Category: Statistics

Expert Rev Gastroenterol Hepatol. 2025 Jul 19. doi: 10.1080/17474124.2025.2537187. Online ahead of print.

ABSTRACT

BACKGROUND: Gender disparity has been documented in celiac disease (CD) with a female (F)-to-male (M) ratio of 2-2.5:1. Studies examining gender differences have yielded conflicting results.

AIMS: To investigate gender differences in clinical presentation at diagnosis, adherence to gluten-free diet (GFD), modification of clinical symptoms with the GFD in adult CD patients.

METHODS: Single-center retrospective study, including all consecutive CD patients referred to our Center between September 2022-July 2024.

RESULTS: 191 patients, 141 F/50 M, mean age at diagnosis of 35.4/37.4 years were included. In 59% F/54% M the diagnosis was prompted by gastrointestinal symptoms. At the diagnosis 13 F (9.1%), 11 M (22%) were asymptomatic. Extra-intestinal manifestations were reported by 34 women (23.9%), 6 men (12%). A low/absent adherence to GFD was reported by 17 women (12%), 9 men (18%). Statistically significant differences were found regarding the prevalence of bone mineral density alterations ( > in M, p-value = 0.017) and the degree of duodenal damage at the diagnosis ( > in F, p-value = 0.021).

CONCLUSIONS: Only slight discrepancies in the clinical presentation at CD diagnosis between the two genders were identified, which are mostly resolved with the GFD. No significant difference with regard to dietary adherence between F/M was found.

PMID:40682368 | DOI:10.1080/17474124.2025.2537187

Womens Health (Lond). 2025 Jan-Dec;21:17455057251347717. doi: 10.1177/17455057251347717. Epub 2025 Jul 19.

ABSTRACT

BACKGROUND: An alarming observation from high-volume obstetric facilities in Nepal indicating a decreased institutional delivery rate and increased institutional neonatal mortality rate after the initial nationwide lockdown signaled the adverse population-level impact of the pandemic on the national trajectory of neonatal survival.

OBJECTIVES: We aimed to estimate the impact of change in institutional delivery coverage on cause-specific neonatal mortality during the coronavirus disease 2019 pandemic in Nepal.

DESIGN: Modeling-based study.

METHODS: We used the open-access Lives Saved Tool, based on a linear deterministic mathematical model validated for estimating cause-specific neonatal mortality in low- and middle-income countries, to estimate the number of additional neonatal lives saved and neonatal mortality rates. Using coverage change in institutional delivery rates as a proxy for interventions during childbirth, we compared the estimates using ‘reported’ coverage change during the pandemic with the ‘targets’ per Nepal Every Newborn Action Plan.

RESULTS: The projected number of additional neonatal lives saved when the pandemic hit the hardest (Nepalese fiscal year 2020-2021) when national annual institutional delivery rate reportedly decreased was lower (104; 95% confidence interval: 69-148) compared to the target scenario (222; 95% confidence interval: 152-313). However, in the next year 2021-2022 when the institutional delivery rate increased, the number was higher (926; 95% confidence interval: 643-1295) compared to target scenario (329; 95% confidence interval: 226-466). The trajectory of the projected neonatal mortality rate per 1000 live births reversed (increased to 20.18) in 2020-2021 compared to 20.11 in 2019-2020 and then tracked down to 18.75 in 2021-2022. Most newborn lives would be saved from asphyxia, sepsis, and prematurity-related complications. Neonatal resuscitation, thermal protection, and cord care are the top three lifesaving interventions during childbirth.

CONCLUSION: Neonatal survival in Nepal was adversely impacted during the peak of the coronavirus disease 2019 pandemic, with a favorable bounce back next year, based on the Lives Saved Tool projection per change in institutional delivery coverage.

PMID:40682341 | DOI:10.1177/17455057251347717

Cancer Med. 2025 Jul;14(14):e71072. doi: 10.1002/cam4.71072.

ABSTRACT

BACKGROUND: CAR-T therapy is approved for the treatment of relapsed refractory multiple myeloma (MM) and is being studied for newly diagnosed MM (NDMM). The use of novel therapies in early-line MM raises questions on the acceptability of upfront risks in exchange for extended relapse-free periods without the treatment burden and limitations on daily activities associated with maintenance therapy.

METHODS: A discrete-choice experiment was designed to elicit adults’ preferences for hypothetical NDMM treatments. Benefits included time to relapse and reduction of treatment impact on daily activities. Severe adverse events were included to better understand patient preferences for rare but significant events.

RESULTS: On average, extending the time to relapse from 3 years (with moderate limitations on daily activities) to 5 years (without limitations) was three times more important than avoiding a 20% risk of hospitalization due to severe ICANS/CRS. Analysis revealed three latent preference classes: a benefit-risk trading class (65%), a class (28%) unwilling to accept increases in short-term treatment-related mortality, and a class (7%) that provided statistically uninformative data. For the trading class, for two additional relapse-free years with minor limitations, all else equal, patients would accept up to a 30% risk of severe ICANS/CRS-related hospitalization along with 0% risk of treatment-related mortality. Alternatively, they would accept up to an 8% risk of treatment-related mortality with a 0% risk of severe ICANS/CRS-related hospitalization, or various combinations of lower AE risks.

CONCLUSION: These results reveal preference heterogeneity among MM patients and the importance of effective communication about the benefits and risks of novel therapies.

PMID:40682335 | DOI:10.1002/cam4.71072

J Adv Nurs. 2025 Jul 19. doi: 10.1111/jan.70098. Online ahead of print.

ABSTRACT

AIM: To better understand what enables evidence-based practice, this study investigated contextual factors influencing evidence-based practice in general, and in relation to the implementation of bladder-monitoring guidelines in orthopaedic care.

DESIGN: Convergent parallel mixed method.

METHODS: This study was part of a hybrid research project across 17 Swedish orthopaedic sites. The data collection (2021-2023) included interviews with orthopaedic staff and patients post-hip surgery, patient survey free-text responses, and a staff survey on organisational context. Data were analysed with deductive content analysis and descriptive statistics, later integrated using a mixed methods approach.

RESULTS: Evidence-based practice was supported by context factors such as staff collaboration and multiprofessional engagement. Staff addressed patient safety and equality by using evidence-based guidelines, but rarely involved the patients. Orthopaedic fast-track procedures positioned patients as passive recipients, while staff voiced a call for a more person-centred context. Positive attitudes, leadership engagement, use of champions, and adequate staffing enabled evidence-based practice, though a shortage in evaluation and high staff turnover hindered its implementation.

CONCLUSION: Orthopaedic context is characterised by several enabling organisational context factors for evidence-based practice, although patients lacking recognition of their needs and queries justify greater focus on person-centredness and mutual information exchange. Audit and feedback are crucial for improvements, but were lacking in the orthopaedic care context.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Assessments of efforts made to implement evidence-based practice and its outcomes should incorporate nursing care. Slimmed care processes require attention to ensure patient participation.

IMPACT: The orthopaedic care context is enabling for evidence-based practice, although staff are challenged by fast-track procedures with extensive information exchange and insufficient person-centredness.

REPORTING METHOD: The Mixed Methods Reporting in Rehabilitation & Health Sciences checklist.

PATIENT OR PUBLIC INVOLVEMENT: No patient or public contribution.

TRIAL REGISTRATION: Identifier: NCT04700969.

PMID:40682329 | DOI:10.1111/jan.70098

Nutr Clin Pract. 2025 Jul 19. doi: 10.1002/ncp.11352. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital nutrition services rarely offer Indigenous-specific menu options, an essential element of delivering “Indigenous cultural safety” in nutrition care to Indigenous patients.

METHODS: Indigenous participants (n = 370) completed a semistructured Indigenous Food Ways survey (paper-based and online) from 2021 to 2022 as part of continuous healthcare quality improvement. Descriptive statistics summarized cultural/traditional foods respondents wanted to see or did not want to see as options on hospital menus.

RESULTS: A majority of respondents (83%) agreed that a menu option for cultural/traditional foods was important, with 716 unique items reported. Seafood and meat/alternatives were common cultural/traditional items for menu options, specifically salmon (22%), traditional meat (14%), moose (12%), and venison (12%). Grain items reported were mostly Bannock (22%). Nearly 20% of the sample listed traditional foods, medicine, or tea as options for hospital menus. Respondents identified 254 items they did not want to see on hospital menus, which were commonly energy-dense/processed foods (16%) or poorly prepared/flavored items (13%), as well as peas and carrots (7%). Notably, some foods (eg, Bannock, salmon, fish eggs) were listed among both desired and not desired menu options.

CONCLUSION: Results showed that offering cultural or traditional foods on hospital menus is considered important by Indigenous people, and that a wide range of foods would be desired. Specific cultural foods to include on menus were salmon, traditional meats, or traditional teas. Foods not to include were also identified. Improving future nutrition care and services will require menu modifications to provide culturally safe options for Indigenous patients.

PMID:40682323 | DOI:10.1002/ncp.11352

J Interpers Violence. 2025 Jul 18:8862605251350127. doi: 10.1177/08862605251350127. Online ahead of print.

ABSTRACT

To align with emerging policies for adolescents, feasible, accurate, and equitable trauma-focused assessment protocols need to be developed. To date, most research on this topic has focused on whether traditional adverse childhood experiences (i.e., maltreatment, impaired caregiving) can adequately index mental health risk. Yet, there are noted clinical and statistical drawbacks to this approach. Instead, examining threat and reward biases, two subtypes of cognitive biases stemming from interpersonal trauma exposure, may provide a reasonable alternative to adversity screening. Thus, the aim of this study was to examine the accuracy and fairness of self-reported, trauma-informed cognitive vulnerabilities for classifying concurrent and prospective adolescent mental health risk relative to more commonly assessed childhood adversities. In a diverse adolescent sample (N = 584; M_Age = 14.43; 48.9% female; 35% African American; 38.5% White; 40% Hispanic) youth completed measures for adversity exposure (family, dating, and community violence), threat biases (posttraumatic cognitions, hostility), and reward biases (anticipatory, consummatory) during an initial assessment, as well as symptoms of posttraumatic stress (PTS), depression, and violent behavior at baseline and 1 year later. Indices of statistical discrimination, calibration, and statistical fairness were examined using an evidence-based medicine analytic approach, which was subsequently compared to a machine learning approach. Overall, posttraumatic cognitions emerged as an accurate and statistically fair predictor of prospective PTS (area under the curve [AUC]_{95% CI} = [0.63, 0.78]; diagnostic likelihood ratio [DLR]_{95% CI} = [1.32, 3.52]), and to a lesser extent depression (AUC_{95% CI} = [0.56, 0.70]; DLR_{95% CI} = [1.25, 2.98]), and both models were well calibrated (i.e., p-value >05 for Spiegelhalter’s Z test). Meanwhile, community violence (CV) exposure best classified the risk for prospective violent behavior (AUC_{95% CI} = [0.62, 0.73]; DLR_{95% CI} = [2.68, 5.49]), especially in males, and was well calibrated. The machine learning algorithms added limited incremental validity to our predictions. Our study suggests that focusing on posttraumatic cognitions and less invasive adversity items (i.e., CV exposure) may lead to trauma screening and assessment protocols that are accurate, equitable, and feasible to implement within applied settings serving diverse youth.

PMID:40682318 | DOI:10.1177/08862605251350127

Hum Reprod. 2025 Jul 18:deaf120. doi: 10.1093/humrep/deaf120. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system?

SUMMARY ANSWER: Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis.

WHAT IS KNOWN ALREADY: Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success.

STUDY DESIGN, SIZE, DURATION: This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS: The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed.

MAIN RESULTS AND THE ROLE OF CHANCE: Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]).

LIMITATIONS, REASONS FOR CAUTION: A larger study population is needed to clinically define relevant sub-groups based on localization of lesions.

WIDER IMPLICATIONS OF THE FINDINGS: The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites.

STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study.

TRIAL REGISTRATION NUMBER: Clinical Trials NCT05624567.

PMID:40682308 | DOI:10.1093/humrep/deaf120

Int J Rheum Dis. 2025 Jul;28(7):e70374. doi: 10.1111/1756-185x.70374.

ABSTRACT

AIM: The multisystem nature of rheumatic diseases (RDs) as well as their treatments can affect pregnancy and its prognosis. The use of assisted reproductive technologies (ART) can increase the probability of fertility in RDs. The aim of this study was to compare ART outcomes in women with versus without RDs.

METHODS: This retrospective cohort study was carried out between August 2023 and August 2024. Using medical records and documents, the ART outcomes of women with and without RDs were included. The descriptive statistics were provided as mean ± SD, number, and percentage. The distribution status of demographic and clinical variables was done through Mann-Whitney and Chi-squared or Fisher’s exact test (for qualitative variables) and the confounder variables were adjusted. Data analysis was performed at a significance level of 5% using SPSS 25 software.

RESULTS: A total of 194 women with 334 cycles of ART were included; 62 participants were with RDs while 132 were without RDs. This study demonstrated that women with RDs are at a significantly higher risk of miscarriage (OR = 5.27, CI 1.28 to 21.75, p = 0.021) and inadequate gestational weight gain during pregnancy (OR = 2.25, CI 1.06 to 4.75, p = 0.034) compared to those without RDs. Additionally, fetal/neonatal complications did not show significant differences between the two groups. However, studies with larger sample sizes may yield different results regarding fetal/neonatal outcomes.

CONCLUSIONS: These results emphasize the importance of personalized and multidisciplinary care for women with RDs, particularly during pregnancy, to manage risks and improve maternal and fetoneonatal outcomes.

PMID:40682306 | DOI:10.1111/1756-185x.70374

Int J Immunopathol Pharmacol. 2025 Jan-Dec;39:3946320251358305. doi: 10.1177/03946320251358305. Epub 2025 Jul 18.

ABSTRACT

The treatment approach to RA has changed over time, but the main goal of treatment has remained the same, that is, achieving disease remission. Given the lack of RA disease activity tools and biomarkers that can reliably predict RA drug effectiveness not just on joints but also on extra-articular manifestations. The involvement of galectins, especially Galectin-1 (Gal1) in the regulation of immune regulation makes them potential good candidate non-specific biomarkers of autoimmune diseases like RA. Examining the possibility of applying Gal1 as a potential biomarker for evaluating the effectiveness of therapy. A quasi-experimental study was conducted to assess changes in serum Gal1 concentrations in patients with RA, compared with a healthy control group. The study included a total of 88 participants, consisting of 48 patients diagnosed with RA and 40 healthy voluntary blood donors. Patients were enrolled in the study based on a selective recruitment process, provided they met the criteria outlined in the Inclusion Criteria section. The diagnosis of RA was established by physicians in accordance with the ACR/EULAR2010 classification criteria. The collected samples were subjected to concentration determination using a commercial ELISA kit for human Gal1. The serum Gal1 concentration of the examined groups differed significantly (P < 0.0001). There was a significant difference in serum concentration of Gal1 between first and second measurement (pre- and post-intervention) (P = 0.015). The obtained values of post-intervention Gal1 did not show a positive correlation with the values of DAS28-ESR, HAQ-DI, and CDAI. The conducted study showed a pronounced statistical significance in the values of Gal1 concentrations in RA patients (in both time points) compared to the group of healthy subjects, suggesting that lower levels of this marker may be associated with the degree of inflammation characteristic of RA. No significant correlation was observed between Gal1 levels and clinical disease activity indices, limiting conclusions.

PMID:40682289 | DOI:10.1177/03946320251358305

Pediatr Blood Cancer. 2025 Jul 18:e31919. doi: 10.1002/pbc.31919. Online ahead of print.

NO ABSTRACT

PMID:40682283 | DOI:10.1002/pbc.31919