.424%) (P = 0.127, odds ratio = 1.69). There was no significant difference in neuroma rates between those with hemoglobin A1c levels 6.5%-8.0%, 8.1%-10%, and >10%.

CONCLUSIONS: Diabetes was associated with a lower painful neuroma risk after amputation, suggesting a possible protective role of hyperglycemia-induced nerve regeneration alterations. Metformin use had no significant impact on painful neuroma rates. These findings challenge assumptions about glycemic control and neuroma formation, highlighting the need for further research on metabolic influences in postamputation nerve healing and pain management.

PMID:40532227 | DOI:10.1097/SAP.0000000000004419

Am J Respir Crit Care Med. 2025 Jun 18. doi: 10.1164/rccm.202505-1134ED. Online ahead of print.

NO ABSTRACT

PMID:40532217 | DOI:10.1164/rccm.202505-1134ED

JMIR Hum Factors. 2025 Jun 18;12:e70177. doi: 10.2196/70177.

ABSTRACT

BACKGROUND: As the prevalence of mild cognitive impairment (MCI) among older adults increases, so does the need to enhance social participation and cognitive functions through innovative interventions. Digital storytelling in group settings holds potential not only to foster social connections but also to integrate with traditional in-person activities, leveraging both for greater impact.

OBJECTIVE: This study aimed to evaluate the feasibility of the Huiyou app in supporting group-based storytelling activities, aiming to enhance social participation for people with MCI. We focused on the app’s ability to improve storytelling goal attainment, social connectedness, self-efficacy, and subjective happiness, comparing these outcomes between the experimental and control groups.

METHODS: We randomly assigned 20 participants with MCI to either an intervention group or a control group, engaging them in the use of the Huiyou digital storytelling app over 4 weekly sessions of 45 minutes each. We measured outcomes through the Assessment of Life Habits questionnaire (77 items), particularly outdoor activities and interpersonal relationships; the Social Connectedness Scale-Revised (20 items); the General Self-Efficacy Scale (10 items), focusing on coping self-efficacy; and the Subjective Well-Being Scale (SWBS; 20 items), with a special emphasis on self-acceptance.

RESULTS: The sample had an average age of 69.7 (SD 3.21) years, with no significant (P=.23) baseline differences between groups in age, sex, or educational background. Cognitive function, assessed via the Montreal Cognitive Assessment-Chinese questionnaire, also showed no significant differences at baseline (P=.20). Specifically, significant enhancements in the outdoor activity (mean value difference 0.171, SD 0.353; Cohen d=1.046; P=.03) and interpersonal adaptation experience subscales of the SWBS (mean value difference 0.167, SD 0.247; Cohen d=1.290; P=.01) were noted. Notably, storytelling performance improved markedly, evidenced by increases in story sharing duration and complexity. Although overall improvements in Assessment of Life Habits (P=.14), Social Connectedness Scale-Revised (P=.59), and Subjective Well-Being Scale (P=.26) scores were not statistically significant, the large effect sizes observed suggest potential benefits of the Huiyou app that might be obscured by the study’s small sample size.

CONCLUSIONS: This study indicates that the Huiyou mobile storytelling app is feasible to enhance social participation and specific aspects of social functioning such as interpersonal adaptation for people with MCI. Despite the lack of significant changes in overall scores for key scales, observed effect sizes highlight a positive trend that merits further investigation. These results advocate for the continuation of digital intervention development to improve quality of life and social integration for individuals with MCI.

PMID:40532206 | DOI:10.2196/70177

JMIR Mhealth Uhealth. 2025 Jun 18;13:e65983. doi: 10.2196/65983.

ABSTRACT

BACKGROUND: Supportive mobile apps are effective tools for family caregivers of persons with dementia to obtain online information and psychological support. Nevertheless, details about the experiences of family caregivers of persons with dementia using mobile apps are limited.

OBJECTIVE: This study aimed to synthesize the perspectives and experiences of family caregivers of persons with dementia regarding supportive mobile apps.

METHODS: We conducted a synthesis of qualitative research and searched 7 English-language databases and 4 Chinese-language databases. We included qualitative studies (peer-reviewed studies and gray literature) written in English and Chinese on the perspectives and experiences of family caregivers of persons with dementia regarding supportive mobile apps published from database establishment to March 2025. Two researchers independently screened the literature and used the JBI Critical Appraisal Checklist for Qualitative Research to conduct quality assessments on the final included studies. Themes were integrated using the 3-stage thematic synthesis approach by Thomas and Harden.

RESULTS: A preliminary search yielded 4772 studies, of which 12 (0.25%) met the criteria. The included studies were from 7 different countries or regions, of which the only low- or middle-income country was Brazil. The studies involved a total of 232 family caregivers, most of whom were older adults and female. The integration of extracted content resulted in 4 themes: dynamic changes in value perception-complex attitudes toward mobile app adoption; from tools to partners-a technology-empowered multidimensional support system for family caregivers; external and internal barriers-challenges in family caregivers’ use of mobile apps; and person-centered design-future directions for improving mobile apps.

CONCLUSIONS: This study found that family caregivers’ attitudes toward using supportive mobile apps are influenced by their perceived value of mobile apps and their caregiving burden. In addition, such supportive mobile apps serve as valuable tools for family caregivers to enhance their caregiving abilities and efficiency, alleviate the burden of care, improve negative emotions, foster social connections, and promote self-care. Future mobile app design needs to address obstacles such as design flaws, family caregivers’ lack of technological literacy, time constraints, concerns about privacy breaches, and other device-related issues, with particular attention to the ease of use of mobile apps. Meanwhile, developers need to commit to designing personalized and multifunctional mobile apps as well as promote online collaboration among members of the care network. Overall, our study offers an important reference for developing person-centered supportive mobile apps for family caregivers of persons with dementia.

TRIAL REGISTRATION: PROSPERO CRD42024510905; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024510905.

PMID:40532203 | DOI:10.2196/65983

JMIR Form Res. 2025 Jun 18;9:e73009. doi: 10.2196/73009.

ABSTRACT

BACKGROUND: Opportunities for neonatal intensive care unit (NICU) training are limited for medical and nursing students due to patient safety concerns and the complexities of neonatal care. In addition, the COVID-19 pandemic significantly disrupted clinical training opportunities, further underscoring the need for alternative educational tools that can provide immersive and practical learning experiences. Serious games have garnered attention as potential tools for medical education; however, few are designed to simulate the complete NICU environment and its unique challenges.

OBJECTIVE: To address the educational gaps in neonatal care training, we aimed to develop and evaluate a serious game that provides a comprehensive NICU simulation experience for students and the general public.

METHODS: The game was developed over 14 months by a collaborative team that included a neonatologist, 4 medical students, and 1 art student, with a total cost of US $10,000. Initially created in TyranoBuilder (STRIKEWORKS), the game was later redeveloped in Unity with Naninovel to support multilingual functionality. Structured as a 6-chapter visual novel, the game follows a high school student observing the NICU during a hospital internship. Scenario-based decision-making and interactive dialogues guide the player through both the clinical and emotional aspects of neonatal care. After completing the game, players were invited to participate in an optional web-based survey that assessed demographic information, gameplay quality, and educational value using Likert scales. Descriptive and inferential statistics were used for data analysis.

RESULTS: The game, titled First Steps in the NICU, was released for iOS, Android, and Steam. As of May 2025, it has been downloaded 2799 times (2260 on iOS and 539 on Android). A total of 160 survey responses were collected, with 46.3% of respondents identifying as health care professionals or students. The majority of participants were female (114/160, 71.3%) and aged 20-29 years (59/160, 36.9%). Mean scores for length, difficulty, and gameplay were 3.05 (SD 0.62), 2.49 (SD 0.76), and 3.65 (SD 0.77), respectively, indicating a well-balanced design. The educational usefulness of the game received high ratings: empathy with the story (4.24), usefulness for knowledge acquisition (4.16), and effectiveness of serious games as a learning tool (4.37). No significant differences in evaluations were found between health care professionals and students and the general public, suggesting broad accessibility and appeal.

CONCLUSIONS: We developed a low-cost serious game that simulates NICU experiences through collaboration between a neonatologist and students. The game received positive feedback and demonstrated educational value for a diverse audience. Positioned as formative research, this study highlights the potential of serious games to supplement neonatal care education. Future updates will incorporate user feedback, leading to improvements in gameplay and expanded content.

PMID:40532200 | DOI:10.2196/73009