Tag: statistics

Diabetol Metab Syndr. 2025 May 2;17(1):148. doi: 10.1186/s13098-025-01711-x.

ABSTRACT

BACKGROUND: The α-klotho is crucial in diabetes and its related complications. This study seeks to explore the link between α-klotho levels and the risk of diabetic kidney disease (DKD) as well as all-cause and cardiovascular mortality among individuals with type 2 diabetes mellitus (T2DM).

METHODS: The investigation involved 126 Chinese T2DM patients and 4,451 individuals from the National Health and Nutrition Examination Survey (NHANES) database. To evaluate the relationship between α-klotho levels and DKD risk, multivariate logistic regression was utilized. Additionally, restricted cubic spline (RCS) regression analysis was conducted to examine the nonlinear relationship between α-klotho levels and DKD incidence. RCS analysis was employed to explore the correlation between α-klotho and both all-cause and cardiovascular mortality.

RESULTS: In the Chinese cohort, α-klotho levels were notably elevated in T2DM group compared to DKD group. The NHANES data revealed a significant inverse relationship between α-klotho levels and DKD risk. Nonlinear analysis further illustrated a substantial nonlinear connection between α-klotho levels and DKD risk. Serum α-klotho levels below 880.78 pg/mL were linked to increased DKD risk in T2DM patients. When compared to the T2DM group, the DKD group had markedly higher all-cause and cardiovascular mortality rates, with the α-klotho low group (e.g., Q1) exhibiting lower survival compared to other groups. Cox regression findings indicated that elevated α-klotho levels could mitigate all-cause mortality in T2DM patients. The relationship between α-klotho levels and all-cause mortality was also nonlinear, with the minimal risk found at α-klotho levels between 776.95 pg/mL and 812.69 pg/mL, varying by gender.

CONCLUSION: There exists a notable association between α-klotho levels and DKD risk, along with mortality in T2DM patients, with varying effects based on gender. These results highlight the potential importance of α-klotho as both a biomarker and a therapeutic target.

PMID:40312464 | DOI:10.1186/s13098-025-01711-x

Sci Rep. 2025 May 1;15(1):15288. doi: 10.1038/s41598-025-00323-9.

ABSTRACT

The primary aim of this study was to investigate the knowledge, attitude, and practice(KAP) concerning Helicobacter pylori (H. pylori) and the factors influencing them among northeast China individuals. A questionnaire regarding H. pylori, grounded in the KAP theoretical framework, was tailored for northeast China individuals. The questionnaire was conducted online and analyzed statistically. Additionally, structural equation modeling was applied to verify the interconnections among social media usage, knowledge, attitude, and practice. A total of 712 valid questionnaires were analyzed. The mean scores were 2.69 ± 1.03 for knowledge, 4.09 ± 0.81 for attitude, and 3.40 ± 0.73 for practice. Various factors including sex, occupation, and social media usage influenced knowledge, attitude, and practice scores, with social media usage exerting a notable impact on all facets. The structural equation modeling analysis demonstrated that social media usage promoted higher levels of knowledge, attitude, and practice regarding H. pylori. Individuals possessing a higher level of knowledge and attitude concerning H. pylori demonstrated superior preventive practice. Northeast China residents have limited H. pylori knowledge but show a positive attitude and good preventive practice. The utilization of social media has significantly improved the population’s knowledge, attitude, and practice concerning H. pylori.

PMID:40312460 | DOI:10.1038/s41598-025-00323-9

Sci Data. 2025 May 1;12(1):723. doi: 10.1038/s41597-025-04996-9.

ABSTRACT

Most multi-region input-output (MRIO) tables in China focus on provinces or urban agglomerations and ignore the tremendous geographical heterogeneities of economic activities across Chinese prefectural cities, where regional economic centres are usually located for domestic and global production. This paper constructs an inter-city input-output (IO) database with 42 sectors in the Greater China area. Compared with previous MRIO tables, it has three important features: (1) A complete coverage of Chinese cities, including 335 prefectural cities, four municipalities, and Hong Kong, Macao, and Taiwan; (2) Distinguishes three types of firm ownership for every city and sector for four benchmark years; (3) A novel data completion approach to reconcile all accessible micro-level data with city and provincial-level aggregate statistics, and effectively combining the bottom-up and top-down methods commonly used in the MRIO compilation literature. The database can be used in a diverse range of socioeconomic and interdisciplinary issues in the Greater China area at the city level. It also sheds light on other large economies to develop their own inter-city IO tables.

PMID:40312452 | DOI:10.1038/s41597-025-04996-9

Animal. 2025 Apr 3;19(5):101506. doi: 10.1016/j.animal.2025.101506. Online ahead of print.

ABSTRACT

Many farmers rely on anthelmintics to control gastrointestinal nematodes in sheep. In response to concerns about rising levels of anthelmintic resistance reported in countries around the world, current advice is to adopt more sustainable practices. A small-scale survey of farmers was used to inform group discussions with farmers, veterinarians and anthelmintic prescribers, to better understand barriers to the adoption of sustainable gastro-intestinal nematode control in sheep flocks across the United Kingdom. Thematic analysis of the discussions identified four barriers to change: not seeing the need for change; lack of specific information and support in implementing changes on farm; lack of confidence in the new approaches; and practical obstacles such as time and cost. Nevertheless, there were examples of sustainable parasite control with some farmers making changes to their habitual practices, typically with the support of their veterinarian or Suitably qualified person. We reflect on the findings through the lens of the Capability, Opportunity, Motivation as drivers of Behaviour model. This draws attention to the need for a process of knowledge exchange that allows advice to be tailored to individual farms and makes use of farmer skills and experiences, rather than expecting farmers to follow generic advice.

PMID:40311159 | DOI:10.1016/j.animal.2025.101506

Injury. 2025 Apr 15;56(6):112333. doi: 10.1016/j.injury.2025.112333. Online ahead of print.

ABSTRACT

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

PMID:40311153 | DOI:10.1016/j.injury.2025.112333

Obstet Gynecol. 2025 May 2. doi: 10.1097/AOG.0000000000005904. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between coronavirus disease 2019 (COVID-19) vaccination and spontaneous abortion.

METHODS: We conducted a case-control study of clinically adjudicated spontaneous abortions (case group) occurring between January 19, 2021, and October 27, 2021, and live births (control group). Patients aged 16-49 years at eight Vaccine Safety Datalink sites who had singleton pregnancies, one or more prenatal visits, continuous health plan enrollment, and spontaneous abortion (fetal loss between 6 and less than 20 weeks of gestation) or live birth were eligible. A random sample of eligible patients with spontaneous abortions was adjudicated to confirm pregnancy outcome, outcome date, and gestational age at fetal death; patients in the adjudicated spontaneous abortion case group were matched 1:2 on Vaccine Safety Datalink site, maternal age, and pregnancy start date with eligible patients with live births. Vaccine exposure was considered from pregnancy start to spontaneous abortion date or equivalent gestational age for the matched live births (index date). Conditional logistic regression was used to evaluate the association between COVID-19 vaccination in pregnancy and spontaneous abortion; secondary analyses explored associations by dose number, vaccine manufacturer, and vaccination within 6 weeks of the spontaneous abortion.

RESULTS: Matched analyses included 296 patients in the spontaneous abortion case group and 592 in the live birth control group. There was no association between spontaneous abortion and COVID-19 vaccination (adjusted odds ratio [aOR] 0.85, 95% CI, 0.56-1.30). There was also no association between spontaneous abortion and dose number compared with no vaccine (one dose: aOR 0.81, 95% CI, 0.39-1.70; two doses: aOR 0.84, 95% CI, 0.51-1.38; vaccine manufacturer: Moderna aOR 0.59, 95% CI, 0.29-1.19 and Pfizer-BioNTech aOR 0.97, 95% CI, 0.57-1.66; or vaccine exposure window of 6 weeks before spontaneous abortion or index date: aOR 0.87, 95% CI, 0.53-1.44).

CONCLUSION: There was no observed association between COVID-19 vaccination in pregnancy and spontaneous abortion. Findings support the safety of COVID-19 vaccination in early pregnancy.

PMID:40311142 | DOI:10.1097/AOG.0000000000005904

N Z Med J. 2025 May 2;138(1614):81-90. doi: 10.26635/6965.6844.

ABSTRACT

AIM: Ethnicity and descent are two different officially recognised identity definitions for the Indigenous Māori population of New Zealand. Official health statistics are usually reported by Māori ethnicity but not descent, as health collections such as the New Zealand Cancer Registry (NZCR) do not record Māori descent information. We explored the potential of linked administrative data to describe health outcomes by Māori descent using gastric (stomach) cancer as an example.

METHODS: The Integrated Data Infrastructure (IDI) was used to source information on Māori descent from the 2013 and 2018 censuses as well as birth and death records linked to the NZCR for gastric cancer registrations for the years 1995-2021 (N=10,575).

RESULTS: Māori descent information could be sourced for 81.8% of gastric cancer registrations. Descent information was available for 65.2% of gastric cancer registrations in death records, 39.5% in the 2013 or 2018 census, 6.1% from a child’s birth record and ≤0.3% from personal birth records. Of the registrations for whom Māori descent information could be obtained, 18.6% were identified as being of Māori descent vs 17.3% identified as Māori by ethnicity. Missing Māori descent data was lower (around 5%) in more recent gastric cancer registrations (2012 onwards).

CONCLUSION: Based on our case study, classifying cancer registrations by Māori descent for health outcome reporting, in addition to Māori ethnicity, may be feasible for recent years of data. Use of death records for Māori descent information should be carefully considered, as this may introduce bias to analyses such as survival analysis.

PMID:40311134 | DOI:10.26635/6965.6844

JMIR Hum Factors. 2025 May 1;12:e66668. doi: 10.2196/66668.

ABSTRACT

BACKGROUND: Latino adults with type 2 diabetes (T2D) have higher rates of diabetes medication nonadherence than non-Hispanic White adults. REACH (Rapid Encouragement/Education And Communications for Health) is a text message platform based on the information-motivation-behavioral skills model that addresses barriers to adherence and was shown to improve adherence and glycated hemoglobin (HbA1c) levels, but it is only available in English.

OBJECTIVE: This study aimed to report the multiphase, stakeholder-driven adaptation of the REACH barriers to diabetes medication adherence content to a Latino population (REACH-Español).

METHODS: This was a qualitative study using focus groups. We identified potentially eligible patients (≥18 y old, Latino ethnicity, Spanish-language preference, and T2D diagnosis) using a Mass General Brigham Hospital query. Eligible patients were invited to participate in a focus group conducted in Spanish between April 13 and November 9, 2023. A total of 5 focus groups were conducted. Focus groups 1-3 centered on ranking 40 barriers to diabetes medication adherence (derived from REACH and the extant literature), whereas focus groups 4-5 centered on translation and cultural modifications of the original SMS text message content associated with each of the REACH barriers. Barriers were mapped onto information-motivation-behavioral constructs. We used descriptive statistics to summarize participant characteristics. Focus groups were audio-recorded, professionally transcribed, and analyzed with thematic content analysis using NVivo (Lumivero).

RESULTS: In total, 22 participants attended the focus groups. The mean (SD) age was 63.2 (11) years, 55% (n=10/22) were female, and the mean HbA1c level was 8.5%. All participants were born in Latin America or the Caribbean and spoke Spanish as their preferred language, and 54.5% (12/22) had completed middle-school education or less. Among the top 10 ranked barriers, 50% (n=5) corresponded to information, 20% (n=2) to social motivation, 20% (n=2) to behavioral skills, and 10% (n=1) to personal motivation. Personal motivation barriers (medication burden and fear of side effects) and behavioral skills (forgetting to take medication) emerged as important themes in the focus groups.

CONCLUSIONS: A stakeholder-driven approach to intervention adaptation identified and prioritized relevant barriers to diabetes medication adherence among Latino adults with T2D and facilitated the adaptation of the REACH platform to a Spanish-speaking population.

PMID:40311126 | DOI:10.2196/66668

JMIR Med Educ. 2025 May 1;11:e66186. doi: 10.2196/66186.

ABSTRACT

BACKGROUND: Approximately 4000 preventable surgical errors occur per year in the US operating rooms, many due to suboptimal teamwork and safety behaviors. Such errors can result in temporary or permanent harm to patients, including physical injury, emotional distress, or even death, and can also adversely affect care providers, often referred to as the “second victim.”

OBJECTIVE: Given the persistence of adverse events in the operating rooms, the objective of this study was to quantify the effect of an innovative and immersive virtual reality (VR)-based educational intervention on (1) safety behaviors of surgeons in the operating rooms and (2) sense-making regarding the overall training experience.

METHODS: This mixed methods pre- versus postintervention pilot study was conducted in a large academic medical center with 55 operating rooms. Safety behaviors were observed and quantified using validated Teamwork Evaluation of Non-Technical Skills instrument during surgical cases at baseline (101 observations; 83 surgeons) and postimmersive VR based intervention (postintervention: 24 observations within each group; intervention group [with VR training; 10 surgeons] and control [no VR training; 10 surgeons]). VR intervention included a 45-minute immersive VR-based training incorporating a pre- and postdebriefing based on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) principles to improve safety behaviors. A 2-tailed, 2-sample t-test with adjustments for multiplicity of the tests was used to test for significance in observable safety behaviors between the groupings. The debriefing data underwent analysis through the phenomenological analysis method to gain insights into how participants interpreted the training.

RESULTS: Preintervention, all safety behaviors averaged slightly above “acceptable” scores, with an overall average of 2.2 (range 2-2.3; 0-3 scale). The 10 surgeons that underwent our intervention showed statistically significant (P<.05) improvements in 90% (18/20) of safety behaviors when compared to the 10 surgeons that did not receive the intervention (overall average 2.5, range 2.3-2.7 vs overall average 2.1, range 1.9-2.2). Our qualitative analysis based on 492 quotes from participants suggests that the observed behavioral changes are a result of an immersive experience and sense-making of key TeamSTEPPS training concepts.

CONCLUSIONS: VR-based immersive training intervention focused on TeamSTEPPS principles seems effective in improving safety behaviors in the operating rooms as quantified via observations using the Teamwork Evaluation of Non-Technical Skills instrument. Further research with larger, more diverse sample sizes is needed to confirm the generalizability of these findings.

PMID:40311122 | DOI:10.2196/66186

JMIR Form Res. 2025 May 1;9:e66189. doi: 10.2196/66189.

ABSTRACT

BACKGROUND: Postoperative bleeding is a serious complication following abdominal tumor surgery, but it is often not clearly diagnosed and documented in clinical practice in China. Previous studies have relied on manual interpretation of medical records to determine the presence of postoperative bleeding in patients, which is time-consuming and laborious. More critically, this manual approach severely hinders the efficient analysis of large volumes of medical data, impeding in-depth research into the incidence patterns and risk factors of postoperative bleeding. It remains unclear whether machine learning can play a role in processing large volumes of medical text to identify postoperative bleeding effectively.

OBJECTIVE: This study aimed to develop a machine learning model tool for identifying postoperative patients with major bleeding based on the electronic medical record system.

METHODS: This study used data from the available information in the National Health and Medical Big Data (Eastern) Center in Jiangsu Province of China. We randomly selected the medical records of 2,000 patients who underwent in-hospital tumor resection surgery between January 2018 and December 2021 from the database. Physicians manually classified each note as present or absent for a major bleeding event during the postoperative hospital stay. Feature engineering involved bleeding expressions, high-frequency related expressions, and quantitative logical judgment, resulting in 270 features. Logistic regression (LR), K-nearest neighbor (KNN), and convolutional neural network (CNN) models were developed and trained using the 1600-note training set. The main outcomes were accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each model.

RESULTS: Major bleeding was present in 4.31% (69/1600) of the training set and 4.75% (19/400) of the test set. In the test set, the LR method achieved an accuracy of 0.8275, a sensitivity of 0.8947, a specificity of 0.8241, a PPV of 0.2024, an NPV of 0.9937, and an F1-score of 0.3301. The CNN method demonstrated an accuracy of 0.8900, sensitivity of 0.8421, specificity of 0.8924, PPV of 0.2807, NPV of 0.9913, and an F1-score of 0.4211. While the KNN method showed a high specificity of 0.9948 and an accuracy of 0.9575 in the test set, its sensitivity was notably low at 0.2105. The C-statistic for the LR method was 0.9018 and for the CNN method was 0.8830.

CONCLUSIONS: Both the LR and CNN methods demonstrate good performance in identifying major bleeding in patients with postoperative malignant tumors from electronic medical records, exhibiting high sensitivity and specificity. Given the higher sensitivity of the LR method (89.47%) and the higher specificity of the CNN method (89.24%) in the test set, both models hold promise for practical application, depending on specific clinical priorities.

PMID:40311117 | DOI:10.2196/66189