Category: Statistics

JMIR Mhealth Uhealth. 2025 Jul 4;13:e64622. doi: 10.2196/64622.

ABSTRACT

BACKGROUND: Mental health is an essential element of life. However, existing mental health services face challenges in utilization due to issues such as societal prejudices and a shortage of counselors. Mobile health is gaining attention as an alternative approach to improving mental health by addressing the shortcomings of traditional services. As a result, various mental health apps are being developed, but there is a lack of evaluation research on whether these apps meet users’ needs.

OBJECTIVE: This study aims to evaluate the content and quality of mental health apps from the user’s perspective and identify the content features that influence evaluation scores. We also aim to guide future updates and improvements in mental health apps to deliver high-quality solutions to users.

METHODS: We searched the Google Play Store and iOS App Store using Korean keywords “mental health,” “mental health care,” “depression,” and “stress.” Apps meeting the following criteria were selected for the study: relevance to the topic, written in Korean, more than 700 reviews (Android) or more than 200 reviews (iOS), updated within the past 365 days, available for free, nonduplicate, and currently operational. After identifying and defining the primary contents of the apps, 7 users evaluated their quality using the user version of the Mobile Application Rating Scale (uMARS). Correlation analysis was performed to examine the relationships among app content, uMARS scores, star ratings, and the number of reviews. Multiple regression analysis was conducted to identify the factors influencing uMARS scores and each evaluation item.

RESULTS: The analysis included a total of 41 mental health apps. Content analysis revealed that reminders (n=29, 71%), recording and statistics features (n=29, 71%), and diaries (n=24, 59%) were the most common app components. The top-rated apps, as determined by uMARS evaluations, consistently provided information about counselors and counseling agencies, and included counseling services. uMARS scores were significantly correlated with the presence of health care provider information (r=0.53; P<.001) and counseling/question and answer services (r=0.55; P<.001). Multiple regression analysis indicated that providing more relevant information was associated with higher uMARS scores (β=.361; P=.02).

CONCLUSIONS: The quality of mental health apps was evaluated from the user’s perspective using a validated scale. To deliver a high-quality mental health app, it is essential to incorporate app technologies such as generative artificial intelligence during development and to continuously monitor app quality from the user’s perspective.

PMID:40614100 | DOI:10.2196/64622

Orv Hetil. 2025 Apr 27;166(17):658-668. doi: 10.1556/650.2025.33284. Print 2025 Apr 27.

ABSTRACT

Bevezetés: Az elmúlt években az egészségügyi rendszerben észlelhető szerkezeti és jogi változások következtében a magánegészségügy szerepe hangsúlyosabbá vált, aminek következtében a Maternity Szülészeti és Nőgyógyászati Magánklinikán az éves szülésszám jelentős növekedése volt megfigyelhető. A klinika alapvető törekvése már a kezdetektől fogva az, hogy magas szintű, szakmai protokollokon nyugvó perinatológiai ellátást nyújtson minden páciens számára, a betegforgalomtól függetlenül. Célkitűzés: A jelen vizsgálat célja a Maternity Szülészeti és Nőgyógyászati Magánklinikán nyújtott 2023. évi neonatológiai ellátás mennyiségi és minőségi mutatóinak elemzése és összegzése. Módszer: Retrospektív vizsgálatunkban a 2023. január 1. és 2023. december 31. között a Maternity Szülészeti és Nőgyógyászati Magánklinikán élve született újszülöttek adatait elemeztük, a releváns eredményeket grafikonon ábrázoltuk. Eredmények: A Maternity Szülészeti és Nőgyógyászati Magánklinikán 2023-ban 1461 újszülött született élve, az újszülöttek túlnyomó többsége a 38–39. héten (n = 1010, 69%). A betöltött 37. terhességi hét előtt 34 újszülött jött a világra (ebből 5 újszülött 35 hetes koraszülött volt). A császármetszések aránya 78% volt. A klinikán született újszülöttek 92%-át eseménytelen kórházi bent fekvést követően 2, illetve 3 nap után haza tudtuk engedni. A hazamenetel napján a kizárólagos anyatejes táplálásban részesülő újszülöttek aránya 71% volt (n = 1027). Újszülöttkori sárgaság miatt 85 újszülött részesült kékfény-kezelésben, mely a kórházi tartózkodást 1–2 nappal hosszabbította meg. A vizsgált időszakban összesen 12 újszülöttnél kezdtünk antibiotikumkezelést újszülöttkori szepszis gyanúja miatt, közülük 5 újszülött részesült komplett 5 napos antibiotikumterápiában. Újszülöttkori légzészavar miatt 32 esetben volt szükség az osztályon NCPAP- (nasalis folyamatos pozitív légúti nyomású) légzéstámogatás alkalmazására, ezek közül 15 alkalommal néhány órás kezelést követően sikeresen el tudtuk hagyni a légzéstámogatást, 17 esetben történt áthelyezés légzészavar miatt. Az 1461 újszülött közül összesen csupán 36 alkalommal (2,4%) volt szükség magasabb progresszivitási szintű intézménybe való áthelyezésre. Két újszülöttnek volt kisebb fejlődési rendellenessége (egy kamrai septumdefektus és egy hypospadiasis). Egyetlen újszülöttet sem veszítettünk el. Megbeszélés: A Maternity Szülészeti és Nőgyógyászati Magánklinika neonatológiai ellátási modellje a 21. századi követelményeknek megfelelően, a betegbiztonságot figyelembe véve, szakmai protokollok alapján működik. Biztosítja az újszülöttek és családok részére a háborítatlan, biztonságos környezetet az anya-újszülött kapcsolat kialakulásához és az anyatejes táplálás elindításához a szülést követő órákban és napokban. Orv Hetil. 2025; 166(17): 658–668.

PMID:40614089 | DOI:10.1556/650.2025.33284

Hepatol Int. 2025 Jul 4. doi: 10.1007/s12072-025-10841-3. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Large-volume paracentesis (LVP), a therapeutic procedure for cirrhosis patients with refractory ascites, is associated with paracentesis-induced circulatory dysfunction (PICD). While albumin infusion is known to prevent PICD, it is unknown whether the addition of vasoconstrictors to albumin reduces complications of LVP.

METHODS: Cirrhosis patients undergoing LVP for refractory ascites were randomized to receive albumin alone (Gr. I), terlipressin with albumin (Gr.II), or midodrine with albumin (Gr. III). The primary endpoint was the incidence of PICD, and the secondary endpoints were the incidence of new-onset complications (hyponatremia, acute kidney injury, and encephalopathy), 28-day survival and adverse events to therapy.

RESULTS: One hundred and sixty-fifty cirrhosis patients with refractory ascites undergoing LVP were equally randomized to 3 groups. The incidence of PICD in Gr. I (14%), II (7%), and III (11%) was similar (p = 0.46). Mean arterial pressure (MAP) reduced in Gr.I and II compared to the rise in Gr. III on day 3 (ΔMAP: Gr.I = – 8.2 ± 5.01; Gr.II = – 4.34 ± 5.82; Gr. III = 9.16 ± 5.14 mmHg; p < 0.001), with a statistically significant rise in PRA (ng/ml/hour) at day 6 in Gr. I and II than in Gr. III. The incidence of new-onset complications was significantly higher in Gr.I (52.72%) and Gr.II (45.46%) than Gr.III (23.63%) (p = 0.005). Overall mortality on day 28 was not different between the groups.

CONCLUSIONS: PICD remains a challenge even in hospitalized settings. The addition of oral midodrine to albumin prevents hypotensive response on day 3, thereby reducing the incidence of new-onset complications following LVP.

PMID:40614032 | DOI:10.1007/s12072-025-10841-3

Lifetime Data Anal. 2025 Jul 4. doi: 10.1007/s10985-025-09663-0. Online ahead of print.

ABSTRACT

Analyses of multi-source data, such as data from multi-center randomized trials, individual participant data meta-analyses, or pooled analyses of observational studies, combine information to estimate an overall average treatment effect. However, if average treatment effects vary across data sources, commonly used approaches for multi-source analyses may not have a clear causal interpretation with respect to a target population of interest. In this paper, we provide identification and estimation of average treatment effects in a target population underlying one of the data sources in a point treatment setting for failure time outcomes potentially subject to right-censoring. We do not assume the absence of effect heterogeneity and hence our results are valid, under certain assumptions, when average treatment effects vary across data sources. We derive the efficient influence functions for source-specific average treatment effects using multi-source data under two different sets of assumptions, and propose a novel doubly robust estimator for our estimand. We evaluate the finite-sample performance of our estimator in simulation studies, and apply our methods to data from the HALT-C multi-center trials.

PMID:40614027 | DOI:10.1007/s10985-025-09663-0

Odontology. 2025 Jul 4. doi: 10.1007/s10266-025-01143-z. Online ahead of print.

ABSTRACT

This study assessed the biological and antimicrobial properties of a calcium silicate-based material and calcium hydroxide (CH) when used as intracanal medications. MTT assay, osteogenic differentiation of human periodontal stem cells (hPDLSCs), cell mineralization-assay, and determination of ALP activity were assessed to investigate the biological properties. While the agar well diffusion, crystal violet (CRV) assay and LIVE/DEAD staining of dentin slices infected with a mature E. faecalis biofilm were used to assess the antimicrobial properties. Normally distributed data were analyzed using one and two-way ANOVA and post hoc Tukey test, while for non-normally distributed data Kruskal Wallis and Dunn’s tests were used. The results showed that both materials were cytocompatible, but BioC-Temp showed statistically higher hPDLSCs viability (P < 0.05). hPDLSCs cultured with BioC-Temp extract demonstrated a significantly higher mineralization and more mineralized nodules than CH extract (P < 0.05). Both BioC-Temp and CH had similar antibacterial potential against E. faecalis in radicular dentin. BioC-Temp has higher mineralization potentials than CH. For the antimicrobial properties, BioC-Temp caused significantly higher inhibition zones than CH (P = 0.0001). The biofilm biomass reduction of BioC-Temp was significantly higher than for CH (P < 0.05). Regarding the percentage of live E. faecalis in biofilm, both BioC-Temp and CH caused significant reductions with no significant difference between them (P > 0.05).

PMID:40614024 | DOI:10.1007/s10266-025-01143-z

J Magn Reson Imaging. 2025 Jul 4. doi: 10.1002/jmri.29834. Online ahead of print.

ABSTRACT

BACKGROUND: Changes in interstitial fluid (ISF) dynamics are potential contributors to idiopathic normal pressure hydrocephalus (iNPH). Spectral diffusion analysis provides surrogate markers for ISF volume (F_int) and diffusivity (D_int).

PURPOSE: To compare F_int and D_int between patients with iNPH and healthy controls (HCs).

STUDY TYPE: Retrospective.

POPULATION: 34 patients with iNPH (24 males, 10 females; 76.9 ± 7.6 years) and 132 HCs (46 males, 86 females; 47.5 ± 16.9 years; three age groups: < 40 years, 40-59 years, and ≥ 60 years).

FIELD STRENGTH/SEQUENCE: 3.0 T/Single-shot spin-echo echo-planar imaging.

ASSESSMENT: F_int and D_int were computed using non-negative least squares and measured in eight regions, including the centrum semiovale (CSO), frontal white matter (FWM), and lenticular nucleus (LN). The regions of interest of iNPH were categorized as either periventricular hyperintensity (PVH) regions (iNPH_PVH group) or non-PVH regions (iNPH group). F_int and D_int were compared among groups, and correlations with age were analyzed.

STATISTICAL TESTS: Kruskal-Wallis test with Dunn’s multiple comparison post hoc test. Spearman correlation coefficient. p < 0.05 was considered statistically significant.

RESULTS: In the CSO, iNPH_PVH group F_int values (40.3% ± 18.4%) exceeded those of other groups, while D_int values (1.53 ± 0.63 [× 10^-3 mm²/s]) were significantly higher than those in younger HCs and the iNPH group. In the FWM, both F_int (53.0% ± 18.9%) and D_int (1.64 ± 0.50 [× 10^-3 mm²/s]) were significantly higher in the iNPH_PVH group than in the other groups. In the LN, F_int correlated positively with age, regardless of the iNPH group’s inclusion (without iNPH, ρ = 0.2114; with iNPH, ρ = 0.3044).

DATA CONCLUSION: Spectral diffusion analysis in iNPH demonstrated that ISF volume and diffusivity increased in PVH regions of the CSO and FWM, whereas ISF dynamics outside PVH regions may not differ significantly from those in HCs.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 1.

PMID:40614019 | DOI:10.1002/jmri.29834

Obes Surg. 2025 Jul 4. doi: 10.1007/s11695-025-08005-1. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary atelectasis is a significant complication of metabolic and bariatric surgery (MBS). Sugammadex enables rapid neuromuscular blockade reversal compared to neostigmine, but its impact on atelectasis prevention remains unclear.

METHODS: This retrospective multicenter study used the TriNetX database to analyze adult patients who underwent MBS between 2010 and 2024. Patients receiving rocuronium were divided into sugammadex and control (i.e., neostigmine use) groups. After propensity score matching, the outcomes were assessed at the 30-day follow-up. The primary outcome was the risk of pulmonary atelectasis, while secondary outcomes included pneumonia, respiratory failure, deep vein thrombosis (DVT), and intensive care unit (ICU) admission.

RESULTS: Among 19,606 propensity-matched pairs, sugammadex significantly reduced the risk of pulmonary atelectasis (0.83% vs. 1.33%, odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.51-0.76, p<0.001). The secondary outcomes showed no significant differences in pneumonia (0.36% vs. 0.45%, p=0.177), respiratory failure (0.36% vs. 0.40%, p=0.460), DVT (0.19% vs. 0.17%, p=0.722), or ICU admission (0.67% vs. 0.81%, p=0.111). Subgroup analyses demonstrated consistent protective effects of sugammadex against pulmonary atelectasis across different patient populations (with or without sleep apnea) and institutional settings (academic vs. non-academic centers). Female patients receiving sugammadex experienced significant reductions in both pulmonary atelectasis (OR: 0.59, p<0.001) and respiratory failure (OR: 0.64, p=0.028), whereas the benefit in male patients was not statistically significant.

CONCLUSION: Sugammadex use was associated with a 38% reduction in postoperative pulmonary atelectasis compared to neostigmine use, suggesting that it may be a beneficial strategy for improving respiratory outcomes in patients undergoing MBS.

PMID:40614004 | DOI:10.1007/s11695-025-08005-1

Environ Monit Assess. 2025 Jul 4;197(8):859. doi: 10.1007/s10661-025-14305-x.

ABSTRACT

Microplastics (MPs), small plastic particles increasingly accumulating in the environment and encountered by humans, pose a particular risk to children due to their heightened vulnerability compared to adults. This study pioneered biological monitoring of MPs and investigated the presence and potential exposure of MPs in the saliva and on the hands of young children attending kindergartens in Kerman, Iran. A sample of 100 children aged 3 to 6 years was randomly selected from five kindergartens across five districts (1, 2, 3, 4, and 5). Following sample digestion and filtration, MPs were identified and classified under an optical microscope. Micro-Raman spectroscopy was employed to analyze the composition of MPs. The study identified a total of 716 MPs, with the majority (299, 41.7%) being black. The number of microplastics on hands and saliva increased by 55.9% and 11.8%, respectively, after entering kindergarten. Most MPs observed were smaller than 100 µm. Micro-Raman spectroscopy analysis of six fibers revealed four composed of polystyrene (PS), one of nylon, and one of low-density polyethylene (LDPE). The average number of MPs on children’s hands upon kindergarten entry was 1.85 ± 1.39, increasing significantly to 4.2 ± 3.05 after kindergarten entry (p-value < 0.0001). This research highlighted the significant role of kindergarten flooring in determining MPs’ presence in children. Specifically, the presence of tatami flooring correlated with higher MPs’ levels.

PMID:40614002 | DOI:10.1007/s10661-025-14305-x

J Robot Surg. 2025 Jul 4;19(1):349. doi: 10.1007/s11701-025-02509-9.

ABSTRACT

Single Port (SP) surgery is the most relevant surgical innovation of the past six years. Few data are available on the advantages and disadvantages of SP Robotic-Assisted reconstructive urology. In the present systematic review, we summarize the results of available literature exploring the feasibility of SP reconstructive urological procedures and comparing the SP and Multi Port (MP) approaches. The MEDLINE, EMBASE and Cochrane Library Databases were systematically searched for articles evaluating outcomes of SP robotic-assisted pyeloplasty, ureteral reimplantation, Boari Flap, fistula repair, bladder diverticulectomy and vaginoplasty. After meticulous study selection, we conducted a meta-analysis to compare perioperative and postoperative outcomes of SP and MP robotic-assisted pyeloplasty (SP-RP and MP-RP). Regarding ureteric reimplantation, Boari Flap, bladder diverticulectomy, fistula repair and vaginoplasty, we underwent a structured narrative synthesis, since meta-analysis was not feasible due to heterogeneity or insufficient study numbers. The meta-analysis included a total of six retrospective cohort studies and 202 patients. SP-RP demonstrated significantly lower Estimated Blood Loss (EBL) (SMD – 0.45, 95%CI – 0.80 to – 0.09, p = 0.01, I² = 0%) and better cosmetic results (MD 1.83, 95%CI 0.98-2.68, p < 0.001). The mean length of hospital stay was shorter for patients submitted to SP-RP, but the difference did not reach significance (SMD = – 0.68, 95%CI – 1.43 to 0.07, p = 0.08, I² = 80%). There were no significant differences in terms of complication rates, operative times, success rate and renal function increase between the two approaches (p > 0.05). Respectively, a total of four, one, two, one and two articles evaluating robotic-assisted SP ureteral reimplantation, Boari Flap, bladder diverticulectomy, fistula repair, and vaginoplasty, were included for the final structured summary. The included studies consistently suggest the feasibility and safety of the SP approach, however, available evidence predominantly consists of small retrospective series or individual case reports, and statistical validation is not possible. SP-RP has been successfully described, with possible advantages in terms of shorter hospital stays, better pain control and cosmetic results. Although successful cases of other major reconstructive urological procedures are reported in the literature, the available evidence remains limited and of low quality. Hopefully, the encouraging findings regarding SP-RP will increase the popularity of the SP robotic system among reconstructive urologic surgeons and the availability of more robust data.

PMID:40613997 | DOI:10.1007/s11701-025-02509-9

Breast Cancer Res Treat. 2025 Jul 4. doi: 10.1007/s10549-025-07758-8. Online ahead of print.

ABSTRACT

PURPOSE: The standard-of-care neoadjuvant treatment for early-stage or locally advanced triple negative breast cancer (TNBC) is the KEYNOTE-522 regimen that combines pembrolizumab and chemotherapy. Although this approach has superior response and survival rates, high-grade adverse events (AEs) are common. Real-world data from a diverse patient population is needed to better understand practice patterns and the impact of immunotherapy in TNBC patients.

METHODS: Medical records from TNBC patients were retrospectively reviewed during neoadjuvant and adjuvant treatment with pembrolizumab and chemotherapy. CTCAE version 5.0 was used to grade AEs. Variables were reported with descriptive statistics, and AE, pCR and hospitalization rates were estimated with 95% confidence intervals.

RESULTS: We identified 415 patients from seven academic medical centers; 60% identified as White and 21% as Black. pCR rate was 52%. 88% of patients experienced an AE, 38% experienced a grade 3+ AE, and 31% stopped pembrolizumab early. Hospitalization rate was 26%. There were no statistically significant differences in AE, pCR or hospitalization rates between White and Black patients. Obese patients had a statistically significant higher hospitalization rate (p = 0.014). There were 18 deaths during treatment, mainly from progressive TNBC.

CONCLUSION: This is one of the largest real-world, diverse patient cohorts for TNBC patients treated with chemotherapy and pembrolizumab. pCR rate was lower than that reported in the KEYNOTE-522 study and in smaller real-world studies, potentially due to high rates of pembrolizumab and chemotherapy discontinuation. AEs and hospitalizations were common, with obese patients more likely to be hospitalized than patients with a normal BMI.

PMID:40613977 | DOI:10.1007/s10549-025-07758-8