Tag: pubmed

BioData Min. 2025 Feb 15;18(1):15. doi: 10.1186/s13040-025-00430-3.

ABSTRACT

Explainable and interpretable machine learning has emerged as essential in leveraging artificial intelligence within high-stakes domains such as healthcare to ensure transparency and trustworthiness. Feature importance analysis plays a crucial role in improving model interpretability by pinpointing the most relevant input features, particularly in disease subtyping applications, aimed at stratifying patients based on a small set of signature genes and biomarkers. While clustering methods, including unsupervised random forests, have demonstrated good performance, approaches for evaluating feature contributions in an unsupervised regime are notably scarce. To address this gap, we introduce a novel methodology to enhance the interpretability of unsupervised random forests by elucidating feature contributions through the construction of feature graphs, both over the entire dataset and individual clusters, that leverage parent-child node splits within the trees. Feature selection strategies to derive effective feature combinations from these graphs are presented and extensively evaluated on synthetic and benchmark datasets against state-of-the-art methods, standing out for performance, computational efficiency, reliability, versatility and ability to provide cluster-specific insights. In a disease subtyping application, clustering kidney cancer gene expression data over a feature subset selected with our approach reveals three patient groups with different survival outcomes. Cluster-specific analysis identifies distinctive feature contributions and interactions, essential for devising targeted interventions, conducting personalised risk assessments, and enhancing our understanding of the underlying molecular complexities.

PMID:39955586 | DOI:10.1186/s13040-025-00430-3

BMC Health Serv Res. 2025 Feb 15;25(1):258. doi: 10.1186/s12913-025-12402-8.

ABSTRACT

BACKGROUND: Ensuring universal access to delivery healthcare services is a core Sustainable Development Goals target to be achieved by 2030. However, in pursuing this target, Bangladesh, like other low- and middle-income countries (LMICs), is now facing an escalation in cesarean section (CS) deliveries, with almost all facility-based deliveries ending in CS. This places an additional burden on the healthcare system as well as maternal and child health. This study aims to explore the association between access to facility-based normal delivery services and health facility-level factors in Bangladesh.

METHODS: We analyzed data from 3,171 mothers and 1,524 healthcare facilities extracted from the 2017-18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. These datasets were linked via GPS coordinates of clusters where mothers resided and healthcare facilities were located. The outcome variable was facility-based normal delivery (yes/no). Explanatory variables included health facility readiness (management and infrastructure), availability of normal delivery services at the nearest facility, readiness for normal delivery care, and average distance from mothers’ homes to the nearest facility offering such care. A multilevel logistic regression model assessed associations between facility-based normal delivery and health facility factors, adjusting for individual, household, and community-level characteristics.

RESULTS: We found 26% access of facility based normal delivery. The likelihood of facility-based normal delivery was found to be increased with higher scores for management (adjusted odds ratio (aOR) 1.24; 95% CI, 1.01-1.62) and infrastructure (aOR, 1.20; 95% CI, 1.01-1.60) of the nearest healthcare facility to mothers’ homes. Furthermore, a one-unit increase in the availability and readiness of the nearest healthcare facility to provide normal delivery care was associated with 2.10 (95% CI, 1.14- 3.12) and 3.15 (95% CI, 1.16-5.11) times higher likelihoods of facility-based normal delivery, respectively. The likelihood of facility-based normal delivery decreased by 20% for every kilometer increase in the distance from mothers’ homes to the nearest healthcare facility.

CONCLUSION: This study’s findings suggest that healthcare facilities’ availability and readiness are important in ensuring facility-based normal deliveries in Bangladesh. It calls for policies and programs to enhance the capacity of facilities to provide normal delivery care.

PMID:39955580 | DOI:10.1186/s12913-025-12402-8

Trials. 2025 Feb 15;26(1):54. doi: 10.1186/s13063-024-08642-4.

ABSTRACT

BACKGROUND: Multimodal rehabilitation has shown good results in adults with temporomandibular disorder (TMD), but there is still doubt regarding the protocol’s ideal format (face-to-face or online), and its effectiveness among adolescents. The purpose of this study is to describe a randomized clinical trial protocol of face-to-face and online multimodal rehabilitation, in adolescents with TMD, and to determine its effects on pain, peripheral oxygenation of the masseter muscle, and mandibular range of motion, kinesiophobia and parafunction.

METHODS: A randomized, controlled clinical trial, blinded to statistical analyses, will be carried out, involving 26 adolescents, diagnosed with TMD. After randomization, the participants will be allocated into two groups: (1) telerehabilitation and (2) face-to-face treatment groups. Each group will undergo an initial assessment, followed by three treatment sessions, reassessment, and follow-up. Appointments and reassessments will be face-to-face, with instruments validated and adapted for adolescent age groups. The intervention protocol also aims at practicality, ease of execution, and strategies for the patient to easily self-manage and perform independently, adapted for face-to-face or online formats. The Diagnostic Criteria for Temporomandibular Disorders, physical and psychosocial aspects, algometry, near-infrared spectroscopy, and the Tampa scale for kinesiophobia will be used to assess the outcomes.

DISCUSSION: It is expected that this study will contribute to online and face-to-face assessments and demonstrate the differences in the practice of rehabilitation of adolescents with TMD. Data will be published after the study is completed, and if the benefits are proven, care modalities may be implemented.

TRIAL REGISTRATION: REBEC-RBR-5scd5tm, UTN code: U1111-1288-4495 . Registered on 19 May 2023.

PMID:39955572 | DOI:10.1186/s13063-024-08642-4

Diabetol Metab Syndr. 2025 Feb 15;17(1):59. doi: 10.1186/s13098-025-01616-9.

ABSTRACT

BACKGROUND: The significant burden of cardiovascular diseases underscores the necessity for identifying novel predictive markers that can forecast both cardiovascular diseases and mortality. In recent years, TyG-obesity-related parameters have gained special attention in this regard. This study aimed to assess the association between TyG-waist circumference (TyG-WC) and cardiovascular diseases and mortality.

METHODS: A comprehensive search was performed in databases including PubMed, Scopus, and Web of Science from their inception until October 6, 2024. The key outcomes of interest included all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardial infarction, stroke, coronary artery diseases, peripheral artery diseases, and heart failure. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated. Meta-analysis was carried out using StataMP 14.0.

RESULTS: A total of 17 studies were included in the analysis. The number of participants ranged between 2,224 and 95,342. The meta-analysis revealed that TyG-WC is significantly associated with an increased risk of all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardial infarction, stroke, coronary artery diseases, and peripheral artery diseases. However, only one study addressed the relationship between TyG-WC and heart failure with a positive correlation.

CONCLUSION: This study indicates that TyG-WC could serve as a promising predictor of cardiovascular diseases, along with cardiovascular and all-cause mortality. Given its accessibility, TyG-WC may be a practical tool for screening purposes.

PMID:39955571 | DOI:10.1186/s13098-025-01616-9

Eur J Med Res. 2025 Feb 15;30(1):105. doi: 10.1186/s40001-025-02365-1.

ABSTRACT

BACKGROUND: Polyethylene glycol electrolyte solution (PEG-ELS) is the standard for bowel preparation but often suffers from poor patient compliance and tolerability due to its high-volume requirement. This prospective, single-blinded, non-inferiority, randomized control trial aims to investigate the efficacy and safety of a lactulose-based regimen as an alternative for bowel preparation.

METHODS: Two hundred nine patients were randomly allocated to receive either a combination regimen consisting of 133.4 g lactulose in 200 mL, 800 mL carbohydrate-containing clear liquid, 2L additional water, and 5 g simethicone (n = 104) or 3L PEG-ELS with 5 g simethicone (n = 105), both administered in a split-dose format. The primary outcome was the rate of adequate bowel preparation, measured by the Boston bowel preparation score (BBPS). Adequate bowel preparation was defined as a BBPS score of 2 or 3 in all colon segments. Secondary outcomes included the percentage of high-quality bowel preparation (defining as a total BBPS score of 8 or 9), polyp detection rate (defining as the percentage of procedures where at least one polyp was detected), willingness to repeat the bowel preparation, adverse events, and changes in blood glucose and electrolyte levels.

RESULTS: The rate of adequate bowel preparation (96.2% vs. 97.1%, p = 0.691), the percentage of high-quality preparation (62.5% vs. 66.7%, p = 0.529), average total BBPS scores (p = 0.607), polyp detection rates (66.3% vs. 77.1%, p = 0.083), and tolerability and acceptability outcomes, including satisfaction (p = 0.729) and willingness to repeat preparation (p = 0.744), were not statistically different between the two arms. Adverse events and changes in blood glucose and electrolytes showed no significant differences (all p > 0.05).

CONCLUSION: The combination of oral lactulose and carbohydrate-containing clear fluids was non-inferior to 3L PEG-ELS for bowel preparation adequacy and polyp detection, without statistically significant differences in terms of tolerability and safety.

PMID:39955567 | DOI:10.1186/s40001-025-02365-1

BMC Psychol. 2025 Feb 15;13(1):125. doi: 10.1186/s40359-025-02480-y.

ABSTRACT

Interoception is a complex, multidimensional construct that refers to the nervous system’s processing of internal bodily signals. Currently, there are no comprehensive measurement tools available to capture the full complexity of interoception. The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), is a widely accepted and utilized interoceptive questionnaire that measures the multiple dimensions of conscious interoception through self-report. The aim of this study was to demonstrate the validity of a new Spanish translation of the MAIA-2 in Peruvian adults and to examine the dimensionality of the MAIA-2. A total of 414 Peruvian participants residing in Lima (Peru) were included; 85% were young adults between 18 and 27 years. The fit of the structural equation model (SEM) was assessed using confirmatory factor analysis (CFA). The dimensionality of the MAIA-2 was assessed using bootstrap exploratory bootstrap graph analysis (bootEGA). The results of the CFA suggest an oblique model (8 factors, 34 items) with modifications (items 11, 12, and 15 deleted). The bootEGA analyses indicate that a five-dimensional model is more parsimonious. These findings suggest that the MAIA-2 may have fewer dimensions than the original eight-dimensional theoretical model. The Peruvian Spanish version of the MAIA-2 proves to be a valid and reliable tool for assessing interoception in Peruvian adults, though slight variations in the dimensional structure were observed compared to the original model. This provides a solid basis for future research and clinical applications in Spanish-speaking contexts.

PMID:39955565 | DOI:10.1186/s40359-025-02480-y

BMC Med Educ. 2025 Feb 15;25(1):246. doi: 10.1186/s12909-025-06823-6.

ABSTRACT

BACKGROUND: E-health literacy is the skill of searching, finding, understanding, and evaluating health information from electronic information sources and using this information to diagnose or treat a health disorder. Adequate health literacy results informed decision-making, and reduced health risks. This study aims to investigate the relationship between eHealth literacy and health-promoting behaviors among students at Khalkhal University of Medical Sciences.

METHOD: This descriptive-analytical study was conducted with students who were selected using a census method. Three questionnaires were used: a demographic questionnaire, the Norman and Skinner eHealth literacy questionnaire, and the Walker Health-Promoting Lifestyle Questionnaire. Data were analyzed using SPSS version 26. Pearson correlation coefficients, independent t-tests, and analysis of variance were employed for comparisons. Multiple linear regression models were used to examine the relationship between eHealth literacy and health-promoting lifestyle, adjusting for some demographic variables.

RESULTS: A total of 255 participants were included in the study. The mean eHealth literacy score was 25.55 (SD = 6.4), and the mean health-promoting lifestyle score was 127.74 (SD = 23.59). There was a statistically significant difference in eHealth literacy scores based on economic status (P < 0.004). Pearson correlation analysis revealed a statistically significant correlation between the total eHealth literacy score and the health-promoting lifestyle score (r = 0.43, p < 0.001). According to the linear regression model, eHealth literacy significantly predicts health-promoting behaviors (β = 1.63, p < 0.001). Thus, each unit increase in eHealth literacy was associated with a 1.63 unit increase in the health-promoting lifestyle score.

CONCLUSION: The level of eHealth literacy and health-promoting lifestyle are both above moderate. Nevertheless, more work needs to be done to improve eHealth literacy, and health-related behaviors. It is recommended that new educational programs integrated into the curriculum for students including how to search the Internet, introduction to health-related databases, and a lesson on health-promoting behaviors.

PMID:39955560 | DOI:10.1186/s12909-025-06823-6

Mol Cancer. 2025 Feb 15;24(1):48. doi: 10.1186/s12943-025-02226-9.

ABSTRACT

BACKGROUND: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) in combination with endocrine therapy are the standard treatment for patients with hormone receptor-positive, HER2-negative metastatic breast cancer (mBC). Despite the efficacy of CDK4/6is, intrinsic resistance occurs in approximately one-third of patients, highlighting the need for reliable predictive biomarkers.

METHODS: Single-cell RNA sequencing analyzed metastatic tumors from HR+/HER2- mBC patients pre-CDK4/6i treatment at baseline (BL) and/or at disease progression. BL samples were from CDK4/6i responders (median progression-free survival [mPFS] = 25.5 months), while progressors were categorized as early-progressors (EP, mPFS = 3 months) and late-progressors (LP, mPFS = 11 months). Metastatic sites included liver, pleural effusions, ascites, and bone. InferCNV distinguished tumor cells, and functional analysis utilized the Molecular Signatures Database.

RESULTS: LP tumors displayed enhanced Myc, EMT, TNF-α, and inflammatory pathways compared to those EP tumors. Samples from BL and LP responders showed increased tumor-infiltrating CD8⁺ T cells and natural killer (NK) cells compared to EP non-responders. Notably, despite a high frequency of CD8⁺ T cells in responding tumors, a functional analysis revealed significant upregulation of genes associated with stress and apoptosis in proliferative CD4⁺ and CD8⁺ T cells in BL tumors compared to in EP and LP tumors. These genes, including HSP90 and HSPA8, are linked to resistance to PD1/PD-L1 immune checkpoint inhibitors. A ligand-receptor analysis showed enhanced interactions associated with inhibitory T-cell proliferation (SPP1-CD44) and suppression of immune activity (MDK-NCL) in LP tumors. Longitudinal biopsies consistently revealed dynamic NK cell expansion and enhanced cytotoxic T cell activity, alongside upregulation of immune activity inhibition, in LP tumors compared to in BL tumors. Notably, the predictive biomarker panel from BL tumor cells was validated in 2 independent cohorts, where it consistently predicted a significant improvement in mPFS duration in signature-high versus -low groups.

CONCLUSION: This study underscores the significance of molecular biomarkers in predicting clinical outcomes to CDK4/6i. Tumor-infiltration CD8⁺ T and NK cells may also serve as baseline predictors. These insights pave the way for optimizing therapeutic strategies based on microenvironment-specific changes, providing a personalized and effective approach for managing HR+/HER2- mBC and improving patient outcomes.

PMID:39955556 | DOI:10.1186/s12943-025-02226-9

J Ovarian Res. 2025 Feb 15;18(1):29. doi: 10.1186/s13048-025-01609-2.

ABSTRACT

INTRODUCTION: Early diagnosis of ovarian cancer, using cost-effective and non-invasive methods remains an unmet medical need, largely due to unspecific symptoms of the disease.

OBJECTIVE: Our goal was to identify differentially methylated CpG loci between cervical swabs obtained from patients diagnosed with benign ovarian disease and with malignant pelvic mass.

METHODOLOGY: Using Infinium EPICv2 array, we interrogated methylation profiles of 77 cervical swabs. The study cohort was then divided into a training and testing set to develop a diagnostic signature. We applied several strategies to pinpoint CpG sites able to differentiate cervical swabs obtained from ovarian cancer patients and patients with benign ovarian disease.

RESULTS AND CONCLUSIONS: None of the statistical methods applied identified CpG loci capable of diagnosing ovarian cancer with sufficient specificity and sensitivity. We conclude that methylation differences observed do not adequately distinguish between benign and malignant ovarian disease. The variations attributable to clinical conditions are likely obscured by the differences in cell composition, which is the primary source of sample heterogeneity. Therefore, we suggest that diagnostic tools should not rely on local methylation profile of the cervix but rather focus on detecting cancer-specific sequences transferred from the tumor site and present in cervical swabs. Ovarian cancer is difficult to detect early, and we aimed to explore whether DNA methylation in cervical swabs could serve as a diagnostic tool. However, our study found that methylation patterns in these samples do not reliably distinguish between benign and malignant conditions, likely due to variations in cell composition. We recommend future research focus on detecting tumor-specific DNA sequences in cervical swabs instead.

PMID:39955551 | DOI:10.1186/s13048-025-01609-2

BMC Health Serv Res. 2025 Feb 15;25(1):259. doi: 10.1186/s12913-025-12400-w.

ABSTRACT

BACKGROUND: In 2019, nearly one billion individuals worldwide were estimated to be living with some form of mental illness. This staggering figure underscores not only the widespread prevalence of mental health issues but also their significant negative impact. Despite the critical impact of mental health problems, there is a substantial gap in treatment at the global scale. Particularly in rural Ethiopia, there is a notable lack of data regarding the use of mental health services by community residents. This study was conducted with the aim of evaluating the utilization of mental health services and identifying factors that influence access to these services among the population of rural southern Ethiopia.

METHODS: A community-based cross-sectional study was conducted on randomly selected adults in southern Ethiopia. A semi-structured questionnaire assessing the sociodemographic status of the participants was used. Depression and anxiety were measured with the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorders Scale (GAD-7), respectively. The data were then analyzed using StataMP version 18. Statistical tests such as frequency, percentage, mean, bivariate logistic regression, and multivariate analysis were performed. P values and confidence intervals were used to determine statistical significance.

RESULTS: A total of 971 participants were enrolled in this study, and the mean age was 34.9 (± 11) years. A minority of the participants (152 [15.5%]) sought some form of help for mental health-related reasons. Only 24 (2.5%) of the participants used biomedical mental health services. The perceived need for any mental health service was 96 (9.9%). Thirty-three percent of the respondents with mild to moderate depression and 37.1% of those with severe depression sought care for their concerns. Similarly, 37% and 35% of individuals with mild to moderate anxiety and severe anxiety, respectively, utilized mental health services. A higher monthly income, psychoactive substance use, perceived need, and symptoms of depression and anxiety were significantly associated with mental health service utilization.

CONCLUSION: Our study revealed a significantly low level of utilization of mental health services among the residents of rural southern Ethiopia. More efforts to address the treatment gap for mental health problems in the country are needed.

PMID:39955546 | DOI:10.1186/s12913-025-12400-w