Category: Statistics

Surg Endosc. 2025 Dec 8. doi: 10.1007/s00464-025-12445-2. Online ahead of print.

ABSTRACT

BACKGROUND: Colonoscopic resection of adenomatous polyps reduces mortality from colorectal cancer, which remains the third leading cause of cancer-related deaths in the U.S. Most polyps can be removed endoscopically by cold snare resection, endoscopic mucosal resection, or endoscopic submucosal dissection. However, technically challenging polyps often require partial colectomy, which confers increased rates of morbidity and mortality. Emerging hybrid approaches such as combined endoscopic-laparoscopic techniques have been developed to manage benign, complex colonic polyps and reduce the need for surgical resection.

OBJECTIVE: Patients with SLD completed a 14-item questionnaire that assigned barriers to healthy eating to three categories: lack of knowledge, lack of self-control, and lack of time, with a higher summary score indicating more perceived barriers. We administered assessments of health literacy and physical activity. We analyzed the data using descriptive statistics and ordinal regression analysis.

METHODS: A hybrid approach integrating endoscopic visualization via colonoscope with robotic-assisted transcolonic access was performed to achieve complete polypectomy in a patient with a technically challenging, benign colonic lesion and a past surgical history of extended right colectomy. The technique was evaluated in terms of feasibility, adequacy of resection, and operative considerations.

RESULTS: The combined endoscopic and robotic-assisted approach successfully enabled complete resection of a benign, complex colonic polyp that had previously failed endoscopic submucosal dissection. The procedure was performed without significant complications and allowed for reduced operative time and anticipated shorter recovery as compared to partial colectomy.

CONCLUSIONS: This case demonstrates that combined endoscopic and robotic-assisted transcolonic polypectomy is a safe, feasible, minimally invasive alternative for select complex, benign colonic polyps. This novel technique may reduce the need for partial colectomy and associated morbidity, offering a promising option for managing challenging lesions, especially in patients with multiple comorbidities and high operative risk.

PMID:41361512 | DOI:10.1007/s00464-025-12445-2

Evid Based Dent. 2025 Dec 8. doi: 10.1038/s41432-025-01197-6. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Massouda J, Ghaltakhchyan N, Judd J, Bocklage C, Selden R, TumSuden O, Nanney E, Lee J, Ginnis J, Strauman T, Sawicki C, Hodges EA, Graves C, Divaris K, Jacox L. Evaluating effects of animal-assisted therapy on paediatric dental care patients: A pilot clinical trial. J Am Dent Assoc. 2025;156:447-457. https://doi.org/10.1016/j.adaj.2025.03.006 DATA SOURCES: This commentary is based on the published pilot clinical trial by Massouda et al. (2025) evaluating animal-assisted therapy (AAT) in paediatric dental care.

STUDY SELECTION: The study included children aged 7-14 undergoing invasive dental procedures, allocated to either an AAT or control group.

DATA EXTRACTION AND SYNTHESIS: Outcome measures included validated self-reported anxiety and pain scales, physiological stress markers, and behavioural observations. Data was synthesised narratively given pilot design and small sample size.

DESIGN: A prospective, non-randomised pilot trial carried out in a university paediatric dental setting assessed the practicality and initial effects of integrating animal-assisted therapy (AAT) into dental treatment.

CASE SELECTION: Thirty-nine children aged 7-14 years scheduled for invasive dental procedures were enroled. Participants were allocated to an AAT group (n = 18) or a control group (n = 21). Inclusion criteria included the ability to assent and a willingness to interact with a certified therapy animal. Exclusion criteria included previous traumatic experiences with AAT, or significant developmental or behavioural disorders affecting cooperation.

DATA ANALYSIS: Physiological and psychological measures were recorded at baseline, during treatment, and post-operatively. Primary outcomes included self-reported pain and anxiety scores using validated scales. Secondary outcomes included heart rate monitoring, salivary cortisol, α-amylase, and video-coded behavioural relaxation. Given the small sample size, statistical analyses employed nonparametric 35 tests with significance set at P < 0.05.

RESULTS: Children exposed to the therapy dog reported significantly lower postoperative pain scores (P = 0.001) and demonstrated smaller heart rate fluctuations during stressful procedural moments, suggesting lower physiological stress responses. Behavioural observations indicated longer periods of relaxed posture in the AAT group, though this did not reach statistical significance (P = 0.204). No significant differences were detected in salivary cortisol or α-amylase. AAT was reported as safe, well-tolerated, and feasible to implement.

CONCLUSIONS: AAT shows potential for reducing distress in paediatric dental settings, but larger, randomised studies are required. Within the limits of a pilot design, animal-assisted therapy may reduce pain and physiological stress in paediatric dental patients. While encouraging, larger randomised trials are needed to confirm these effects, explore mechanisms, and assess practicality and cost in routine dental practice.

PMID:41361505 | DOI:10.1038/s41432-025-01197-6

J Health Popul Nutr. 2025 Dec 8. doi: 10.1186/s41043-025-01184-8. Online ahead of print.

NO ABSTRACT

PMID:41361501 | DOI:10.1186/s41043-025-01184-8

BMC Psychol. 2025 Dec 9. doi: 10.1186/s40359-025-03810-w. Online ahead of print.

ABSTRACT

BACKGROUND: Depression is a big health concern and a leading cause of disability worldwide that is inadequately addressed. Severe somatic illnesses are often associated with psychological distress that can reach the level of a depressive disorder requiring treatment. Depression as a comorbidity is linked with a poor quality of life and noncompliance to treatment in these patients, which may lead to increased use of health services. Information on the frequency and the disease course of depression in patients with severe somatic diseases and the need for inpatient treatment and subsequent treatment is still lacking.

METHODS: A cohort study including patients with a diagnosis of cardiovascular diseases (heart attack, stroke, peripheral artery disease) or systemic inflammatory disease (rheumatoid arthritis, inflammatory bowel disease) who are admitted to the University Hospital of Augsburg will be established. At recruitment during hospital stay/outpatient visit, data on mental health (e.g. depressive symptoms, stress, quality of life), clinical data, and lifestyle data will be gathered through self-administered questionnaires and chart review. Furthermore, blood samples will be collected and stored. After hospital discharge, study participants will be repeatedly contacted over time (at the beginning in shorter intervals, then about every 3 months) to provide further information about their mental well-being, life circumstances (e.g. incapacity to work), quality of life, and utilization of medical services. Altogether at least 500 patients should be included and followed up in this study. Descriptive statistics including prevalence and group differences will be calculated. Multivariable generalized linear mixed-effects models with random intercepts will be performed to examine determinants of depression and predict the occurrence and course of the disease.

DISCUSSION: The strengths of the DESIE study are the mainly digital assessments and its longitudinal character with frequent follow-up questionnaires. The study will substantially contribute to the current research about comorbid depression in somatic diseases.

TRIAL REGISTRATION: The study was prospectively registered in the German Clinical Trials Registry and WHO International Clinical Trials Registry Platform (registration number: DRKS00033245, date of registration: 14 December 2023) prior to the start of recruitment.

PMID:41361494 | DOI:10.1186/s40359-025-03810-w

J Health Popul Nutr. 2025 Dec 8. doi: 10.1186/s41043-025-01168-8. Online ahead of print.

ABSTRACT

BACKGROUND: Climate change threatens food security and child nutrition in Africa. This study assessed the impact of community-based, solar-powered drip irrigation gardens (SMGs) on the nutritional status of children in households reliant on local food production.

METHODS: Women’s groups (WGs) from 16 matched villages in Northern Benin were randomly assigned to receive SMGs (WG_SMG) or continue traditional irrigation (WG_C). Additional households without women’s groups (NWG_SMG and NWG_C) were recruited from intervention and comparison villages. Children aged 1-5 years participated in baseline and one-year follow-up surveys. Outcomes included dietary diversity, anthropometry, anemia, and micronutrient status. Dietary diversity was assessed using the WHO minimum dietary diversity indicator, based on consumption from at least five of eight food groups in the previous 24 h. Anemia was defined as hemoglobin < 10.5 g/dL or < 11 g/dL, age dependent. Difference-in-differences analysis estimated treatment effects (TEs).

RESULTS: WG_SMG participation increased the percentage of children meeting minimum dietary diversity compared with all groups (TE: 0.64; p < 0.001). Hemoglobin concentrations increased in WG_SMG children versus all groups (TE: 0.53; p < 0.05), with reductions in anemia compared with WG_C (TE: – 0.15; p < 0.05). WG_SMG membership also improved weight-for-age z-scores (TE: 0.35; p < 0.05) and reduced wasting (TE: – 0.04; p < 0.01). Effects remained statistically significant when clustering at child or village levels.

CONCLUSIONS: Children from women-owned SMGs had improved dietary diversity, hemoglobin status, and growth outcomes while reducing anemia and wasting compared to controls. Expanding this technology may enhance food security and child nutrition in climate-vulnerable regions.

PMID:41361488 | DOI:10.1186/s41043-025-01168-8

Trials. 2025 Dec 8. doi: 10.1186/s13063-025-09324-5. Online ahead of print.

ABSTRACT

BACKGROUND: Parallel-group multi-arm trials are randomised controlled trials (RCTs) where participants are allocated to three or more concurrent treatment groups. Multiplicity occurs when several statistical tests are conducted within the same study. Statistical adjustments to the design and analysis of multi-arm trials can be used to control the study-wise type I error rate. There is no clear guidance or consensus on the necessity of multiplicity adjustment in multi-arm trials, nor on which methods are most appropriate. This comprehensive review aimed to investigate the design, analysis and reporting of publicly funded parallel-group multi-arm trials and to report the approach to multiplicity in these trials with respect to sample size and statistical analysis.

METHODS: We searched the United Kingdom’s National Institute for Health and Care Research (NIHR) online Journals Library, from 1 January 1997 to 31 December 2024 for reports of multi-arm RCTs. Information on the trial characteristics, the sample size estimation and analysis of the primary outcome was extracted. Two researchers conducted the search and selected reports for inclusion. Data from each report was independently extracted by two reviewers, and any disagreement was resolved by discussion.

RESULTS: A total of 2452 reports, published online in the NIHR Journals Library, were screened for eligibility; 97 reports of multi-arm parallel-group trials met the inclusion criteria. Of these, 90 included the results of a multi-arm efficacy analysis. In the review, 35% (34/97) of the trials did adjust for multiplicity in the sample size calculation; in 84% (76/90), the potential between-arm comparisons were described in the methods, and 37% (33/90) made a multiplicity adjustment in the analysis. A further 86% (77/86) reported 95% confidence intervals. For the minority of multi-arm trials that did adjust for multiplicity, the most common adjustment method was Bonferroni.

CONCLUSIONS: The majority of the publicly funded multi-arm trials did not adjust for multiplicity in the sample size, statistical analysis, or estimation of confidence intervals. Researchers should follow the Consolidated Standards of Reporting Trials guidelines for multi-arm trials and clearly state in protocols and trial reports whether a multiplicity adjustment was made or provide a reason if no adjustment was made.

PMID:41361478 | DOI:10.1186/s13063-025-09324-5

BMC Nurs. 2025 Dec 8;24(1):1471. doi: 10.1186/s12912-025-04112-7.

ABSTRACT

BACKGROUND: Nurses play a crucial role as essential healthcare providers, and their health-promoting lifestyle behaviors (HPLB) can significantly influence patients’ attitudes toward health promotion. Despite their importance, limited research has been conducted on HPLB among clinical nurses in Mogadishu. This study aims to examine the HPLB of clinical nurses in Mogadishu and identify key factors influencing these behaviors.

METHODOLOGY: A descriptive cross-sectional study was conducted from September to November 2024, involving 423 nurses from public and private hospitals in Mogadishu. Cluster random sampling was used, and data were collected using self-administered questionnaires based on the modified Health-Promoting Lifestyle Profile II (HPLP-II). Data analysis was performed using descriptive statistics, independent t-tests, ANOVA, and categorical regression with SPSS version 27.

RESULTS: A total of 423 nurses participated in the study. The mean scores for self-actualization, health responsibility/physical activity, nutrition, job security, interpersonal support, and overall health-promoting lifestyle were 25.87 ± 4.99, 26.70 ± 5.71, 10.16 ± 2.48, 18.73 ± 4.09, and 17.68 ± 3.95, respectively, with an overall mean score of 99.14 ± 16.1 out of 152. Nurses demonstrated moderate levels of health-promoting behaviors, with self-actualization reflecting frequent engagement in personal growth, while nutrition and interpersonal support indicated moderate adherence to recommended practices. Categorical regression analysis identified monthly income, employment sector, number of children, educational qualification, working department, gender, and years of work experience as predictors of overall health-promoting lifestyle behaviors (p < 0.001), with adjusted R² values ranging from 0.023 to 0.094 across the six subscales.

CONCLUSION: Nurses in Mogadishu demonstrated moderate health-promoting lifestyle behaviors. Key predictors included income, employment sector, working department, gender, and work experience. Interventions that promote healthy habits and supportive work environments are essential to enhance nurses’ well-being and quality of care.

PMID:41361464 | DOI:10.1186/s12912-025-04112-7

Lipids Health Dis. 2025 Dec 9. doi: 10.1186/s12944-025-02825-x. Online ahead of print.

ABSTRACT

BACKGROUND: Brown adipose tissue (BAT) regulates metabolic homeostasis, yet its role in tumor presence remains undefined. This study investigates the associations among BAT, body mass index (BMI), and tumor presence in a large Chinese cohort.

METHODS: We retrospectively analyzed 1,736 adults who underwent ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) at Shanghai East Hospital (2016-2024). Patients were grouped by BAT status with propensity score matching and sex stratification. BAT was identified by FDG uptake at typical depots with CT density criteria. Statistical analyses included chi-square tests, regression models, and mediation analysis (structural equation modeling with bootstrapping) to assess the role of BMI in the BAT-tumor presence association.

RESULTS: The presence of BAT was associated with younger age, female sex, and lower BMI. In multivariable logistic regression, age (p < 0.001) and BMI (p = 0.014) were independently associated with tumor presence. After propensity score matching (PSM), sex-stratified mediation analysis showed that in females, BAT was indirectly associated with a lower likelihood of tumor presence (Natural Indirect Effect OR = 0.88, 95% CI 0.72-0.98), whereas no significant mediation effect was observed in males. Among cancer patients, individuals with BAT had a significantly lower BMI compared to individuals without BAT (overall: 21.08 vs. 23.34; females: 21.33 vs. 22.97; males: 19.65 vs. 24.68).

CONCLUSIONS: Our findings indicate that BAT and tumor presence are statistically associated in a sex-specific manner, with BMI potentially playing a mediating role in females. The consistently lower BMI among BAT(+) cancer patients further indicates a plausible link between BAT and body weight regulation. These observations warrant further investigation to elucidate the underlying mechanisms.

PMID:41361455 | DOI:10.1186/s12944-025-02825-x

BMC Public Health. 2025 Dec 9. doi: 10.1186/s12889-025-25859-3. Online ahead of print.

ABSTRACT

BACKGROUND: The World Health Organization recommends adopting smoke-free campuses (SFCs), and in 2024, the European Council has urged Member States to implement smoke-free policies on educational premises. However, unlike North America, Australia and New-Zealand, Europe has been slow to adopt SFCs. In France, the EHESP School of Public Health became the first SFC in 2018. This research assessed students’ support for this SFC policy since its implementation and examined associated factors.

METHODS: An online cross-sectional study was conducted annually from 2018 to 2025. The dependent variable was students’ support for the SFC policy, measured using a four-point Likert scale ranging from strong opposition to strong support. Explanatory variables included tobacco use behaviors, knowledge of tobacco’s dangers, and sociodemographic characteristics. An ordered logit regression model was applied to account for the ordinal nature of the outcome variable. Explanatory variables were introduced sequentially to evaluate their incremental contribution.

RESULTS: The sample comprised 2,532 students with a 56.97% overall response rate. Support for the SFC policy was nearly universal (96.7% – 91.4% among students who smoked), exceeding levels reported outside Europe. Smoking status, demographic factors, and time were significantly associated with it. Current smoking or vaping, or ever smoking were negatively associated with support. Support increased between 2018 and 2025. Being a woman, an aspiring public servant, or older in age positively influenced it. Knowledge of tobacco’s dangers showed no significant association with support.

CONCLUSIONS: Most research on SFC policies has been conducted in settings with low smoking prevalence where SFCs are typical. Our study is the first to assess support in a country where SFC policies were not yet widespread. The high level of support observed should encourage the broader implementation of SFCs in France and across other European countries.

PMID:41361437 | DOI:10.1186/s12889-025-25859-3

Cardiovasc Diabetol. 2025 Dec 8;24(1):455. doi: 10.1186/s12933-025-02942-y.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing global health challenge. Conventional diagnostic tools have limited sensitivity and specificity for early-stage disease. In this context, long non-coding RNAs (lncRNAs) have emerged as promising biomarkers for T2DM risk. However, studies exploring their predictive value remain limited. This study aimed to evaluate the potential of circulating lncRNAs in T2DM development and to assess their interaction with dietary interventions.

METHODS: The study included 462 non-diabetic participants from the CORDIOPREV study, followed for 5 years under Mediterranean or low-fat diet interventions. Expression levels of 22 circulating lncRNAs were quantified by qPCR. A series of statistical and machine learning methods were applied.

RESULTS: Random forest analysis identified four lncRNAs (XIST, LINC01116, CASC2, LINC01370) as predictive of T2DM incidence. The combination of these lncRNAs with clinical variables significantly improved prediction performance (AUC = 0.730) compared to models with Hb1Ac (p = 0.015) or clinical variables alone (p < 0.001). Regarding the constructed lncRNA score from the previous model, a lower lncRNA score was associated with a reduced risk of developing T2DM (HR 0.37 (0.24-0.59), p < 0.001), and showed an inverse correlation with the disposition index among individuals following a Mediterranean diet (r = – 0.18, p = 0.009).

CONCLUSION: Circulating lncRNAs, particularly integrated into an epigenetic score, represent promising predictive biomarkers for T2DM development. The interaction with dietary intervention-especially the Mediterranean diet-supports their potential use in guiding personalized dietary strategies for T2DM prevention in high-risk populations.

PMID:41361433 | DOI:10.1186/s12933-025-02942-y