Category: Statistics

Rev Bras Ginecol Obstet. 2025 Jul 15;47:e-rbgo55. doi: 10.61622/rbgo/2025rbgo55. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aims to evaluate the clinical and functional implications of cesarean section (CS) skin scars on women’s lives, emphasizing the relationship between scar characteristics and quality of life.

METHODS: In this cross-sectional study, women older than 18 years old who had undergone CS with a Pfannenstiel incision within the past 6-36 months were evaluated. The Patient Scar Assessment Questionnaire (PSAQ) and the Patient and Observer Scar Assessment Scale (POSAS) were used to assess clinical scar parameters. Functionality was appraised using eight questions derived from the International Classification of Functionality, Disability, and Health (ICF). The association between scar appearance scores and functionality questions was analyzed statistically.

RESULTS: Ninety-six women were assessed, revealing that appearance and satisfaction with appearance had the worst scores on the PSAQ. Scar irregularity was the most frequently reported scar characteristic on the POSAS. On the ICF-derived questionnaire, the “self-care” domain was the most affected, with women reporting problems on activities such as choosing swimwear and lingeries. There was a significant correlation (p < 0,05) between the women dissatisfaction with the scar appearance and impairment in ‘interpersonal interactions and relationships’ and ‘self-care’, as the “domestic life” domain wasn’t affected.

CONCLUSIONS: Cesarean section skin scars can lead to dissatisfaction and functional impairments, affecting women’s quality of life. These findings underscore the necessity for multidisciplinary care and thorough discussions about delivery methods to improve post-surgical outcomes.

PMID:40673039 | PMC:PMC12266858 | DOI:10.61622/rbgo/2025rbgo55

Rev Bras Ginecol Obstet. 2025 Jul 15;47:e-rbgo54. doi: 10.61622/rbgo/2025rbgo54. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aims to compare the plasma protein profiles between 7 preeclampsia patients with severe features (PE+) and 7 preeclampsia patients without severe features (PE-) and 10 healthy pregnancies (HP); identify differentially expressed proteins among these groups and explore the altered signaling pathways and their association with the severity of this cardiovascular condition.

METHODS: Plasma proteins were quantified using mass spectrometry, followed by comprehensive bioinformatics and statistical analyses. Protein identification and annotation were performed using UniProt and PatternLab for Proteomics. Multivariate statistical analyses, including PLS-DA and sPLS-DA, as well as VIP score evaluation and Volcano plot visualization, were conducted with MetaboAnalyst to assess group separation and identify key discriminative features. Functional enrichment and pathway analyses were carried out using Metascape.

RESULTS: Using a fold change and volcano plot validation of 1.2, comparisons between HP and PE+ revealed that proteins such as AMBP (inter-alpha trypsin inhibitor light chain), VTN (vitronectin), CLU (clusterin), F2 (prothrombin), and PZP (pregnancy zone protein) were upregulated in PE+. Conversely, ITIH4 (inter-alpha trypsin inhibitor heavy chain H4), APOL1 (apolipoprotein 1) and SERPIND1 (heparin cofactor II) were downregulated in PE+ relative to HP. When comparing HP with PE-, SERPINA3 (alpha-1-antichymotrypsin) and HBB (hemoglobin subunit beta) were downregulated in PE-. Between PE- and PE+, APCS (serum amyloid P component) and HBB were upregulated in PE+; whereas SERPINC1 (antithrombin), PSG1 (pregnancy-specific beta-1-glycoprotein 1), ITIH4, and C5 (complement C5) were downregulated in PE+ compared to PE-.

CONCLUSION: These findings offer valuable insights into the different pathophysiological mechanisms underlying the two subgroups of PE. The upregulated proteins in PE+ (AMBP, VTN, CLU, F2, PZP, APCS, and HBB) play key roles in regulating blood pressure, modulating the extracellular matrix and influencing immune responses. Overall, this research deepens our understanding of the complexity and clinical significance of PE.

PMID:40673030 | PMC:PMC12266872 | DOI:10.61622/rbgo/2025rbgo54

Rev Bras Ginecol Obstet. 2025 Jul 15;47:e-rbgo50. doi: 10.61622/rbgo/2025rbgo50. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate the impact of São Paulo State Law n° 17.137/2019 on the cesarean section rate at a public secondary-level maternity hospital and to analyze predictive factors and complications associated with cesarean under request. This law was enacted to allow pregnant women in São Paulo to request a cesarean section without medical indication.

METHODS: This retrospective study analyzed medical records of pregnant women ≥ 39 weeks gestation attended at the Ribeirão Preto Women’s Health Reference Center (CRSMRP-Mater). Two groups were evaluated: 1,999 patients before the law (July 2018-July 2019) and 3,207 after its implementation (August 2019-July 2021, excluding the suspension period). Descriptive and analytical statistical methods were applied.

RESULTS: The overall cesarean rates increased significantly from 23.6% to 27.7% (p < 0.01), with 15,1% of cesareans during the law period being under maternal request (134 patients). A previous cesarean was the only factor significantly associated with electing a new cesarean. Hospital length of stay was significantly longer in the law period (p < 0.01), possibly reflecting the increased cesarean rate. No significant differences were observed in maternal or neonatal complications between cesareans under request and those conducted for medical reasons.

CONCLUSION: São Paulo State Law n°. 17.137/2019 was associated with an increased cesarean rate in CRSMRP-Mater. The findings highlight the need for robust educational approaches and evidence-based obstetric practices to reduce unnecessary elective cesareans.

PMID:40673026 | PMC:PMC12266855 | DOI:10.61622/rbgo/2025rbgo50

Rev Bras Ginecol Obstet. 2025 Jul 15;47:e-rbgo28. doi: 10.61622/rbgo/2025rbgo28. eCollection 2025.

ABSTRACT

OBJECTIVE: To assess the association between early menarche and the nutritional status of the adolescents from the RPS – Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) birth cohort in São Luís, Maranhão.

METHODS: A longitudinal study with data from the first and third follow-up of the cohort was conducted. A total of 1,225 adolescents aged 18 to 19 years were surveyed and analyzed for age at menarche, defined as early if <12 years old, and for the variable body mass index (BMI) for age, classified into z-scores by sex, as underweight (z-score <-2), adequate weight (z-score ≥-2 and ≤+1), and excess weight (z-score >+1). Directed acyclic graphs were constructed using the DAGitty^® program to select confounding variables for adjustment. Multinomial logistic regression adjusted for confounding variables such as parental obesity (yes or no), skin color (white or non-white), and birth weight (low birth weight, adequate birth weight, and high birth weight) was used to assess the association between early menarche and nutritional status. Statistical analyses were performed using STATA 15.0 software.

RESULTS: Out of the 1,225 adolescents investigated, 32.6% experienced early menarche, and the majority had a BMI appropriate for their age (75.2%). Among adolescents with early menarche, 28.3% were classified as excess weight for their age. Multinomial logistic regression revealed an association between early menarche and excess weight (OR = 1.80; 95% CI = 1.21-2.69; p-value = 0.004).

CONCLUSION: Thus, the results indicate an association between the occurrence of early menarche and excess weight in the investigated adolescents.

PMID:40673021 | PMC:PMC12266849 | DOI:10.61622/rbgo/2025rbgo28

Knee. 2025 Jul 15;56:479-487. doi: 10.1016/j.knee.2025.06.019. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have raised concerns about the potential cytotoxic effects of tranexamic acid (TXA) on cartilage. This study aimed to evaluate the safety of low-dose TXA exposure on human cartilage.

METHOD: In this ex-vivo study, 30 patients with a varus osteoarthritic knee undergoing total knee arthroplasty (TKA) were enrolled. During the surgery, a set of six osteochondral plugs was harvested from the apparently intact lateral condyle of each patient’s femur, resulting in a total of 180 plugs. Subsequently, all three plugs of each set were randomly exposed to one of the TXA treatment groups: 1 mg/ml (TI group), 5 mg/ml (TV group), or 10 mg/ml (TX group) of TXA. The remaining three plugs of each set were assigned to the control group and exposed to 0.9 % saline as a match for comparison. The effects of TXA dose and exposure time on cell viability were assessed using acridine orange/propidium iodide staining at baseline, 3, and 6 h post-exposure.

RESULTS: Cell viability decreased over time in the TI, TV, TX, and control groups compared with their baselines (P = 0.006, P < 0.001, P = 0.001, P < 0.001, respectively). However, the differences in the trend of decline were not statistically significant between groups (P = 0.3), and direct comparisons among TXA concentrations and saline control at baseline, 3, and 6 h after exposure showed no statistically significant difference in cell death (P = 0.538, P = 0.256, P = 0.287, respectively).

CONCLUSIONS: Exposure to low-dose TXA (≤10 mg/ml) for up to 6 h did not cause significant toxic effects on human cartilage.

PMID:40669096 | DOI:10.1016/j.knee.2025.06.019

ESMO Open. 2025 Jul 15;10(8):105496. doi: 10.1016/j.esmoop.2025.105496. Online ahead of print.

ABSTRACT

BACKGROUND: T4 is one of the most important prognostic factors in localized colon cancer (CC), especially in stage II (pT4N0). However, the optimal adjuvant treatment in this subset of patients remains unclear. We present a large, multicenter, international, real-world analysis of pT4N0 CC patients.

PATIENTS AND METHODS: A real-world database regarding clinicopathological characteristics of patients with stage II pT4N0 CC surgically removed between 2010 and 2021 was queried. Primary endpoints were overall survival (OS) and relapse-free survival (RFS), and analyses were adjusted on age (with a cut-off of 75 years) to reduce selection bias.

RESULTS: Our study included 492 patients; outcomes data were available for 390 patients. Median age was 73 years. Microsatellite status was assessed in 294 (75%), including 74 (25%) mismatch repair deficient (dMMR)/microsatellite instability (MSI). Adjuvant chemotherapy was prescribed in 204 patients (52%), mostly oxaliplatin-based (70%). After a median follow-up of 46.8 months, 6 months of adjuvant chemotherapy was associated with a significant improvement in OS [hazard ratio (HR) age-adjusted 0.22, P < 0.001] when compared with no adjuvant. The benefit was seen also with 3 months of adjuvant chemotherapy, even if the benefit was lower (HR age-adjusted 0.60, P < 0.001). Similar results were observed in terms of RFS, with a statistically significant benefit both in the 6-month group (HR age-adjusted 0.47, P = 0.001) and in the 3-month group (HR age-adjusted 0.71, P = 0.001). Considering the regimen and the duration of treatment, 6 months of oxaliplatin-based chemotherapy was associated with a significant improvement in both OS and RFS (P < 0.001). In univariate analysis, MMR status was not associated with OS nor RFS.

CONCLUSIONS: T4 was confirmed to be a poor prognostic factor. Adjuvant chemotherapy provided a large benefit, with a significant reduction in risk of recurrence and death. The benefit was proportional to its duration, and oxaliplatin-based chemotherapy may be better than monotherapy.

PMID:40669095 | DOI:10.1016/j.esmoop.2025.105496

JMIR Res Protoc. 2025 Jul 16;14:e63549. doi: 10.2196/63549.

ABSTRACT

BACKGROUND: Nursing in palliative medicine combines primary patient care with the special challenges of this medical field (eg, handling the processes of dying, grief, and death). These cause high stress levels and burden on the nursing staff, resulting in an early exit from working life because of physical or psychological disorders like burnout.

OBJECTIVE: DiPa (digitally identifying and minimizing stressors in palliative care) is a prospective study investigating the feasibility of measuring burden and its causes in palliative care using methods of subjective and objective stress detection. Based on these results, stress-reducing interventions are to be deduced and evaluated. In this paper, we present our study protocol.

METHODS: The nursing staff of an inpatient university palliative hospital ward gathered data over 6 weeks. Each was equipped with a smart wristband and a smartphone that continuously measure physiological and ambient parameters throughout their working day. These objective data were enriched by subjective measurements: a questionnaire at the beginning of the study that assessed multiple potential stressful situations and constellations in the private and working environment as well as ecological momentary assessments (EMAs) during the workday. The EMAs were prompted by scanning near-field communication (NFC) tags placed at different locations on the ward. The ongoing data analyses will be processed using computer algorithms partly programmed specifically for this study and partly drawn from existing libraries, such as toolboxes for neurophysiological signal processing for Python. Comparisons between subjective and objective measures and group comparisons between variables of interest will be made using inferential statistics, including regression analyses and analyses of variance. Data analysis using machine learning algorithms will be implemented once sufficient data are gathered.

RESULTS: The study was funded in October 2019. As of July 2025, 12 of 18 nurses in the palliative care unit consented to participate in our study. We expect to start detailed data analysis in in the third quarter of 2025 and to finish and publish our results in 2026.

CONCLUSIONS: The DiPa study aims at testing the feasibility of measuring and merging subjective and objective stress parameters for palliative care nurses.

TRIAL REGISTRATION: German Register for Clinical Studies DRKS00024425; https://drks.de/search/en/trial/DRKS00024425/details.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63549.

PMID:40669075 | DOI:10.2196/63549

JMIR Form Res. 2025 Jul 16;9:e65157. doi: 10.2196/65157.

ABSTRACT

BACKGROUND: Nigeria has one of the highest child mortality rates globally, with 111 deaths per 1000 live births. Exclusive breastfeeding (EBF) improves infant survival by providing essential nutrients and antibodies that protect against infections and diseases. Despite its benefits, EBF rates in Nigeria remain low at 29%, largely due to limited health care support and breastfeeding guidance. With the proliferation of mobile phones in Nigeria, mobile health (mHealth) interventions are being explored as scalable solutions. SMS text messaging interventions have demonstrated success in delivering behavioral interventions; yet, few use artificial intelligence (AI) for personalized breastfeeding support.

OBJECTIVE: This study evaluates the effectiveness of Mwana, an AI-powered SMS-based app, in improving breastfeeding outcomes for postpartum mothers in Lagos, Nigeria.

METHODS: Mwana was developed using TextIt for SMS integration and Meta’s Wit.ai for natural language processing (NLP). The chatbot provides breastfeeding support via SMS, offering personalized tips, addressing common challenges, and connecting users to human agents when necessary. The intervention was piloted with 216 postpartum mothers recruited through local health care networks, focusing on usability, usefulness, and engagement. The study used a mixed methods approach, using structured surveys and observation to assess participant experiences at multiple intervals over a 6-month period. Primary outcomes measured were app usability, usefulness, and breastfeeding adherence.

RESULTS: The intervention was well-received, with high scores for both usefulness (mean 4.01, SD 1.41) and usability (mean 3.92, SD 1.35) on a 5-point scale. The majority of respondents, 57% (118/206), rated the chatbot’s usefulness at the highest score of 5. Qualitative feedback statements identified areas for improvement, including enhancing AI comprehension, response times, and human-like interaction.

CONCLUSIONS: The study highlights the potential of Mwana to improve breastfeeding outcomes in resource-limited settings, contributing to the growing body of evidence supporting mHealth interventions in maternal and child health. By leveraging personalized messaging, SMS-based delivery, and language localization, Mwana offers a scalable, accessible solution. However, challenges remain regarding AI comprehension, and further research is necessary to evaluate Mwana’s effectiveness among populations not actively engaged with health care services. Future iterations will expand AI training datasets, refine NLP capabilities, and scale to broader populations.

PMID:40669071 | DOI:10.2196/65157

JMIR Serious Games. 2025 Jul 16;13:e73044. doi: 10.2196/73044.

ABSTRACT

BACKGROUND: Virtual reality (VR) interventions are emerging as promising nonpharmacological strategies for people with dementia, aiming to prevent cognitive decline, reduce behavioral and psychological symptoms of dementia (BPSD), and alleviate caregiver burden. Although some studies have reported beneficial effects, findings remain inconsistent, and little is known about the duration and sustainability of these effects, particularly in real-world care settings.

OBJECTIVE: This study aimed to examine both the immediate and long-term effects of an immersive VR reminiscence intervention on BPSD and caregiver burden in people with dementia attending day care centers.

METHODS: This longitudinal observational study was conducted in 10 dementia day care centers in Kaohsiung, Taiwan. A total of 82 participants with dementia were enrolled. The VR intervention consisted of twice-weekly sessions over one month, featuring culturally familiar live-action 360° scenes filmed in well-known Taiwanese locations. Each session lasted approximately 10-12 minutes and included interactive elements. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire, and caregiver burden was assessed using the Zarit Caregiver Burden Interview. Measurements were taken at 3 time points: preintervention, immediately postintervention, and 2 months after the intervention ended. The Wilcoxon signed-rank test was used for statistical comparisons, and rank-biserial correlation was calculated as the effect size.

RESULTS: Significant improvements were observed after 1 month of VR intervention in both caregiver burden (Z=-3.095, P=.002, r=0.34) and neuropsychiatric symptoms (Z=-2.929, P=.003, r=0.32). At the two-month follow-up, neuropsychiatric symptoms remained significantly improved (Z=-4.327, P<.001, r=0.48), although caregiver burden returned to preintervention levels. Regarding specific neuropsychiatric symptoms, significant improvements were observed immediately after the intervention in dysphoria or depression, anxiety, and sleep or nighttime behaviors. These effects were sustained over time, with additional long-term improvements noted in euphoria or elation, apathy or indifference, irritability or lability, aberrant motor behavior, and appetite or eating behaviors.

CONCLUSIONS: A 1-month immersive VR reminiscence intervention appears to improve neuropsychiatric symptoms and temporarily reduce caregiver burden in people with dementia, with some symptom improvements lasting up to 2 months. These findings suggest that VR may offer a meaningful therapeutic option in day care settings. Future studies with control groups, including nonimmersive 2D conditions, and comparisons to traditional reminiscence therapy are needed to validate and expand upon these findings.

PMID:40669069 | DOI:10.2196/73044

JMIR Hum Factors. 2025 Jul 16;12:e57314. doi: 10.2196/57314.

ABSTRACT

BACKGROUND: A guideline-based clinical decision support system (CDSS) is a knowledge-based system designed to collect crucial data from electronic medical records to generate decision-making based on system data requirements and inputs from standard guidelines. Despite the potential to enhance health care delivery, the adoption rate of CDSSs in clinical practice remains suboptimal.

OBJECTIVE: This study aimed to evaluate the determinants influencing the intention to use a new CDSS in preventive care within clinical practice.

METHODS: A single-center, questionnaire-based, cross-sectional study was conducted among physicians and medical students responsible for providing comprehensive preventive services at the Continuity of Care Clinic, Siriraj Hospital, Thailand.

RESULTS: In total, 89 participants were enrolled. Relationships between factors impacting the adoption of CDSSs were analyzed using correlation and regression analysis. We found that physicians’ intentions to adopt the CDSS for preventive care were high, with 79% (70/89) of participants expressing their intention to use the system. According to the study’s conceptual framework, modified from the original unified theory of acceptance and use of technology model, physicians’ positive attitudes toward CDSS use in preventive services and a high level of effort expectancy emerged as crucial factors influencing the intention to use the new CDSS. The odds ratios for these factors were 5.44 (95% CI 1.62-18.34, P=.006) and 7.60 (95% CI 1.55-31.37, P=.01), respectively. Similar results were observed for medical students and for physicians who had graduated. The most prevalent barriers to CDSS implementation were related to physicians’ attitudes, followed by issues such as the accuracy and burden of data input, time constraints for clinicians, and the risk of workflow disruption.

CONCLUSIONS: There was a high intention to adopt the CDSS in preventive care. Positive physician attitudes toward CDSS use in preventive services and effort expectancy were found to be critical factors influencing the intention to use the new CDSS.

PMID:40669060 | DOI:10.2196/57314