Category: Statistics

Pharmacoeconomics. 2025 Sep 8. doi: 10.1007/s40273-025-01537-5. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is a major contributor to the health and economic burden of disease globally. In this paper we discuss the literature on the health economics of the prevention and early intervention in CVD. We reveal the large economic impact of CVD and provide the economic argument supporting the calls for early detection and diagnosis of CVD outlined in the Global Heart Hub’s patient-led Manifesto for Change. Many challenges in conducting cost-effectiveness analyses of interventions for CVD prevention are identified, as well as the emerging statistical and economic methods to help overcome these issues. Lastly, we acknowledge the profound disparities in cardiovascular health faced by minority or underserved populations, and the important role that prevention and early intervention can play in improving health equity.

PMID:40921978 | DOI:10.1007/s40273-025-01537-5

J Mol Histol. 2025 Sep 8;56(5):303. doi: 10.1007/s10735-025-10513-4.

ABSTRACT

Survivin, an inhibitor of apoptosis protein, is minimally expressed in normal adult tissues but overexpressed in multiple cancers. This study investigates survivin expression alongside autophagy markers ATG7 and LC3B in seven solid tumor types in Indian patient samples. Immunohistochemical analysis was performed on 48 cancer tissue samples (breast n = 7, buccal n = 6, cervical n = 5, colon n = 8, renal n = 6, liver n = 10, thyroid n = 6) and adjacent normal tissues (n = 9) using anti-human antibodies against survivin, ATG7, and LC3B. Expression levels were semi-quantitatively scored (0-3 +) and statistically analyzed. Survivin demonstrated significant overexpression in cancer tissues compared to normal tissues across all tumor types (p ≤ 0.05-0.0001). Moreover, a statistically significant inverse correlation was observed between survivin and autophagy marker (ATG7/LC3B) expression in 85% of examined samples. Breast, buccal, liver, and kidney cancers showed strong-to-moderate survivin expression in > 50% of cases, while thyroid cancers exhibited predominantly weak survivin expression with strong autophagy marker expression. These findings demonstrate consistent survivin overexpression with concomitant autophagy suppression in Indian cancer patients. The inverse relationship between survivin and autophagy marker expression suggests survivin inhibition as a potential therapeutic strategy to activate autophagic cell death, particularly in breast, buccal, liver, and kidney cancers with high survivin expression. Future large-scale validation studies and mechanistic investigations are warranted to translate these findings into personalized survivin-targeted therapeutic strategies. This study contributes to a better understanding of survivin and its relation to autophagy in various solid tumors, paving the way for novel therapeutics for cancer.

PMID:40921963 | DOI:10.1007/s10735-025-10513-4

Obes Surg. 2025 Sep 8. doi: 10.1007/s11695-025-08222-8. Online ahead of print.

ABSTRACT

BACKGROUND: Bariatric surgery pre-operative workup mandates many multidisciplinary visits demanding patient’s commitment in time and travel. Due to the COVID pandemic, our bariatric clinic transitioned to a telemedicine model. The objective of this work is to determine the impact of this shift.

METHODS: Our population is adults who underwent gastric bypass or sleeve gastrectomy at a single hospital between 2018 and 2022. We analyzed the impact of telemedicine on demographics, days from consultation to surgery, length of hospital stay, type of procedures, BMI, and complications. Statistical analyses were conducted using χ² tests for categorical variables and t-test for continuous variables as well as logistic regression.

RESULTS: Of 794 patients, 71.3% received in-person care while 28.7% received telemedicine. There were no differences in race, ethnicity, or gender. The average duration from consultation to surgery was longer (p < 0.001) for in-person (551.1 days) compared to telemedicine (375.8 days). The pre-operative BMI was higher for the in-person cohort versus telemedicine (45.5; SD 8.0 vs. 43.9; SD 6.7; p < 0.001), but there was no difference in percent weight loss at 12 months. The average length of stay was longer in the in-person group compared to telemedicine (1.9 vs 1.2 days). There was no difference in readmission or emergency department visit rates.

CONCLUSION: Despite being the best treatment for severe obesity, bariatric surgery remains underutilized. When comparing telemedicine to an in-person model, we found shorter time to surgery, shorter length of stay, and similar outcomes with no difference in weight loss or complications. Telemedicine may be a safe and useful way to improve access.

PMID:40921958 | DOI:10.1007/s11695-025-08222-8

Obes Surg. 2025 Sep 8. doi: 10.1007/s11695-025-08228-2. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is the most effective obesity treatment. The increasing number of MBS among young patients has led to more post-bariatric pregnancies. Our study investigates how breastfeeding duration impacts postpartum weight retention and health outcomes for mothers and babies after MBS.

METHODS: MOMBARIS (Maternal Outcomes of Bariatric Surgery and Pregnancy Study) is a multicentre study. The population is derived from MOMBARIS 2, which focused on obstetric outcomes. It included patients who became pregnant following MBS, analysing pre-operative metrics, type of surgery, pregnancy details, and breastfeeding duration. Data analysis was conducted using Julius.ai.

RESULTS: We analysed 156 patients post-MBS, with 148 pregnancies leading to childbirth. Among them, 131 had laparoscopic sleeve gastrectomy (LSG), 12 underwent Roux-en-Y gastric bypass (RYGB), and 5 had one anastomosis gastric bypass (OAGB). The mean age was 31.7 ± 5.45 years (range 19-48) with a pre-operative BMI of 43.9 kg/m² ± 5.8 kg/m² (range 31.9-68.8). The mean %EWL was 72% (± 28.6). Seventeen patients had multiple children. Breastfeeding results indicated that 116 patients (78.4%) initiated breastfeeding, with 40.5% continuing beyond 6 months. No significant differences were found in BMI metrics across breastfeeding groups.

CONCLUSIONS: Bariatric outcomes (%EWL, %TWL) show no statistical difference based on breastfeeding patterns, nor does breastfeeding significantly affect weight loss maintenance post-surgery. Additionally, delaying pregnancy after surgery does not guarantee more significant weight loss.

PMID:40921955 | DOI:10.1007/s11695-025-08228-2

Int J Clin Oncol. 2025 Sep 8. doi: 10.1007/s10147-025-02875-2. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the effects of cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT), individually and in combination, on alleviating anxiety and depression, and improving quality of life (QoL) in breast cancer patients.

METHODS: We searched PubMed and EMBASE for articles published up to April 6, 2025, using the keywords “randomized controlled trials (RCTs)”, “cognitive-behavioral therapy”, “mindfulness-based therapy”, and “breast cancer”. Pooled effects were expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs).

RESULTS: Fifty-one RCTs were included. Compared with controls (usual care, wait-list control, etc.), CBT and MBT (analyzed separately or in combination) demonstrated significant benefits. The SMDs (95% CIs) were as follows: anxiety [CBT ( – 0.33, – 0.52 to – 0.14); MBT ( – 0.80, – 1.16 to – 0.45); combined ( – 0.55, – 0.74 to – 0.37)], depression [CBT ( – 0.31, – 0.49 to – 0.14); MBT ( – 0.80, – 1.12 to – 0.48); combined ( – 0.55, – 0.73 to – 0.37)] and QoL [CBT (0.38, 0.15 to 0.62); MBT (0.33, 0.11 to 0.55); combined (0.37, 0.20 to 0.53)]. MBT showed significantly greater efficacy than CBT for anxiety (p = 0.020) and depression (p = 0.009). Pooled effects of CBT and MBT were stronger for group-based and longer duration interventions (all outcomes), with effects on depression and QoL being especially strong in Asians. Face-to-face CBT outperformed internet-delivered CBT across all outcomes.

CONCLUSION: CBT and MBT, individually and combined, are effective for anxiety, depression, and QoL in breast cancer patients, with MBT demonstrating superior efficacy for anxiety and depression. The selection of psychological treatments for breast cancer patients should consider intervention method, ethnicity, intervention duration, and delivery format.

PMID:40921953 | DOI:10.1007/s10147-025-02875-2

Invest New Drugs. 2025 Sep 9. doi: 10.1007/s10637-025-01584-x. Online ahead of print.

ABSTRACT

In China, many solid tumor drugs have been approved via the accelerated approval (AA) pathway. We extracted data regarding indications for solid tumor-treating drugs approved by the National Medical Products Administration (NMPA) between 2015 and 2023, along with their corresponding Chinese Society of Clinical Oncology (CSCO) guideline recommendation levels and inclusion data. Descriptive statistics, Fisher’s exact tests, and t-tests were used to examine associations between NMPA approval pathways and CSCO guideline recommendation levels. The study included 92 solid tumor drugs comprising 191 indications. Sixty-three indications were approved via the regular approval (RA), and 128 were approved via the AA. One hundred fifty-seven indications obtained CSCO guideline recommendation level I, 28 obtained level II, and 6 obtained level III. No significant difference in the recommendation level was observed between the approval pathways. The average time for the indications approved via the RA to obtain the recommendation level was 2.03 months before NMPA approval. The average time for the indications approved via the AA to obtain the level was 6.66 months after NMPA approval. Compared with initial levels, 57 indications had their recommendation levels upgraded. Most indications obtain the CSCO guideline recommendation level I, with similar likelihoods across obtaining different approval pathways. Indications approved via the RA tended to obtain the CSCO guideline recommendation earlier than those via the AA. Given the limitations in data completeness and CSCO guideline coverage, these findings should be interpreted with caution. Clearer criteria for evaluating recommendation levels and standardizing rating procedures will enable CSCO guidelines to better support clinicians and patients.

PMID:40921945 | DOI:10.1007/s10637-025-01584-x

Acad Psychiatry. 2025 Sep 8. doi: 10.1007/s40596-025-02211-w. Online ahead of print.

ABSTRACT

OBJECTIVE: A deep understanding of patients in psychiatry requires an ability to appreciate and describe the biopsychosocial determinants of health. Great works of theatre portray a nuanced observation of the human condition, but these have not been formally evaluated in psychiatric literature as teaching tools. The purpose of this study was to explore Shakespeare’s King Lear as an educational intervention in supporting formulation skills training in geriatric psychiatry residency.

METHODS: Seven residents attended a half-day educational session where they interacted with four professional actors of diverse backgrounds in creating five scenes from King Lear, with faculty debriefing. Residents completed pre-and post-surveys measuring confidence on topics related to the workshop learning objectives. Three-month follow-up surveys and semi-structured interviews were conducted with all participants.

RESULTS: A non-parametric Friedman test among repeated measures indicated statistically significant improvements in confidence in formulating a biopsychosocial understanding (chi-square 9.30, p = 0.01), in communicating an understanding of social and cultural determinants of health (7.60, p = 0.02), and in describing the role of ageism and stigma associated with mental disorders in older adulthood (8.09, p = 0.02). Key themes from the semi-structured interviews included the importance of contextualizing and taking a holistic approach to formulation. This experience was deemed helpful and recommended for inclusion in the residency program.

CONCLUSIONS: The study demonstrates the potential benefits of using live performance of ancient text on residents’ confidence in formulation, communicating determinants of health, and in describing ageism in geriatric psychiatry.

PMID:40921913 | DOI:10.1007/s40596-025-02211-w

Ann Surg Oncol. 2025 Sep 8. doi: 10.1245/s10434-025-18261-1. Online ahead of print.

ABSTRACT

BACKGROUND: Right-sided hepatectomy (RH) is the standard surgical approach for perihilar cholangiocarcinoma (PHC) due to anatomical considerations but is associated with a high risk of post-hepatectomy liver failure (PHLF). Left-sided hepatectomy (LH) and central hepatectomy (CH) have been proposed as alternative strategies to preserve liver function, but the feasibility and outcomes of CH have not been sufficiently investigated. CH allows for greater preservation of liver parenchyma, potentially reducing the risk of PHLF.

METHODS: This retrospective study analyzed 63 patients with PHC who underwent major hepatectomy at the Juntendo University Hospital between January 2019 and March 2024. Patients were categorized into the LH (n = 18), RH (n = 28), and CH (n = 17) groups. Preoperative future liver remnant volume, perioperative outcomes, pathological findings, and long-term outcomes were compared. Statistical significance was set at p < 0.05.

RESULTS: The CH group had a significantly higher future liver remnant volume compared with the RH group (62.7% vs. 45.5%; p < 0.001). The incidence of PHLF was lower in CH (11.8%) than RH (39.3%), although not statistically significant. CH was associated with a longer median operative time (691 min) and a higher incidence of bile leakage (47.1%). R0 resection rates and long-term outcomes were comparable among the three groups.

CONCLUSIONS: CH is a feasible alternative in selected PHC, offering comparable oncological outcomes while preserving functional liver volume despite its technical complexity.

PMID:40921895 | DOI:10.1245/s10434-025-18261-1

Environ Monit Assess. 2025 Sep 8;197(10):1090. doi: 10.1007/s10661-025-14554-w.

ABSTRACT

To a large extent, the food security and ecological balance of a region, particularly in agriculturally dominated areas, largely depend on the sustainable use and management of groundwater resources. However, in recent times, both natural and human-driven factors have heavily impacted the lowering of groundwater resources. Therefore, the present study has been carried out in a drought-prone region of Birbhum district, part of the red-lateritic agro-climatic zone of West Bengal, Eastern India, to delineate groundwater potential zones (GWPZs). In this regard, 12 hydrological and environmental factors were selected after a multicollinearity test, i.e., elevation, slope, curvature, geomorphology, geology, lineament density, distance from river, topographic wetness index (TWI), groundwater level, rainfall, land use land cover, and soil types for modeling groundwater potentiality. To fulfill the objective, standard machine learning (ML) algorithms like “random forest (RF),” “support vector regression (SVR),” “maximum-entropy (Max-Ent),” and the ensemble approach of RF-Max-Ent have been applied. To validate the obtained result, five statistical techniques, i.e., area under curve (AUC), sensitivity, specificity, F-score, and Kappa coefficient, have been selected. The ranking and relative importance of all factors revealed that elevation, rainfall, TWI, and soil type are the most influential factors for groundwater potentiality in this study. The result of the evaluation metric indicates that the ensemble of RF-Max-Ent is the most suitable model to delineate GWPZ in this study site, as AUC is 0.893 in validation, followed by RF, Max-Ent, and SVR. Additionally, the rank value in the Friedman rank test and chi-squared test for RF-Max-Ent is 3.824 and 32.121, respectively. Overall, the findings revealed that a sizeable section of the study area has moderate to very good groundwater potential. The findings of this study can significantly support achieving sustainable development goals and help to improve groundwater levels in this region through appropriate groundwater policy planning.

PMID:40921891 | DOI:10.1007/s10661-025-14554-w

Environ Monit Assess. 2025 Sep 8;197(10):1093. doi: 10.1007/s10661-025-14534-0.

ABSTRACT

Understanding seagrass dynamics is crucial for the effective management and conservation of seagrass meadows. However, such information remains limited for many regions worldwide, including Kuta Mandalika on Lombok Island, Indonesia. This rapidly developing coastal area, which is home to both tourism infrastructure and an international race circuit, hosts extensive seagrass meadows whose condition and dynamics require careful assessment. Establishing a baseline is essential for long-term monitoring, especially in light of ongoing coastal development. In this study, we integrated time-series Sentinel-2 imagery with a robust seagrass aboveground carbon stock (AGC) mapping model to monitor changes in seagrass AGC from 2019 to 2023. Our analysis shows that seagrass AGC exhibits a clear seasonal pattern, with peak biomass typically occurring in May and June each year. Additionally, results from Seasonal-Trend Decomposition using Loess (STL) and a Generalized Additive Mixed Model (GAMM) with an AR(1) error structure indicate a statistically significant decline in seagrass AGC associated with the construction of the Kuta Mandalika Circuit. These findings provide a critical baseline for distinguishing between natural seasonal variability and long-term anthropogenic impacts, offering valuable insights to inform future monitoring, management, and conservation strategies for these vital coastal ecosystems.

PMID:40921888 | DOI:10.1007/s10661-025-14534-0