Category: Statistics

Fam Pract. 2025 Jun 4;42(4):cmaf054. doi: 10.1093/fampra/cmaf054.

ABSTRACT

BACKGROUND: Appropriate medication behavior is important to ensure patients receive optimal health benefits from interacting with their healthcare providers. Communication between patients and providers is essential in ensuring patients take prescribed medication appropriately.

OBJECTIVE: To investigate the available evidence on the effectiveness of bi-directional communication interventions that focus on both patients and clinicians in outpatient settings aimed at changing how patients take their medications. The desired patient medication behavior changes included initiation, adherence, dose escalation, dose reduction, and discontinuation.

METHODS: We performed a systematic review of research studies assessing bi-directional patient-provider communication interventions targeting patient medication behavior change in the outpatient setting. We identified the types of interventions used in each study and the components of successful trials.

RESULTS: We included eight randomized controlled trials and two quasi-experimental trial with a total of 2,911 adult participants. Among the 10 studies, 9 reported statistically significant improvement in the desired direction of medication behavior change in the intervention group compared to control group.

CONCLUSION: This scoping review shows the promise of bi-directional patient-provider communication tools in impacting behavior related to how patients take their prescribed medications. More randomized controlled trials with standardized outcomes are needed to better assess the utility of patient-provider communication tools.

PRACTICE IMPLICATIONS: Including both patient and provider in an effort to improve desired patient medication behavior change should be considered when educational interventions are designed.

PMID:40747580 | DOI:10.1093/fampra/cmaf054

Health Promot Int. 2025 Jul 1;40(4):daaf132. doi: 10.1093/heapro/daaf132.

ABSTRACT

Health literacy (HL) is a critical determinant of health, as it affects health behavior and outcomes, in addition to equity in health. This study aimed to translate, culturally adapt, and validate the Swedish version of HLS19-Q12 (HLS19-Q12-SE). The HLS19-Q12 is a widely used instrument that consists of 12-items and is often used to assess HL in Europe. A convergent mixed-methods design was applied, including cognitive interviews (n = 8) and psychometric testing with a survey sample (n = 374) and test-retest group (n = 28). The instrument was forward and backwards translated and culturally adapted. Data was analyzed using confirmatory and exploratory factor analysis, correlation testing, and reliability assessments. Cognitive interviews explored the clarity, interpretation, and contextual relevance of the items. Participants found the HLS19-Q12-SE clear and easy to understand, though some reported difficulties with unfamiliar health situations and uncertainty of the term “health information.” Based on the interviews, the examples for one of the items were culturally adapted. Psychometric testing showed good feasibility, no floor or ceiling effects on scale level, and moderate positive correlations with other HL instruments, supporting internal and external validity. Structural validity was confirmed, and internal consistency and test-retest reliability were satisfactory. However, ceiling effects were observed at the dichotomous item level, and correlations with self-rated health and social status were low. The HLS19-Q12-SE is a reliable and valid instrument for assessing general HL in Sweden. While psychometric properties were strong overall, future research should address ceiling effects on item level and explore the instrument’s performance in more diverse populations.

PMID:40747568 | DOI:10.1093/heapro/daaf132

Jpn J Nurs Sci. 2025 Oct;22(4):e70013. doi: 10.1111/jjns.70013.

ABSTRACT

AIM: Currently, there is no Japanese tool to measure organizational context factors that influence nurses’ implementation of evidence-based practices. This study aimed to translate, culturally adapt, and psychometrically evaluate the Alberta Context Tool (ACT) for nurses in Japan.

METHODS: We completed forward translations with reconciliation, expert discussions, back translations with reconciliation, back translation review by tool developers, and semi-structured cognitive interviews with verbal probing. A convenience sample of nurses from five hospitals completed the translated tool. Item descriptives (including missing data), internal structure (confirmatory factor analyses [CFA]), criterion validity (correlations with Team Climate Inventory [TCI] items “support for innovative ideas”), internal consistency reliability (Cronbach’s alpha, item-concept correlations), and test-retest reliability (intraclass correlation) were examined.

RESULTS: Cognitive debriefing with nine nurses led to modifying 10 ACT items. A total of 508 nurses completed the survey. CFA showed an acceptable model fit for the seven scale-based concepts ( $x^2$ = 1037.28, root mean square error of approximation = 0.054, Comparative Fit Index = 0.913, Tucker-Lewis Index = 0.902, standardized root mean square residual = 0.053). Correlations between the 10 ACT concepts and TCI ranged from .08 to .43, with nine statistically significant (p < .05). Cronbach’s alpha ranged from .22 to .91 (exceeding 0.70 for 8/10 concepts), and item-concept correlations ranged from .15 to .96 (exceeding 0.70 for 26/56 items). Retest reliability (N = 65) ranged from 0.45 to 0.81.

CONCLUSIONS: The ACT Japanese version demonstrated initial evidence of acceptable validity and reliability for most concepts and items, supporting its use in assessing organizational context.

PMID:40747563 | DOI:10.1111/jjns.70013

Cancer Med. 2025 Aug;14(15):e71121. doi: 10.1002/cam4.71121.

ABSTRACT

BACKGROUND: The increasing number of cancer survivors (CSs) globally highlights the critical need for healthcare systems to address their unmet needs. These needs span physical, psychosocial, spiritual, informational, and practical dimensions and, if unaddressed, can impact quality of life and healthcare satisfaction.

AIMS: This study aimed to identify and understand the unmet needs of CSs in Italy to guide the development of patient-centered survivorship care services.

METHODS: A cross-sectional qualitative study was conducted between April 2023 and January 2024 at the Comprehensive Cancer Centre of Reggio Emilia, Italy. Data were collected through focus groups and individual interviews with 35 CSs and seven caregivers selected via convenience sampling. Eligibility criteria included non-cutaneous CSs with a 5-year survival rate of ≥ 65% who had completed active treatment and were in follow-up care. Data were analyzed using the Framework Method.

RESULTS: Four key themes emerged: (1) Dignity and Respect: Emphasis on the importance of treating CSs with dignity and respect within healthcare settings; (2) Desire for Normality: Highlighting CSs’ strong desire to regain a sense of normalcy post-treatment; (3) Pursuit of Control Over One’s Life: CSs’ need to maintain control, particularly regarding information needs and treatment management; (4) Existential Vulnerability: The vulnerability and fragility felt by CSs, underscoring their need for emotional support and reassurance.

CONCLUSIONS: Unmet needs remain a significant challenge for CSs, necessitating the implementation of tailored, patient-centered care interventions. Addressing these needs can enhance quality of life, satisfaction, and outcomes for CSs worldwide.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06236373.

PMID:40747540 | DOI:10.1002/cam4.71121

Iran J Parasitol. 2025 Apr-Jun;20(2):213-226. doi: 10.18502/ijpa.v20i2.19027.

ABSTRACT

BACKGROUND: The use of nanocarriers in combination with other treatments shows significant promise in addressing drug-resistant diseases, particularly malaria. Given the high prevalence of drug-resistant malaria, research into innovative therapies is crucial. This study focuses on a nanoform of chitosan, a biodegradable polymer, combined with Crocus sativus (saffron) and chloroquine to enhance their antimalarial effects.

METHODS: Saffron extract and chloroquine were separately conjugated with chitosan, followed by confirmation tests to determine conjugation efficiency. Both chloroquine-resistant and sensitive strains of Plasmodium falciparum were cultured to calculate the IC50 values of various treatments in vitro. This study was conducted at the School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2024.

RESULTS: Confirmation tests (FTIR, DLS, Zeta potential, TEM) verified proper drug conjugation to nanocomposites, with observed nanosize, the percentage of conjugation was 64.4% for chloroquine and 42.9% for saffron. Toxicity and hemolysis tests confirmed safe doses. The IC50s values for Chloroquine, Nanoparticle-Chloroquine, Saffron, and Nanoparticle-Saffron were 0.3, 0.8, 42.5, and 6.24 μg/ml, respectively, for the sensitive strain, and 5, 1, 12.5, and 3.12 μg/ml, respectively, for the resistant strain. Combination therapy with the fixed ratio method showed synergistic effects. Statistical analysis revealed synthesized nanocomposites’ superior inhibition of P. falciparum growth compared to non-nano. Significant differences were observed in some cases (P< 0.05).

CONCLUSION: Utilizing nanocarriers and combination therapy is an appropriate strategy for addressing drug resistance. Saffron’s anti-malarial effects on P. falciparum were notably increased when linked to chitosan nanocomposites. Furthermore, employing a fixed ratio technique enhanced the therapeutic effectiveness of saffron when combined with chloroquine and chloroquine-nanocomposites across all concentrations.

PMID:40747512 | PMC:PMC12307787 | DOI:10.18502/ijpa.v20i2.19027

Iran J Parasitol. 2025 Apr-Jun;20(2):280-288. doi: 10.18502/ijpa.v20i2.19047.

ABSTRACT

BACKGROUND: The Mediterranean form of visceral leishmaniasis (VL) is endemic in some regions of Iran and is often seen in children under 10 years old. There is a 90% mortality in patients, if diagnosis and treatment are not done on time. Canids, as reservoirs, play an important role in the spread of the disease.

METHODS: Bushehr Province, southern Iran is always mentioned as one of the endemic areas for VL, so for this purpose, as the first study in the region, 112 sheltered dogs in Bushehr City were evaluated for canine leishmaniasis (CanL) using serological Direct Agglutination Test (DAT) as well as detailed clinical examinations.

RESULTS: Out of 112 samples collected, 71.4% of cases had anti-L. infantum IgG antibody titers of 1:80 and higher and therefore considered as seropositive. Furthermore, from the 70 seropositive dogs with antibody titer of 1:320 and higher, 47 (42%) had at least one of the clinical symptoms associated with VL and considered as cases with CanL.

CONCLUSION: The current seroprevalence situation of dogs in this region, is very noticeable and can be an important alarm for policymakers and health system practitioners. More comprehensive and complementary parasitological studies should be carried out on a number of reservoirs in the region for diagnosis and treatment and to accurately determine the statistics of the disease compared to the obtained seroprevalence status.

PMID:40747508 | PMC:PMC12307777 | DOI:10.18502/ijpa.v20i2.19047

Iran J Parasitol. 2025 Apr-Jun;20(2):299-306. doi: 10.18502/ijpa.v20i2.19049.

ABSTRACT

BACKGROUND: Respiratory infections caused by Lophomonas blattarum and Pneumocystis jirovecii are significant threats, especially to immunocompromised patients. Both pathogens are associated with severe pneumonia and are often underdiagnosed due to the challenges in identifying them accurately, particularly in co-infections. We aimed to evaluate the prevalence and clinical impact of co-infections with L. blattarum and P. jirovecii in patients with respiratory symptoms.

METHODS: This cross-sectional study involved 111 patients admitted to the Pulmonary Ward of Imam Reza Hospital in Mashhad, Iran in 2023. Bronchoalveolar lavage (BAL) samples were collected from all patients and analyzed microscopically and molecularly. PCR amplification targeting L. blattarum and P. jirovecii was performed, with subsequent sequencing for molecular identification. The presence of Pneumocystis was identified using a 346-bp PCR band.

RESULTS: Of the 111 patients, Lophomonas was detected in 48 patients (43.2%), and Pneumocystis in 47 patients (42.3%). Co-infections were identified in 26 patients (23.6%). Both infections were more common in males, though the difference between genders was not statistically significant. The highest prevalence was observed in patients over 60 years, with 18% and 19.8% infection rates for Lophomonas and Pneumocystis, respectively. Co-infection rates were significantly higher in older patients and in males (P= 0.028).

CONCLUSION: The study demonstrates a significant prevalence of co-infections with L. blattarum and P. jirovecii in patients with respiratory conditions, particularly in the elderly. The findings underscore the need for comprehensive diagnostic strategies, including molecular and microscopic approaches, to accurately diagnose and manage these co-infections in high-risk populations.

PMID:40747507 | PMC:PMC12307776 | DOI:10.18502/ijpa.v20i2.19049

Iran J Parasitol. 2025 Apr-Jun;20(2):307-315. doi: 10.18502/ijpa.v20i2.19050.

ABSTRACT

BACKGROUND: We aimed to investigate the presence of thyroid peroxidase antibodies (anti-TPO) in women with spontaneous abortion, both with and without toxoplasmosis. This was achieved by evaluating and comparing the serum levels of interleukins IL-4, IL-6, IL-10, IL-17, and TNF-α in women who experienced abortion due to toxoplasmosis, categorized by positive and negative anti-TPO status, with those who were toxoplasmosis-negative and also negative for anti-TPO.

METHODS: We evaluated the serological presence of IgG and IgM antibodies to Toxoplasma using an ELISA method, in Samarra City, Salah al-Din Governorate, Iraq in 2021-2022. A sample of 153 women with spontaneous abortion were enrolled. We also measured the serum levels of interleukins IL-4, IL-6, IL-10, IL-17, TNF-α, and anti-TPO using the same technique.

RESULTS: Overall, 103 were Toxoplasma-positive. Of these, 14 had positive anti-TPO results (13.5%), compared to only 3 positive cases among the 50 matched controls who were Toxoplasma-negative (6.0%). The difference between Toxoplasma-positive and Toxoplasma-negative women regarding anti-TPO status was statistically significant for interleukins IL-4 (P=0.010), IL-6 (P=0.017), and IL-10 (P=0.003), but not for IL-17 or TNF-α. Additionally, the statistical analysis revealed a highly significant difference in the average concentrations of interleukins IL-4 (P=0.013) and IL-10 (P<0.001) between the Toxoplasma-positive/anti-TPO-positive group and the Toxoplasma-negative/anti-TPO-negative group of aborted women.

CONCLUSION: Elevated concentrations of IL-4, IL-10, and IL-6 have been associated with women undergoing recurrent miscarriages and negative anti-TPO results. The complex interaction between pro-inflammatory and anti-inflammatory cytokines is essential for immunological balance and pregnancy outcomes in a condition of toxoplasmosis. An increase in IL-4 and IL-10 levels in anti-TPO-positive individuals may lead to an imbalance in immune response, facilitating the development of autoimmune thyroid disease.

PMID:40747501 | PMC:PMC12307780 | DOI:10.18502/ijpa.v20i2.19050

Front Cardiovasc Med. 2025 Jul 17;12:1563068. doi: 10.3389/fcvm.2025.1563068. eCollection 2025.

ABSTRACT

BACKGROUND: Galectin-3 is a well-established biomarker on the predictor of cardiovascular events in patients with heart failure. Its pathophysiologic association with inflammation, cell proliferation, and fibrogenesis may implicate serum galectin-3 as a predictor of clinical outcomes in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The aim of this study was to examine the prognostic value of the galectin-3 level in patients with CAD who underwent PCI with DES.

METHODS: A total of 939 patients undergoing successful PCI with DES were consecutively enrolled between January 2007 and December 2009. The serum galectin-3 level was measured, classified into two groups according to the median galectin-3 level (9.52 ng/ml, interquartile range 7.31-12.81), and compared with the composite of all-cause mortality, non-fatal myocardial infarction (MI), and stroke.

RESULTS: The median follow-up duration was 997 days (interquartile range 766-1,264 days). The high galectin-3 group had a significantly higher incidence of all-cause mortality, cardiac mortality, and composite of all-cause mortality, non-fatal MI, and stroke. High galectin-3 was a significant independent predictor of the composite of all-cause mortality, non-fatal MI, and stroke (adjusted hazard ratio 1.670, 95% confidence interval 1.014-2.751, p = 0.044). The addition of the serum galectin-3 level to the conventional clinical risk model improves the model discrimination (C-statistic = 0.694-0.786, p for difference < 0.01), reclassification [continuous net classification improvement (0.297, p < 0.01) and integrated discrimination improvement (0.064, p < 0.01)].

CONCLUSION: Our data suggest that serum galectin-3 is an independent predictor of cardiovascular events in patients undergoing PCI with DES.

PMID:40747494 | PMC:PMC12310497 | DOI:10.3389/fcvm.2025.1563068

Am Stat. 2025 Jul 3;79(3):371-382. doi: 10.1080/00031305.2025.2505514. eCollection 2025.

ABSTRACT

In this tutorial we present the use of R package mgcv to implement Distributed Lag Non-Linear Models (DLNMs) in a flexible way. Interpretation of smoothing splines as random quantities enables approximate Bayesian inference, which in turn allows uncertainty quantification and comprehensive model checking. We illustrate various modeling situations using open-access epidemiological data in conjunction with simulation experiments. We demonstrate the inclusion of temporal structures and the use of mixture distributions to allow for extreme outliers. Moreover, we demonstrate interactions of the temporal lagged structures with other covariates with different lagged periods for different covariates. Spatial structures are also demonstrated, including smooth spatial variability and Markov random fields, in addition to hierarchical formulations to allow for non-structured dependency. Posterior predictive simulation is used to ensure models verify well against the data.

PMID:40747491 | PMC:PMC12312768 | DOI:10.1080/00031305.2025.2505514