Category: Statistics

J Health Popul Nutr. 2025 Jun 14;44(1):199. doi: 10.1186/s41043-025-00949-5.

ABSTRACT

BACKGROUND: This study aimed to examine the validity and reliability of the Chrono-Med Diet Score (CMDS) to assess adherence to the Mediterranean diet in Turkish adults.

METHODS: The methodological research conducted in Gümüşhane and Ordu from January to June 2024, including 592 individuals (62.3% women, 37.7% men, and the mean age 43.4 ± 10.6 years). Data were collected through face‒to‒face interview that contained socio-demographic characteristics, the CMDS, the Mediterranean Diet Adherence Screener (MEDAS), and 24-h dietary recall. Internal consistency reliability was assessed using Cronbach’s alpha coefficient, while repeatability was examined using the test-retest method. Construct validity was assessed by the MEDAS, and components of the adapted CMDS obtained from the 24-h dietary recall were analyzed using confirmatory factor analysis. The content validity was assessed by the Paired samples t-test and Wilcoxon test. The Bland-Altman test with 95% limits of agreement was used to evaluate the agreement between sum of CMDS. The results were statistically evaluated at a p < 0.05 significance level.

RESULTS: The content validity index of CMDS was 0.87. The overall Turkish version of CMDS had acceptable internal consistency (Cronbach’s α = 0.853), thus indicating that the score was reliable. The Paired samples t test coefficients between each item and the overall questionnaire ranged from 0.234 to 1.000. A higher intake of olive oil and fish obtained from a 24-h dietary recall was associated with a higher CMDS quartile (p < 0.05). The MEDAS score was correlated with a higher CMDS quartile (p < 0.001). A moderate positive correlation was determined between total CMDS and MEDAS (r = 0.467; p < 0.001).

CONCLUSIONS: Our assessments of the CMDS, consisting of 13 items, in Türkiye demonstrate that it is a viable and reliable instrument to measure adherence to the Mediterranean diet for the adult population. The CMDS is more accurate than other Mediterranean diet scores as it questions about the amount of physical activity and grain products, which helps determine each participant’s eating patterns and general health.

PMID:40517281 | DOI:10.1186/s41043-025-00949-5

J Health Popul Nutr. 2025 Jun 14;44(1):198. doi: 10.1186/s41043-025-00875-6.

ABSTRACT

INTRODUCTION: Globally, reproductive-age women appear to be the major users of herbal products, particularly during pregnancy and breastfeeding. Despite safety concerns, lactating women in Ethiopia use herbal products to increase their milk supply or to treat ailments. Thus, the current study aimed to assess the prevalence of herbal medicine use and associated factors among lactating women visiting maternal and child health clinics at Woldia Comprehensive Specialized Hospital.

METHODS: A cross-sectional study was conducted on 362 lactating women who visited the Expanded Program Immunization and Family Planning Clinics at Woldia Comprehensive Specialized Hospital from February 1 to April 30, 2023. The study participants were chosen using a systematic sampling method. Data were collected using a structured questionnaire through face-to-face interviews and entered using EPI-Data version 4.2.0. It was then analyzed using SPSS version 25. A binary logistic regression model was used to identify factors associated with the use of herbal medicine. Statistical significance was considered at a p-value of less than 0.05 in the final model. The findings were presented using texts, tables, and graphical representations.

RESULTS: Out of 362 pregnant women who participated in this study, 150 (41.43%, 95% CI: 36.3, 46.5%) used herbal products during their lactating period. The most frequently used herbal products during lactation were Zingiber officinale 73 (48.6%), followed by Lepidium sativum 67 (44.6%), Ocimum lamifolium 60 (40%), and Linum usitatissimum 53 (35.3%). Among lactating mothers attending the clinics, factors associated with herbal medicine use included having a positive attitude toward herbal medicine use (AOR = 5.6; 95% CI = 3.1,9.9), having a history of using herbal products (AOR = 2.2; 95% CI = 1.2,3.9), lacking postpartum counseling (AOR = 2.6; 95% CI = 1.2,5.7), living further away from medical facilities (AOR = 2.8; 95% CI = 1.7, 4,8), and earning less than 5000 ETB per month (AOR = 3.5; 95% CI: 1.0, 12.2).

CONCLUSIONS: In the study area, herbal medicine use was a common practice among lactating mothers. Factors influencing this trend include women’s attitudes toward herbal medicine, postpartum counseling, and their previous experiences with such remedies. Therefore, it is crucial to prioritize efforts aimed at shifting the perceptions of reproductive women regarding herbal medicine use and to enhance postpartum counseling. Further, it is essential to emphasize the potential risks of certain herbal medicines, especially those with unknown safety profiles, as they can significantly impact the health of the women and breastfeeding infants.

PMID:40517276 | DOI:10.1186/s41043-025-00875-6

Cardiovasc Diabetol. 2025 Jun 14;24(1):256. doi: 10.1186/s12933-025-02789-3.

ABSTRACT

INTRODUCTION & OBJECTIVES: As in the general population, people living with type 1 diabetes (PWT1D) are faced with overweight and obesity, which contribute to cardiovascular (CV) risk. However, the role of visceral adiposity, due to its adverse metabolic profile, should also be addressed in PWT1D. We aimed to assess the 10-year CV risk of PWT1D according to body mass index (BMI) and waist-to-height ratio (WHtR), a parameter for estimating visceral adiposity.

METHODS: In this cross-sectional study, PWT1D in primary CV prevention from the SFDT1 cohort were categorized by BMI status, either normal (18.5-24.9 kg/m²) or overweight/obesity (≥ 25 kg/m²), and by WHtR according to the validated threshold of 0.5. The 10-year CV risk was estimated using the Steno Type 1 Risk Engine and classified into three categories: low (< 10%), intermediate (10-20%) and high (> 20%). The distribution of CV risk was assessed using density plots. In multivariable analysis, the association between BMI, WHtR, and high estimated 10-year CV risk was studied using spline regression models with sex stratification. Thresholds were determined by the Receiver Operating Characteristic (ROC) curve.

RESULTS: The study included 1,482 patients; 49.9% had a normal BMI, and 50.1% a BMI ≥ 25 kg/m². The proportion of patients with high CV risk was higher in PWT1D with overweight/obesity (12% vs. 7%) and in those with WHtR ≥ 0.5 (13% vs. 4%). BMI was significantly associated with high CV risk in men (p = 0.001) but a non-significant trend was found in women (p = 0.053). WHtR was significantly associated with high CV risk in both men (p < 0.001) and women (p = 0.046). The BMI threshold associated with high CV risk was 24.9 kg/m² for men, and the WHtR threshold was 0.5 for both men and women.

CONCLUSION: In PWT1D in condition of primary CV prevention, visceral adiposity, assessed by WHtR, is a more robust marker of estimated 10-year CV risk than overweight/obesity status in both men and women.

PMID:40517273 | DOI:10.1186/s12933-025-02789-3

Adv Rheumatol. 2025 Jun 14;65(1):28. doi: 10.1186/s42358-025-00451-w.

ABSTRACT

BACKGROUND: Myocardial fibrosis is an important adverse prognostic marker, however; determinants of myocardial fibrosis in immune-mediated inflammatory diseases (IMIDs) remain poorly defined. We aimed to identify determinants of myocardial fibrosis in patients with IMIDs, as measured by cardiovascular magnetic resonance (CMR) extracellular volume (ECV).

METHODS: Cross-sectional study of 116 patients with IMIDs undergoing clinical CMR at Manchester University NHS Foundation Trust. IMIDs included rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (SSc), ankylosing spondylitis, psoriatic arthritis and vasculitis. CMR included pre- and post-contrast T1 mapping to measure myocardial ECV, with same day blood sampling. Determinants of ECV were investigated with univariable and multivariable linear regression.

RESULTS: ECV varied significantly according to IMID diagnosis (ANOVA F statistic 2.80, P = 0.015); ECV was higher in patients with SSc compared to other IMIDs. Major determinants of ECV as a continuous variable were SSc, smoking and body mass index (BMI); regression coefficients 3.33 (95% confidence interval 0.82-5.84), 3.08 (0.73-5.43), and – 0.19 (-0.29 – -0.09) respectively, P < 0.01 (SSc, smoking and lower BMI were associated with increased ECV). Approximately a quarter of the variability in ECV could be explained by these predictors (optimism adjusted R² 0.265).

CONCLUSION: SSc is associated with a higher burden of myocardial fibrosis compared to other IMIDs. In patients with IMIDs, independent determinants of myocardial fibrosis were presence of SSc, smoking and BMI. Importantly, participants underwent CMR for clinical indications and may not be representative of IMID populations in the community.

PMID:40517266 | DOI:10.1186/s42358-025-00451-w

Mol Autism. 2025 Jun 14;16(1):35. doi: 10.1186/s13229-025-00664-2.

ABSTRACT

BACKGROUND: Autistic communities in Europe continue to face difficulties accessing services despite increasing rates of autism diagnosis in recent years.

METHODS: To investigate autistic people’s access to services in Europe and reasons for unsuccessful access, we conducted the ACCESS-EU survey comprising of 2322 formally diagnosed autistic people and family carers living within the European Union (EU) and the United Kingdom (UK). The survey also examined age group (adult vs. child) and gender (male vs. female) differences in results.

RESULTS: Overall, autistic people reported access to therapy (33.38%), mental health (29.89%), educational (27.05%), medical (34.28%), financial (26.66%), needs assessment (14.90%), information/referral (14.73%), social care (14.43%), employment (7.54%), housing (6.80%), legal (3.96%), helpline (3.40%) and other services (0.26%), and most (≥ 57.61%) had waited up to 6 months from referral to access most services. Several respondents were also unable to access therapeutic (13.53%), mental health (11.90%), autism diagnostic (5.92%), needs assessment (8.32%), financial (9.62%), educational (8.10%), social care (7.39%), information/referral (6.14%), medical (7.28%), housing (5.92%), employment (5.43%), legal (3.42%), and helpline services (2.34%). Reasons cited by respondents for their unsuccessful service access included service unavailability (23.08%), service unsuitability or participant ineligibility (20.04%), long waitlists (17.42%), service unaffordability (11.80%), and rejection from service due to autism diagnosis (9.87%), along with other reasons not listed in the survey (18.42%). Significant age group and gender differences were observed for successful access to services, waiting time, unsuccessful access and reasons for unsuccessful access. Among the five most represented countries in the survey-the UK (33.33%), Spain (14.04%), Poland (13.87%), France (11.07%) and Germany (6.03%)-overall service access was most inconsistent in Poland and the UK, highest in Germany and Spain but poorest in France.

LIMITATIONS: Issues related to survey presentation such as the languages in which the survey was conducted and the phrasing of some questions should be considered, as well as issues regarding subjectivity and ambiguity of data analysis such as translation of non-English responses into English.

CONCLUSIONS: Our findings suggest that service access among autistic people in Europe is inconsistent. Significant improvement to current policies is required to enhance access to services across Europe.

PMID:40517258 | DOI:10.1186/s13229-025-00664-2

J Health Popul Nutr. 2025 Jun 14;44(1):196. doi: 10.1186/s41043-025-00962-8.

ABSTRACT

BACKGROUND: Female Genital Mutilation (FGM) also referred to as female genital cutting or female circumcision, has become a global health concern. It is a deeply entrenched traditional practice involving partial or total removal of the external female genitalia for non-medical reasons. To inform effective policymaking and raise awareness about FGM’s health risks, understanding socioeconomic and demographic factors influencing the status of circumcision is crucial.

METHODS: The study employed logistic regression and maximum likelihood models to examine the association between mothers’ educational level and the circumcision status of under five girls in Ethiopia. The data used in this study was extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS) report, which was conducted by the Central Statistical Agency (CSA).

RESULTS: The study found a strong association between mother’s educational level and the risk of circumcision of under five girls. The girls whose mothers have no education or primary education have significantly higher odds of being circumcised with crude odds ratios of 7.69 (2.27-26.02) and 5.54 (1.64-18.65), respectively, compared to those whose mothers have secondary or higher education. Additionally, children whose mothers are Muslims (AOR: 1.98, 1.55-2.53), rural residence (AOR: 1.83, 1.21-2.78), and paternal education level (no education AOR: 2.03, 1.24-3.35) were also significant factors.

CONCLUSIONS: The results highlight the importance of maternal education, religious beliefs, and geographic location in influencing circumcision practices in Ethiopia. We recommend that more public education on the effect of FGM on the girl child will be enrolled especially in the rural communities in Ethiopia.

PMID:40517256 | DOI:10.1186/s41043-025-00962-8

Diabetol Metab Syndr. 2025 Jun 14;17(1):213. doi: 10.1186/s13098-025-01766-w.

ABSTRACT

OBJECTIVE: Metabolic syndrome (MetS) has a high prevalence in the United States (US); however, limited research comprehensively evaluates the relationship between muscle quality index (MQI) and MetS. This study aims to investigate the association between MQI and MetS.

METHODS: Adults aged 20-60 years from the 2011-2014 National Health and Nutrition Examination Survey were included. Handgrip strength (HGS) was measured using a dynamometer, and appendicular skeletal muscle mass (ASM) was assessed via dual-energy X-ray absorptiometry. MQI_total was calculated as the sum of HGS from both hands divided by ASM. Weighted multivariable logistic regression models and restricted cubic splines (RCS) were used to explore the association between MQI_total and MetS, and subgroup, interaction, and sensitivity analyses were conducted.

RESULTS: A total of 4,503 US residents were included in the study, with 1,165 diagnosed with MetS, yielding a prevalence of 25.9% (1,165/4,503). The weighted multivariable logistic regression model indicated that after adjusting for multiple covariates, MQI was negatively associated with the risk of MetS (odds ratio [OR] = 0.49, 95%CI: 0.32-0.73). Among the different components of MetS, MQI was negatively associated with elevated waist circumference (OR = 0.19, 95%CI: 0.12-0.28), elevated high-density lipoprotein cholesterol (OR = 0.66, 95%CI: 0.51-0.85), and elevated serum triglycerides (OR = 0.66, 95%CI: 0.51-0.85). RCS revealed a negative linear relationship between MQI and MetS (P < 0.001, P_non-linear = 0.98).

CONCLUSION: Low MQI is associated with an increased risk of MetS, exhibiting a linear relationship. These findings suggest that improving muscle quality may be an effective strategy for the prevention of MetS.

PMID:40517241 | DOI:10.1186/s13098-025-01766-w

Int J Equity Health. 2025 Jun 15;24(1):175. doi: 10.1186/s12939-025-02515-1.

ABSTRACT

BACKGROUND: Assessing food and nutrition security among indigenous populations in Brazil is challenging due to their significant cultural and linguistic diversity. This study aimed to validate a national food insecurity measurement scale for indigenous peoples in Brazil (EBIA-I).

METHODS: A total of 495 indigenous households, from 15 rural communities and one urban area, were included in the analyses. Internal psychometric validity scale was tested with the Rasch Model, and external validity was examined with bivariate analyses.

RESULTS: An 8-item scale was internally valid (Infit values ranged between 0.7 and 1.3), 6 of the items referred to households with children under 16 years of age, 5 to households only with residents aged 16 years or more, with 3 being common to both. The external validity of the EBIA-I was high, as shown by the significantly lower prevalence of moderate or severe food insecurity, in households where some members regularly received income vs. those not receiving any income, 17.5% vs. 30.6%, respectively. Likewise, interviewees who self-reported good/very good health vs. poor/very poor health status were less likely to experience moderate or severe food insecurity (19.1% vs. 34.8%).

CONCLUSIONS: EBIA-I is a valid scale with strong potential to inform decisions by policymakers and to support indigenous organizations monitoring, addressing, and advocating for policies to prevent or mitigate food and nutrition insecurity in their communities.

PMID:40517230 | DOI:10.1186/s12939-025-02515-1

BMC Geriatr. 2025 Jun 14;25(1):425. doi: 10.1186/s12877-025-06090-6.

ABSTRACT

BACKGROUND: There is limited understanding regarding the patterns and trajectories of social participation and their associations with medical care utilization among rural older adults. We aimed to investigate the patterns and trajectories of social participation and their associations with medical care utilization among rural older adults in China using longitudinal data.

METHODS: In this longitudinal study, we used data from 1600 participants aged 60 years and above in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We included participants with social participation information in 2011 (T1) as the baseline and followed them up in 2014(T2) and 2018(T3). Latent profile analysis (LPA) and latent transition analysis (LTA) were employed to identify the latent classes of social participation and the transition probabilities between these classes. Multinomial logistic regression was used to examine the predictors of transitions, while a two-part model and cross-lagged model were utilized to clarify the longitudinal relationship between social participation and medical care utilization among rural older adults.

RESULTS: Three social participation classes were identified by LPA: low, moderate, and high social participation. The high social participation class exhibited strong stability, with rare transitions to other classes. Subjective economic status, self-rated health, and the number of chronic diseases significantly predicted social participation transition patterns (P < 0.05). Regarding outpatient care utilization, social participation consistently predicted more frequent outpatient visits in all waves (P < 0.05) but was associated with higher outpatient expenses only at T3 (P < 0.05). However, no significant association was observed between social participation and inpatient care utilization. This finding was further supported by cross-lagged modeling, demonstrating significant effects of social participation on outpatient care utilization (β = 0.016 to 0.018, SE = 0.004, P < 0.001).

CONCLUSIONS: This research reveals the social participation dynamics in rural older adults and their effects on medical care utilization in China. Social participation can significantly promote outpatient care utilization among rural older adults. Targeted policy and practice are needed for those with low levels of social participation in rural areas.

PMID:40517227 | DOI:10.1186/s12877-025-06090-6

Trials. 2025 Jun 14;26(1):206. doi: 10.1186/s13063-025-08906-7.

ABSTRACT

BACKGROUND: Antenatal multiple micronutrient supplementation (MMS) has been shown to be more effective than iron-folic acid (IFA) alone in reducing adverse pregnancy and birth outcomes. However, there is a concern that MMS containing 30 mg of iron may be less effective in reducing maternal anemia compared to IFA supplements containing 60 mg of iron. This poses a clinical and programmatic dilemma for countries with a high burden of maternal anemia (> 40% prevalence) where the World Health Organization (WHO) recommends using IFA with 60 mg of iron.

METHODS/DESIGN: We will conduct an individually randomized, quadruple-blind superiority trial of daily antenatal MMS in Dar es Salaam, Tanzania (n = 6381 pregnant women). Participants will be randomized to receive a daily MMS regimen during pregnancy containing 60 mg iron, 45 mg iron, or 30 mg iron at a ratio of 1:1:1. The trial participants, outcome assessors (research staff and care providers), investigators, trial statistician, and data analysts will be blinded. Pregnant women will be enrolled in the trial before 20 weeks of gestation and will receive the randomized MMS regimen from enrollment until the time of pregnancy outcome/delivery. The primary outcome is maternal third-trimester moderate or severe anemia (Hb < 10.0 g/dL). The proportion of women who have moderate or severe anemia at 32 weeks of gestation will be compared between MMS containing 60 mg iron versus MMS containing 30 mg iron, as well as MMS containing 45 mg iron versus MMS containing 30 mg iron. Secondary outcomes include maternal hemoglobin concentration, anemia, maternal iron deficiency, and maternal iron deficiency anemia at 32 weeks gestation and 6 weeks postpartum; preeclampsia, antepartum bleeding, postpartum hemorrhage, maternal peripartum infection, pregnancy-related death, symptoms consistent with depression, fatigue, and maternal malaria during pregnancy and 42 days following; fetal death, stillbirth, birth weight, low birthweight, gestational age at birth, preterm birth, birthweight for gestational age, and small-for-gestational age birth; infant hemoglobin concentrations, infant iron status, neonatal death, and infant death at 6 weeks of age; and maternal side effects. Relative risks for binomial outcomes and mean differences for continuous outcomes and their 95% confidence intervals will be calculated for all the primary and secondary outcomes.

DISCUSSION: This study will produce causal evidence on whether MMS containing 60 or 45 mg of iron is superior to MMS containing 30 mg of iron in reducing maternal anemia and improving other important maternal and infant health outcomes. The findings of this study will inform Tanzania and similar contexts on the optimal formulation of MMS as many countries begin transitioning from IFA to MMS.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06079918. Registered on 2023-10-06.

TRIAL STATUS: The trial is recruiting. We report protocol version 1.7 dated March 2, 2025. Recruitment started with the first patient enrolled on March 3, 2025. At the submission of this manuscript on April 10, 2025, 111 participants have been randomized. Recruitment is ongoing and should be completed by December 2026.

PMID:40517226 | DOI:10.1186/s13063-025-08906-7