Category: Statistics

BMC Nurs. 2025 Jul 17;24(1):935. doi: 10.1186/s12912-025-03601-z.

ABSTRACT

BACKGROUND: Ventilator-associated pneumonia (VAP) poses a significant challenge in critical care settings, impacting patient outcomes and healthcare costs. In Saudi Arabia, several studies have reported concerns regarding VAP, including variable VAP rates, inconsistent compliance with and knowledge of VAP prevention practices, and inadequate national data.

OBJECTIVES: To investigate the intensive and critical care nurses’ (ICCNs) self-reported perceived compliance with VAP prevention guidelines, barriers and challenges in caring for mechanically ventilated patients, the demographic variables that associate compliance and factors affecting VAP prevention, and the association between perceived compliance and the barriers affecting the care of mechanically ventilated patients.

METHODS: A descriptive, correlational, and cross-sectional design was used. ICCNs (n = 152) were conveniently recruited from two tertiary government-owned hospitals. Data were collected using self-report scales from April to June 2024. Descriptive and inferential statistics were used for data analyses.

RESULTS: Findings showed that 43% of ICCNs had high compliance with VAP prevention guidelines. The use of protective gloves at every approach to a patient (96.70%) was the VAP guideline that received the highest perceived compliance among ICCNs. Meanwhile, those with 11 to 15 years of experience were more compliant (p = 0.023) than other groups and demographics. Major barriers to compliance included nursing staffing shortages (94.10%) and limited resources (75.00%). Only ICCNs with 11 to 15 years of experience showed greater awareness of VAP prevention guidelines (p = 0.023). Nurses’ nationality, i.e., non-Saudi nurses (p = 0.024) and higher educational levels (p = 0.005), demonstrated greater awareness of barriers to managing and caring for mechanically ventilated patients. ICCNs perceived barriers negatively influenced their perceived compliance with VAP prevention (p = 0.002), indicating that increased barriers are associated with lower compliance. Finally, the considerable challenges in VAP prevention were time constraints and the need for more communication among the health team.

CONCLUSION: Staffing shortages and resource limitations impacted ICCNs’ compliance with VAP prevention guidelines. Furthermore, they became less compliant with higher VAP barrier perceptions. Time constraints and team communication were considerable challenges in VAP prevention. As a result, nurse managers could create comprehensive programs like long-term VAP prevention training and interdisciplinary collaboration in the ICU. Healthcare organization administrators should enhance resource allocation and policy formulation to foster compliance.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40676608 | DOI:10.1186/s12912-025-03601-z

BMC Public Health. 2025 Jul 17;25(1):2482. doi: 10.1186/s12889-025-23701-4.

ABSTRACT

INTRODUCTION: Anemia is a major public health issue that significantly affects health, as well as social and economic development worldwide. Among adolescent girls, the prevalence of anemia is higher due to increased demands for blood volume expansion associated with the onset of menstruation and the rapid growth during adolescence. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled prevalence of anemia and its associated factors among adolescent girls in East and West African countries.

METHODS: All published and unpublished studies from East and West Africa available in PubMed, the Cochrane Library, Hinari, and Google Scholar were screened based on their titles, abstracts, study design, and full-text review before inclusion in the meta-analysis. Data were extracted after assessing the quality of evidence using the Joanna Briggs Institute (JBI) critical appraisal tool for cross-sectional studies. Microsoft Excel was used for data extraction, and STATA version 14 was employed for statistical analysis. A forest plot was used to display the pooled prevalence of anemia among adolescent girls in East and West Africa. Heterogeneity was assessed using random-effects models, subgroup analysis, meta-regression, and sensitivity analysis. Publication bias was evaluated using Egger’s regression test and funnel plot analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to present the factors associated with anemia among adolescent girls.

RESULTS: A total of twenty-nine studies involving 12,905 participants were included in the analysis. The pooled prevalence of anemia among adolescent girls was 32.88% [95% CI: 24.62%, 41.14%], based on a random-effects model. The meta-analysis also identified significant associations between anemia and certain factors. Adolescent girls living in rural areas were more likely to have anemia compared to those in urban areas (OR = 4.19; 95% CI: 1.42, 12.41; I² = 76.2%, p = 0.006). Additionally, girls who had not heard about anemia had significantly higher odds of being anemic (OR = 12.25; 95% CI: 4.59, 32.64; I² = 81.1%, p < 0.01).

CONCLUSION: The pooled prevalence of anemia among adolescent girls in East and West African countries represents a moderate public health concern. Adolescent girls living in rural areas and those who had not heard about anemia were significantly more likely to develop the condition. Addressing this nutritional challenge requires strong intersectoral collaboration between the health and education sectors to promote awareness, prevention, and effective interventions targeting adolescent girls.

PMID:40676606 | DOI:10.1186/s12889-025-23701-4

BMC Med Res Methodol. 2025 Jul 17;25(1):175. doi: 10.1186/s12874-025-02618-x.

ABSTRACT

BACKGROUND: Individualized prediction of health outcomes supports clinical medicine and decision making. Our primary objective was to offer a comprehensive survey of methods for the dynamic prediction of Alzheimer’s disease (AD), encompassing both conventional statistical methods and deep learning techniques.

METHODS: Articles were sourced from PubMed, Embase and Web of Science databases using keywords related to dynamic prediction of AD. A set of criteria was developed to identify included studies. The correlation information for the construction of models was extracted.

RESULTS: We identified four methodological frameworks for dynamic prediction from 18 studies with two-stage model (n = 3), joint model (n = 11), landmark model (n = 2) and deep learning (n = 2). We reported and summarized the specific construction of models and their applications.

CONCLUSIONS: Each framework possesses distinctive principles and attendant benefits. The dynamic prediction models excel in predicting the prognosis of individual patients in a real-time manner, surpassing the limitations of traditional baseline-only prediction models. Future work should consider various data types, complex longitudinal data, missing data, assumption violations, survival outcomes, and interpretability of models.

PMID:40676602 | DOI:10.1186/s12874-025-02618-x

BMC Cancer. 2025 Jul 17;25(1):1183. doi: 10.1186/s12885-025-14065-4.

ABSTRACT

BACKGROUND: DNA damage and repair (DDR) is involved in the antitumor immune response, however, the correlation between DNA damage response with immunotherapy in NSCLC remain unclear. We examined the relationship between DDR alterations and expression of PD-L1 in non-small cell lung cancer.

METHODS: Tumor tissues, para-carcinoma and normal tissues, were obtained from 54 patients who were surgically resected NSCLC tumors. Patient characteristics, neoplasm staging and pathological information were collected. Immunohistochemical analysis of tissue samples was analyzed for γH2AX、RAD51, PARP-1 and PD-L1 protein expression.

RESULTS: A total of 54 patients with non-small cell lung cancer were included in this study, including 24 males and 30 females with ages ranging from 45 to 79 years (mean, 63.5 years). The high expression rate of γH2AX staining in lung cancer was 81.5%(44/54)and the expression levels of γH2AX protein were significantly higher in NSCLC than those in paired para-carcinoma 50%(27/54) and normal tissues 42.6%(23/54). The expression levels of RAD51 protein were significantly higher in lung cancer tissue 68.5%(37/54) than those in paired para-carcinoma 48.1%(26/54) and normal tissues 40.7%(22/54). There was a significant correlation between high RAD51 expression and male patients 87.5%(21/24) (p = 0.009) and a history of smoking 90%(18/20) (p = 0.014). The presence of any DDR alteration was showed with PD-L1. (1) HigherγH2AX expression was observed in the PD-L1 positive cases 90.6% (29/32) compared to the PD-L1 negative cases 68.2% (15/22). Lung cancers with higher γH2AX expression were associated with the higher expression of PD-L1 (p = 0.046, r = 0.284). (2) There was no statistically significant correlation between expression of PD-L1 and RAD51 (p = 0.221, r = 0.168). (3) Higher PARP-1 expression was observed in the PD-L1 negative cases 59.1% (13/22) compared to the PD-L1 positive cases 25% (8/32). Lung cancers with higher PARP-1 expression were associated with the lower expression of PD-L1 (p = 0.009, r=-0.344). (4) No statistically significant association was observed in relationship between expression of DDR Expression (γH2AX、RAD51) and PARP-1 of patients (p = 0.507 and p = 0.817,respectively).

CONCLUSION: Overall, our study shows that high expression of γH2AX, RAD51, and PARP1 proteins display in NSCLC and proves that DNA damage repair may be closely related to the occurrence and development of NSCLC. γH2AX could be a predictor of the adaptation of ICIs as an alternative to PD-L1, and NSCLC is expected to benefit from PARP-1 inhibitors combined with immunotherapy.

PMID:40676600 | DOI:10.1186/s12885-025-14065-4

J Hazard Mater. 2025 Jul 16;496:139257. doi: 10.1016/j.jhazmat.2025.139257. Online ahead of print.

ABSTRACT

Diabetes and kidney diseases are complex disorders influenced by organ-specific abnormalities and systemic dysregulation. Previous research suggests per- and polyfluoroalkyl substances (PFAS) can interfere with glucose metabolism and kidney function, but their impact on pancreas-kidney inter-organ crosstalk is unclear. In this study, we conducted a three-wave repeated-measures analysis, in a non-diabetic, non-chronic kidney disease (CKD) cohort. We assessed 23 PFAS, 23 amino acids, 5 glucose indicators, and 3 renal biomarkers across three visits. Our findings showed that perfluorooctane sulfonate (PFOS) was linked to both glucose and renal biomarkers, suggesting its potential role in impairing pancreas-kidney crosstalk. We also identified amino acids, particularly serine and citrulline, as key mediators in this process, implicating amino acid metabolism as a common mechanism through which PFOS influences inter-organ communication. Serine was found to positively mediate approximately 50 % of the total effect of PFOS exposure on insulin and glucose metabolism, while citrulline negatively mediated about 15 % of PFOS’s effects on kidney function biomarkers. These results highlight PFOS’s role in disrupting pancreas-kidney crosstalk within a non-diabetic, non-CKD cohort and provide new insights into amino acid regulation in metabolic and kidney diseases. This is the first study to demonstrate PFAS involvement in this inter-organ crosstalk and suggests a novel mechanism involving amino acids.

PMID:40674800 | DOI:10.1016/j.jhazmat.2025.139257

J Surg Res. 2025 Jul 16;313:222-229. doi: 10.1016/j.jss.2025.06.019. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the accessibility of online health resources for nipple reconstruction in English and Spanish to identify areas of improving information access.

METHODS: A deidentified Google search was conducted using the search phrase “nipple reconstruction” in English and “reconstrucción del pezón” in Spanish. The first ten websites in English and Spanish were included. A quality assessment of these websites was performed using the Patient Education and Materials Assessment Tool, Cultural Sensitivity Assessment Tool, and Simple Measure of Gobbledygook to evaluate understandability and actionability, cultural sensitivity, and readability, respectively. Unpaired t-tests and Chi-square tests were used to analyze differences between the groups.

RESULTS: English sites scored similarly to Spanish sites on understandability (70.1% versus 71.0%, P = 0.82) and actionability (46.3% versus 37.5%, P = 0.27), although actionability scores were below the acceptable threshold (70%) in both groups. English sites were significantly more culturally sensitive than Spanish sites (60% versus 10%, P < 0.001). English sites had a statistically significant higher average reading grade level compared to Spanish sites (12.3 versus 10.4, P = 0.005); however both groups exceeded recommended reading grade levels for online health resources. For websites from the same organization, English websites tended to be difficult to read; however, more culturally sensitive, compared to Spanish ones.

CONCLUSIONS: These findings suggest areas of improvement for culturally competent care for reconstruction patients. Improving the readability of online health resources for nipple reconstruction is essential in enabling patients to create informed decisions about their reconstructed breast.

PMID:40674797 | DOI:10.1016/j.jss.2025.06.019

J Surg Res. 2025 Jul 16;313:198-209. doi: 10.1016/j.jss.2025.06.024. Online ahead of print.

ABSTRACT

INTRODUCTION: Uptake of minimally invasive surgery (MIS) in low- and middle-income countries (LMICs) has been slow due to various barriers. This study examined the experiences of surgeons across multiple countries, highlighting the complications and challenges that arise with MIS.

METHODS: Forty-one surgeons from Japan, Singapore, Uganda, the United States, Cambodia, Vietnam, and Malaysia completed 12-question surveys detailing the challenges of their MIS cases. Data were collected from April 2021 to February 2023, and descriptive statistics were generated.

RESULTS: A total of 198 MIS cases were reported by 36 surgeons during the study period. In LMICs, patients tended to be older (P < 0.001), more likely to be female (P < 0.001), and have fewer comorbidities (P < 0.01) than in high-income countries (HICs). Antireflux procedures, appendectomies, and cholecystectomies were the most common MIS performed. Surgical assistants varied, with Japanese surgeons reporting the highest usage of experienced surgeons as assistants (n = 53, 56%). Minimal blood loss was perceived for 80% of cases in HICs (n = 99), whereas greater than minimal blood loss was perceived in LMICs (n = 41, 55%; P < 0.001). While most HIC surgeons found cases easy (n = 93, 75%) with no technical challenges, a higher percentage of LMIC surgeons considered converting to open procedures (n = 5, 7%) or had to convert (n = 6, 8%; P < 0.001). Thematic grouping identified four key barriers in LMICs: access to resources, maintenance of equipment, difficult intraoperative pathology, and surgical training availability.

CONCLUSIONS: This study highlights significant differences in the MIS experience between HICs and LMICs. Technical difficulties and intraoperative challenges were more frequent in LMICs, and all cases converted to open procedures originated from these regions. The identified barriers-access to resources, equipment maintenance, difficult intraoperative pathology, and surgical training-are critical areas that need targeted interventions.

PMID:40674795 | DOI:10.1016/j.jss.2025.06.024

Mol Biochem Parasitol. 2025 Jul 16;263:111689. doi: 10.1016/j.molbiopara.2025.111689. Online ahead of print.

ABSTRACT

Ovine theileriosis is a disease caused by the genus Theileria (e.g., T. ovis, T. lestoquardi), preventing the sheep farming industry from developing, particularly in regions reliant on sheep for milk, meat, and associated economic benefits. However, there is limited information available on the epidemiological data and genetic diversity of T. ovis in Xinjiang. This study was conducted in May 2024 to investigate the molecular prevalence of T. ovis in sheep from five counties (Shaya, Wensu, Aketao, Keping, Awati) in Xinjiang. A total of 357 blood samples were screened for the presence of Theileria DNA through the amplification of the 18S rRNA gene using PCR, the genetic diversity among the chosen T. ovis sequences from geographical regions (including sequences in this study) was subsequently analyzed. BLAST analysis confirmed that the detected Theileria pathogen was T. ovis. Statistical results showed that the infection rate of T. ovis in sheep was 44.5 % (159/357). The highest infection rate was observed in Awati County, while the lowest was recorded in Shaya County. The prevalence exhibited significant variation among the sampling sites (χ² = 115.3, p < 0.05). To characterize the phylogenetic relationships within the detected Theileria populations, the sequenced T. ovis isolates were analyzed and found to be 96.6-99.8 % similar, showing a high degree of similarity to isolates from Turkey. Haplotype analysis further demonstrated that H1 constitutes the core haplotype (including sequences from Turkey, Iraq and Saudi Arabia), surrounded by derivative haplotype. To further investigate these haplotype distributions, population structure analysis revealed distinct genetic diversity patterns among groups, showing that genetic groups G1 and G4 had high haplotype diversity (Hd) but low nucleotide diversity (Pi), whereas G2 and G3 had low Hd and high Pi. In addition, Tajima’s D＜0 in all four T. ovis populations. These biological and genetic indices suggest that these populations are possibly undergoing expansion. Our results suggest that the protozoan parasitizing local sheep is T. ovis. Moreover, the local population of T. ovis is as rich in genetic diversity and population expansion as other populations in different geographical locations.

PMID:40674794 | DOI:10.1016/j.molbiopara.2025.111689

Gen Hosp Psychiatry. 2025 Jul 10;96:156-167. doi: 10.1016/j.genhosppsych.2025.07.008. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: With China’s aging population, the prevalence of cognitive frailty (CF) is increasing, posing significant risks such as reduced quality of life, higher hospitalization and mortality rates, cognitive impairment, and dementia. This study aimed to determine the prevalence of CF among Chinese older adults through a systematic review and meta-analysis to provide evidence that informs healthcare policy and practice.

METHODS: A systematic search was conducted across eight databases: PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and SinoMed from their inception up to April 5, 2024. Observational studies (cross-sectional, cohort, or population-based longitudinal studies) were included. Two researchers independently reviewed the literature, extracted data, and assessed the quality of the studies. All statistical analyses were performed using Stata 14.2.

RESULTS: A total of 79,059 records were screened, of which 93 studies involving 89,760 Chinese older adults met the inclusion criteria. The pooled CF prevalence was determined to be 21 % (95 % CI: 0.19, 0.23, P < 0.001). Notably, CF prevalence varied significantly across subgroups, depending on variables such as age, gender, education, marital status, living arrangements, presence of hypertension, presence of diabetes, BMI, history of falls, nutritional status, sleep condition, exercise, activities of daily living, polypharmacy, and presence of depressive symptoms (all P < 0.001).

CONCLUSIONS: This study revealed a pooled CF prevalence of 21 % among Chinese older adults, with a concerning upward trend from 2012 to 2023. The CF prevalence was influenced by demographic, health, and lifestyle factors. These findings underscore the complexity of CF and highlight the need to identify key risk and protective factors, as well as to develop targeted interventions that address both health and lifestyle factors in this population.

PMID:40674778 | DOI:10.1016/j.genhosppsych.2025.07.008

Medwave. 2025 Jul 17;25(6):e3056. doi: 10.5867/medwave.2025.06.3056.

ABSTRACT

INTRODUCTION: Motor skills encompass a series of movements essential for daily activities and have been associated with well-being and child development. However, there are various external and internal conditions that can affect children’s motor development. Therefore, the purpose of our study was to analyze the motor skills of Peruvian children aged three to six years and compare differences based on region, sex, age, and type of educational institution.

METHODS: An observational study was conducted with a sample of 265 children aged three to six years from public and private institutions in three regions of Peru: the central region (Metropolitan Lima), the jungle region (Tarapoto), and the southern region (Chincha Alta). The Test of Gross Motor Development, Third Edition (TGMD-3) was applied. Data were processed and analyzed using descriptive statistics and non-parametric tests such as the Mann-Whitney U test and Kruskal-Wallis test (p<0.05). Additionally, a multiple linear regression analysis with robust standard errors was conducted.

RESULTS: The results revealed significant differences between regions. Children from the Selva (Tarapoto) and Sur (Chincha) regions of Peru reported higher scores than those from the central region. In addition, girls reported higher scores than boys in locomotor skills. Also, it was found that motor performance usually reaches better performance after five years and six months of age.

CONCLUSIONS: It is concluded that infant motor performance varies by region, age and sex. Therefore, future interventions adjusted for these variables are required to strengthen and improve these skills.

PMID:40674770 | DOI:10.5867/medwave.2025.06.3056