Category: Statistics

Epigenetics Chromatin. 2025 Jan 30;18(1):7. doi: 10.1186/s13072-025-00567-9.

ABSTRACT

BACKGROUND: The DNA methylation-based epigenetic clocks are increasingly recognized for their precision in predicting aging and its health implications. Although prior research has identified connections between accelerated epigenetic aging and multiple sclerosis, the chronological and causative aspects of these relationships are yet to be elucidated. Our research seeks to clarify these potential causal links through a bidirectional Mendelian randomization study.

METHODS: This analysis employed statistics approaches from genome-wide association studies related to various epigenetic clocks (GrimAge, HannumAge, PhenoAge, and HorvathAge) and multiple sclerosis, utilizing robust instrumental variables from the Edinburgh DataShare (n = 34,710) and the International Multiple Sclerosis Genetics Consortium (including 24,091 controls and 14,498 cases). We applied the inverse-variance weighted approach as our main method for Mendelian randomization, with additional sensitivity analyses to explore underlying heterogeneity and pleiotropy.

RESULTS: Using summary-based Mendelian randomization, we found that HannumAge was associated with multiple sclerosis (OR = 1.071, 95%CI:1.006-1.140, p = 0.033, by inverse-variance weighted). The results suggest that an increase in epigenetic age acceleration of HannumAge promotes the risk of multiple sclerosis. In reverse Mendelian randomization analysis, no evidence of a clear causal association of multiple sclerosis on epigenetic age acceleration was identified.

CONCLUSIONS: Our Mendelian randomization analysis revealed that epigenetic age acceleration of HannumAge was causally associated with multiple sclerosis, and provided novel insights for further mechanistic and clinical studies of epigenetic age acceleration-mediated multiple sclerosis.

PMID:39885544 | DOI:10.1186/s13072-025-00567-9

J Orthop Surg Res. 2025 Jan 30;20(1):119. doi: 10.1186/s13018-024-05425-0.

ABSTRACT

BACKGROUND: Anterior shoulder instability with glenoid bone loss presents a challenge in orthopedic surgery. The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are commonly employed for its management, but direct comparative evidence is insufficient.

METHODS: Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted. Randomized controlled trials (RCTs) and cohort studies directly comparing the Latarjet and ICBGT procedures were included. Primary outcomes included postoperative recurrent instability, apprehension test, and complications, while secondary outcomes comprised Rowe score, Subjective Shoulder Value (SSV), pain level assessed by visual analogue scale (VAS), range of motion (ROM), and radiologic outcomes. Quality assessment was performed using RoB2 and MINORS tools. The weighted mean difference (WMD) for continuous variables and odds ratio (OR) for dichotomous variables were calculated, along with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4.1 software.

RESULTS: A total of 6 studies with 409 patients were included. There was no significant difference in postoperative recurrent instability (OR, 1.33; 95% CI, 0.44 to 4.03; P = 0.61), positive apprehension test (OR, 0.78; 95% CI, 0.20 to 3.10; P = 0.73), revision surgery (OR, 2.06; 95% CI, 0.74 to 5.71; P = 0.16), mild complications (OR, 0.49; 95% CI, 0.23 to 1.06; 0.07), SSV (WMD, -1.94; 95% CI, -3.94 to 0.06; P = 0.06) or VAS score (WMD, 0.15; 95% CI, -0.17 to 0.47; P = 0.36) between the two procedures. The ICBGT group exhibited statistically superior Rowe scores (WMD, -3.10; 95% CI, -5.10 to -1.10; P = 0.002), as well as improved external (WMD, -5.32; 95% CI, -7.30 to -3.30; P < 0.001) and internal rotation (WMD, -5.11; 95% CI, -6.76 to -3.45; P < 0.001). However, these differences did not surpass the minimal clinically important difference (MCID). Radiological evaluations showed that the ICBGT procedure had statistically better outcomes in immediate glenoid augmentation, preservation and reduced fatty degeneration of the subscapularis (SSC) tendon, and graft remodeling at short-term follow-up.

CONCLUSIONS: The ICBGT procedure showed statistically superior Rowe scores and range of motion, but these differences may not be clinically significant. Both procedures had comparable outcomes in recurrent instability, apprehension test results, revision surgery, mild complications, SSV, and pain levels. ICBGT appears to offer advantages in glenoid augmentation and SSC preservation at short-term follow-up.

PROSPERO REGISTRATION ID: CRD42024586157.

PMID:39885541 | DOI:10.1186/s13018-024-05425-0

Malar J. 2025 Jan 30;24(1):30. doi: 10.1186/s12936-025-05266-0.

ABSTRACT

BACKGROUND: The increasing availability of electronic health system data and remotely-sensed environmental variables has led to the emergence of statistical models capable of producing malaria forecasts. Many of these models have been operationalized into malaria early warning systems (MEWSs), which provide predictions of malaria dynamics several months in advance at national and regional levels. However, MEWSs rarely produce predictions at the village-level, the operational scale of community health systems and the first point of contact for the majority of rural populations in malaria-endemic countries.

METHODS: This study developed a hyper-local MEWS for use within a health-system strengthening intervention in rural Madagascar. It combined bias-corrected, village-level case notification data with remotely sensed environmental variables at spatial scales as fine as a 10 m resolution. A spatio-temporal hierarchical generalized linear regression model was trained on monthly malaria case data from 195 communities from 2017 to 2020 and evaluated via cross-validation. The model was then integrated into an automated workflow with environmental data updated monthly to create a continuously updating MEWS capable of predicting malaria cases up to three months in advance at the village-level. Predictions were transformed into indicators relevant to health system actors by estimating the quantities of medical supplies required at each health clinic and the number of cases remaining untreated at the community level.

RESULTS: The statistical model was able to accurately reproduce village-level case data, performing nearly five times as well as a null model during cross-validation. The dynamic environmental variables, particularly those associated with standing water and rice field dynamics, were strongly associated with malaria incidence, allowing the model to accurately predict future incidence rates. The MEWS represented an improvement of over 50% compared to existing stock order quantification methods when applied retrospectively.

CONCLUSION: This study demonstrates the feasibility of developing an automatic, hyper-local MEWS leveraging remotely-sensed environmental data at fine spatial scales. As health system data become increasingly digitized, this method can be easily applied to other regions and be updated with near real-time health data to further increase performance.

PMID:39885540 | DOI:10.1186/s12936-025-05266-0

J Orthop Surg Res. 2025 Jan 30;20(1):116. doi: 10.1186/s13018-025-05550-4.

ABSTRACT

BACKGROUND: Although non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture.

METHODS: A retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up.

RESULTS: We bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant (p < 0.05).

CONCLUSION: The procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon.

PMID:39885537 | DOI:10.1186/s13018-025-05550-4

J Orthop Surg Res. 2025 Jan 30;20(1):118. doi: 10.1186/s13018-024-05430-3.

ABSTRACT

OBJECTIVE: This study examines whether cross-education training of the healthy limb promotes cross-transfer through central nervous system stimulation, enhancing the function, kinematic parameters, dynamic balance, and plantar pressure of the affected knee joint in patients recovering from postoperative anterior cruciate ligament reconstruction (ACLR).

METHODS: Forty anterior cruciate ligament reconstruction (ACLR) patients, 5-6 weeks postoperatively, were included and randomly assigned to either an experimental group (n = 20) or a control group (n = 20). The experimental group participated in six weeks of cross-education (CE) training in addition to conventional rehabilitation, while the control group received only conventional rehabilitation. Assessment outcomes included knee function (Lysholm score, joint mobility, and surface electromyographic characteristics of the rectus femoris muscle), kinematic parameters (stride length, stride speed, and stride width), dynamic balance (gait line length, single-support line length, and medial-lateral displacements), and plantar pressure (forefoot, midfoot, and hindfoot pressures). The effect of CE training on postoperative ACLR rehabilitation was comprehensively assessed by comparing the pre- and post-intervention changes within each group and the differences between the groups.

RESULTS: Before the intervention, no statistically significant differences were observed between the two groups across all measured parameters (P > 0.05). Following the intervention, significant improvements in knee function, kinematic parameters, balance function, and plantar pressure were observed in both groups, with the experimental group showing significantly more significant improvements (P < 0.05). The Lysholm score, range of motion (ROM), and surface electromyographic activity of the rectus femoris muscle were significantly higher in the experimental group compared to the control group (P < 0.01). Among kinematic parameters, the experimental group demonstrated a significant increase in stride length and reduced stride width, whereas differences in stride speed were not statistically significant (P > 0.05). Regarding balance function, the experimental group exhibited significantly longer gait and single-support line lengths, significantly reducing medial-lateral displacement (P < 0.05). Analysis of plantar pressure revealed significant improvements in forefoot and hindfoot pressures in the experimental group, with a particularly notable increase in hindfoot pressure (P < 0.05). However, changes in midfoot pressure were not statistically significant (P > 0.05).

CONCLUSION: CE training markedly enhanced knee function, kinematic metrics, dynamic stability, and plantar pressure in postoperative ACLR patients providing initial evidence for the prospective utilization of CE theory in rehabilitation. Nonetheless, the fundamental mechanics of its effects remain ambiguous, and variables such as individual differences and neuromuscular adaptation processes may affect training results. Future studies should examine its long-term impacts and uncover potential neuromuscular pathways to establish a solid scientific basis for improving postoperative rehabilitation procedures.

PMID:39885535 | DOI:10.1186/s13018-024-05430-3

Gut Pathog. 2025 Jan 30;17(1):7. doi: 10.1186/s13099-025-00682-8.

ABSTRACT

BACKGROUND: Helicobacter pylori (H. pylori) eradication regimens may have different effects on the gut microbiota. Few studies have analyzed the safety of high-dose dual therapy (HDDT) from a micro-ecological perspective. This study aimed to compare the impact of H. pylori eradication with HDDT and bismuth quadruple therapy (BQT) on gut microbiota.

PATIENTS AND METHODS: H. Pylori-infected treatment-naive patients were recruited and screened from September 2023 to April 2024 and randomly assigned to the HDDT group (esomeprazole 20 mg, amoxicillin 750 mg, qid, 14 days) or BQT group (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 600 mg, bid, 14 days). Fresh stool specimens were collected and stored before treatment and at week 2 and week 8 after treatment. The diversity and composition of the gut microbiota were compared and analyzed in both groups using 16 S rRNA gene sequencing.

RESULTS: Forty-nine H. pylori positive patients were enrolled and randomly assigned to either the HDDT (n = 24) or the BQT group (n = 25) group. Compared with baseline, alpha and beta diversities significantly changed at week 2 after receiving BQT and did not recover fully at week 8. However, in the HDDT group, the diversities at week 2 changed mildly without statistical significance, compared to baseline. Additionally, a greater number of species had alterations in their abundances in the BQT group compared to the HDDT group at week 2. However, the abundances of these species were restored to their previous levels at week 8 in both the HDDT and BQT groups.

CONCLUSIONS: Compared to BQT, HDDT exerted less impact on the diversity and composition of the gut microbiota.

CLINICAL TRIAL REGISTRATION: ChiCTR2100053268.

PMID:39885529 | DOI:10.1186/s13099-025-00682-8

BMC Health Serv Res. 2025 Jan 30;25(1):179. doi: 10.1186/s12913-025-12294-8.

ABSTRACT

INTRODUCTION: Healthcare provider burnout is highly prevalent and has negative consequences. However, many healthcare workers in LMICs, including Nepal, rarely recognize or ameliorate it. This problem is worse in rural settings. Competency-focused interventions that are developed using theoretical frameworks can address this gap.

METHODS: We used Kern’s framework of curriculum development to create, refine, and assess a theory-driven intervention tailored to the needs and constraints of rural healthcare workers in Nepal. During the first phase, we conducted a targeted needs assessment using an online survey among nine rural primary care physicians working in Charikot Hospital. We then developed learning objectives for knowledge, attitude, and skills domains based on the World Health Organization (WHO) definition of burnout. Then, we created animated educational videos designed to meet the learning objectives. We then implemented the educational intervention with rural physicians and assessed their knowledge, attitudes, and feedback. During the second phase, we further developed the intervention based on findings from the first phase and assessed acceptability, feasibility, and preliminary impact using pre- and post-intervention questionnaires and key informant interviews.

RESULTS: In the first phase, nine physicians participated in the targeted needs assessment, and eight responded to the post-intervention assessment. In the second phase, 18 attendees completed the pre-intervention burnout assessment, and 16 completed both the pre-test and post-test questionnaires. On the pre-test, correct answers across questions ranged from 31-88%, while on the post-test, participants responded correctly 88-100% of the time. Related-samples Wilcoxon signed-rank test showed a statistically significant difference (P = 0.007) in the post-test scores on the knowledge domain. Qualitative results showed burnout as an unrecognized and unreported issue, and its drivers included stigma and feelings of helplessness. Participants praised the interventions and reported that they translated learned skills into practice.

CONCLUSION: In this proof-of-concept study, we found that educational interventions developed using a theory-driven framework to meet the unique needs of rural healthcare workers are acceptable and feasible. Future studies can test the intervention impact in well-powered trials to support scale-up efforts to identify and address burnout.

PMID:39885518 | DOI:10.1186/s12913-025-12294-8

BMC Public Health. 2025 Jan 30;25(1):396. doi: 10.1186/s12889-025-21453-9.

ABSTRACT

BACKGROUND: Low back pain (LBP) is a leading cause of years lived with disability. However, the association of non-chronic LBP with levels of daily physical activity (PA) remains poorly explored. This study investigated the association between previous and current non-chronic LBP with daily PA and compliance with PA recommendations in middle and older-aged adults.

METHODS: This is a cross-sectional analysis including volunteers from the Baltimore Longitudinal Study of Aging who answered questions about LBP and wore an Actiheart accelerometer for 7days. Generalized linear models and logistic models were used and adjusted for potential confounders.

RESULTS: 662 volunteers were included (50.8% women, 68.1% white), aged 68.0 (± 11.4) years. Previous non-chronic LBP was reported by 240 (36.3%) participants with mean pain intensity of 3.5 ± 2.0 (ranging from 0 to 10). Current non-chronic LBP was reported by 5.7% (n = 38) with mean pain intensity of 4.1 ± 2.3. Participants reporting current non-chronic LBP had lower levels of total (β -0.18, 95% CI -0.34 to -0.02) and vigorous (β -0.29, 95% CI -0.56 to -0.007) daily PA and lower odds of meeting PA recommendations (OR 0.20, 95% CI 0.05 to 0.92) compared to those reporting no LBP. No association was observed for LBP intensity. Conversely, previous non-chronic LBP showed no statistically significant association with daily PA levels.

CONCLUSION: The presence of current non-chronic LBP seems to be negatively associated with PA levels driven mainly by lower engagement in vigorous PA. No association was observed for pain intensity.

PMID:39885512 | DOI:10.1186/s12889-025-21453-9

BMC Nurs. 2025 Jan 30;24(1):113. doi: 10.1186/s12912-025-02756-z.

ABSTRACT

BACKGROUND: Nursing prescribing rights have been proposed in many countries, with physicians’ attitudes playing an important role. This study aimed to investigate the attitudes of physicians toward nurse prescribing rights.

METHODS: A cross-sectional study of 112 Chinese physicians was conducted from January to March 2024. This study utilized a demographic information form, nurses’ prescription right knowledge questions, and a scale to measure nurse-physician collaboration. The data was analyzed with IBM SPSS-21 software using descriptive and inferential statistics. We used the mean±standard deviation, frequencies and percentages to describe the demographic information, T-test, Chi-square test or Fisher’ s exact test, and binary logistic regression analysis to analyze the correlated factors of the attitudes of physicians toward nurse prescribing rights.

RESULTS: Of 112 physicians, 60 supported nurse prescribing rights, accounting for 53.57% of the total. The results of the single-factor analysis indicated significant differences in the aspects of sex. The binary logistic regression revealed that being female (OR = 0.195, 95%CI = 0.072 ∼ 0.529), having knowledge of nurse prescribing rights (OR = 1.513, 95%CI = 1.051 ∼ 2.176), and promoting nurse-physician collaboration (OR = 1.058, 95%CI = 1.032 ∼ 1.084) were the factors that correlated with physicians’ attitudes toward nurse prescribing rights.

CONCLUSIONS: Most physicians expressed a favorable attitude toward nurse prescribing rights. The results of this study will help advance the development of nurse prescribing rights and ultimately improve the quality of patient care.

PMID:39885498 | DOI:10.1186/s12912-025-02756-z

BMC Health Serv Res. 2025 Jan 31;25(1):180. doi: 10.1186/s12913-025-12332-5.

ABSTRACT

BACKGROUND: Antenatal care is an essential component of maternal healthcare that plays a crucial role in promoting the health and well-being of both mother and baby. While previous studies have examined factors influencing antenatal care visits in other parts of Ethiopia, there is a lack of research specifically focusing on the Afar region. This study aimed to assess determinants of antenatal care visits among pregnant women in Afar region, Ethiopia.

METHODS: The data is 2019 Ethiopian Mini Demographic and Health Survey. In this study 641 weighted sample womens were included. Negative binomial regression model is applied.

RESULTS: About 27.77% achieve optimal ANC visits. Living rural (IRR = 0.575, 95%CI: 0.467, 0.708). Reading whole sentences (IRR = 1.683, 95%CI: 1.212, 2.339). Under five children in house 1-2 (IRR = 0.789, 95%CI: 0.632, 0.984), 3-4 (IRR = 0.692, 95%CI: 0.509, 0.941), > = 5 (IRR = 0.075, 95%CI: 0.021, 0.268). Married (IRR = 1.550 95%CI: 1.172, 2.051), Widowed (IRR = 2.043, 95%CI: 1.238, 3.372). Age first birth 16-20 (IRR = 0.805, 95%CI: 0.652, 0.992).

CONCLUSION: The study examined the utilization of antenatal care services among women in Afar regional state, North Eastern Ethiopia. The findings reveal that a significant proportion of women did not receive the recommended number of antenatal care visits during their pregnancy. Factors such as residence, mother’s literacy rate, age at first birth, number of living children, number of under five children in the house and marital status were major determinants of ANC (Antenatal Care) visit in Afar region. Increase access to antenatal care services by improving the availability and quality of health facilities in the region. Maternal health-care program should be expanded and mainly in rural areas of the region. Moreover, the necessary assessment and follow-up of ANC health care services should be encouraged in Afar region to decrease maternal mortality.

PMID:39885497 | DOI:10.1186/s12913-025-12332-5