Category: Statistics

BMC Public Health. 2025 Aug 2;25(1):2616. doi: 10.1186/s12889-025-23885-9.

ABSTRACT

While ambient fine particulate matter (PM_2.5) and ozone (O₃) are extensively associated with population health, no studies have yet assessed the potential association between concurrent exposure to these two pollutants and physical function (PF) in middle-aged and elderly individuals. By collecting data from three phases of the China Health and Retirement Longitudinal Study (CHARLS), we included 8834 follow-up observations from 4110 participants aged 45 years and older who had undergone at least two physical examinations between 2011 and 2015. PF scores of enrolled participants were assessed through four objective tests including grip strength, balance, walking speed, and repeated chair stands. Annual average concentrations of PM_2.5 and O₃ prior to physical tests were assigned to participants at the prefecture-level residence in each survey. A linear mixed-effects model was used to evaluate the effects of long-term exposure to PM_2.5 and O₃ on PF, adjusting for multiple covariates including sociodemographic, behavioral, and health status. Stratified analyses were performed to compare the effects of PM_2.5 under low- and high-level O₃ groups and the effects of O₃ under low- and high-level PM_2.5 groups. Additive interactive effects were testified by introducing a 2 × 2-level dummy variable to model the joint exposure of PM_2.5 and O₃. Each 10-µg/m³ increase in PM_2.5 and O₃ exposure was associated with a declined PF score of -0.561 points (95% confidence interval: -0.617, -0.506) and -1.154 points (-1.341, -0.968), respectively. Stratified analyses for co-pollutants indicated weakened effects of PM_2.5 and O₃ at higher co-pollutant levels (PM_2.5: -0.448 [-0.522, -0.373]; O₃: -0.796 [-1.070, -0.522]) than at lower levels (PM_2.5: -0.608 [-0.708, -0.507]; O₃: -1.293 [-1.612, -0.974]). Despite greater effects in the case of simultaneous high-level exposures to both pollutants, we did not identify any evidence for additive interactive effects of co-exposures to PM_2.5 and O₃ in the total and age- and sex-subgroup populations. This study provided novel evidence for the independent and modifying effects of long-term exposure to PM_2.5 and O₃ on impaired PF in middle-aged and elderly people.

PMID:40753416 | DOI:10.1186/s12889-025-23885-9

Eur J Med Res. 2025 Aug 2;30(1):699. doi: 10.1186/s40001-025-02957-x.

ABSTRACT

OBJECTIVES: The aim of the current study was to assess chin characteristics, in terms of soft tissue thickness and mandibular divergency, in a cohort of adult population and explore potential demographic correlations.

METHODS: The sample included 465 lateral cephalograms of adult subjects. Cephalometric measurements were recorded to determine the subjects’ anteroposterior and vertical classifications. The soft tissue characteristics of the chin were determined using the upper and lower lip to E line, pogonion to nasion perpendicular, and soft tissue thickness at level of pogonion (Pog), gnathion (Gn) and menton (Me). The differences between the cephalometric parameters based on the age and gender groups as well as the relationship between soft tissue thickness measurements and mandibular divergence angle were statistically analyzed.

RESULTS: ANB angle, soft tissue thickness at the level of Pog point and menton point showed statistically significant differences between male and female subjects (p = 0.00, 0.029, 0.007, respectively). All measured parameters showed statistically significant differences based on the age group except FMA (p = 0.052), L1-MP (p = 0.28), Gn (p = 0.2), and Me (p = 0.42). No significant differences were detected in the mandibular divergency as measured by FMA at different age and gender groups. However, statistically significant differences were detected at different age and gender as measured by SN-GoMe. All parameters showed statistically significant differences among the different mandibular divergency patterns as measured by FMA and SN-GoMe angle except for ANB and Me.

CONCLUSION: The soft tissue thickness and characteristics of the chin were significantly influenced by age, gender, and malocclusion pattern in the studied sample. These variations are essential considerations for effective orthodontic and orthognathic surgical treatment planning.

CLINICAL RELEVANCE: Malocclusion and mandibular divergence significantly influence the morphology of the chin and surrounding facial structures. This study highlights variations in skeletal and soft tissue parameters across age, gender, and mandibular divergence patterns. These findings are clinically valuable for personalized orthodontic diagnosis and treatment planning and have broader implications in forensic science and anthropological assessments, where accurate interpretation of chin morphology is essential.

PMID:40753406 | DOI:10.1186/s40001-025-02957-x

Eur J Med Res. 2025 Aug 2;30(1):697. doi: 10.1186/s40001-025-02906-8.

ABSTRACT

BACKGROUND: The microRNA-371a-3p (M371) is a sensitive novel serum biomarker of testicular germ cell tumours (GCTs) and a certified test is available for consistent clinical testing. In view of the well-known biological analogies of GCTs and embryogenesis, we hypothesized that the marker substance M371 is also present in serum of pregnant women. The goal of this report was to analyse maternal serum for M371.

MATERIALS AND METHODS: M371 serum levels were measured in 36 third-trimester pregnant women. Control groups consisted of 12 non-pregnant young women, 12 healthy young males, and 12 patients with GCTs. M371 levels were measured by quantitative real time PCR using the certified M371 test with the standard cutoff of RQ = 5. Statistical methods involved receiver operating characteristics (ROC) analysis with Youden index analysis, and statistical comparisons of median serum levels of patients with those of controls as well as for comparisons of subgroups of patients according to age and infant sex.

RESULTS: All pregnant women had measurable M371 levels, with 83.3% of the patients having elevated levels above the cutoff, while traces below cutoff were detected in the remainder. Healthy female and male controls were both below cutoff. ROC analysis revealed a 100% sensitivity and 100% specificity of the test when the cutoff of RQ = 0.4 defined by Youden index analysis was employed. The median level in pregnant women was significantly lower than that in GCT patients (10.8 [interquartile range 6.1-20.3] versus RQ = 139.5 [IQR 54.9-630.3], p < 0.001). Individual M371 levels were not associated with patient age and with infant sex.

CONCLUSIONS: The evidence for elevated levels of microRNA-371a-p in maternal serum is a novel finding. This result accords with the various analogies between GCTs and embryogenesis documented previously. The finding supports the view that cells involved in human reproduction share epigenetic features with human embryonic stem cells. Further studies are required to explore if this finding could be utilized clinically.

PMID:40753402 | DOI:10.1186/s40001-025-02906-8

BMC Pediatr. 2025 Aug 2;25(1):590. doi: 10.1186/s12887-025-05924-x.

ABSTRACT

BACKGROUND: This study examined the association between problematic smartphone use (PSU) and risk behaviors among Korean adolescents during the COVID-19 pandemic. It also aimed to develop preventive measures for adolescent health promotion in the event of future pandemics.

METHODS: A secondary analysis of data from the 16th Korean Youth Risk Behavior Web-based Survey (2020) was conducted, which included 54,948 middle and high school students. Smartphone use, PSU, alcohol use, and smoking status were assessed via self-reported questionnaires. Complex samples descriptive statistics and logistic regression analyses were performed using SPSS 25.

RESULTS: Korean adolescents averaged 282.8 and 393.4 min of smartphone use across weekdays and on weekends, respectively, with a 25.5% prevalence of PSU. Female and high school students exhibited significantly higher PSU rates (p <.001). Current alcohol use and smoking increased PSU risk by 1.098- and 1.295-fold, respectively.

CONCLUSIONS: The findings emphasize the need for intervention strategies targeting PSU and associated risk behaviors. Continuous monitoring in home and school settings, along with gender-specific and educational-level interventions, is recommended to promote healthy smartphone use among adolescents.

PMID:40753400 | DOI:10.1186/s12887-025-05924-x

BMC Neurol. 2025 Aug 2;25(1):318. doi: 10.1186/s12883-025-04342-x.

ABSTRACT

BACKGROUND: Blood pressure management strategies in patients with hemorrhagic stroke remain ineffective in reducing mortality. The circadian blood pressure pattern has been shown to be associated with mortality in patients with non-hemorrhagic stroke, but few studies have explored this association in patients with hemorrhagic stroke. We aimed to investigate the relationship between circadian blood pressure pattern and mortality in patients with hemorrhagic stroke.

METHODS AND RESULTS: Adult hemorrhagic stroke patients hospitalized in intensive care unit for more than 24 h in the Medical Information Mart for Intensive Care (MIMIC-IV) database were recruited for this retrospective cohort study. All patients were divided into the dipping group, the nondipping group, the reverse dipping group and the extreme dipping group. We used binary logistic regression analysis to explore the relationship between circadian blood pressure patterns and mortality of patients with hemorrhagic stroke. The overall cohort comprised 1040 patients. The patients in the extreme dipping group had higher mortality than other groups (57.1% versus 15.6%,17.0%, and 22.3%, respectively). After adjusting for covariates, the statistical analysis showed that the extreme dipping pattern was significantly associated with the mortality of hemorrhagic stroke patients in intensive care unit (odds ratio: 4.961[95%CI: 1.289-19.086]). Interaction analysis had no statistical significance in all results.

CONCLUSIONS: The extreme dipping pattern may be an important risk factor for increased mortality in patients with hemorrhagic stroke.

PMID:40753399 | DOI:10.1186/s12883-025-04342-x

J Exp Clin Cancer Res. 2025 Aug 2;44(1):224. doi: 10.1186/s13046-025-03481-w.

ABSTRACT

BACKGROUND: Bone marrow dissemination of tumor cells, common in various cancers, including neuroblastoma, is associated with poor outcome, necessitating sensitive detection methods for bone marrow minimal residual disease (MRD) and offer detection of biomarkers for therapy stratification. Current standard-of-care diagnostics, involving cytomorphological and histological assessment of bone marrow aspirates and trephine biopsies, lack sensitivity, leading to undetected MRD in many patients, and do not allow molecular biomarker assessment.

METHODS: This study evaluates advanced multi-modal high-sensitivity MRD detection techniques in 509 bone marrow specimens from 108 high-risk neuroblastoma patients across two centers. We employed automatic immunofluorescence plus interphase fluorescence in situ hybridization (AIPF) and reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) panels to quantify disseminated tumor cells (DTCs), disialoganglioside 2 (GD2) and CD56/Neural cell adhesion molecule (NCAM) levels, and adrenergic (ADRN) and mesenchymal (MES)-phenotype mRNA markers.

RESULTS: This multi-modal analysis significantly improved MRD detection compared to standard-of-care methods; 395 samples yielded results for RT-qPCR-ADRN, AIPF and CM/histology and 223 showed concordant results (64 positive, 159 negative). 114 samples did not produce results as either no cytospins were prepared (n = 96) or results were inconclusive (all techniques n = 18). AIPF and RT-qPCR complemented each other in detecting MRD and characterizing ADRN- and MES-phenotypes and GD2 immunotherapy target. RT-qPCR-ADRN alone frequently detected low tumor cell burden. High DTC infiltration at diagnosis showed bilateral bone marrow disease, whereas MRD settings often involved only one side. RT-qPCR-MES, despite lower sensitivity, identified 37 additional cases and showed delayed clearance of MES markers post-chemotherapy, with increases prior to relapse.

CONCLUSIONS: Our findings demonstrate the feasibility of integrating high-sensitivity techniques with standard-of-care assessments in an international multicenter setting. Advanced multi-modal MRD detection, monitoring phenotype switches and assessing immunotherapy targets are crucial for improving patient outcomes in neuroblastoma and other cancers.

PMID:40753395 | DOI:10.1186/s13046-025-03481-w

BMC Public Health. 2025 Aug 2;25(1):2627. doi: 10.1186/s12889-025-23963-y.

ABSTRACT

PURPOSE: For decades, incidence of human papillomavirus (HPV)-associated cancers has been increasing in rural communities across the United States. Although emerging evidence shows a widening rural-urban disparity, rural intersectionality has been understudied. Our study examined the incidence of HPV-associated cancers within rural communities to identify differences by race/ethnicity for males and females, and explore how these differences varied by cancer type, socioeconomic, and geographic factors.

METHODS: We accessed age-adjusted cancer incidence rates (2010-2019) from the North American Association of Central Cancer Registries (NAACCR) for HPV-associated cancers (cervical, vaginal, vulvar, penile, anal, oropharyngeal) in rural counties. Stratifying by sex, we calculated incidence rate ratios by race/ethnicity. Subgroup analyses included age, site, census-tract poverty, census tract socioeconomics, and region.

RESULTS: Between 2010 and 2019, rural HPV-associated cancer was 11.8 cases per 100,000 population. We found significant heterogeneity within male (10.5) and female (13.2) rates. For males, the lowest rate was found in non-Hispanic Asian-American/Pacific-Islander populations (3.7) and Hispanic populations (4.8), and the highest rate was found in non-Hispanic White populations (11.2). For females, the lowest rate was also found in Hispanic Asian-American/Pacific-Islander populations (8.8) and the highest rates were found in non-Hispanic Black (13.8) and non-Hispanic American Indian/Alaska Native populations (14.5). However, these racial/ethnic differences varied across rural subpopulations, geography, and poverty.

CONCLUSIONS: Appreciating the diversity of the rural cancer burden can be used to effectively develop and implement public health interventions to address HPV-related cancer disparities in rural communities. Actions are needed to prioritize reducing the burden of HPV-associated cancer in AIAN populations in high-poverty rural communities.

PMID:40753394 | DOI:10.1186/s12889-025-23963-y

BMC Prim Care. 2025 Aug 2;26(1):238. doi: 10.1186/s12875-025-02920-z.

ABSTRACT

INTRODUCTION: Vertigo is a common symptom that strongly impacts patients’ quality of life. More than 80% of patients experiencing vertigo are primarily treated by their general practitioner (GP). The GP’s’diagnostic toolkit’ for vertigo has serious limitations, though, because diagnostic accuracy studies on conditions that may cause vertigo have never been performed in a general practice setting. Our aim was to determine which tests should be investigated in a diagnostic accuracy study for patients with vertigo in general practice.

METHOD: We conducted an online Delphi procedure involving national and international experts. The experts were asked to judge a selection of 40 diagnostic tests based on the Dutch GP guideline on vestibular symptoms, supplemented by tests identified during a systematic review. Panellists were allowed to suggest additional tests after the first round. In case of consensus of at least 70%, a test was included or excluded. We also conducted a secondary sub-analysis of our Delphi procedure to demonstrate non-dominance of Dutch experts within our expert panel. Data were analysed using descriptive statistics and content analysis. Data were analysed using descriptive statistics and content analysis.

RESULTS: A panel of 20 experts from five countries, including 7 specialists in otolaryngology, 6 neurologists and 7 GPs, participated in the Delphi procedure. The panel judged 46 diagnostic tests in total, with 6 additional tests added to the original selection based on suggestions by experts. After the first two rounds (100% response rate), 16 tests were included, 22 tests were excluded and no consensus was reached on 8 tests. During the consensus round, one of the 8 tests was added to the included 16 tests. Of these 17 tests, 15 are recommended by the Dutch GP guideline, supplemented by the non-recommended Tandem walking test and the Romberg test.

CONCLUSIONS: An international expert panel reached consensus on 17 tests for vertigo in general practice that should be investigated in a diagnostic accuracy study.

PMID:40753388 | DOI:10.1186/s12875-025-02920-z

J Foot Ankle Res. 2025 Sep;18(3):e70053. doi: 10.1002/jfa2.70053.

ABSTRACT

INTRODUCTION: Understanding podiatrists’ perceptions of their undergraduate education is important to ensure that educational content and delivery meets the needs of the current workforce to inform future planning. This study aims to explore podiatrists’ perceptions of their undergraduate podiatry training at the University of Newcastle, Australia, and their preferences regarding educational content and delivery.

METHODS: We conducted an online survey of podiatry graduates from the University of Newcastle, Australia. Data were analysed using descriptive statistics and Fisher’s exact test to compare responses between groups. Qualitative responses were analysed using inductive content analysis.

RESULTS: A total of 114 podiatrists responded. Nail avulsions, business management and modifying orthoses were perceived as being given insufficient time and focus in undergraduate training, with a higher proportion of private (71%) compared to public (33%) podiatrists reporting business management as lacking (p = 0.02). There was strong support for embedding endorsed scheduled medicines training within the programme (80%) and for delivering theoretical content face-to-face rather than online. Inductive content analysis revealed four areas to be emphasised in future curricula: modern technologies, biomechanics, wound care and routine podiatric care. Potential strategies to reduce examination stress included mock assessments, changed assessment weighting, reduced exam structure rigidity and reducing assessor bias.

CONCLUSIONS: This study provides insights into Australian podiatrists’ preferences for pre-registration curricula. Topics to emphasise in future curricula at the University of Newcastle, Australia, include greater manual skills and business training, modern technologies, biomechanics and routine podiatric care. Our results suggest exercising caution when substituting face-to-face with online learning. These findings provide valuable guidance for future curricula in a context of declining student numbers and increasing healthcare demands.

PMID:40751492 | DOI:10.1002/jfa2.70053

Clin Exp Allergy. 2025 Aug 2. doi: 10.1111/cea.70125. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the effectiveness and safety of JAK inhibitors in patients with moderate to severe atopic dermatitis by performing a systematic review and meta-analysis using data from studies in real-world settings.

DESIGN: Systematic review and meta-analysis. Pooled estimates for effectiveness and safety were assessed using the Freeman-Tukey Double ArcSine method. Statistical heterogeneity was assessed using I² statistics. A random-effects model (DerSimonian-Laird method) was applied to consider the heterogeneity within and between studies and to give a more conservative estimate. The study quality assessment tools developed by the National Heart, Lung, and Blood Institute were used.

DATA SOURCE: Relevant studies were searched in March 2025 using four databases: PubMed, Embase, Scopus, and Web of Science.

ELIGIBILITY CRITERIA: Studies evaluating the effectiveness or safety of systemic JAK inhibitors among patients with moderate to severe atopic dermatitis in a real-world setting were included.

RESULTS: A total of 50 studies were included in this review. Regarding their effectiveness, the pooled estimates with a 95% CI of Eczema Area and Severity Index (EASI)-75 were 44% (34%-55%), 45% (28%-62%), 59% (51%-66%), 73% (64%-81%), 70% (57%-81%), and 86% (72%-96%) at 4, 8, 12, 16, 24, and 52 weeks. For safety, the most common adverse events were acne (16%), followed by increased creatine phosphokinase levels (13%) and increased lipids (12%).

CONCLUSION: Our meta-analysis of JAK inhibitors in patients with atopic dermatitis demonstrated that the overall outcomes from real-world settings are comparable to those from clinical trials.

SYSTEMATIC REVIEW REGISTRATION: Protocol Registration: PROSPERO CRD42024569258.

PMID:40751489 | DOI:10.1111/cea.70125