Category: Statistics

BMC Pediatr. 2025 Sep 10;25(1):679. doi: 10.1186/s12887-025-05797-0.

ABSTRACT

BACKGROUND: Red blood cell (RBC) transfusion is a common intervention for anemia in preterm infants; however, its association with bronchopulmonary dysplasia (BPD) remains debated. While biological mechanisms suggest potential harm, the clinical impact of transfusion frequency on BPD incidence and severity remains unclear.

OBJECTIVE: To investigate whether RBC transfusion frequency is independently associated with the risk and severity of BPD in preterm infants born before 32 weeks of gestation.

METHODS: This retrospective cohort study included preterm infants (< 32 weeks gestational age) admitted to the NICU at Zhangzhou Affiliated Hospital of Fujian Medical University between January 2020 and December 2022. Only transfusions administered before 36 weeks postmenstrual age were included. Clinical data, including transfusion frequency, hemoglobin levels, and respiratory diagnoses, were collected. Logistic regression was used to identify independent risk factors for BPD, and ROC curve analysis determined the optimal transfusion threshold. Subgroup and sensitivity analyses were conducted to evaluate confounding effects.

RESULTS: Among 228 included infants, 184 (80.7%) received at least one RBC transfusion. The BPD group received a higher number of transfusions (mean 4.24 vs. 1.89, p < 0.001). Multivariate analysis identified transfusion frequency (OR = 1.245; 95% CI: 1.023-1.514; p = 0.049) and lower gestational age (OR = 0.749; 95% CI: 0.561-0.998; p = 0.05) as independent risk factors for BPD. ROC analysis demonstrated transfusion frequency effectively predicted BPD (AUC = 0.749), with ≥ 4 transfusions (sensitivity 51%, specificity 77%) correlating with increased severity (Kendall’s τ_b = 0.453, p < 0.001). Neonatal hemoglobin levels inversely correlated with transfusion requirements (r=-0.187, p < 0.001). Subgroup analysis confirmed this association across GA strata (p < 0.05). Early transfusion (≤ 14 days of life) was not associated with increased severity.

CONCLUSION: RBC transfusion frequency is an independent, dose-dependent risk factor for BPD in preterm infants. Reducing unnecessary transfusions and optimizing anemia management may help mitigate BPD risk and severity.

PMID:40926206 | DOI:10.1186/s12887-025-05797-0

BMC Public Health. 2025 Sep 9;25(1):3044. doi: 10.1186/s12889-025-24362-z.

ABSTRACT

We study the dynamics of coexisting influenza and SARS-CoV-2 by adapting a well-established age-specific COVID-19 model to a multi-pathogen framework. Sensitivity analysis and adjustment of the model to real-world data are used to investigate the influence of age-related factors on disease dynamics. Our findings underscore the critical role that transmission rates play in shaping the spread of influenza and COVID-19. Furthermore, our analysis highlights the significant interaction between influenza and SARS-CoV-2 transmission rates, particularly in scenarios with partial cross-immunity. This underscores the importance of comprehensive interventions that simultaneously target both pathogens to effectively control their spread in coexisting environments. Our results demonstrate the importance of age-structured models in capturing the dynamics of influenza and COVID-19, underscoring the importance of accounting for age structure. Notable disparities emerge in estimated transmission rates between single-pathogen and multi-pathogen models, shedding light on the complex interactions between pathogens and their impacts on disease transmission across different age groups.

PMID:40926205 | DOI:10.1186/s12889-025-24362-z

BMC Health Serv Res. 2025 Sep 9;25(1):1193. doi: 10.1186/s12913-025-13393-2.

ABSTRACT

BACKGROUND: Maternal healthcare (MHC) in Cameroon reflects the persistent challenges in Sub-Saharan Africa, where high maternal mortality continues despite improved service utilization, stressing inequitable effective coverage (EC). This study applied EC cascade analysis-including service contact, continuity, and input-adjusted coverage-to quantify geographic and socioeconomic disparities, informing equity-focused strategies to dismantle structural barriers in the MHC continuum.

METHODS: We combined population and health facility data (2018 Cameroon Demographic and Health Survey and 2015 Emergency Obstetric and Neonatal Care Assessment) to estimate the input-adjusted coverage of antenatal care (ANC) and intra-and postpartum care (IPC). Inequalities were assessed using absolute and relative measures.

RESULTS: The MHC cascade showed significant falls in input-adjusted coverage. For ANC, 86.3% service contact eroded to 25.3% continuity and 14.4% input-adjusted coverage. For IPC, the service continuum dropped from 51.4 to 31.4% input-adjusted coverage, revealing steeper losses compared to ANC (20.0% vs. 10.9%). When accounting for service readiness, relative inequalities intensified (e.g., the wealth-based RII for ANC increased by 122%), while absolute gaps narrowed (SII declined by 25%), indicating a greater loss of coverage among socioeconomically privileged groups (IPC input-adjusted coverage dropped by 20.9% for the highest quintile vs. 11.1% for the lowest quintile). At the same time, marginalized populations experienced compounded exclusion-facing severely limited access to care and substandard service quality at available facilities-highlighting the critical need to improve both access and quality.

CONCLUSION: Cameroon’s MHC disparities stem from systemic resource and quality gaps. Integrating absolute and relative inequality metrics into policy frameworks can dismantle structural biases, aligning interventions with continuum-of-care strategies to prevent avoidable mortality.

PMID:40926204 | DOI:10.1186/s12913-025-13393-2

BMC Endocr Disord. 2025 Sep 9;25(1):207. doi: 10.1186/s12902-025-02038-4.

ABSTRACT

BACKGROUND: Thyroid nodules (TNs) are frequent and often benign. Accurately differentiating between benign and malignant nodules is crucial for proper management. This research aims to use ultrasonography to examine TNs and identify possible risk factors in order to improve patient outcomes and diagnostic accuracy.

METHODS: The study included 128 euthyroid participants who underwent thyroidectomy, splitted into two groups (benign and malignant) regarding the histopathological outcomes. Data on age, sex, family history of thyroid cancer and radiation exposure were collected. Ultrasound (US) was used to assess nodule number, size, vascularity and TIRAD scores. US Lymph node status was also evaluated. Statistical analysis compared benign and malignant nodules.

RESULTS: No significant differences were found between benign and malignant groups regarding age, sex, family history, and radiation exposure. Significant differences were observed in nodule size (p < 0.05), echogenicity (p < 0.001), and margins (p < 0.05), with larger, hyper/isoechoic, and smooth-margined nodules more common in the benign group. TIRAD scores (p < 0.001) and lymph node status (p < 0.001) also differed significantly, with benign cases showing TR3 scores and non-suspicious lymph nodes, while malignant cases had more TR4 scores and suspicious lymph nodes. Additionally, malignant nodules were significantly more hypoechoic (p < 0.001). Most benign cases were nodular colloid hyperplasia, followed by follicular adenoma and thyroiditis. Most malignant cases were Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). PTC was associated with younger age (p = 0.006), smaller nodule size (p = 0.04), and hypoechoic nodules (p = 0.04).

CONCLUSION: Sex, age, family history of thyroid cancer, and radiation exposure history did not significantly vary between groups with benign and malignant thyroid tumors, according to the research. Higher TIRAD scores and hypoechoic nodules were more common in malignant nodules. Benign nodules had smoother margins, were bigger, and were more likely to be hyper/isoechoic.

PMID:40926198 | DOI:10.1186/s12902-025-02038-4

BMC Public Health. 2025 Sep 9;25(1):3043. doi: 10.1186/s12889-025-24378-5.

ABSTRACT

BACKGROUND: Sedentary behavior (SB) and the absence of physical activity (PA) have become increasingly prevalent in modern societies due to changes in physical and social-environmental conditions, particularly in university students. This cross-sectional study aimed to describe and identify the prevalence and correlates of self-reported and accelerometer-determined SB and PA of German university students.

METHODS: A convenience sample of 532 students participated in a questionnaire survey during the lecture period in the summer term 2018. Self-reported total PA, university-, travel-, and leisure-time-related PA were calculated, in addition to self-reported sitting time (ST) within the university. A sub-sample of forty-six participants also received body composition measurements and then wore an ActiGraph wGT3X-BT for seven consecutive days to objectively determine SB, PA, and sleep duration. Differences in descriptive characteristics between samples were analyzed using independent t-test for normally distributed variables or the nonparametric or Mann-Whitney U-Test for not normally distributed variables. Forward stepwise logistic regression analyses were used to analyze correlates associated with self-reported SB and PA in the university context. Stepwise, multiple linear regression analysis was used to determine the associations of anthropometric, sociodemographic, study-related, self-reported SB and PA variables with objectively-determined SB controlling for potential confounders.

RESULTS: Self-reported ST within the university was 2020.5 min/week (95% CI: 1915.8-2125.1), while females reported a 4 h per day higher ST compared with male students (p = 0.023). Self-reported PA exclusively at the university was 211.9 min/week (195.3-228.6) with additional time in active travel (AT) of 266.1 min/week (236.8-295.4). Students with higher amounts of sitting (e.g. in the library or in lectures; p < 0.001) and students who had lower time in AT (p = 0.023) were more likely to be sedentary in the university context. Furthermore, students with a higher monthly net household income (p = 0.043), higher values in university-related PA (e.g. walking between lectures or stair climbing; p < 0.001) and students who were also engaged in higher times of AT (p = 0.004) were more physically active at the university compared with students in the reference group. Correlates associated with accelerometer-determined SB included light-intensity PA (LIPA; p < 0.001), moderate-to-vigorous PA (MVPA; p < 0.001), sleep duration (p < 0.001), monthly net household income (p = 0.006) and total cycling time at the university (p = 0.032).

CONCLUSION: Our sample of university students were highly sedentary, but also very active and met current PA recommendations. Daily LIPA, MVPA and also sleep duration were negatively associated with accelerometer-determined SB. Beyond that, daily AT might be a supporting correlate to reduce SB in university students and should be considered as a key variable in future longitudinal interventional studies on activity-friendly and health promoting university environments.

PMID:40926191 | DOI:10.1186/s12889-025-24378-5

Ren Fail. 2025 Dec;47(1):2556301. doi: 10.1080/0886022X.2025.2556301. Epub 2025 Sep 9.

ABSTRACT

The Grams model, designed to predict adverse event risks in advanced chronic kidney disease (CKD) patients, was evaluated in a Chinese cohort of 1,333 patients with eGFR below 30 mL/min/1.73 m². The model demonstrated moderate to good discrimination across outcomes, performing well in predicting kidney replacement therapy (KRT) but overestimating the risks of cardiovascular disease (CVD) and mortality. Calibration for KRT was accurate, while other outcomes required recalibration to improve alignment with observed data. Although recalibration enhanced calibration, it did not improve the model’s discrimination. Importantly, the study identified key predictors, such as albumin levels, that were not included in the original Grams model but significantly improved prognostic accuracy when incorporated. These findings suggest that while the Grams model has moderate applicability to the Chinese CKD population, its predictive performance can be improved by including additional critical variables. Further efforts are needed to improve the Grams model prior to application in the Chinese CKD population, such as the inclusion of novel valuable predictors.

PMID:40926185 | DOI:10.1080/0886022X.2025.2556301

Matern Child Health J. 2025 Sep 9. doi: 10.1007/s10995-025-04157-9. Online ahead of print.

ABSTRACT

BACKGROUND: While it is well established that trying to conceive while experiencing infertility and undergoing fertility treatment is associated with anxiety, little is known about the mental health toll of trying to conceive without fertility treatment. Minimal contact with the healthcare system while trying to conceive without treatment contributes to low rates of detection and support for this population.

OBJECTIVE: This research aims to provide formative insights into the prevalence of mental health distress and desire for emotional support among people who are trying to conceive without treatment, and how this compares to people who are considering or using fertility treatment.

METHODS: This retrospective cohort study included 3,458 US-based individuals who used Maven, a comprehensive digital platform for reproductive and women’s health. Descriptive statistics and bivariate tests were used to determine differences in prevalence of depression, anxiety, conception-specific anxiety, and interest in receiving emotional support at various stages of the trying to conceive pathway.

RESULTS: Users trying to conceive without treatment, considering treatment, and using treatment screened positive at comparable rates for depression (4.1%, 4.2%, 4.6%; p = 0.82), generalized anxiety (7.5%, 8.9%, 8.8%; p = 0.77), and conception-specific anxiety (22.0%, 23.5%, 20.4%; p = 0.13). Interest in receiving emotional support was lowest in people trying to conceive without treatment, higher among people considering treatment, and highest among people using treatment (32.0%, 34.6%, 39.5%; p = 0.005), respectively.

CONCLUSIONS: People trying to conceive without treatment had comparable rates of anxiety and depression to users considering or undergoing treatment. Across all groups, more than 30% of users reported interest in support for their emotional well-being. Primary care providers and digital health platforms can screen and support this population.

PMID:40926166 | DOI:10.1007/s10995-025-04157-9

Metabolomics. 2025 Sep 9;21(5):136. doi: 10.1007/s11306-025-02335-y.

ABSTRACT

INTRODUCTION: Initially developed for transcriptomics data, pathway analysis (PA) methods can introduce biases when applied to metabolomics data, especially if input parameters are not chosen with care. This is particularly true for exometabolomics data, where there can be many metabolic steps between the measured exported metabolites in the profile and internal disruptions in the organism. However, evaluating PA methods experimentally is practically impossible when the sample’s “true” metabolic disruption is unknown.

OBJECTIVES: This study aims to show that PA can lead to non-specific enrichment, potentially resulting in false assumptions about the true cause of perturbed metabolic states.

METHODS: Using in silico metabolic modelling, we can create disruptions in metabolic networks. SAMBA, a constraint-based modelling approach, simulates metabolic profiles for entire pathway knockouts, providing both a known disruption site as well as a simulated metabolic profile for PA methods. PA should be able to detect the known disrupted pathway among the significantly enriched pathways for that profile.

RESULTS: Through network-level statistics, visualisation, and graph-based metrics, we show that even when a given pathway is completely blocked, it may not be significantly enriched when using PA methods with its corresponding simulated metabolic profile. This can be due to various reasons such as the chosen PA method, the initial pathway set definition, or the network’s inherent structure.

CONCLUSION: This work highlights how some metabolomics data may not be suited to typical PA methods, and serves as a benchmark for analysing, improving and potentially developing new PA tools.

PMID:40926162 | DOI:10.1007/s11306-025-02335-y

Thromb Res. 2025 Sep 5;254:109452. doi: 10.1016/j.thromres.2025.109452. Online ahead of print.

ABSTRACT

Warfarin is a widely used vitamin K antagonist (VKA) with known pleiotropic effects beyond anticoagulation. Preclinical and case-control evidence suggests that warfarin may affect hematopoiesis, but longitudinal human evidence is lacking. To explore this potential effect, we conducted a post-hoc analysis of participants in the Hokusai-VTE and ENGAGE AF-TIMI 48 trials, which randomized patients to warfarin or the direct oral anticoagulant edoxaban with routine laboratory testing at predefined follow-up visits. We analyzed changes in total circulating white blood cells (WBC) and subpopulations (lymphocytes, monocytes, granulocytes) using linear regression and mixed-effects models, adjusting for baseline counts, age, sex, and time. Among 23,618 patients enrolled in the two phase 3 trials, warfarin use was associated with a modest but statistically significant reduction in WBC count (-2.3 %, 95 % CI -2.9 % to -1.7 %) and granulocyte count (-3.6 %, 95 % CI -4.5 % to -2.7 %) compared with edoxaban, while lymphocyte and monocyte counts did not differ. The associations remained consistent across multiple sensitivity analyses. No increase in clinically relevant granulocytopenia was observed. In the context of two large randomized trials, these findings support a subtle hematologic effect of warfarin, particularly in granulocytes, that aligns with preclinical findings and warrants further investigation into the long-term impact of VKAs on hematopoiesis.

PMID:40925065 | DOI:10.1016/j.thromres.2025.109452