Tag: statistics

J Health Popul Nutr. 2025 May 29;44(1):180. doi: 10.1186/s41043-025-00941-z.

ABSTRACT

BACKGROUND: Life’s Essential 8 (LE8) for assessing cardiovascular health (CVH) has been demonstrated to be inversely associated with osteoporosis (OP). This study aims to create a machine learning (ML) model to assess the clinical association value of lifestyle and behavioral factors, assessed by LE8, on OP risk in the United States.

METHODS: This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES), encompassing participants aged ≧ 50 with comprehensive LE8 and OP information. Initially, the study compared the characteristics of participants with OP against those with normal bone health. Linear and nonlinear associations of LE8 and OP were analyzed by multifactor logistic regression and restricted cubic spline (RCS). Subsequently, LE8 features were integrated into six distinct ML models for OP analysis. Evaluate model performance using relevant metrics and curves. The best-performing model was further analyzed using SHapley Additive exPlanations (SHAP) to rank and clarify the positives and negatives of the contribution of individual LE8 components.

RESULTS: Among 3,902 participants, 364 (9.33%) were identified as having OP. Conventional regression showed that health behaviors (HB) and health factors (HF) in LE8 were negatively and positively correlated with OP, respectively, and that total LE8 was nonlinearly associated with OP. Through comparison of the Area Under the Curve (AUC), Accuracy, F1-Score, Precision, Recall, Specificity, Receiver Operating Characteristic (ROC), Decision Curve Analysis (DCA), and Calibration Curve Analysis (CCA), the optimal performance achieved by the Light Gradient Boosting Machine (LightGBM) model incorporating the 20 features. SHAP analysis revealed that the contributions of LE8 components were ranked as follows: Body Mass Index (BMI) > sleep health > blood glucose > nicotine exposure > blood lipids > blood pressure > Healthy Eating Index-2015 (HEI-2015) > physical activity. Where sleep health, blood lipids, and HEI-2015 were the main negative contributors to OP, BMI was the main positive contributor.

CONCLUSIONS: The integration of LE8 with a LightGBM model offers a promising strategy for analysing OP in the American population, underscoring the potential of ML approaches in enhancing clinical assessments.

PMID:40442859 | DOI:10.1186/s41043-025-00941-z

Stem Cell Res Ther. 2025 May 30;16(1):268. doi: 10.1186/s13287-025-04404-4.

ABSTRACT

BACKGROUND: This study evaluated the effectiveness of intrathecal autologous bone marrow mononuclear cell (BMMNC) therapy combined with education compared with education alone for the treatment of autism spectrum disorder (ASD).

METHODS: Fifty-four children with ASD, aged three to seven years, were randomly assigned to two groups. Fifty patients completed the study (25 patients per group). The cell therapy (CT) group received two BMMNC infusions six months apart along with an educational intervention, while the control group received education only. Efficacy outcomes were assessed at baseline, two, six, and 12 months, based on: (1) changes in ASD severity evaluated through the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the Childhood Autism Rating Scale (CARS), and the Clinical Global Impression-Severity (CGI-S) scale scores and (2) improvements in social interaction, adaptive behavior, and daily living skills measured by the Vineland Adaptive Behavior Scales (VABS-II) and Clinical Global Impression-Improvement (CGI-I) scale scores.

RESULTS: At 12 months, the CT group presented a 48.0% reduction in individuals classified at the most severe DSM-5 level compared with 8.0% in the control group (p = 0.004). The CARS scores were significantly lower in the CT group (-5.9 points) than in the control group (-1.5 points) (p < 0.0001). Similarly, the CT group exhibited greater improvement in CGI-S scores (-1.5 points) than did the control group (-0.1 points) (p < 0.0001). The VABS-II scores increased by 8.5 points in the CT group versus 1.4 points in the control group (p < 0.0001). Finally, the CGI-I scores improved from 2.8 to 2.0 in the CT group but worsened from 3.0 to 3.5 in the control group (p < 0.0001).

CONCLUSIONS: Intrathecal BMMNC combined with an educational intervention improved disease severity and adaptability more than education alone in children with ASD.

TRIAL REGISTRATION: clinicaltrials.gov, NCT05307536. Date registered 12 February 2022. http://clinicaltrials.gov/study/NCT05307536 .

PMID:40442857 | DOI:10.1186/s13287-025-04404-4

Arch Public Health. 2025 May 29;83(1):139. doi: 10.1186/s13690-025-01626-z.

ABSTRACT

BACKGROUND: Dementia represents one of the greatest global health challenges. Women have a greater lifetime risk of developing dementia compared to men. Both pharmacological and non-pharmacological interventions aimed at slowing cognitive decline show promising results. However, most studies do not examine whether there are sex and gender differences in access to treatment, quality of care or treatment effectiveness.

OBJECTIVES: To summarise evidence on sex and gender differences in access to treatment, management, and treatment effectiveness for people with dementia.

METHODS: This scoping review followed PRISMA guidelines and was conducted in PubMed/MEDLINE, EMBASE, Google Scholar, and ClinicalTrials.Gov databases in November 2023 and updated in January 2024. Systematic reviews and observational studies were included to explore sex and gender differences in access or management of dementia. Systematic reviews and clinical trials were included to investigate sex and gender differences in treatment effectiveness.

RESULTS: We included 16 studies in our review. Sex and gender differences were observed in the prescription and receipt of anti-dementia medications, as well as access to primary care, with variations by settings. Mixed results were found concerning polypharmacy and inappropriate medications, with women being prescribed antipsychotic and other psychotropic medications for longer periods compared to men. Studies of the impact of exercise on cognitive decline yielded mixed results, though limited disaggregated data by sex indicated a more pronounced impact in women than in men. Cognitive stimulation therapy interventions showed greater cognitive improvements for women. Clinical trials assessing the effectiveness of disease-modifying therapies (DMTs) suggest that women may be less responsive to DMTs than men.

CONCLUSIONS: There are important differences between men and women living with dementia in access to diagnosis, treatments, quality of care and effectiveness of treatments. Such differences can significantly impact health outcomes. Sex and gender inequalities should be considered when planning and implementing healthcare, social care, and associated strategies in dementia. To provide conclusive evidence, it is essential for clinical trials to have sufficient statistical power and report outcomes disaggregated by sex.

PMID:40442851 | DOI:10.1186/s13690-025-01626-z

BMC Res Notes. 2025 May 29;18(1):240. doi: 10.1186/s13104-025-07293-1.

ABSTRACT

OBJECTIVE: Even though the growing prevalence of Parkinson’s disease (PD) is inclusive of ethnic and racial minority groups, these populations remain underrepresented in PD clinical research. This community-based study seeks to add to the limited knowledge on barriers and facilitators to underrepresented group (URG) enrollment in PD trials by assessing minority community members’ PD and research knowledge, trust in medical researchers, and likelihood to participate in research based on various study design factors.

RESULTS: Of the 97 total workshop participants, 80 completed demographic information, with the majority female (71%) and from minority racial groups — African American/Black (37.5%) and East/Southeast Asian (45%). Levels of trust in medical researchers were generally high and improved post-workshop. Most respondents were likely to participate in trials requiring DNA or cognitive testing, and unlikely if requiring intravenous infusion or lumbar puncture. Facilitators to trial participation included offering transportation and financial incentives, while longer study visits and study duration were barriers.

PMID:40442830 | DOI:10.1186/s13104-025-07293-1

Diabetol Metab Syndr. 2025 May 30;17(1):181. doi: 10.1186/s13098-025-01732-6.

ABSTRACT

BACKGROUND: The association between newly developed insulin resistance (IR) indices and all-cause mortality in elderly patients with diabetes has not been investigated.

METHODS: Baseline data and all-cause mortality for 1,248 elderly diabetes patients from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018 were collected. The traditional IR index homeostasis model assessment of insulin resistance (HOMA-IR) and several newly developed indices, including metabolic score for insulin resistance (METS-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose index (TyG), triglyceride glucose combined with body mass index (TyG-BMI), estimated glucose disposal rate (eGDR), and visceral adiposity index (VAI), were calculated for the patients. Cox proportional hazards regression and restricted cubic spline (RCS) regression models assessed the relationship between IR indices and all-cause mortality.

RESULTS: In a median follow-up period of 73.3 months, there were 381 recorded deaths. In the total cohort, METS-IR (p < 0.001), TyG-BMI (p < 0.001), and eGDR (p = 0.011) demonstrated a significant association with all-cause mortality as continuous variables. HOMA-IR, METS-IR, TyG-BMI, and eGDR exhibited significant correlations with all-cause mortality in the Cox regression models (p < 0.05) when analyzed as categorical variables. A U-shaped relationship exists between METS-IR, TyG-BMI, eGDR, and all-cause mortality (p-overall < 0.0001, p-nonlinear < 0.05). No significant associations were found between TyG, TG/HDL-C, VAI, and all-cause mortality. Among male patients, TyG-BMI and HOMA-IR exhibited superior prognostic value, whereas in female patients, METS-IR, TyG-BMI, and eGDR showed better performance.

CONCLUSION: HOMA-IR, TyG-BMI, METS-IR, and eGDR were associated with mortality in elderly diabetic patients, with gender differences in their prognostic values.

PMID:40442829 | DOI:10.1186/s13098-025-01732-6

J Health Popul Nutr. 2025 May 29;44(1):174. doi: 10.1186/s41043-025-00898-z.

ABSTRACT

BACKGROUND: Folate level is associated with depression, yet prospective evidence is lacking on the relationship of dietary intake, serum, and red blood cell (RBC) folate levels with mortality risk in patients with depression.

METHODS: Dietary intake, serum, and RBC folate data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included. Depression was diagnosed using the PHQ-9 with a cutoff value of 5. Additionally, all-cause and cause-specific mortality data up to December 31, 2019, were determined from the National Death Index. Weighted multivariable Cox regression and restricted cubic spline (RCS) analysis were used to determine the relationship between folate and outcomes.

RESULTS: A total of 4843 adult patients with depression were included, with a mean age of 45.16 years, and females accounted for 61.59%. Over a mean follow-up of 7.2 years, 544 participants died. Weighted Cox regression showed that, after adjustment, only RBC folate among nine folate indicators significantly predicted all-cause mortality in patients with depression. A per standard deviation (SD) increase in RBC folate increased the all-cause mortality risk by 12% (HR: 1.12, 95% CI: 1.04-1.21, p = 0.003). RCS analysis revealed a U-shaped association of RBC folate with all-cause, CVD, and cancer mortality, with inflection points at 540.5 ng/ml, 575.2 ng/ml, and 624.1 ng/ml, respectively. Further segmented regression showed that an increase in RBC folate reduced only cancer mortality risk to the left of the inflection points. To the right of these points, RBC folate was significantly positively associated with all-cause, CVD, and cancer mortality risks.

HIGHLIGHTS: RBC folate exhibited a U-shaped association with all-cause, cardiovascular-specific, and cancer-specific mortality risks in patients with depression.

CONCLUSION: Dietary and serum folate were not associated with overall mortality rates in patients with depression. However, RBC folate exhibited a U-shaped association with all-cause, cardiovascular-specific, and cancer-specific mortality risks in patients with depression.

PMID:40442828 | DOI:10.1186/s41043-025-00898-z

J Health Popul Nutr. 2025 May 29;44(1):176. doi: 10.1186/s41043-025-00881-8.

ABSTRACT

BACKGROUND: Hypovitaminosis D or vitamin D deficiency is a significant public health issue. Several vitamin D preparations are currently available. However, there is no consensus on the optimal dose and duration of vitamin D supplementation. This study aimed to evaluate the effects of vitamin D supplementation on symptoms and clinical outcomes in adults with insufficient or deficient baseline vitamin D levels.

METHOD: A pre-post two-month intervention with 50,000 IU vitamin D3 supplementation for adults with documented insufficient or deficient baseline vitamin D levels, presented at Jazan University Hospital from August to December 2022.

RESULTS: Of the 204 participants, 65.1% had baseline vitamin D levels < 30 nmol/L. Vitamin D insufficiency is more prevalent among females, older adults, married individuals, and those with low income. However, these differences were not statistically significant (p > 0.5). The symptoms and clinical outcomes were significantly improved after 2 months of vitamin D3 supplementation for the participants who achieved vitamin D levels > 50 nmol/L (p = 0.000). After adjusting for multiple confounders, the significant determinants of symptom improvement and clinical outcomes post-supplementation included education level, income, smoking status, and baseline vitamin D level.

CONCLUSIONS: Hypovitaminosis D or vitamin D deficiency was observed in study participants. The use of a 50,000 IU cholecalciferol (vitamin D3) orally once per week for two months is sufficient to improve the symptoms and clinical outcomes of vitamin D deficiency. However, long-term follow-up could better assess the sustainability of benefits and explore long-term outcomes, such as the risk of deficiency recurrence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40442818 | DOI:10.1186/s41043-025-00881-8

J Orthop Surg Res. 2025 May 30;20(1):546. doi: 10.1186/s13018-025-05934-6.

ABSTRACT

BACKGROUND: Calcaneal fractures usually arise from high-energy trauma and predominantly impact young individuals. In older adults (aged ≥ 50 years), declining bone density and muscle strength increase fracture risk from low-energy trauma, leading to a bimodal epidemiological distribution. The intricacies of calcaneal fractures in older adults, alongside osteoporosis and soft tissue fragility, complicate surgical intervention. This study aims to analyze age-related differences in calcaneal fracture characteristics using three-dimensional(3D) mapping and assess their impact on medial incision design.

METHOD: A total of 95 patients with closed calcaneal fractures were categorized into two groups: Younger (< 50 years, n = 61) and Older (≥ 50 years, n = 34). The process of 3D fracture mapping was executed utilizing Mimics and 3-matic software, alongside the reconstruction of soft tissue, which encompassed the posterior tibial neurovascular bundle. Differences in fracture distribution and incision parameters (length, α angle, D1, and D2) were statistically analyzed, with p < 0.05 considered statistically significant.

RESULTS: Fracture lines in both groups were predominantly located around the lateral Gissane’s angle and critical weight-bearing areas of the calcaneus. In the Younger Group, fracture lines were long, continuous, and involved fewer fragments, correlating with high-energy trauma. The Older Group showed more comminuted lines, characteristic of osteoporotic fractures. The α angle and D1 distance were significantly smaller in the Older Group (p < 0.05), indicating closer proximity to the medial malleolus. D2 values were also smaller (p < 0.05), with 48.65% intersecting the neurovascular bundle compared to 31.34% in the Younger Group.

CONCLUSION: Age significantly influences medial wall fracture patterns and complexity in calcaneal injuries. A personalized medial incision based on fracture morphology provides better exposure and reduction compared to traditional methods. Although the incision is closer to the neurovascular bundle in older patients, meticulous surgical technique guarantees safety. The integration of a medial incision with sinus-tarsi (ST) approach minimizes the necessity for extensive lateral exposure, thereby diminishing soft tissue complications and improving surgical outcomes for the elderly population.

LEVEL OF EVIDENCE: Level IV, retrospective case series.

PMID:40442805 | DOI:10.1186/s13018-025-05934-6

Malar J. 2025 May 29;24(1):172. doi: 10.1186/s12936-025-05418-2.

ABSTRACT

BACKGROUND: As malaria-endemic countries progress towards elimination, distinct patterns of heterogeneous transmission are emerging. In south-eastern Tanzania, despite intensive control efforts, localized transmission shows prevalence ranging from under 1% to over 50% among nearby villages. This study investigated the socioeconomic and environmental factors driving this spatial heterogeneity.

METHODS: A cross-sectional survey was conducted in the Kilombero and Ulanga districts of south-eastern Tanzania between 2022 and 2023, screening 3,249 individuals (ages 5-60) across 10 villages for malaria using rapid diagnostic tests (RDTs). Socioeconomic data was collected from all surveyed households and villages via questionnaires, while environmental data were obtained from remote sensing data sources. Associations between socioeconomic factors and malaria infection were analysed using a zero-inflated negative binomial model and employed a generalized additive model (GAM) to assess the impact of rainfall, and temperature on malaria infection.

RESULTS: Greater elevation and higher rainfall were positively associated with malaria infection (OR = 1.68, 95% CI 1.38-2.05, p < 0.001 and OR = 1.46, 95% CI 1.14-1.87, p < 0.05 respectively), while temperature showed no significant effect (OR = 0.70, 95% CI 0.51-1.13, p = 0.117). Households in densely vegetated areas had higher malaria infections compared to those in more developed, built-up areas. At the individual level, males had a higher prevalence (355; 28.6%) and displayed significantly greater odds of infection (OR = 1.53, 95% CI 1.15-2.03, p < 0.05) than females (433; 21.6%). School-aged children (5-17 years) had a higher prevalence (36.9%) compared to adults (18-60 years) (15.9%). The probability of infection declined with increasing age (OR = 0.28, 95% CI 0.25-0.31, p < 0.001). Larger household sizes (more than four members) were positively associated with malaria infection (OR = 1.72, 95% CI 1.29-2.29, p < 0.001). Open-eave housing was associated with higher odds of malaria, whereas closed eaves (OR = 0.56, 95% CI 0.38-0.82, p < 0.05) and metal roofs (OR = 0.62, 95% CI 0.44-0.87, p < 0.05) were protective factors. Open water sources were positively associated with malaria infection compared to protected water sources (OR = 0.57, 95% CI 0.38-0.85, p < 0.05). Lack of bed net use was positively associated with malaria but this was not statistically significant (OR = 1.54, 95% CI 0.68-3.48, p = 0.299).

CONCLUSION: This study highlights the complex interplay between socioeconomic and environmental factors contributing to the fine-scale spatial heterogeneity of malaria in south-eastern Tanzania. Understanding these localized drivers is essential for designing targeted, effective strategies that support broader malaria elimination goals.

PMID:40442793 | DOI:10.1186/s12936-025-05418-2

BMC Musculoskelet Disord. 2025 May 29;26(1):529. doi: 10.1186/s12891-025-08792-9.

ABSTRACT

BACKGROUND: Osteoarthritis (OA) is a degenerative and inflammatory joint disease caused by multiple factors, the underlying mechanisms of which are not fully understood. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are both novel biomarkers and predictors of inflammation. Thus, this study aimed to evaluate the relationship between SII, SIRI and OA in adult.

OBJECTIVE: The ultimate goal is to gain a deeper understanding of how SII, SIRI influences OA and the implications of this relationship.

MATERIALS AND METHODS: We analyzed data from 7204 participants aged 20 and older from the NHANES surveys conducted in 1999-2020, all of whom provided comprehensive data for this study. Standardized surveys assessed the presence of osteoarthritis and SII, SIRI. To thoroughly understand their relationship, we employed statistical techniques including multivariable logistic regression, stratified analysis with interaction, restricted cubic splines (RCS), and threshold effect analysis.

RESULTS: A total of 7204 adult participants were enrolled, composing of 2830 (39.3%) male and 4374 (60.7%) female with a median age of 62.2 ± 13.9 years, 2955 (41.0%) were diagnosed with OA. Accordingly, A linear relationship between SII and OA was discovered after adjusting for underlying confounders, (p > 0.05) in RCS, and the association between the SIRI and OA exhibited a nonlinear relationship (p = 0. 042) in RCS. In the threshold analysis, the OR of developing OA was 1.648 (95% CI: 1.144 ~ 2.374, p < 0.05) in participants with SIRI of < 0.99 10³ cells/ml. There was no significantly association between the SIRI and OA when the SIRI was ≥ 0.99 10³ cells/ml. Further sensitivity analyses provided confidence that the results are robust and not likely to be substantially influenced by unmeasured confounding factors.

CONCLUSIONS: This cross-sectional study demonstrated that a linear relationship between SII and OA, and the association between the SIRI and OA was found to be nonlinear.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40442764 | DOI:10.1186/s12891-025-08792-9