Category: Statistics

Confl Health. 2025 Jul 25;19(1):49. doi: 10.1186/s13031-025-00695-9.

ABSTRACT

BACKGROUND: Chronic diseases represent a major global health burden, with their impact becoming even more pronounced in conflict settings. In such environments, the mental health and quality of life of chronic disease patients often deteriorate due to the disruptions caused by war. This study aimed to assess mental health issues among chronic disease patients and evaluate their quality of life during the ongoing armed conflict in Sudan.

METHODS: A cross-sectional study was conducted among chronic disease patients in the safest states of Sudan during the current war. Mental health was assessed with the Patient Health Questionnaire-9 for depression and Generalized Anxiety Disorder-7 for anxiety, and quality of life was evaluated using the EuroQol 5-Dimension 5-Level scale. Chi-square tests and Spearman’s rank examined associations between socio-demographic factors and mental health outcomes. Multiple linear regression identified predictors influencing mental health issues, with statistical significance set at p ≤ 0.05.

RESULTS: Among 1116 chronic disease patients, the median depression score was 7 (IQR = 8), with 50.3% reporting mild to moderate depression, while the median anxiety score was 6 (IQR = 8), with 47.1% experiencing mild to moderate anxiety. Depression showed significantly strong positive correlation with anxiety (ρ = 0.810, p < 0.00). In terms of health-related quality of life, the pain/discomfort domain showed 40.7% of patients reporting moderate to extreme problems, followed by the anxiety/depression domain at 43.4%, making these the most affected areas.

CONCLUSION: This study revealed high levels of depression and anxiety among Sudanese chronic disease patients during the war, alongside a notably poor quality of life. The findings underscore the urgent need for intervention to implement targeted mental health support programs, aiming to improve the quality of life for this vulnerable population.

PMID:40707924 | DOI:10.1186/s13031-025-00695-9

Sleep Med Rev. 2025 Jul 17;83:102137. doi: 10.1016/j.smrv.2025.102137. Online ahead of print.

ABSTRACT

Sleep abnormalities are core features of bipolar disorders (BD), but they have not been thoroughly examined across mood phases. This meta-analysis investigated sleep disturbance prevalence and sleep characteristics differences in BD across mood phases. A systematic search through September 2024 identified 44 studies (7614 BD cases, 3164 controls), including 11 prevalence and 34 case-control studies. Poor sleep quality prevalence was 52% during euthymia, and insomnia prevalence was 63% during the depressive phase. Individuals with euthymic BD reported worse sleep quality and objectively measured longer total sleep time and sleep onset latency than controls. Depressive phase BD showed higher rapid eye movement percentages, while manic/mixed phase exhibited shorter total sleep time, lower sleep efficiency, and longer sleep onset latency. During euthymia, BD demonstrated greater variability in sleep duration and continuity, and more prominent sleep differences when assessed with sleep diary versus objective sleep measures, highlighting the importance of integrating objective assessments and patient-reported outcomes. Overall, these findings indicate that poor sleep quality and insomnia are highly prevalent in BD, and that some sleep parameter differences are present during euthymia, while others occur during depressive and manic phases, emphasizing the need for sleep assessments and tailored management throughout the course of BD.

PMID:40706099 | DOI:10.1016/j.smrv.2025.102137

Hematology. 2025 Dec;30(1):2538318. doi: 10.1080/16078454.2025.2538318. Epub 2025 Jul 24.

ABSTRACT

BACKGROUND: Acute lymphoid leukaemia (ALL) is a significant cause of morbidity and mortality globally, with increasing incidence rates observed in Saudi Arabia. Despite advances in treatment, there is a lack of localized, sex-specific forecasts to guide public health interventions.

OBJECTIVE: This study aims to forecast the future incidence of acute lymphoid leukaemia in males and females using ARIMA models.

METHODS: Saudi national cancer registries data from 1990 to 2019 were used. The dataset was divided into training (80%) and testing (20%) sets. ARIMA models were developed for male and female incidence, with model parameters determined using ACF and PACF plots. Stationarity was assessed using the Augmented Dickey-Fuller test, and model accuracy was validated using MAE, MSE, and MAPE. Forecasts included point estimates and 95% confidence intervals.

RESULTS: For males, the ARIMA (3, 3, 3) model forecasted an increase in ALL incidences from 957 cases in 2020 to 2181 cases in 2029. For females, the ARIMA (4, 3, 0) model projected an increase from 1019 cases in 2020 to 2159 cases in 2029. The models demonstrated high accuracy, with MAE of 1.19895 and 2.749188, MSE of 62.33 and 31.83, and MAPE of 0.6805807 and 1.443453 for males and females, respectively.

CONCLUSION: Forecasts indicate a substantial rise in ALL incidence among both sexes, highlighting the urgent need for improved surveillance, early detection, and healthcare capacity planning. Incorporating ARIMA modelling into routine monitoring could support proactive resource allocation. Further studies should integrate additional predictive variables to enhance model precision.

PMID:40706089 | DOI:10.1080/16078454.2025.2538318

JMIR Infodemiology. 2025 Jul 24;5:e73619. doi: 10.2196/73619.

ABSTRACT

BACKGROUND: In recent years, there has been a dramatic increase in the popularity and use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss. As such, it is essential to understand users’ real-world discussions of short-term, long-term, and co-occurrent adverse events associated with currently used GLP-1 RA medications.

OBJECTIVE: This study aims to quantitatively analyze temporal and co-occurrent GLP-1 RA adverse event trends through discussions of GLP-1 RA weight loss medications on Facebook from 2022 to 2024.

METHODS: We collected 64,202 Facebook posts (59,293 posts after removing duplicate posts) from January 1, 2022, to May 31, 2024, through CrowdTangle, a public insights tool from Meta. Using English language social media posts from the United States, we examined discussions of adverse event mentions for posts referencing 7 GLP-1 RA weight loss product categories (ie, semaglutide, Ozempic, Wegovy, tirzepatide, Mounjaro, Zepbound, and GLP-1 RA as a class). All analyses were conducted using Python (version 3; Python Software Foundation) in a Google Colab environment.

RESULTS: Temporal time series analysis revealed that the GLP-1 RAs’ adverse event mentions on social media aligned with several key events: the Food and Drug Administration’s approval of Wegovy for pediatric weight management in December 2022, increased media coverage in August 2023, celebrity endorsement in December 2023, and Medicare Part D coverage expansion for weight loss medications in March 2024. Gastrointestinal (GI)-related adverse events (general term) were most prevalent for posts mentioning the GLP-1 RA class (210/4885, 4.30%) and Mounjaro (241/4031, 5.98%). In contrast, the most prevalent adverse event mentions noted for tirzepatide were headache (78/4202, 1.86%) and joint pain (71/4202, 1.69%). Hypertension (13/1769, 0.73%) was frequently mentioned in Zepbound posts, while pancreatitis was commonly associated with Mounjaro posts (44/4031, 1.08%), and 2.85% (139/4885) of posts broadly referring to the GLP-1 RA class. Furthermore, an integrated node network analysis revealed 3 distinct GLP-1 RA adverse events-mentioned clusters: cluster 1 (purple) contained allergies, anxiety, depression, chronic obstructive pulmonary disease, fatigue, fever, hypertension, indigestion, insomnia, gastroesophageal reflux disease, hives, swelling, restlessness, and seizures. Cluster 2 (pink) contained constipation, dehydration, headache, diarrhea, dizziness, hypoglycemia, sweating, and jaundice. Cluster 3 (brown) contained GI symptoms, such as nausea, pancreatitis, rash, and vomiting. The GI symptoms, such as nausea, vomiting, pancreatitis, diarrhea, and indigestion, were strongly associated together (≥100 co-occurrence mentions), while the mentioned neurological symptoms, such as anxiety, depression, and insomnia, were highly correlated with each other (50-100 co-occurrence mentions).

CONCLUSIONS: This social media study highlights the adverse event mention patterns for posts referencing GLP-1 RA medications. While further research is needed to rigorously examine and validate these findings, this study demonstrates the importance of monitoring social media discussions to predict novel, underreported, or rare drug adverse events, thereby improving patient care, clinical research, and health policy interventions.

PMID:40706081 | DOI:10.2196/73619

Bol Med Hosp Infant Mex. 2025;82(3):145-151. doi: 10.24875/BMHIM.24000104.

ABSTRACT

BACKGROUND: Orotracheal intubation can cause complications such as stridor and airway obstruction, which favors weaning failure. The objective of this study was to assess the usefulness of airway ultrasound prior to extubation to predict stridor and extubation failure.

METHOD: Cross-sectional descriptive study, from March 2023 to June 2024. A total of 50 patients were studied, admitted to the pediatric emergency service of the Children’s Hospital of the State of Sonora, under mechanical ventilation ≥ 24 hours and in whom the first extubation attempt. An ultrasound of the airway was performed, calculating the peritube free space and the width of the air column before extubation, and the total number of patients who presented post-extubation stridor and extubation failure were identified.

RESULTS: The mean peritube free space in patients who presented stridor was 3.2 mm (0.3-6.2), with a statistically significant difference (p = 0.012) compared to patients who did not present stridor. The mean width of the air column in patients who presented stridor was 1.21 mm (0.16-4.78 mm), but it did not show a statistically significant difference (p = 0.153) compared to patients who did not present stridor. There were no statistically significant differences in both measurements for the outcome of extubation failure.

CONCLUSIONS: Airway ultrasound seems to have a good correlation with the risk of post-extubation stridor.

PMID:40706076 | DOI:10.24875/BMHIM.24000104

J Med Internet Res. 2025 Jul 24;27:e70118. doi: 10.2196/70118.

ABSTRACT

BACKGROUND: Incorporating initial serum chloride levels as a prognostic indicator in the intensive care environment has the potential to refine risk stratification and tailor treatment strategies, leading to more efficient use of clinical resources and improved patient outcomes.

OBJECTIVE: Quantitative analysis of the relationship between serum chloride levels at intensive care unit (ICU) admission and in-hospital mortality, and the establishment of a personalized survival curve prediction deep learning model to enhance risk stratification and clinical decision-making.

METHODS: A large-scale, cross-country, multicohort study of 189,462 ICU patients from four cohorts was conducted: 70,370 from Medical Information Mart for Intensive Care IV (MIMIC-IV), 112,457 from eICU Collaborative Research Database (eICU-CRD; 2 US cohorts), 4653 from Yantai Yuhuangding Hospital, and 1982 patients from Zigong Fourth People’s Hospital (2 Chinese cohorts). We collected demographics, underlying diseases, ICU complications, electrolyte levels, biochemical parameters, and vital signs at ICU admission, along with length of stay and in-hospital survival outcomes. Causal graph analysis pinpointed clinical variables linked to mortality. Nonlinear associations between chloride levels and mortality were evaluated using restricted cubic splines and Cox proportional hazards models, validated with the Cox frailty model, Kaplan-Meier curves, and sensitivity analyses. A deep learning model was created for individualized survival predictions.

RESULTS: Causal inference revealed a significant association between admission serum chloride levels and 28-day mortality. The median serum chloride level at ICU admission was 104 (IQR 100-108) mEq/L. In analyzing all 42 variables, restricted cubic splines identified thresholds at 103 mEq/L and 115 mEq/L, categorizing patients into three groups: ≤103 mEq/L, 103-115 mEq/L, and >115 mEq/L. Cox proportional hazards models revealed higher death risks for patients outside this range, with hazard ratios (HRs) of 1.36 (95% CI 1.29-1.43) for ≤103 mEq/L and 1.27 (95% CI 1.14-1.41) for >115 mEq/L. Four cross-cohort validations confirmed these critical ranges. For the eICU-CRD dataset, the HRs for the key intervals are 1.30 (95% CI 1.24-1.36) and 0.97 (95% CI 0.89-1.06). In the Yantai Yuhuangding Hospital affiliated with Qingdao University (YHD-HOSP) dataset, the HRs for the key intervals are 1.23 (95% CI 1.09-1.38) and 1.58 (95% CI 1.27-1.96). In the Sichuan Zigong Fourth People’s Hospital (SCZG-HOSP) dataset, the HR for the key interval is 2.20 (95% CI 1.43-3.39). The Causal SurvivalNet accurately predicted individual survival curves using admission chloride levels and other factors, achieving Brier scores of 0.09, 0.12, and 0.15. Results from cohort analyses in both China and the United States consistently and closely correlate the critical range of chloride with the prognosis of ICU patients.

CONCLUSIONS: Using initial serum chloride levels enhances prognostic accuracy and facilitates tailored treatment plans for ICU patients in critical care settings.

PMID:40706028 | DOI:10.2196/70118

JMIR Form Res. 2025 Jul 24;9:e71393. doi: 10.2196/71393.

ABSTRACT

BACKGROUND: Social frailty poses a potential risk even for relatively healthy older adults, necessitating development of early detection and prevention strategies. Recently, consumer-grade wearable devices have attracted attention due to their ability to continuously collect physiological and activity-related data. These data can potentially be used to calculate digital biomarkers for screening social frailty in older adults.

OBJECTIVE: The objective of this study was to explore digital biomarkers associated with social frailty using sensor data recorded via Fitbit devices and evaluate their relationship with health outcomes in older adults.

METHODS: This cross-sectional study was conducted in 102 community-dwelling older adults. Participants attending frailty prevention programs wore devices from the Fitbit Inspire series on their nondominant wrist for at least 7 consecutive days, during which step count and heart rate data were collected. Standardized questionnaires were used to assess physical functions, cognitive functions, and social frailty, and based on the scores, the participants were categorized into 3 groups: robust, social prefrailty, and social frailty. The sensor data were analyzed to calculate nonparametric and extended cosinor rhythm metrics, along with heart rate-related metrics.

RESULTS: The final sample included 86 participants who were categorized as robust (n=28, 33%), social prefrailty (n=39, 45%), and social frailty (n=19, 22%). The mean age of the participants was 77.14 (SD 5.70) years, and 91% (78/86) were women. Multinomial logistic regression analysis revealed that a step-based rhythm metric (intradaily coefficient of variation) was significantly associated with social frailty (odds ratio 1.05, 95% CI 1.01-1.11; P=.01). The heart rate metrics, including the delta resting heart rate and time of transition from rest to activity, showed significant associations with both social prefrailty (odds ratio 0.82, 95% CI 0.68-0.99; P=.04) and social frailty (odds ratio 0.69, 95% CI 0.50-0.95; P=.01). Specifically, delta resting heart rate, defined as the difference between the overall average heart rate and resting heart rate, exhibited significant negative associations with social prefrailty (odds ratio 0.82, 95% CI 0.68-0.97; P=.02) and social frailty (odds ratio 0.74, 95% CI 0.58-0.94; P=.02). Furthermore, analysis using a linear regression model revealed a significant association between the intradaily coefficient of variation and the word list memory score, a measure of cognitive decline (β=-0.04; P=.02).

CONCLUSIONS: This study identified associations between novel rhythm and heart rate metrics calculated from the step count and heart rate recorded by Fitbit devices and social frailty. These findings suggest that consumer-grade wearable devices, which are low cost and accessible, hold promise as tools for evaluating social frailty and its risk factors through enabling the calculation of digital biomarkers. Future research should include larger sample sizes and focus on the clinical applications of these findings.

PMID:40706025 | DOI:10.2196/71393

JMIR Form Res. 2025 Jul 24;9:e50504. doi: 10.2196/50504.

ABSTRACT

BACKGROUND: The accurate diagnosis of mental disorders, such as depression, requires comprehensive, valid, and reliable tools to ensure evidence-based treatments and effective outcome monitoring. Existing diagnostic practices often lack standardization, leading to missed comorbidities and variable diagnostic accuracy. The Klenico system is an innovative, web-based diagnostic tool that integrates patient self-reports with clinical validations by mental health professionals. This system covers a broad spectrum of mental disorders, including depression.

OBJECTIVE: This research aimed to evaluate the psychometric properties of the Klenico Depression Domain (KDD), the component of the Klenico system that measures depressive symptomatology, in a real-world clinical setting. Specifically, the evaluation focused on the assessment of its construct validity, internal consistency, and sensitivity to change in symptom severity.

METHODS: Anonymized data from 496 inpatients with mental disorders collected between 2019 and 2022 were analyzed. Patients completed the KDD alongside parts of the Patient Health Questionnaire (PHQ), Beck Depression Inventory (BDI-II), and Satisfaction With Life Scale (SWLS) at both admission and discharge. Internal consistency was measured using Cronbach α. Exploratory factor analysis was conducted to examine the factor structure. Construct validity was assessed via Pearson correlations with PHQ-9 and BDI-II, while divergent validity was tested against the PHQ Somatic Symptoms Scale (PHQ-15), PHQ-Generalized Anxiety Disorder-7, and SWLS. Sensitivity to change was evaluated using paired 1-tailed t tests, effect sizes, and repeated measures correlations.

RESULTS: The KDD demonstrated excellent internal consistency (Cronbach α=0.91 at admission and 0.93 at discharge). Factor analysis revealed a 7-factor structure encompassing dimensions like “inadequacy,” “anhedonia,” and “self-hatred,” aligning with core depressive symptoms outlined in the International Statistical Classification of Diseases, Tenth Revision. The correlations with the convergent questionnaires PHQ-9 (r=0.68; P<.001) and BDI-II (r=0.70; P<.001) were high. While the KDD showed a moderate correlation with the divergent PHQ-15 (r=0.35; P<.001), it was more strongly associated with the divergent SWLS (r=-0.51; P<.001) and Generalized Anxiety Disorder-7 (r=0.51; P<.001). Sensitivity to change was high, with significant reductions in KDD scores for patients with improved symptoms (t₂₇=5.36, P<.001; Cohen d=0.79) and high repeated measures correlation with both the BDI-II (r=0.61; P<.001) and the PHQ-9 (r=0.59; P<.001).

CONCLUSIONS: The KDD shows promise as a reliable and valid instrument for diagnosing depression and monitoring treatment outcomes in psychotherapeutic settings. Its alignment with International Statistical Classification of Diseases, Tenth Revision diagnostic criteria and sensitivity to symptom change underlines its potential utility. These findings highlight the Klenico system’s potential to enhance clinical diagnostics by addressing current gaps in mental health care, thus improving diagnostic accuracy and consistency. Further research is recommended to validate its performance across different populations and settings.

PMID:40706024 | DOI:10.2196/50504

JMIR Form Res. 2025 Jul 24;9:e67550. doi: 10.2196/67550.

ABSTRACT

BACKGROUND: Adverse childhood experiences such as violence, substance use, and family disruption disproportionately affect youth in urban communities, increasing the risk of emotional and behavioral challenges. Social-emotional learning (SEL) and trauma-informed programming are effective strategies for mitigating these effects, fostering resilience, and promoting mental well-being. Game-based learning is a promising, engaging method for delivering SEL content. STRYV365 developed Brain Agents, a trauma-informed, game-based SEL intervention aimed at improving emotional regulation, coping strategies, and interpersonal skills among students in grades 5 through 9.

OBJECTIVE: This study explored students’ experiences with and perceptions of Brain Agents, evaluating its effectiveness in fostering SEL skills and resilience across 4 diverse urban schools in Milwaukee, Wisconsin.

METHODS: A cluster-randomized, incomplete block factorial crossover design was implemented from 2022-2024. Of 1626 eligible students, 329 (20%) had caregiver consent and student assent. Among these, 180 students in grades 5-9 played Brain Agents at school over 4-5 weeks, for an average of 10 sessions and 23 minutes per session. SEL-related outcomes were assessed using surveys, focus groups, and interviews. Qualitative data were analyzed using Dedoose software, with thematic coding conducted by multiple coders to ensure reliability.

RESULTS: Student demographics included 189/321 (58.9%) Black, 112/321 (34.9%) White, and 221/321 (68.8%) from economically disadvantaged backgrounds. Baseline surveys of 277 children revealed that 202 (72.9%) of students had experienced the death of someone close, 147 (53.1%) had a close contact incarcerated, and 39 (14.1%) reported feeling nervous or anxious daily. Strengths included 230 (83.0%) students reporting life satisfaction and 183 (66.1%) able to calm down when upset. Game performance data from 328 students indicated varying levels of achievement, with a median of 3 (IQR 1.5-4) missions completed, 4 (IQR 2-6) stars earned, 8 positive energies collected, and 2 (IQR 1-2.5) crew members rescued. Grades 7-8 had the highest engagement, while grade 9 students had the lowest participation. Qualitative analysis from 62 participants identified 8 core themes: qualities of most pride, neighborhood relationships, challenges in life, emotions associated with loss of control, coping strategies, future goals, experiences with Brain Agents, and suggestions to improve the game. Students most frequently cited anger as a cause of emotional dysregulation and named coping strategies such as self-calming, asking for help, and perseverance. Feedback on Brain Agents highlighted improved focus, emotional control, and critical thinking, with younger students more positively engaged. Suggested improvements included better graphics, more customization, and cooperative play.

CONCLUSIONS: Brain Agents was positively received by students, particularly those in earlier grades, and demonstrated potential as an effective trauma-informed SEL tool. The findings support the role of game-based interventions in enhancing resilience and emotional intelligence among youth exposed to adversity. Broader implementation may extend benefits to diverse student populations and settings.

PMID:40706022 | DOI:10.2196/67550

J Cogn Neurosci. 2025 Jul 18:1-18. doi: 10.1162/jocn.a.81. Online ahead of print.

ABSTRACT

Graphical representations of quantitative data abound in our culture, and yet the brain mechanisms of graphicacy, by which viewers quickly extract statistical information from a data graphic, are unknown. Here, using scatterplots as stimuli, we tested two hypotheses about the brain areas underlying graphicacy. First, at the perceptual level, we hypothesized that the visual processing of scatterplots and their main trend recycles cortical regions devoted to the perception of the principal axis of objects. Second, at a higher level, we speculated that the math-responsive network active during arithmetic and mathematical truth judgments should also be involved in graphical perception. Using fMRI, we indeed found that the judgment of the trend in a scatterplot recruits a right lateral occipital area involved in detecting the orientation of objects, as well as a right anterior intraparietal region also recruited during mathematical tasks. Both behavior and brain activity were driven by the t value that indexes the statistical correlation in the data, and right intraparietal activation covaried with participants’ graphicacy level. On the basis of this first approach to the neural bases of graphical perception, we suggest that, like literacy and numeracy, graphicacy relies on the recycling of brain areas previously attuned to a similar problem, here the perception of object orientation.

PMID:40706015 | DOI:10.1162/jocn.a.81