Category: Statistics

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

Turk J Pediatr. 2025 Jul 6;67(3):327-337. doi: 10.24953/turkjpediatr.2025.5532.

ABSTRACT

BACKGROUND: Pulmonary hemorrhage (PH) leads to acute and catastrophic deterioration in neonates, and there is no curative treatment available. Off-label use of recombinant Factor VIIa (rFVIIa) is a promising treatment to control bleeding. The aim of this study was to investigate the efficacy and safety of rFVIIa in neonatal massive PH.

METHODS: We used rFVIIa for PH in our neonatology unit during October 2022. We compared demographic and prognostic data of neonates with PH, for two years prior to and following this time point. Intravenous rFVIIa (50-90 μg/kg/dose) was administered to patients with life-threatening PH that was unresponsive to conventional therapies including surfactant administration, vitamin K treatment, blood product transfusion, increasing airway pressure, high frequency ventilation, and endotracheal adrenaline. Potential side effects, such as thromboembolism, were monitored for one week.

RESULTS: We present 16 neonates (7 females; 14 preterm) treated with rFVIIa in addition to conventional treatments and compared their clinical outcomes with the rFVIIa-untreated group (n=21). Median (interquartile range [IQR]) birth weight (960 [775-2377] vs 910 [710-1360] g, p=0.20) and gestational age (29 [27-32] vs 27 [27-29] weeks, p=0.25) did not significantly differ between the groups. Median (IQR) postnatal day of PH occurrence was 7.5 (3-15) in the rFVIIa-treated group and 3 (1.5-6) in the rFVIIa-untreated group (p=0.019). Overall, six neonates died of PH complications in the intervention group. All neonates responded to rFVIIa to varying degrees (cessation of bleeding, n=11; reduced bleeding, n=5). A second dose was required in three. No thromboembolism was observed during the treatment period. Death attributable to PH [6 (37%) vs 16 (76%), p=0.042] and overall mortality (7 [43%] vs 18 [86%], p.

PMID:40674767 | DOI:10.24953/turkjpediatr.2025.5532

Turk J Pediatr. 2025 Jul 6;67(3):293-303. doi: 10.24953/turkjpediatr.2025.5744.

ABSTRACT

BACKGROUND: Substance use is rapidly increasing in the pediatric age group worldwide. There is not enough toxicological data on substance use among children and adolescents in Türkiye. This study aims to reveal the forensic toxicological characteristics of cases under the age of eighteen with substance use detected.

METHODS: In our study, forensic toxicological reports of biological samples taken from 587 cases brought to our institution by law enforcement officers due to allegations and/or suspicions of substance abuse between January 1, 2022, and June 30, 2024 were retrospectively examined. The cases were reviewed in terms of variables such as gender, age, age group, substance type (if any), and presence of multiple substance use.

RESULTS: Out of the cases, 89.1% (n=523) of the cases were male and 10.9% (n=64) were female. The majority of cases (93.2%) were observed in the 15-17 age group, accounting for 547 individuals. Of the cases, 29.0% (n = 170) were identified as multiple substance users. Amphetamine-type stimulants (ATS) were present in 68.7% (n = 403) and cannabis was found in 48.2% (n = 283) of cases. It was observed that only cannabis use was significantly higher among males and only ATS use was higher among females (Cramer’s V = 0.202, p < 0.001). The association between gender and substance type was statistically significant; however, the strength of the association was small to moderate.

CONCLUSION: This study assessed substance use profiles in adolescent populations through substance testing. ATS were the most frequently detected substances. The analysis revealed a significant increase in the proportion of female cases over time. While cannabis use was more prevalent among males, ATS use was more common among females. Collecting objective, valid, and definitive data will facilitate the identification of substance use issues and support the development of effective preventive policies.

PMID:40674764 | DOI:10.24953/turkjpediatr.2025.5744

Turk J Pediatr. 2025 Jul 8;67(3):372-384. doi: 10.24953/turkjpediatr.2025.5782.

ABSTRACT

BACKGROUND: Disruptive behaviors (DB) are common problems in young children. The aim of the current study was to highlight the effect of disruptive behaviors on functionality in preschool children and their families and identify factors that may be related to functionality.

MATERIALS AND METHODS: A total of 223 patients were included in the current study from the Turkish Validity and Reliability Study of Preschool Age Psychiatric Assessment (PAPA). The disruptive behavior problems group (n=93) was selected according to PAPA and consisted of patients who had more than 3 conduct problem symptoms, with these symptoms leading to impairment. The control group (n=130) was selected from patients with no disruptive behavior disorder and 3 or fewer conduct problem symptoms . Preschool Age Psychiatric Assessment and Child Behavior Checklist for Ages 1.5-5 (CBCL/1½-5) were used for assessment.

RESULTS: We found that spanking with the hand, verbal dispraise, and selective negative view to child were more frequent in the DB group than in the control group. DB symptoms were found to have a negative impact both on the child’s functioning in several areas and on the parent’s life in specific areas. Additionally, most of the CBCL scores were significantly higher in the DB group. Finally, it was shown that not only disruptive symptoms but factors such as the presence of attention deficit hyperactivity disorder, parental psychopathology, and the age of the child predicted impairment in this functioning.

CONCLUSION: These findings emphasize that parents’ and child’s functionalities can be highly affected by disruptive problems even in an early period such as preschool and that this area should not be ignored in evaluation and interventions.

PMID:40674763 | DOI:10.24953/turkjpediatr.2025.5782

Turk J Pediatr. 2025 Jul 6;67(3):338-348. doi: 10.24953/turkjpediatr.2025.5804.

ABSTRACT

BACKGROUND: Children with cleft palate (CP) are at high risk for otitis media with effusion (OME), which may impair hearing, speech, and development. Although ventilation tube (VT) insertion during palatoplasty is common, its universal use is debated due to uncertain long-term benefits and potential complications. This study aimed to identify preoperative audiological predictors of VT necessity and evaluate VT-related complications.

METHODS: A retrospective review was conducted on 65 non-syndromic CP patients who underwent palatal repair without prior or concurrent VT placement. Preoperative audiological evaluations were performed, and patients were followed postoperatively for VT insertion and complications. Preoperative hearing thresholds, cleft severity (Veau classification), and VT related complications were analyzed statistically.

RESULTS: The likelihood of VT insertion rose significantly in parallel with the severity of preoperative hearing loss, ranging from just 5.9% in patients with normal hearing to 75% in those with moderate conductive hearing loss (CHL) (p < 0.001). Pairwise comparisons showed significant differences between normal hearing and both mild (p = 0.0026) and moderate CHL (p = 0.01). CP severity was not associated with preoperative hearing but correlated with higher VT placement (Veau I: 10%, Veau IV: 69.2%; p = 0.035). Complications included otorrhea (45.2%), early extrusion (35.5%), and tympanic membrane perforation (12.9%), with no significant associations to preoperative hearing level and CP severity.

CONCLUSION: Preoperative hearing level at the time of palate repair is a strong predictor of VT need in CP patients. Mild to moderate CHL significantly increases the risk of persistent OME, supporting early intervention. Normal or slight loss often resolves without treatment, favoring a conservative approach. Higher cleft severity is associated with increased VT placement rates; it does not correlate with preoperative hearing levels or increased VT-related complications. These findings highlight the value of individualized, hearing-based decisions over routine tube placement.

PMID:40674761 | DOI:10.24953/turkjpediatr.2025.5804

Turk J Pediatr. 2025 Jul 6;67(3):304-316. doi: 10.24953/turkjpediatr.2025.5886.

ABSTRACT

BACKGROUND: This study aimed to examine the socio-demographic factors associated with measles vaccination coverage among Indonesian children aged 12-23 months, using data from a nationally representative survey.

METHODS: A cross-sectional analysis was conducted using the 2018 Indonesian Basic Health Survey (Riskesdas), including 19,425 children aged 12-23 months. Multivariate logistic regression was used to identify factors associated with measles vaccination status, and subgroup analyses were performed across three regional clusters.

RESULTS: Of the children surveyed, 73.46% had received measles vaccination, 68.14% had at least one antenatal care visit per trimester, and 53.59% had received at least one postnatal care visit. The most significant predictors of measles vaccination were frequent postnatal care (AOR: 2.36, 95% CI: 1.86-2.99) and higher maternal education (AOR: 2.31, 95% CI: 1.30-4.10). Other associated factors included the age and employment status of the head of the household (as defined by the Riskesdas study), travel time to healthcare facilities, household expenditure, and urban-rural residence.

CONCLUSION: Utilization of postnatal care and higher maternal education were key determinants of measles vaccination coverage. Improving maternal healthcare access and promoting female education may enhance vaccination uptake among Indonesian children.

PMID:40674759 | DOI:10.24953/turkjpediatr.2025.5886

Turk J Pediatr. 2025 Jul 6;67(3):398-409. doi: 10.24953/turkjpediatr.2025.6049.

ABSTRACT

BACKGROUND: Hypospadias, a congenital condition characterized by the urethral opening being on the underside of the penis, has received limited attention in its association with the MTHFR C677T variant. Given the crucial role of folate metabolism in embryonic development, and the involvement of the MTHFR C677T polymorphism in folate metabolism, this study aims to investigate whether this variant contributes to the risk of hypospadias in an Algerian population.

METHODS: This case-control study included 105 patients with hypospadias and 125 controls. Genotyping of the MTHFR gene C677T variant was performed using polymerase chain reaction-restriction fragment length polymorphism.

RESULTS: A statistically significant difference in the genotype distribution of the MTHFR C677T variant between patients with hypospadias and controls was revealed. The significance was observed in the codominant genetic model CT vs. CC (p=0.034, odds ratio [OR]: 1.89, 95% CI: 1.04-3.44) and TT vs. CC (p=0.042, OR: 2.15, 95% CI: 1.02-4.53), as well as in the dominant model CC vs. CT+TT (p=0.010, OR: 1.98, 95% CI: 1.17-3.35). Maternal periconceptional folic acid supplement intake showed a significant association with the anatomical types of hypospadias in relation to the MTHFR C677T genotypes when folic acid was taken (p=0.006). Furthermore, a significant association was observed with the TT genotype in isolated hypospadias cases (p=0.038, OR=3.47, 95% CI: 1.03-11.68), suggesting a potential role of folic acid in modifying hypospadias risk. Multiple logistic regression analysis identified intrauterine growth restriction, gestational hypertension, residency, and the MTHFR C677T variant as independent potential risk factors for hypospadias development (p-values: 0.030, 0.016, 0.040, and 0.045, respectively).

CONCLUSIONS: This study reports, for the first time, an association between the MTHFR gene C677T variant and hypospadias in the Algerian population. The findings suggest a strong association between the MTHFR C677T variant and susceptibility to hypospadias. Identified risk factors such as intrauterine growth restriction, gestational hypertension, rural residency, and the MTHFR C677T variant contribute valuable insights into the multifaceted etiology of hypospadias in this population.

PMID:40674756 | DOI:10.24953/turkjpediatr.2025.6049