Category: Statistics

Bull World Health Organ. 2025 Apr 1;103(4):266-274. doi: 10.2471/BLT.24.292434. Epub 2025 Feb 25.

ABSTRACT

OBJECTIVE: To evaluate the outcome of Peru’s strategy to introduce new vaccines in the poorest regions with high child mortality rates.

METHODS: We analysed data from nationally representative annual health surveys conducted between 2004 and 2022. We examined associations between vaccine coverage and poverty (proportion of households in the poorest 40% of the national wealth index) at the ecological level using the country’s 25 regions and at the individual child level using household wealth quintiles. We obtained vaccination data from home-based records.

FINDINGS: The surveys included 49 023 children aged 18-29 months. In the ecological analyses, coverage for Haemophilus influenzae type b, pneumococcal conjugate and rotavirus vaccines was positively associated with poverty prevalence in the initial post-introduction period, but these associations disappeared over time. In contrast, the individual-level analyses indicated that children from wealthier families were consistently more likely to be vaccinated than children from poorer families. In the most recent period (2018-2022), vaccination coverage in the wealthiest quintile was about 10 percentage points higher than in the poorest quintile. Coverage levels for boys and girls were similar. Children whose low-income families were enrolled in the Juntos cash transfer programme had higher coverage than the rest of the population.

CONCLUSION: The strategy increased coverage in the poorest districts initially and, as national coverage grew, regional disparities were eliminated. However, socioeconomic differences persisted, with wealthier children maintaining higher vaccination rates throughout the study. To eliminate these disparities, geographic targeting should be complemented with household-level targeting.

PMID:40207242 | PMC:PMC11978405 | DOI:10.2471/BLT.24.292434

Front Immunol. 2025 Mar 26;16:1566939. doi: 10.3389/fimmu.2025.1566939. eCollection 2025.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) plus fluorouracil-based chemotherapy (Chemo) have been approved as an initial treatment strategy for metastatic or recurrent human epidermal growth factor receptor 2 (HER2)-negative gastric cancer (GC) or gastroesophageal junction cancer (GEJC). However, since programmed cell death protein-1 (PD-1) or its ligand 1 (PD-L1) inhibitors have just recently been investigated for the treatment of unresectable GC/GEJC, there is ongoing debate regarding their safety and effectiveness for prespecified subgroups. The purpose of this research is to establish a foundation toward stratified decision-making by methodically assessing the merits and drawbacks of PD-1/PD-L1 inhibitors combined with chemo in the clinical utilization of advanced HER2-negative GC/GEJC according to certain prominent large-scale randomized controlled trials (RCTs). In addition, we limitedly explored the favorable short-term efficacy of PD-1/CTLA-4 bispecific antibodies for the above-mentioned tumors.

METHODS: The researchers retrieved several databases, including PubMed, Embase, Web of Science, ClinicalTrials.gov, and the Cochrane Library, to collect all the relevant literature published since the establishment of the databases until October 30, 2024, and then screened to determine the qualified literature and extracted the relevant information. We only included RCTs for PD-1/PD-L1 inhibitors with or without chemo in advanced GC or GEJC. The primary endpoints were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). A subgroup analysis for the median overall survival (mOS) was conducted for the following variables: microsatellite instability (MSI) status, PD-L1 expression, combined positive scores (CPS), metastasis status, and primary tumor location. When moderate heterogeneity was found, a random-effect model was applied. The outcome indicators were then statistically analyzed, taking advantage of Review Manager 5.4. Hazard ratio (HR) and risk ratio (RR) were selected as the effect values for statistical analysis.

RESULTS: A total of 7 eligible RCTs and 6537 participants were included in this meta-analysis. Combining PD-1/PD-L1 inhibitors with chemo significantly improved patients’ OS compared with chemo alone, especially in the tumor cell PD-L1 expression ≥ 1% [HR = 0.62, 95% CI (0.48, 0.81); a p-value = 0.0004], PD-L1 CPS ≥ 10 [HR = 0.66, 95% CI (0.57, 0.77); a p-value < 0.00001], and MSI-H subgroups [HR = 0.40, 95% CI (0.28, 0.59); a p-value < 0.00001]. Moreover, distinct primary tumor location (GC or GEJC) and the presence of liver metastases could also benefit from the additive or sustained effect of anti-cancer chemo-immunotherapy.

CONCLUSION: For patients with advanced HER2-negative GC/GEJC, PD-1/PD-L1 inhibitors in combination with chemo have almost demonstrated consistent synergistic anti-tumor benefits to survival outcomes when compared to chemo alone. However, the subgroup analysis in this meta-study revealed that neither PD-L1 expression level nor MSI status could fully predict the efficacy of the dual treatment model but faced a higher possibility of serious treatment-related adverse events (sTRAEs), particularly in the synchronous therapy arm. Therefore, urging the need for more investigations into the development of collaborative prognostic forecasting models for achieving precise stratification, established harmonized testing standards and methods for PD-L1 expression and positivity, optimal CPS threshold for benefits, as well as alternative molecular biomarkers for the reason that certain indicators alone may not discriminate responders clearly. Lastly, dual anti-therapy might be a useful tactic for the population with low PD-L1 expression in the future.

PMID:40207218 | PMC:PMC11979168 | DOI:10.3389/fimmu.2025.1566939

Curr Res Food Sci. 2025 Mar 17;10:101037. doi: 10.1016/j.crfs.2025.101037. eCollection 2025.

ABSTRACT

Fixation methodology serves as the critical determinant in shaping green tea’s multi-dimensional quality attributes; however, the impact of different fixation methods and the corresponding combinations on the overall metabolites and quality of in green tea remains unclear. In this study, non-volatile metabolites (NVMs) and volatile metabolites (VMs) analyses and objective quantitative techniques were used to determine the effects of electromagnetic roller-hot air coupling fixation (ROHF), electromagnetic roller-steam coupling fixation (ROSF), electromagnetic roller-hot air-steam coupling fixation (RHSF), electromagnetic single roller fixation (ROLF), and carding fixation (CDF) on the quality of green tea. Forty-four NVMs, 99 VMs, and 15 flavor objective quantitative indexes were identified, with 12 differential NVMs and 9 differential VMs statistically screened. The green tea processed via ROLF was lustrous and emerald green with a bright and clear liquor; ROSF resulted in low caffeine and flavonoid glycosides contents and an umami (UMS) taste; and RHSF was associated with high trans-β-ionone, hexanal and 1-octen-3-ol levels, with a floral and fresh aroma. These findings provide a precise control scheme for the customized processing of green tea, and promote the upgrading of traditional fixation process to intelligent standardization.

PMID:40207208 | PMC:PMC11981776 | DOI:10.1016/j.crfs.2025.101037

Gastroenterol Rep (Oxf). 2025 Apr 9;13:goaf030. doi: 10.1093/gastro/goaf030. eCollection 2025.

ABSTRACT

BACKGROUND: Pancreatic cancer (PC) is a heterogeneous disease with various histological and molecular subtypes. This study aimed to provide updated epidemiological estimates, survival outcomes, and treatment information for PC based on histological subtypes in the USA.

METHODS: Data from the US Cancer Statistics and Surveillance, Epidemiology, and End Results (SEER)-17 databases (2000-2020) were used, including adults aged ≥20 years who were diagnosed with PC. The trends of incidence and prevalence by histological types were calculated by using the Joinpoint Regression model. Survival by histological type was analysed by using Kaplan-Meier curves and log-rank tests for group comparisons.

RESULTS: Overall, the age-adjusted PC incidence per 100,000 increased from 9.54 to 12.05 in SEER-17 and from 9.75 to 12.19 in the US Cancer Statistics between 2001 and 2019. A further SEER-17 study comprised 113,681 PC cases that were sorted by histologic type between 2000 and 2020. The incidence per 100,000 of invasive intraductal papillary mucinous neoplasm (IPMN) and invasive mucinous cystic neoplasm (MCN) decreased (IPMN from 0.67 to 0.20 and MCN from 0.05 to 0.01) whereas that of other histological subtypes increased. Survival analysis indicated the best outcomes for solid pseudopapillary tumors and the poorest for squamous cell carcinoma. At the localized stage, the proportion of surgery in the treatment modalities varied depending on the biological behavior; the proportion of surgery for pancreatic neuroendocrine tumor was the highest and that for pancreatic ductal adenocarcinoma (PDAC) was the lowest. At the distant metastasis stage, a chemotherapy-based regimen remained the primary treatment of PDAC, pancreatic neuroendocrine tumor, and IPMN.

CONCLUSIONS: PC incidence and prevalence have been increasing. The incidence of IPMN and MCN decreased whereas that of other subtypes increased. Treatment distribution varies among subtypes and stages.

PMID:40207198 | PMC:PMC11981714 | DOI:10.1093/gastro/goaf030

BMC Oral Health. 2025 Apr 9;25(1):508. doi: 10.1186/s12903-025-05890-x.

ABSTRACT

OBJECTIVES: This study aims to evaluate the efficacy of combining the coronally advanced flap (CAF) technique with concentrated growth factor (CGF) in the treatment of gingival recession (GR), and to compare this approach with other alternative treatments.

METHODS: This systematic review and meta-analysis included randomized controlled trials (RCTs) comparing CAF combined with CGF to other treatments for root coverage procedures. Included studies evaluated systemically healthy adults (> 18 years) with Miller Class I/II or Cairo RT1 gingival recessions. Primary outcomes were complete root coverage (CRC) and mean root coverage (MRC); secondary outcomes included changes in keratinized tissue width (KTW), gingival thickness (GT), clinical attachment level (CAL), recession width (RW), recession depth (RD), and probing depth (PD). A comprehensive search was conducted across multiple databases, including PubMed, Scopus, Cochrane Library, Web of Science, and Embase, up to November 9, 2024. The study protocol was prospectively registered in PROSPERO (CRD42024556815). Statistical analyses were performed using Review Manager 5.4.1.

RESULTS: Eight studies were included in the meta-analysis. Compared to CAF alone, the combination of CAF and CGF significantly improved CRC (OR = 1.79, P = 0.04), MRC (MD = 10.38%, P = 0.04), KTW (MD = 0.40 mm, P = 0.02), GT (MD = 0.26 mm, P < 0.00001), and CAL (MD = 0.36 mm, P = 0.03). CAF combined with connective tissue graft (CTG) showed superior efficacy for CRC compared to CAF + CGF (OR = 0.25, P = 0.009). However, no significant differences were found between CAF + CTG and CAF + CGF for MRC, CAL, KTW, RD, RW, or PD. Additionally, no significant differences were observed when comparing CAF + CGF with CAF + PRF across all clinical parameters (all P > 0.05).

CONCLUSIONS: The findings of this meta-analysis indicate that CAF/CGF improves clinical outcomes in treating GR compared to CAF alone, and CGF may be a viable alternative to CTG when CTG is not applicable. Further studies are needed to validate the efficacy of CAF/CGF in the treatment of GR.

CLINICAL SIGNIFICANCE: In cases where CTG is not applicable, CGF may serve as a viable alternative for the treatment of Miller class I and II GR.

PMID:40205617 | DOI:10.1186/s12903-025-05890-x

Genome Med. 2025 Apr 10;17(1):35. doi: 10.1186/s13073-025-01459-z.

ABSTRACT

BACKGROUND: Genome-wide association studies (GWAS) have identified hundreds of loci underlying adult-onset asthma (AOA) and childhood-onset asthma (COA). However, the causal variants, regulatory elements, and effector genes at these loci are largely unknown.

METHODS: We performed heritability enrichment analysis to determine relevant cell types for AOA and COA, respectively. Next, we fine-mapped putative causal variants at AOA and COA loci. To improve the resolution of fine-mapping, we integrated ATAC-seq data in blood and lung cell types to annotate variants in candidate cis-regulatory elements (CREs). We then computationally prioritized candidate CREs underlying asthma risk, experimentally assessed their enhancer activity by massively parallel reporter assay (MPRA) in bronchial epithelial cells (BECs) and further validated a subset by luciferase assays. Combining chromatin interaction data and expression quantitative trait loci, we nominated genes targeted by candidate CREs and prioritized effector genes for AOA and COA.

RESULTS: Heritability enrichment analysis suggested a shared role of immune cells in the development of both AOA and COA while highlighting the distinct contribution of lung structural cells in COA. Functional fine-mapping uncovered 21 and 67 credible sets for AOA and COA, respectively, with only 16% shared between the two. Notably, one-third of the loci contained multiple credible sets. Our CRE prioritization strategy nominated 62 and 169 candidate CREs for AOA and COA, respectively. Over 60% of these candidate CREs showed open chromatin in multiple cell lineages, suggesting their potential pleiotropic effects in different cell types. Furthermore, COA candidate CREs were enriched for enhancers experimentally validated by MPRA in BECs. The prioritized effector genes included many genes involved in immune and inflammatory responses. Notably, multiple genes, including TNFSF4, a drug target undergoing clinical trials, were supported by two independent GWAS signals, indicating widespread allelic heterogeneity. Four out of six selected candidate CREs demonstrated allele-specific regulatory properties in luciferase assays in BECs.

CONCLUSIONS: We present a comprehensive characterization of causal variants, regulatory elements, and effector genes underlying AOA and COA genetics. Our results supported a distinct genetic basis between AOA and COA and highlighted regulatory complexity at many GWAS loci marked by both extensive pleiotropy and allelic heterogeneity.

PMID:40205616 | DOI:10.1186/s13073-025-01459-z

BMC Med Educ. 2025 Apr 10;25(1):509. doi: 10.1186/s12909-025-06679-w.

ABSTRACT

BACKGROUND: The art of percussion in physical examination is a critical skill for clinicians, offering insights into the condition of internal organs. Historical ties between music and medicine, exemplified by Apollo, the Greek God of both domains, suggest a potential correlation between musical aptitude and clinical acumen. This study investigates the relationship between musical abilities, as measured by the Montreal Battery of Evaluation of Amusia (MBEA), and the proficiency in identifying percussion notes among medical students.

METHODS: A cross-sectional study was conducted with 250 pre-clinical undergraduate medical students from the state of Uttar Pradesh, India. Participants completed the MBEA, which assesses various aspects of music processing, along with a self-engineered percussion sound test. The percussion test involved identifying different percussion notes from clinical demonstration videos. Correlation and regression analyses were performed to evaluate relationships between MBEA scores, prior musical training, and proficiency in identifying percussion notes. Statistical significance was determined at p < 0.05.

RESULTS: Among 250 participants, 38.8% had prior musical experience. MBEA scores weakly correlated with percussion competency (r≈0.18, R^2 = 0.033, p = 0.003), while prior training in music strongly correlated with MBEA scores (r≈0.89, p < 0.001) and modestly with percussion competency (r≈0.23, p < 0.001). Logistic regression revealed variability in predictive accuracy, highlighting the complex interplay of factors influencing auditory skills and supporting music education as a supplementary tool in medical training.

CONCLUSION: The study indicates a minimal correlation between musical aptitude and the ability to discern percussion notes, highlighting the complexity of auditory perception skills among medical students. While prior musical experience shows a stronger association with MBEA scores, the overall impact on clinical percussion skills appears limited. These findings suggest that while there may be a relationship between musical training and auditory skills, it is not a strong predictor of clinical percussion proficiency.

PMID:40205615 | DOI:10.1186/s12909-025-06679-w

BMC Pediatr. 2025 Apr 9;25(1):283. doi: 10.1186/s12887-025-05629-1.

ABSTRACT

BACKGROUND: Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates ≤ 2000 g in Uganda.

METHODS: This observational study was embedded within the OMWaNA trial, which examined the impact of KMC on neonatal mortality before clinical stability. An independent observer (considered the gold standard) monitored neonates every 2 h to confirm KMC position, using an Android tablet-based application adapted from the EN-BIRTH study. The gold standard was compared to routine healthcare workers’ charting and caregiver diary reports of KMC.

RESULTS: Among 222 caregiver-newborn pairs, 219 initiated KMC. The mean daily KMC duration recorded by the gold standard was 8·4 h (SD 3·5). Healthcare workers reported an average of 8·5 h (SD 4·0), while caregivers reported 10·4 h (SD 3·8). The mean difference was 0·2 h less for healthcare workers (95% CI -0·3 to 0·6) and 1·7 h more for caregivers (-2·1 to -1·3) compared to the gold standard. Agreement rates for individual KMC episodes were 55·2% (95% CI 54·4-55·9) for healthcare workers and 58·2% (57·2-59·0) for caregivers. Participants with a helper (substitute KMC provider) had longer daily duration compared to those without (mean difference 1·89 h [0·89 – 2·84]; p < 0·001).

CONCLUSION: Healthcare worker records provide a reasonably accurate estimate of KMC duration at the population level, supporting the integration of KMC indicators into national health information systems to facilitate monitoring and evaluation. The presence of a helper increases KMC duration, underscoring the need for research to identify strategies to increase family involvement.

PMID:40205609 | DOI:10.1186/s12887-025-05629-1

Biopsychosoc Med. 2025 Apr 9;19(1):7. doi: 10.1186/s13030-025-00328-w.

ABSTRACT

BACKGROUND: Chronic pain, particularly pain secondary to trauma, is often accompanied by a feeling of perceived injustice. A prevalent feeling of injustice often goes along with a prolonged rehabilitation and problematic development of chronic pain. This feeling also correlates to catastrophizing. To date, too little is known about how the perception of injustice in chronic pain patients is interwoven with a variety of psychological, social and somatic factors. The present study sought to examine whether perceived injustice is correlated with pain level, pain diagnosis, depression, anxiety, stress, quality of life, pain related disability, occupation status and ongoing workers compensation litigation.

MATERIAL AND METHODS: During the three month period, all patients undergoing an interdisciplinary assessment of their chronic pain at our institution (n = 191) were asked to take part in the study. 164 patients (86%) completed the injustice experience questionnaire (IEQ). Data regarding pain level, pain diagnosis, gender, age, depression, anxiety, stress, quality of life, pain related disability, occupation status and ongoing workers compensation litigation were extracted from the patient’s charts. Correlations of these data to IEQ scores and differences between distinct subgroups of patients were analysed.

RESULTS: Median total IEQ scores were 36.0 (IQR: 29.0-42.75). Median IEQ scores for the subscale blame and severity were 14.0 (IQR: 10.0-19.5) and 21.0 (IQR: 18.0-24.0) respectively. The IEQ correlated statistically significant with anxiety, depression and stress. No statistically significant differences were found in the IEQ scores between men and women. There was no statistically significant correlation of the IEQ scores with age, neither were statistically significant correlations with pain localizations found. No statistically significant correlation between IEQ scores and the different pain scores were found. IEQ values were higher in patients with pension application and with current sick leave. The presence of biographical factors (i.e. childhood trauma or experiences of emotional neglect) was related with higher IEQ values.

CONCLUSION: The IEQ appears to be more closely related to psychological and social determinants of pain than to somatic factors.

PMID:40205605 | DOI:10.1186/s13030-025-00328-w

J Health Popul Nutr. 2025 Apr 9;44(1):112. doi: 10.1186/s41043-025-00860-z.

ABSTRACT

BACKGROUND: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases (CVD). Patients with inflammatory bowel disease (IBD) may be at higher risk of developing MetS due to chronic inflammation, altered adipokine profiles, and the effects of corticosteroid treatment. However, the prevalence of MetS in IBD patients remains inconsistent across studies. This meta-analysis aims to estimate the prevalence of MetS in IBD patients and compare its occurrence between Crohn’s disease (CD) and ulcerative colitis (UC).

METHODS: A systematic search was conducted across PubMed, Scopus, Embase, and Web of Science from their inception up to January 19, 2025. Eligible observational studies reporting MetS prevalence in IBD patients were included. Meta-analysis was performed using a random-effects model, with heterogeneity assessed via the I² statistic. Comprehensive Meta-Analysis (CMA) software, version 4.0 was used for analysis.

RESULTS: The pooled prevalence of MetS in IBD patients was 21.8% (95% CI: 14.3-31.6%). The prevalence was higher in UC patients (32.7%, 95% CI: 16.0-55.5%) compared to CD patients (14.1%, 95% CI: 8.6-22.3%). Patients with UC had significantly higher odds of MetS than those with CD (OR = 1.38, 95% CI: 1.03-1.85, P = 0.02). Additionally, IBD patients with MetS were significantly older than those without (MD: 9.89, 95% CI: 5.12-14.67, P < 0.01).

CONCLUSION: In summary, this meta-analysis reveals a notable prevalence of MetS among patients with IBD, particularly in those with UC, where the prevalence is higher than in CD. The analysis also shows that IBD patients with MetS tend to be older, suggesting age as a contributing factor. These findings underscore the need for routine metabolic screening in IBD care, especially in UC and elderly patients.

PMID:40205601 | DOI:10.1186/s41043-025-00860-z