Nevin Manimala

Stat Methods Med Res. 2025 Apr 13:9622802241313288. doi: 10.1177/09622802241313288. Online ahead of print.

ABSTRACT

We propose a procedure to estimate the “time-specific average treatment effect” and “global average treatment effect” for observational studies with outcomes and covariates repeatedly measured over time. This research is motivated by the National Heart, Lung and Blood Institute Growth and Health Study (NGHS), a longitudinal cohort study that aims to evaluate the influences of race and other risk factors on the levels of blood pressure for children and adolescents. As with most longitudinal cohort studies, we do not have a known propensity score model to further discuss the average treatment effects in the NGHS. To solve this problem, a nonparametric machine learning method, the generalized boosted models (GBMs), is used to estimate the propensity score. Based on the estimated propensity score, the “time-specific average treatment effect” can be obtained through the inverse probability weighting methods, then the “global average treatment effect” is also obtained. We apply the proposed GBM-based estimation method to the NGHS blood pressure data and demonstrate through a simulation study that the GBM-based estimation method is superior to the commonly used logistic regression-based method.

PMID:40223335 | DOI:10.1177/09622802241313288

Pediatr Emerg Care. 2025 Apr 14. doi: 10.1097/PEC.0000000000003386. Online ahead of print.

ABSTRACT

Cardiac POCUS is sometimes performed in patients with chest pain or syncope in the pediatric ED. It is possible that adolescent females are less likely to receive a scan due to provider discomfort with the potential obstruction of breast tissue. The primary aim of this study was to compare the proportion of cardiac POCUS obtained in adolescent males versus females to determine whether there is a difference. This was a retrospective chart review of adolescent patients who presented with chest pain or syncope from the year 2018 to 2020. Cardiac POCUS scans obtained on this cohort were reviewed, and the patients were then compared by sex to see whether there were differences in the number and proportion of scans obtained. The quality of the overall scans was also evaluated and compared to see whether there was a sex-based difference. Descriptive statistics was calculated, and differences were assessed by sex using χ2 test. A total of 2814 patients were enrolled in the study; 1096 were male, and 1718 were female. Of those, 259 received cardiac POCUS; 132 (51%) were male and 127 (49%) were female. There was a significant difference in the proportion of patients who received cardiac POCUS, based on sex (P<0.0001). There was no significant difference in the sex of the patient and the quality of the images obtained. Interrater reliability between a Pediatric Emergency Medicine fellow who has had cardiac POCUS training and a pediatric cardiologist was compared and yielded a kappa of 0.565. There was a significant difference in the sex of the patients who received cardiac POCUS for the complaint of chest pain or syncope.

PMID:40223316 | DOI:10.1097/PEC.0000000000003386

Cleft Palate Craniofac J. 2025 Apr 13:10556656251332119. doi: 10.1177/10556656251332119. Online ahead of print.

ABSTRACT

ObjectiveAccording to food texture preference (FTP), children can be categorized as soft likers (SL) or hard likers. This study explored the relationship between FTP and having an oral cleft in children of the mixed dentition stage. The hypothesis stated that having an oral cleft phenotype would shift a child’s FTP toward soft-food textures.DesignA case-control study that employed a validated child food texture preference questionnaire (CFTPQ) to assess FTP. Children’s general demographics, food neophobia, and food intake data were collected using validated questionnaires. A pediatric dentist evaluated the children’s dental status.SettingData was collected in a dental teaching center and 5 public schools for cases and controls, respectively.ParticipantsThis study included 6- to 13-year-old children with treated oral clefts (n = 87) and their non-cleft peers (n = 413).Main outcome measureCFTPQ index.ResultsCases demonstrated a significantly lower mean CFTPQ index (31.97 ± 16.20) compared to controls (42.07 ± 16.42, P < .001). A total of 45 cases (51%) and 94 (23%) controls were identified as SL (P < .001). Cases were more food neophobic (42.67 ± 9.03) compared to controls (39.03 ± 11.62, P = .002). The final linear regression model identified age and oral cleft phenotype as variables of significant impact on FTP. Moreover, the cleft type, the type, and the number of surgical interventions received did not significantly influence their FTP.ConclusionsThis study offers new insight into a potential relationship between FTP and oral clefts in 6- to 13-year-old children. Children with cleft lip and/or palate demonstrate a preference for soft food textures and are more food-neophobic compared to their non-cleft counterparts.

PMID:40223297 | DOI:10.1177/10556656251332119

Neurol Res Pract. 2025 Apr 14;7(1):24. doi: 10.1186/s42466-025-00381-4.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is a common cause of cardioembolic stroke and can lead to severe and recurrent cerebrovascular events. Thus, identifying patients suffering from cardioembolic events caused by undetected AF is crucial. Previously, we found an association between increasing stroke severity and a decreasing left atrial appendage (LAA) blood flow velocity below 60 cm/s.

METHODS: This was a prospective single-center cohort study including hospitalized patients who underwent a transesophageal echocardiography (TEE) in sinus rhythm. The participants were divided into two groups (≥ 60 cm/s;<60 cm/s) based on their maximum LAA blood flow velocity. The results of the cardiovascular risk assessment and 24- to 72-hour ECG Holter were recorded. Follow-up appointments were scheduled at 3, 6, 12, 24 and 36 months. The primary endpoint was new-onset AF. The statistics included a Cox-proportional-hazard-model and a binary logistic regression. Numerical data or categorical data were analyzed with the Mann-Whitney U test or chi-square test.

RESULTS: A total of 166 patients were recruited. The median LAA blood flow velocity was 64 cm/s. New-onset AF was diagnosed in 22.9% of the patients. An LAA blood flow velocity ≤ 60 cm/s was associated with a threefold increased risk of new-onset AF (35.8% vs. 11.5%; HR3.56; CI95%1.70-7.46; p < 0.001), independently according to a multivariate analysis (p = 0.035). Furthermore, a decreasing LAA blood flow velocity was associated with an increased risk of new-onset AF (OR1.043; CI95%1.021-1.069; p < 0.001).

CONCLUSION: A low LAA blood flow velocity (≤ 60 cm/s) in sinus rhythm is prospectively associated with an increased risk of new-onset AF. Additional simple LAA-TEE examinations could help to identify patients who benefit from more accurate cardiac rhythm monitoring.

PMID:40223142 | DOI:10.1186/s42466-025-00381-4

Commun Med (Lond). 2025 Apr 13;5(1):114. doi: 10.1038/s43856-025-00846-2.

ABSTRACT

BACKGROUND: Various factors associated with long COVID have been evidenced, but the heterogeneity of definitions and epidemiological investigations has often hidden risk pathways relevant for understanding and preventing this condition.

METHODS: This nationwide random sampling survey conducted in France after the Omicron waves in autumn 2022 assessed eight sets of factors potentially associated with long COVID in a structured epidemiological investigation based on a conceptual model accounting for the relationships between these sets of factors. A representative sample of 1813 adults of whom 55% were infected with SARS-CoV-2 was assessed for infection dates and context, post-COVID symptoms and these factors. Four definitions of long COVID, including the World Health Organisation’s, were used.

RESULTS: Female sex, household size (≥2), low financial security, negative impact of COVID-19 pandemic on occupation and work conditions, number of comorbidities (≥2), presence of respiratory disease, mental and sensory disorders, number of SARS-CoV-2 infections (≥2) and initial symptoms (≥6), perceived high severity of COVID-19 are positively and consistently associated with long COVID. Age ≥ 75 years, retirement, SARS-CoV-2 vaccination (≥2 doses) and good perceived information regarding long Covid are negatively associated with the condition.

CONCLUSIONS: The broad spectrum of factors confirmed here strongly suggests that long COVID should be regarded not only as a direct complication of SARS-CoV-2 infection but also as driven by a broader network of contextual, medical, psychological and social factors. These factors should be better considered in strategies aimed at limiting the long COVID burden in the general population.

PMID:40223130 | DOI:10.1038/s43856-025-00846-2

Sci Rep. 2025 Apr 13;15(1):12715. doi: 10.1038/s41598-025-96745-6.

ABSTRACT

Ischaemic heart disease (IHD) remains a major public health threat globally. The aim of this study was to evaluate the short-term burden of air pollution exposure on years of life lost (YLLs) from IHD in Pudong New Area, Shanghai. Data on air pollutants, meteorological factors, and daily IHD deaths were collected from 2013 to 2021. A distributed lag nonlinear model (DLNM) combined with linear (for YLLs) and quasi-Poisson (for mortality) regression models was applied to analyse the association between air pollution exposure and the IHD burden. A stratified analysis was conducted according to sex, age, education level, and residence registration. Each 10 µg/m³ increase in PM₁₀, SO₂, and NO₂ exposure was associated with YLL increases of 0.40 (95% CI: -0.32, 1.11), 4.38 (95% CI: 0.83, 7.92), and 0.67 (95% CI: -0.71, 2.04) years, respectively, at lag0-3. The corresponding YLL increase due to PM_2.5 exposure was 0.28 (95% CI: -0.24, 0.80) years at lag0-1. The impacts of air pollution exposure on YLLs and daily IHD deaths were greater for male and urban groups than for female and rural groups. Furthermore, the difference in SO₂ exposure was statistically significant among sex-stratified groups. Air pollution exposure was positively associated with IHD-related YLL increases in Pudong New Area, Shanghai.

PMID:40223129 | DOI:10.1038/s41598-025-96745-6

Sci Rep. 2025 Apr 13;15(1):12726. doi: 10.1038/s41598-025-95371-6.

ABSTRACT

Stroke is a serious public health problem in developing countries like India, leading to rising deaths and disability-adjusted life years related to stroke. Pre-hospital delay is a major concern in most acute stroke cases, affecting timely interventions and treatment outcomes. Hence the current study aimed to identify the factors influencing the time from stroke onset to arrival at the emergency department and to map the spatial distribution of stroke cases from the tertiary care hospital. We conducted a hospital-based cross-sectional study among stroke patients presenting to the emergency department of a tertiary care hospital in Mysuru. Data on sociodemographic, clinical, and pre-hospital factors, along with detailed addresses of the place of stroke onset, first and second consultation, and their proximal first referral units were collected. GIS mapping was done using the software ArcGIS v10.8.2, and statistical analysis was performed using SPSS v25. Most of the study participants were men, over 60 years of age, and residents from rural areas of Mysuru and its neighboring districts. The study found that only 25% of the stroke cases arrived within 4.5 h of symptom onset, with hemiparesis and slurred speech being the most common presenting complaints. Almost all the cases were within a 20 km radius of the first referral units with factors such as age group (p = 0.028), diabetes as a comorbid condition (p = 0.007), the decision taken for symptom onset (p < 0.01), the person involved in decision-making (p = 0.006), and the mode of arrival at the hospital (p = 0.004) being significantly associated with the duration from stroke onset to arrival at the hospital. This highlights the need for public awareness campaigns on stroke symptoms, the importance of early hospital presentation following stroke onset, and the capacity building of first referral units to provide timely emergency stroke care for people residing in rural areas.

PMID:40223117 | DOI:10.1038/s41598-025-95371-6

J Health Popul Nutr. 2025 Apr 13;44(1):116. doi: 10.1186/s41043-025-00852-z.

ABSTRACT

OBJECTIVE: To explore the clinical efficacy of commonly used conservative treatments for adenomyosis using both TCM and Western medicine.

METHODS: 210 patients with adenomyosis were selected and divided into 3 groups: Group A (Dan’e Fukang), Group B (Dienogest), and Group C (Goserelin + Mirena), with 70 cases in each group. Afterward, indicators were collected for comparison.

RESULTS: Different treatment approaches exhibited varying effects on uterine VAS, and PBAC among the 3 groups (P < 0.001). The effects of different treatment approaches on serum levels of estradiol (E2), FSH, and CA125 also differed among the 3 groups (P < 0.001). After 3 months of treatment, the incidence of adverse reactions among the 3 groups was significantly different (P < 0.001), with further comparison indicating a lower incidence of adverse reactions in Groups A and B than in Group C (P < 0.017). Meanwhile, statistically significant differences in the incidence of adverse reactions among the 3 groups were observed again after 6 months of treatment (P = 0.004), with further comparison revealing a lower incidence of adverse reactions in Group B than in Group C. Additionally, the comparison of uterine volume (P < 0.001) and VAS (P < 0.001) among the 3 groups was different after 12 months of treatment, and further comparison revealed that the uterine volume was ranked as Group B > Group C > Group A, while the pelvic pain VAS scores were ranked as Group C > Group B = Group A.

CONCLUSION: Dan’e Fukang Decoction is markedly effective in alleviating pain; Goserelin + Mirena exhibits significant efficacy in reducing bleeding.

PMID:40223114 | DOI:10.1186/s41043-025-00852-z

BMC Med. 2025 Apr 14;23(1):216. doi: 10.1186/s12916-025-04034-w.

ABSTRACT

BACKGROUND: Differential attainment (DA), or differences in performance of groups (rather than individual differences), has been observed in a number of postgraduate medical specialty examinations used in UK medical training. Until now, much of the published research on DA has been limited in scope and size to one specialty, one examination or one type of assessment. This retrospective cohort study addressed this gap by examining the relationship between numerous sociodemographic differences and performance in almost all UK postgraduate medical examinations using a dataset of more than 180,000 examination attempts by UK and international medical graduates, adjusting for prior academic attainment.

METHODS: This retrospective cohort study used the UK Medical Education Database (UKMED) to analyse the impact of a range of sociodemographic factors on performance in all UK postgraduate medical examinations aggregated into written and clinical exams. Pass/fail data at the first examination attempt were analysed for all candidates (UK medical school graduates (UKG) and those from non-UK schools (IMG)) sitting an examination between 2014 and 2020. Univariate analyses identified variables to carry forward into multivariate logistic regression models. Informed by previous research, all models were adjusted for prior academic attainment.

RESULTS: 180,890 examination first-attempts were made by UKG and IMG candidates, and 121,745 (67.3%) passed at the first attempt. Multivariate regression models showed that place of primary qualification (UKG vs IMG), gender, age, ethnicity, religion, sexual orientation, disability status and working less than full-time were all statistically significant, independent predictors of examination outcomes for all examination candidates. Additionally, there were significant associations between socioeconomic backgrounds and performance for UKGs alone. The strongest independent predictors of failing written and clinical examinations were graduating from a non-UK medical school, having a minority ethnic background and having a registered disability.

CONCLUSIONS: This, the largest study of UK postgraduate medical examination outcomes, identified sociodemographic differences that were independently predictive of performance in written and clinical postgraduate medical examinations. Further analysis is now required to ascertain whether these group-level differences exist in each postgraduate medical examination, the majority or a select few.

TRIAL REGISTRATION: Not applicable.

PMID:40223107 | DOI:10.1186/s12916-025-04034-w

Echo Res Pract. 2025 Apr 14;12(1):9. doi: 10.1186/s44156-025-00072-5.

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, highlighting the importance of identifying prognostic factors to guide treatment escalation plans. This study investigates the short-term prognostic potential of transthoracic echocardiogram (TTE), a commonly performed investigation in OHCA patients. This study is among the first to report left ventricle (LV) global longitudinal strain (LVGLS) in OHCA patients.

METHODS: This single-center retrospective cohort study included 54 patients treated between 2019 and 2022, during the COVID-19 pandemic. Patient characteristics were reported using the 2015 Utstein template, and echocardiographic parameters were assessed following British Society of Echocardiography guidelines. Univariate analyses compared TTE parameters by survival-to-discharge and implantable cardioverter-defibrillator implantation outcomes. Correlations between LV ejection fraction (LVEF) derived from cardiac magnetic resonance imaging (cMRI) and echocardiographic LV systolic parameters were evaluated.

RESULTS: The survival-to-discharge rate was 77.8%. Non-survivors had a significantly larger right atrium (RA) area (RAA) (20.8 cm² vs. 15.2 cm² in survivors; p = 0.003). No statistically significant differences were observed for other right or left heart parameters. The median LVGLS was reduced at -11.4% (interquartile range: -14.0 to -7.6). LVEF correlates well on cMRI and TTE (Pearson correlation coefficient = 0.830).

CONCLUSION: This study identifies a novel association between larger RAA and short-term mortality following OHCA, alongside a higher survival rate in a tertiary center. Further research should consider incorporating RA parameters into analyses to refine prognostic assessments.

PMID:40223106 | DOI:10.1186/s44156-025-00072-5