Tag: statistics

Health Informatics J. 2025 Oct-Dec;31(4):14604582251401402. doi: 10.1177/14604582251401402. Epub 2025 Dec 5.

ABSTRACT

Introduction: Pediatric restraint orders require frequent renewal to ensure patient safety. Previously, providers depended on nurses paging them upon order expiration, leading to lapses. Methods: In April 2023, we implemented an alerting system in our 38-bed pediatric intensive care unit (PICU) that sent automated text messages to providers upon order expiration. Pediatric wards and adult ICU served as controls. We analyzed 2 years of restraint order data. An unpaired t-test compared pre- and post-intervention. Results: A total of 1394 orders were included (133 PICU, 628 pediatric wards, 633 adult ICU). In the PICU, time without an active order decreased by 39% (2 h 23 min to 1 h 27 min, p = .24) though this result did not reach statistical significance. Conclusion: Despite not reaching statistical significance, this exploratory case study demonstrated that automated EHR alerts may reduce time without an active restraint order. This pilot led the institution’s informatics team to system-wide adoption. While promising, such systems must be balanced against risks like provider alarm fatigue.

PMID:41348972 | DOI:10.1177/14604582251401402

JMIR Public Health Surveill. 2025 Dec 5;11:e83323. doi: 10.2196/83323.

ABSTRACT

BACKGROUND: Long COVID affects millions worldwide, straining health systems and workforce stability. This first nationwide survey among French civil servants combines epidemiological assessment with a Knowledge, Attitudes, and Behaviors approach. Long COVID remains a diagnostic and epidemiological challenge with evolving symptoms and uncertain categorization, particularly among self-suspected cases. Beyond prevalence and risk factors, understanding behavioral dimensions is essential to developing prevention strategies and maintaining workforce resilience.

OBJECTIVE: This study aimed to (1) assess the prevalence of long COVID among French civil servants; (2) identify associated sociodemographic, occupational, and health-related factors; (3) assess disease-related knowledge of long COVID and (4) examine attitudes and behaviors regarding COVID-19 vaccination.

METHODS: This cross-sectional survey was conducted in 2024 among active or retired civil servants in France. A Knowledge, Attitudes, and Behaviors-validated questionnaire, based on World Health Organization guidelines, was used. Responses were compared across 4 COVID-19 status groups (no COVID, COVID-19 without long COVID, diagnosed long COVID, and suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected long COVID.

RESULTS: Among 3962 eligible respondents, 61 (1.54%; 95% CI 1.20-1.97) reported a formal diagnosis of long COVID and 241 (6.08%; 95% CI 5.38-6.87) without diagnosis. Diagnosed long COVID was significantly associated with long-term sick leave (odds ratio [OR] 1.15, 95% CI 1.03-6.28; P=.04) and long-term illness coverage (OR 0.72, 95% CI 0.27-0.92; P=.03). Suspected long COVID was associated with being in a relationship (OR 1.65, 95% CI 1.08-2.52; P=.02), widowed (OR 2.25, 95% CI 1.18-4.31; P=.01), and uncertain (OR 1.90, 95% CI 1.32-2.74; P<.001) or incomplete COVID-19 vaccination status (OR 1.67, 95% CI 1.16-2.42; P=.01). Knowledge scores differed significantly across groups (ANOVA F3,3476=24.31, P<.001; χ²6=54.92, P<.001), with diagnosed cases showing the highest proportion of high knowledge (13/61, 21%) compared to 12.4% in the non-COVID group. Among 61 diagnosed cases, 36 (59%; 95% CI 46.4-70.5) were vaccinated, 13 (21%; 95% CI 12.9-33.2) intended to get vaccinated, and 12 (20%; 95% CI 11.6-31.3) remained unvaccinated; among suspected cases, these proportions were 173 (71.8%; 95% CI 65.9-77.1), 30 (12.4%; 95% CI 8.8-17.3), and 38 (15.8%; 95% CI 11.6-21.0), respectively.

CONCLUSIONS: Unlike previous studies that examined the clinical or behavioral factors separately, this nationwide analysis linked epidemiological data with knowledge and vaccination behaviors. Among French civil servants, long COVID remains underdiagnosed, where absenteeism and sick leave threaten essential services. The study highlights disparities in disease-related knowledge, vaccination attitudes, and behaviors, underlining the importance of workplace health education and systematic screening. Vaccination is associated with lower odds of long COVID, reinforcing its preventive value. Thus, findings reveal organizational implications and support workplace-based prevention strategies integrating vaccination promotion, early detection, and health literacy to sustain the resilience of public services.

PMID:41348962 | DOI:10.2196/83323

Diagn Interv Radiol. 2025 Dec 5. doi: 10.4274/dir.2025.253574. Online ahead of print.

ABSTRACT

PURPOSE: Skull base osteomyelitis (SBO) and nasopharyngeal carcinoma (NPca) are challenging to differentiate due to overlapping clinical and radiological features. This study aimed to develop and validate a multi-parametric magnetic resonance imaging (MRI)-based radiomics model with high sensitivity, enabling reliable diagnosis of SBO in adult patients presenting with equivocal imaging findings.

METHODS: This was a retrospective, multicenter study using institutional data. The training cohort, comprising 63 adult patients from two classes (31 SBO, 32 NPca) with MRI data, was used for model development and optimization. An external test set (n = 30; 12 SBO, 18 NPca) obtained from two different clinical centers was used for model performance analysis and generalizability. Lesion segmentation was performed using a manual volumetric technique on three axial MRI sequences (pre-contrast T1-weighted, fat-suppressed T2-weighted, and post-contrast fat-suppressed T1-weighted). Hand-crafted radiomic features (n = 2,553) were extracted using the Pyradiomics library. A multi-step process was used to select the final features, including reproducibility analysis using an interclass correlation coefficient threshold of 0.9, pairwise Spearman correlation analysis with a threshold of 0.8 to reduce redundancy, and least absolute shrinkage and selection operator regression. The final set of five features were used to train six machine learning models. The models were internally validated using 5-fold cross-validation, and performance was confirmed using the unseen external test set. Traditional statistical tests, including the Mann-Whitney U test and chi-squared test, were used to compare baseline characteristics, with a P value of <0.05 considered significant.

RESULTS: Among the evaluated classifiers, the random forest model demonstrated the best diagnostic performance, yielding the highest area under the curve (AUC) value in the 5-fold cross-validation analysis. In the external test set, the semantic model demonstrated the best diagnostic performance, achieving an AUC of 0.940 [95% confidence interval (CI): 0.857-1.00], followed by the radiomics model (AUC: 0.903, 95% CI: 0.784-1). The apparent diffusion coefficient (ADC)-based model demonstrated limited discriminative ability (AUC: 0.694, 95% CI: 0.497-0.892). The difference between the semantic and radiomics models did not reach statistical significance (P = 0.644), whereas both significantly outperformed the ADC model (P < 0.05).

CONCLUSION: Radiomics achieved high and consistent performance in distinguishing SBO from advanced NPca. Although expert-based semantic assessment performed slightly better, radiomics provides an objective alternative. ADC-based methods showed limited generalizability due to inter-center variability.

CLINICAL SIGNIFICANCE: Our study confirms the importance of expert radiologist assessment while demonstrating that radiomics offers a comparably effective and objective decision-support tool. Its ability to provide a consistent, quantitative output is particularly valuable for standardizing the diagnostic approach and empowering less experienced radiologists to make more confident assessments.

PMID:41347386 | DOI:10.4274/dir.2025.253574

Clin Nephrol. 2025 Dec 5. doi: 10.5414/CN111841. Online ahead of print.

ABSTRACT

OBJECTIVE: The association between the atherogenic index of plasma (AIP) and chronic kidney disease (CKD) among individuals with different metabolic syndromes remains inadequately characterized. The aim of this study is to assess the correlations between AIP and the risk of CKD among individuals diagnosed with hypertension (HTN), diabetes mellitus (DM), and hyperuricemia (HUA).

MATERIALS AND METHODS: Data from the National Health and Nutrition Examination Survey, collected between 2009 and March 2020, were used to categorize eligible participants into HTN, DM, and HUA groups. Weighted logistic regression models and restricted cubic splines were employed to examine the correlations between AIP and CKD. The incremental predictive value of AIP, compared with conventional CKD risk factors, was assessed using the area under the curve, net reclassification improvement index, and integrated discrimination improvement.

RESULTS: Among individuals in the HTN and DM groups, an increase of one unit in AIP was associated with a 17% increase in the risk of CKD (odds ratio (OR): 1.17, 95% confidence interval (CI): 1.10 – 1.25) and a 29% increase (OR: 1.29, 95% CI: 1.18 – 1.40), respectively. Conversely, within the HUA group, neither persistent AIP nor any of the three AIP levels demonstrated a statistically significant correlation with CKD.

CONCLUSION: The findings demonstrated a significant association between AIP and CKD in individuals with HTN and DM, indicating a potential link between dyslipidemia and CKD risk within these populations. In contrast, AIP did not exhibit a significant association with CKD among individuals with HUA.

PMID:41347374 | DOI:10.5414/CN111841

Int J Gynaecol Obstet. 2025 Dec 5. doi: 10.1002/ijgo.70719. Online ahead of print.

ABSTRACT

BACKGROUND: Subglottic stenosis (SS) is a type of laryngotracheal stenosis defined by a location of less than 1.5 cm below the glottis or the vocal cords. Approximately 20% of cases are idiopathic.

OBJECTIVE: We performed a systematic literature review of idiopathic subglottic stenosis (ISS) complicating pregnancy.

SEARCH STRATEGY: PubMed, Scopus, and clinicaltrials.gov databases were queried from inception through August 10, 2023 with the following terms: idiopathic subglottic tracheal stenosis, subglottic stenosis, subglottic stenoses, tracheal stenosis, tracheal stenoses, and pregnancy. This systematic review was conducted according to the methods described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for reporting systematic reviews.

SELECTION CRITERIA: Studies detailing cases of ISS affecting pregnancy were included and studies reporting SS in pregnancy from a known etiology were excluded.

DATA COLLECTION AND ANALYSIS: Our search identified 31 peer-reviewed published cases of ISS complicating pregnancy that met the inclusion criteria. We also included two additional cases from our institution. Publication bias was checked by the Joanna Briggs Institute critical appraisal tools. Descriptive statistical analyses were performed using Excel.

MAIN RESULTS: A majority of patients (26/33, 79%) were diagnosed with ISS during the reported pregnancy. Prior to pregnancy, 20/33 (61%) patients had a working diagnosis or reported symptoms of airway obstruction. Of these patients, 9/20 (45%) carried a diagnosis of asthma, and 6/20 (30%) carried a diagnosis of ISS. Specific symptoms prior to pregnancy were reported in 10/33 (30%) patients. The most common symptoms in these patients were dyspnea (10/10, 100%) and stridor (4/10, 40%). During pregnancy, all patients experienced worsening respiratory symptoms, with dyspnea (31/33, 94%), stridor (18/33, 55%), cough (13/33, 39%), hoarseness (7/33, 21%), and wheeze (5/33, 15%) being the most common symptoms. A total of 22/33 (67%) patients required medical and/or surgical management with dilation and/or excision during pregnancy. Postpartum outcomes were reported in 27/33 (82%) patients, and 1/27 (3.7%) required a tracheostomy immediately postpartum. The majority (18/27, 67%) of these patients required intervention postpartum, while 9/27 (33.3%) were asymptomatic.

CONCLUSION: ISS should be considered in pregnant patients with worsening respiratory symptoms despite medical management of asthma. If high clinical suspicion for upper airway obstruction exists, an otolaryngology referral for evaluation with bronchoscopy is recommended.

PMID:41347323 | DOI:10.1002/ijgo.70719

Swiss Dent J. 2025 Dec 5;135(4):1-15. doi: 10.61872/sdj-2025-04-01.

ABSTRACT

Post-endodontic treatment preferences can be influenced by educational, healthcare, financial, and historical factors. This study aimed to compare the post-endodontic treatment choices – particularly post and single-crown placement – of dentists in Germany and Switzerland. From August to November 2023, a questionnaire was distributed amongst 334 Swiss and 570 German dentists. A total of 50 Swiss dentists (response rate: 15.0%) and 60 German dentists (response rate: 10.5%) completed the survey. Descriptive analyses were conducted, and data presented as percentages. German dentists reported placing posts in 5–20% of endodontically treated teeth, whereas most Swiss dentists did so in less than 5%. Swiss dentists (58%) tended to place posts in teeth with 0–40% remaining tooth structure, while German dentists (60%) began at 40–70%. Regarding post-endodontic restorations, the majority of German dentists (67%) preferred single crowns, whereas most Swiss dentists (68%) favored composite-resin fillings and maintained even teeth with severely reduced coronal hard tissue. These trends were further supported by responses to various clinical case scenarios.

PMID:41347313 | DOI:10.61872/sdj-2025-04-01

Circ Cardiovasc Imaging. 2025 Dec 5:e018176. doi: 10.1161/CIRCIMAGING.125.018176. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic aortic regurgitation (AR) is associated with significant cardiac remodeling, but the prevalence and prognostic impact of extravalvular cardiac damage remain unexplored.

METHODS: Adults with moderate or greater chronic AR identified on echocardiogram between January 2008 and July 2024 were included. Exclusion criteria were acute AR, hypertrophic and infiltrative cardiomyopathies, prior cardiac surgery, and valve stenosis. Cardiac damage was classified into hierarchical stages: no cardiac damage (stage 0), left ventricular damage (stage 1), moderate or greater mitral regurgitation or left atrial damage (stage 2), pulmonary hypertension or moderate or greater tricuspid regurgitation (stage 3), and significant right ventricular dysfunction (stage 4). The primary outcome was the association between cardiac damage stages and all-cause mortality under medical surveillance.

RESULTS: Of 4026 patients (median age, 72 [61-80] years), 78% had moderate AR, 11% had moderate-severe, and 11% had severe AR. Cardiac damage was present in 87% of patients: 14% in stage 1, 53% in stage 2, 18% in stage 3, and 2% in stage 4. In a multivariable model, including age, sex, AR severity, and Charlson Comorbidity Index, cardiac damage stages were associated with mortality. Adjusted hazard ratios were 1.42 (95% CI, 1.04-1.96) for stage 1, 1.58 (95% CI, 1.21-2.06) for stage 2, 2.78 (95% CI, 2.10-3.67) for stage 3, and 5.34 (95% CI, 3.67-7.76) for stage 4. Adding cardiac damage staging to multivariable models improved predictive accuracy for mortality, increasing the concordance statistics from 0.73 (95% CI, 0.71-0.75) to 0.76 (95% CI, 0.74-0.77).

CONCLUSIONS: Cardiac damage is present in nearly 90% of patients with moderate or greater AR and is associated with increased mortality, highlighting the need for a more comprehensive evaluation of cardiac structure and function beyond the aortic valve and left ventricle.

PMID:41347312 | DOI:10.1161/CIRCIMAGING.125.018176

Pediatr Pulmonol. 2025 Dec;60(12):e71419. doi: 10.1002/ppul.71419.

ABSTRACT

BACKGROUND: In cystic fibrosis (CF), the defect of the CF transmembrane conductance regulator (CFTR) can also affect sensory nerve cell function, as recently demonstrated in animal models. The aim of this prospective cohort study was to investigate whether taste and smell disorders in CF correlate with persistent CFTR dysfunction detectable by iontophoresis or rather with inflammation or lung function. Participants with primary ciliary dyskinesia (PCD) and controls without pulmonary disease served as comparators.

METHODS: In 65 participants (age median 19 years IQR [12-26]; CF n = 23, PCD n = 22, controls n = 20) at the University Children´s Hospital Bochum, we measured taste (salty, sweet, sour, bitter) at four concentrations (“Taste-Strips,” score 0-16, hypogeusia age-adjusted < 8/< 9/< 9.9/< 10 points) and smell (“U-Sniff”-test, score 0-12, reduced odor identification performance < 8 points), pilocarpine iontophoresis, spirometry, inflammatory markers (e.g., CRP) and subjective chemosensory impairment.

STATISTICS: Chi²/Fisher’s-exact, Mann-Whitney-U, Kruskal-Wallis, linear regression; p < 0.05.

RESULTS: Hypogeusia occurred only in CF (17.4%). Particularly misidentification of the taste “salty” occurred significantly more frequently in CF (34.8% vs. PCD 19.3% and controls 17.5%), especially in the CF subgroup with elevated sweat chloride ≥ 60 mmol/l. Reduced odor identification performance was significantly more common in PCD (30% vs. CF 4%). Chemosensory disorders were not related to current lung function or inflammation.

CONCLUSION: Taste disorders in CF are mostly attributed to difficulties tasting salty and are associated with elevated sweat chloride, probably caused by increased salivary salt following CFTR dysfunction in salivary glands rather than in the nerve cells. Smell disorders, however, remain a significant issue, particularly in PCD.

PMID:41347296 | DOI:10.1002/ppul.71419

JB JS Open Access. 2025 Dec 8;10(4):e25.00179. doi: 10.2106/JBJS.OA.25.00179. eCollection 2025 Oct-Dec.

ABSTRACT

BACKGROUND: Geographic access to orthopaedic surgery remains limited in nonmetropolitan regions, where over half of US counties lack an orthopaedic surgeon. Osteopathic physicians (DOs) are nearly twice as likely as allopathic physicians (MDs) to practice in these areas, making them a key component of the rural surgical workforce. However, their representation in orthopaedic training has declined since the ACGME-AOA merger.

METHODS: This cross-sectional national study used 2022 Area Health Resource Files, National Residency Matching Program Match data (2020-2024), and USDA Rural-Urban Continuum Codes (RUCC) to evaluate workforce distribution and match outcomes. Statistical analysis included chi-square testing and odds ratios to assess nonmetropolitan representation by degree and state.

RESULTS: Of 30,243 orthopaedic surgeons, 92.9% practiced in metropolitan counties and 7.1% in nonmetropolitan areas. Among DOs, 12.5% practiced in nonmetropolitan regions compared with 6.9% of MDs (OR = 1.92; 95% CI: 1.67-2.19). Eleven states showed significantly higher odds of DOs practicing in nonmetropolitan counties, 9 of these states with longstanding in-state osteopathic schools. From 2010 to 2022, DO presence in nonmetropolitan areas increased by 59%, nearly double the rate of MDs. Despite these contributions, DO match rates in orthopaedic surgery declined from 63.3% to 45.7% between 2020 and 2024, widening the DO-MD gap.

CONCLUSIONS: DOs play an important role in orthopaedic coverage, as a percentage of their total, in nonmetropolitan communities. Declining match rates raise concerns about the sustainability of this workforce, particularly in states where DOs help maintain surgical access. Structural reforms in training pathways and residency selection may help preserve geographic workforce diversity.

CLINICAL RELEVANCE: Targeted strategies, such as rural training programs, holistic applicant evaluation, and state-specific recruitment efforts, may strengthen access to musculoskeletal care in underserved regions and support a more equitable orthopaedic workforce.

PMID:41347250 | PMC:PMC12674144 | DOI:10.2106/JBJS.OA.25.00179

NAR Genom Bioinform. 2025 Dec 3;7(4):lqaf169. doi: 10.1093/nargab/lqaf169. eCollection 2025 Dec.

ABSTRACT

Current strategies for optimizing gene therapeutics and recombinant protein production typically rely on universal host codon usage indices. However, there is a growing shift toward incorporating gene-specific traits to enhance therapeutic characteristics. In this study, we investigate position-specific variations in codon and adjacent codon-pair usage biases (CPUBs), offering potential for more tailored gene engineering approaches. We focus our analysis on the coding sequences of four coagulation factors: ADAMTS13, von Willebrand factor, factor VIII, and factor IX, which have been used in therapeutic applications. By aligning transcript homologs with human sequences for each gene using Discontiguous Megablast and MACSE, we assess “sequence-position-specific” codon and CPUBs; 157 homologous sequences for ADAMTS13, 148 for F8, 96 for F9, and 202 for VWF. Species with homologs ranged from Primates and Artiodactyla (Even-toed Ungulates) to Testudines. Statistically significant, position-specific positive CPUBs were observed that contrasted with conventional, alignment-specific negative CPUBs. Moreover, we observed that codon and codon-pair usages are highly associated at sequence positions despite little or no association in conventional-position-agnostic analyses. The distinct biases observed at different positions/functionally critical domains in coding sequences highlight the importance of considering position-specific effects in codon optimization strategies.

PMID:41347229 | PMC:PMC12673856 | DOI:10.1093/nargab/lqaf169