Category: Statistics

Clin Transplant. 2025 Sep;39(9):e70285. doi: 10.1111/ctr.70285.

ABSTRACT

BACKGROUND: Prior studies have demonstrated an association between donor/recipient sex mismatch and worse outcomes in donation after brain death (DBD) heart transplant. This study aims to determine the impact of donor/recipient sex mismatch on outcomes in donation after circulatory death (DCD) transplant.

METHODS: The study cohort consisted of 1260 patients from the United Network for Organ Sharing (UNOS) dataset who underwent DCD heart transplant between 12/2019 and 12/2023. Transplants were stratified into four groups: female donor/female recipient (FD/FR), female donor/male recipient (FD/MR), male donor/male recipient (MD/MR), and male donor/female recipient (MD/FR). The primary outcomes were acute rejection and post-operative complications, while the secondary outcome was mortality. Multivariable logistic regression was used to analyze factors associated with rejection, while Kaplan-Meier (KM) survival analyses were compared using the log-rank test with post-hoc binary comparisons.

RESULTS: Female recipients who received DCD transplant had higher rates of acute rejection compared to male recipients (FD/FR: 26 (20%), MD/FR: 28 (22.2%), MD/MR 110 (11.8%), FD/MR 6 (9%), p = 0.001) while rates of stroke, dialysis, and pacemaker implantation were similar. Among male recipients, weight, height, and left ventricular assist device (LVAD) were associated with acute rejection. However, neither weight nor height was associated with acute rejection in female recipients. The KM curve showed no difference in long-term mortality.

CONCLUSIONS: Female recipients who receive DCD hearts from male and female donors have an increased risk of acute rejection compared to their male counterparts. Height and weight are associated with acute rejection in male patients. Male and female recipients have similar long-term mortality.

PMID:40891331 | DOI:10.1111/ctr.70285

Stroke. 2025 Sep 2. doi: 10.1161/STROKEAHA.125.051312. Online ahead of print.

ABSTRACT

BACKGROUND: The introduction of novel therapeutics into clinical practice could impact equity in health outcomes.

METHODS: This was a retrospective, observational cohort study based on the Get With The Guidelines-Stroke program of the American Heart Association. Two epochs were considered: January 2010 to December 2014 and January 2016 to December 2019. The primary exposure was the availability of endovascular thrombectomy (EVT) at the hospital level defined by the degree of implementation of EVT (>10% change from pre-2015 to post-2015) after balancing key patient and hospital characteristics with overlap weighting. The coprimary end points were (1) the difference in in-hospital mortality for patients from counties with median income >$60 000 versus <$60 000 and (2) the difference in in-hospital mortality between Black and White patients. Secondary end points were differences in in-hospital mortality by sex, insurance status, county-level poverty, and county-level educational attainment. Exploratory end points were differences in ambulatory status at hospital discharge and a composite of in-hospital mortality/discharge to hospice across the above categories.

RESULTS: Of 173 049 patients (median age, 75 years; 53.9% female) potentially eligible for EVT, 39 196 (22.7%) received EVT (7572 [10.0% of potentially eligible patients] between 2010 and 2014 and 31 624 [32.6% of potentially eligible patients] between 2016 and 2019). From 2010 to 2014, 1565 (20.7%) of patients and from 2016 to 2019, 5158 (16.3%) who received EVT died in hospital. Implementation of EVT was associated with decreased disparities in mortality rates for patients from counties with median inflation-adjusted income >$60 000 versus <$60 000 (absolute risk difference, 3.9% [95% CI, 0.53%-7.3%]). Implementation of EVT was not associated with changes in differences in in-hospital mortality by race, sex, county poverty rates, county educational attainment, or insurance status.

CONCLUSIONS: Among patients with acute ischemic stroke who were potentially eligible for EVT, the implementation of EVT on a hospital level did not worsen health equity in any dimension (race/ethnicity, sex, or insurance status) and was associated with improvements in socioeconomic equity in acute ischemic stroke mortality.

PMID:40891327 | DOI:10.1161/STROKEAHA.125.051312

Clin Transplant. 2025 Sep;39(9):e70300. doi: 10.1111/ctr.70300.

ABSTRACT

BACKGROUND: Heart transplantation (HT) following donation after circulatory death (DCD) has grown substantially in recent years. However, the effects of functional ischemic injury during procurement on exercise capacity remain unknown. We compared exercise performance parameters between DCD and donation after brain death (DBD) recipients.

METHODS: We conducted a single-center, retrospective, case-control study of adults with isolated HT between January 2022 and April 2024 and completed a treadmill cardiopulmonary exercise test (CPET) post-transplant. DCD-HT recipients (cases) were matched to DBD-HT recipients (controls) based on major demographics and CPET timing. The primary outcome was peak oxygen consumption (pVO₂). Secondary outcomes included additional exercise capacity parameters and echocardiographic indices at peak exercise.

RESULTS: Cases (DCD-HT: n = 10, 20% female) and controls (DBD-HT: n = 10, 20% female) had similar baseline characteristics. Total ischemic time was longer in the DCD group (6.9 [interquartile range (IQR): 6.4-7.1] vs. 4.6 [IQR: 3.94.8] h; p = 0.002). Time from HT to CPET did not differ. DCD and DBD-HT recipients had similar pVO₂ (17.1 [IQR: 15.2-19.7] vs. 19.7 [IQR: 13.3-21.2] mL/kg/min; p = 0.545). Respiratory exchange ratio (RER) was slightly lower in the DCD group (1.1 [IQR: 1.0-1.2] vs. 1.2 [IQR: 1.21.3]; p = 0.031). Ventilatory efficiency (VE/VCO₂) at anaerobic threshold, left ventricular ejection fraction, and E/e’ at peak exercise were comparable between groups.

CONCLUSION: DCD and DBD heart transplant recipients demonstrate similar exercise performance. Overall, exercise capacity remains limited after HT, highlighting the need for further studies to identify underlying mechanisms and potential therapeutic interventions.

PMID:40891317 | DOI:10.1111/ctr.70300

Anxiety Stress Coping. 2025 Sep;38(5):599-606. doi: 10.1080/10615806.2025.2475292. Epub 2025 Mar 6.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study investigated the impact of war stress on birth outcomes, specifically birth mode and the subjective childbirth experience (“flow”). We hypothesized that war stress would adversely affect birth mode and the reported “flow.”

DESIGN AND METHODS: A comparative study was conducted utilizing birth data from two online surveys of 411 Israeli women who gave birth before (82%) and during (17.8%) the Israel – Hamas war. Data collected included demographics, birth mode, and self-reported childbirth experience.

RESULTS: Contrary to our initial hypothesis, no significant differences between the two groups regarding birth mode or reported flow during childbirth were found.

CONCLUSIONS: These findings suggest women possess an innate ability to immerse themselves in the birthing process, disconnecting from external stressors, particularly within a safe and supportive birthing environment. We explain our findings from evolutionary, psychological, and biochemical perspectives. Humans have likely evolved to focus on childbirth and shut out external threats. A safe birthing space allows women to enter a focused state for successful birth. Moreover, women tend toward “tend-and-befriend” behavior under stress, seeking safety and social support. The study highlights the importance of the immediate birthing environment for successful childbirth outcomes, even during times of significant external stress.

PMID:40891311 | DOI:10.1080/10615806.2025.2475292

Eur J Psychotraumatol. 2025 Dec;16(1):2542045. doi: 10.1080/20008066.2025.2542045. Epub 2025 Sep 2.

ABSTRACT

Background: Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents, particularly in psychiatric settings, where prevalence rates exceed those observed in the general community. Childhood maltreatment (CM) is a known risk factor for NSSI; however, the mechanisms linking CM to NSSI are not fully understood.Objective: This study explored the mediating roles of stressful life events (SLEs) and negative affect (depression and anxiety) in the relationship between CM and NSSI, grounded in the cumulative adversity theory.Methods: In this cross-sectional survey, 226 Chinese adolescents (Mage = 14.76, SD = 1.70) admitted to a psychiatric unit participated. Measures included the Childhood Trauma Questionnaire (CTQ-SF), the Adolescent Self-Rating Life Events Checklist (ASLEC), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC). Structural equation modelling (SEM) was used to analyze mediation pathways.Results: Stressful life events and negative affect fully mediated the relationship between childhood maltreatment and NSSI. Specifically, CM indirectly influenced NSSI severity through increased negative affect (β = 0.088, 95% CI: 0.014-0.186, p = .039) and through a sequential pathway involving both SLEs and negative affect (β = 0.137, 95% CI: 0.072-0.251, p = .002). However, the pathway from CM to NSSI via SLEs alone was not significant (β = -0.053, 95% CI: -0.267 to 0.093, p = .565).Conclusion: The findings align with cumulative adversity theory, suggesting that childhood maltreatment elevates NSSI risk by increasing emotional distress in response to subsequent stressful life events. Targeted interventions should focus on helping at-risk adolescents manage stress and strengthen emotional resilience.

PMID:40891308 | DOI:10.1080/20008066.2025.2542045

J Liver Cancer. 2025 Sep 2. doi: 10.17998/jlc.2025.08.26. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying metabolic biomarkers can enhance early detection and risk stratification of hepatocellular carcinoma (HCC). We conducted a two-sample Mendelian randomization (MR) study to assess the potential causal effects of metabolites on HCC risk.

METHODS: We performed meta-analyses to pool the effects of genetic instruments from 64 previously published genome-wide association studies. Summary statistics for HCC were obtained from a meta-analysis of the UK BioBank and FinnGen cohorts. MR analyses for the association between 3,275 metabolites and HCC risk were performed using inverse variance weighted, weighted median, MR-Egger, and MR-PRESSO methods to estimate the association. Enrichment analyses were performed on the significant metabolites to identify biological pathways associated with macronutrient intake.

RESULTS: We identified 99 metabolites that were positively and 36 metabolites that were negatively associated with HCC risk. Methyl glucopyranoside and phosphatidylcholine C38:3 were positively associated with HCC risk, whereas while 3-dehydrocarnitine and 10-undecenoate were inversely associated, with no evidence of heterogeneity, pleiotropy, or outlier effects for any of these associations. Pathway enrichment analysis showed that metabolites associated with increased HCC risk were primarily related to amino acid transport and solute carrier transporter disorders, whereas those linked to reduced risk were mainly involved in inositol and phosphatidylinositol metabolism, glycerophospholipid catabolism, and MeCP2-related regulatory processes.

CONCLUSION: This comprehensive MR study identified several metabolites with potential causal roles in HCC development. Our findings highlight nutrient transport, lipid metabolism, and related regulatory mechanisms as key components of HCC pathogenesis, offering new avenues for biomarker discovery and therapeutic intervention.

PMID:40891298 | DOI:10.17998/jlc.2025.08.26

Alzheimers Dement. 2025 Sep;21(9):e70605. doi: 10.1002/alz.70605.

ABSTRACT

INTRODUCTION: Alzheimer’s disease (AD) involves complex neurodegeneration in the locus coeruleus (LC) and substantia nigra (SN), critical brain regions affecting cognitive and emotional processes.

METHODS: Using the National Alzheimer’s Coordinating Center dataset of 11,583 participants, we conducted a multimodal analysis involving descriptive statistics, multifactorial regression, mediation analysis, and receiver operating characteristic curve assessment.

RESULTS: LC degenerative changes (18.57%) significantly exceeded SN changes (4.69%). The LC demonstrated stronger correlations with psychiatric symptoms and cognitive impairment. High LC/low SN damage patterns showed the strongest associations with mild cognitive impairment (OR = 2.38) and AD (OR = 3.56).

DISCUSSION: Our research reveals the heterogeneous degeneration patterns of LC and SN in AD, providing crucial insights into neurobiological mechanisms and potential strategies for early diagnosis and intervention.

HIGHLIGHTS: This study provides a comprehensive framework for understanding the heterogeneous neurodegeneration patterns in AD through a detailed examination of the LC and SN. The research bridges the gap between neuroanatomical changes and neuropsychiatric symptoms, offering a more nuanced perspective on disease progression. Our findings challenge traditional linear models of neurodegeneration, emphasizing the complex and non-uniform nature of neural deterioration in AD. The study underscores the critical importance of investigating multiple neural nuclei to comprehensively understand neurodegenerative processes. By exploring the differential vulnerabilities of LC and SN, we provide new insights into potential targeted therapeutic interventions.

PMID:40891260 | DOI:10.1002/alz.70605

Cancer Rep (Hoboken). 2025 Sep;8(9):e70335. doi: 10.1002/cnr2.70335.

ABSTRACT

BACKGROUND: Poly-ADP ribose polymerase inhibitors have been shown to improve progression-free survival in patients with advanced high-grade epithelial non-mucinous ovarian cancers characterized by a deficiency in homologous recombination (HRD). Guidelines recommend all patients with advanced high-grade epithelial ovarian cancer undergo genomic tumor testing for HRD. Our aim was to evaluate the first year of HRD testing at the statewide Western Australia Gynecologic Cancer Service to assess factors associated with obtaining a diagnostic HRD testing result.

METHODS: Retrospective chart review.

RESULTS: HRD testing was indicated in 84 patients, and ordered in 79, of which three had non-diagnostic/inconclusive results, all due to insufficient tumor quantity. One patient had the sample collected using a 20-gauge core biopsy needle under image guidance, one patient following interval debulking surgery, and one following primary debulking surgery. Of 76 patients with an HRD result, HRD was positive in 29 (38.2%). A somatic BRCA mutation was detected in six of these 29 patients (20.6%) and HRD positive, BRCAwt was detected in 23 of 29 patients (79.4%). All core biopsies with 16- and 18-gauge needles had a diagnostic HRD result. Ten of 11 patients who were treated by neoadjuvant chemotherapy and whose biopsies were obtained at interval cytoreductive surgery had sufficient tumor tissue for testing and had a diagnostic HRD result. All ascitic/pleural fluid samples sent for HRD testing yielded diagnostic results.

CONCLUSIONS: Compliance with HRD testing was high, and only three of 79 (3.8%) patients had non-diagnostic results.

PMID:40891252 | DOI:10.1002/cnr2.70335

Scand J Occup Ther. 2025 Aug 29;32(1):2555182. doi: 10.1080/11038128.2025.2555182. Epub 2025 Sep 2.

ABSTRACT

BACKGROUND: Assessment of work ability is complex yet crucial in occupational health and vocational rehabilitation. Evaluating psychometric properties is essential to ensure the accuracy of assessment tools in this field.

AIM: The aim of this study was to investigate the psychometric properties of the Finnish version of the Assessment of Work Performance (AWP-FI) with a focus on construct validity.

MATERIAL AND METHODS: The AWP assesses a client’s observable working skills during work performance in three domains: motor skills, process skills, and communication and interaction skills. Ninety-four AWP-FI assessments were performed by 17 occupational therapists in Finland. A Rasch analysis was conducted to evaluate the psychometric properties.

RESULTS: The AWP-FI presented an overall fit to the Rasch model with acceptable item-fit statistics and items performing stably between gender, work tasks, and observation types. A suboptimal targeting was evident and issues concerning local dependency among items and indications of multidimensionality were indicated.

CONCLUSION: This study provides an initial validation of the AWP-FI, demonstrating generally acceptable psychometric properties, suggesting that the AWP-FI is valid and reliable for assessing work performance. Further testing is recommended to address the identified issues with local dependence and suboptimal targeting.

PMID:40891248 | DOI:10.1080/11038128.2025.2555182

Glob Health Action. 2025 Dec;18(1):2547495. doi: 10.1080/16549716.2025.2547495. Epub 2025 Sep 2.

ABSTRACT

Over the coming decades Africa is projected to undergo a significant demographic shift towards an older population. Healthcare provision for older adults is made more complex by age-related multimorbidity and frailty, which contribute to older adults more frequently requiring intensive, hospital-based treatment than those in younger age groups. We investigate age and sex-stratified, diagnosis-specific hospital referral patterns in Harare, Zimbabwe to understand referral practices for older adults. This retrospective analysis of attendance records from primary health clinics (n = 8) over six years (2016 to 2021) investigated associations between age, sex and diagnosis and recommended hospital referral. Analysis compared the percentage referred between those aged ≥65 years and those younger than 65 years. The records contained 195,999 attendances. Median attendee age was 9 years (IQR 1.75-32); 52.5% were female; 5.4% were aged ≥65 years. Overall, 14.9% attendances resulted in hospital referral. The highest referral percentage by diagnosis was for trauma (47.8% referred overall, 40.5% of those aged ≥65 years referred). The overall percentage referred in those aged ≥65 years (18.5%) was the same as those aged 35-44 years (18.0%); this pattern was observed across diverse diagnoses including acute respiratory infections, hypertension and musculo-skeletal pain. Despite age-associated morbidity and theoretically free public healthcare to those aged ≥65 years in Zimbabwe, older adults are no more likely to be referred than young adults to higher level care, across multiple disease classes, including infective, musculoskeletal and cardiovascular diseases. This may reflect a healthcare system not yet orientated towards an ageing population’s needs.

PMID:40891239 | DOI:10.1080/16549716.2025.2547495