Tag: statistics

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

BMC Health Serv Res. 2025 Feb 15;25(1):257. doi: 10.1186/s12913-025-12269-9.

ABSTRACT

BACKGROUND: This study examined the serial mediating roles of perceived quality and customer satisfaction in the relationship between trust and repurchase intentions among private health insurance owners.

METHODS: This cross-sectional study included 525 private health insurance owners. The data were collected between 15.12.2023 and 15.03.2024, and SPSS AMOS was used to analyze the direct and indirect estimates. The study utilized structural equation modeling (SEM) to examine the relationships among the constructs. The proposed model was tested using maximum likelihood estimation. Model fit indices and statistical significance levels were reported to ensure the robustness of the findings. Using an online survey, the participants completed self-reported measures of perceived quality, customer satisfaction, trust, and repurchase intention.

RESULTS: Trust significantly affected perceived quality, customer satisfaction and repurchase intention. Furthermore, perceived quality acted as a mediator in the relationship between trust and customer satisfaction. Additionally, customer satisfaction played a partial mediating role in the relationship between trust and repurchase intention. Both perceived quality and customer satisfaction play a serial mediating role in the relationship between trust and repurchase intention.

CONCLUSIONS: This study highlighted the significance of perceived quality and customer satisfaction in the relationship between trust and repurchase intention. Private health insurance agencies both alleviate the burden on public health services and operate as profit-driven entities. Considering their indirect benefits to healthcare services, maintaining existing customer portfolios and acquiring new customers are important for both the health system and the profitability of insurance businesses.

PMID:39955545 | DOI:10.1186/s12913-025-12269-9

Respir Res. 2025 Feb 15;26(1):56. doi: 10.1186/s12931-025-03135-7.

ABSTRACT

BACKGROUND: To develop effective strategies for controlling asthma, a thorough assessment of its disease burden is essential. In this study, we examined long-term trends in the asthma burden in China over the past three decades and analyzed its epidemiological features.

METHODS: We assessed the burden of asthma in China via the global burden of disease (GBD) 2021 database, focusing on prevalence, incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Additionally, we employed joinpoint analysis and age-period-cohort (apc) methods to interpret the epidemiological characteristics of asthma. Finally, we analyzed the attributable burden of asthma to gain a comprehensive understanding of its impact.

RESULTS: The age-standardized incidence rate (ASIR) and mortality rate (ASMR) for both sexes in China shifted from 524.81 (95% UI: 421.31, 672.76) to 314.17 (95% UI: 283.22, 494.10) and from 5.82 (95% UI: 4.46, 8.50) to 1.47 (95% UI: 1.15, 1.79) per 100,000 population between 1990 and 2021. According to joinpoint analysis, the average annual percentage change (AAPC) in the age-standardized incidence rate was – 1.2 (95% CI: – 1.4, – 1.1), indicating a gradual but fluctuating decline (with significant turning points in 2005 and 2014). The apc fitting results suggest that the prevalence is now lower than it was in the past and that the relative prevalence risk is high among adolescents and middle-aged to elderly individuals, possibly due to different pathophysiological mechanisms. In 2021, the primary asthma-related burdens were metabolic risks, especially obesity.

CONCLUSIONS: In conclusion, we found that the disease burden of asthma in China has significantly decreased. However, it remains a major concern among adolescents and elderly individuals. Metabolic risk factors, particularly obesity, are the main contributors to the asthma burden. It is essential to address specific risk factors and develop targeted public health strategies for different age groups.

PMID:39955544 | DOI:10.1186/s12931-025-03135-7

Int J Health Geogr. 2025 Feb 15;24(1):1. doi: 10.1186/s12942-025-00387-w.

ABSTRACT

BACKGROUND: Addressing key behavioral risk factors for chronic diseases, such as diet, requires innovative methods to objectively measure dietary patterns and their upstream determinants, notably the food environment. Although GIS techniques have pushed the boundaries by mapping food outlet availability, they often simplify food access dynamics to the vicinity of home addresses, possibly misclassifying neighborhood effects. Leveraging Google Location History Timeline (GLH) data offers a novel approach to assess long-term patterns of food outlet utilization at an individual level, providing insights into the relationship between food environment interactions, diet quality, and health outcomes.

METHODS: We leveraged GLH data previously collected from a sub-set of participants in the Washington State Twin Registry (WSTR). GLH included more than 287 million location records from 357 participants. We developed methods to identify visits to food outlets using outlet-specific buffer zones applied to the InfoUSA data on food outlet locations. This methodology involved the application of minimum and maximum stay durations, along with revisit intervals. We calculated metrics from the GLH data to detect frequency of visits to different food outlet classifications (e.g. grocery stores, fast food, convenience stores) important to health. Several sensitivity analyses were conducted to examine the robustness of our food outlet metrics and to examine visits occurring within 1 and 2.5 km of residential locations.

RESULTS: We identified 156,405 specific food outlet visits for the 357 study participants. 60% were full-service restaurants, 15% limited-service restaurants, and 16% supermarkets. Mean visits per person per month to any food outlet was 12.795. Only 8, 10 and 11% of full-service restaurants, limited-service restaurants, and supermarkets, respectively, occurred within 1 km of residential locations.

CONCLUSIONS: GLH data presents a novel method to assess individual-level food utilization behaviors.

PMID:39955543 | DOI:10.1186/s12942-025-00387-w

J Orthop Surg Res. 2025 Feb 15;20(1):166. doi: 10.1186/s13018-025-05518-4.

ABSTRACT

PURPOSE: This study aims to systematically assess the surgical outcomes and postoperative recovery discrepancies between Robotic-Assisted Total Knee Arthroplasty (RA-TKA) and Conventional Total Knee Arthroplasty (C-TKA) using machine learning algorithms. The objective is to analyze the advantages and disadvantages of both techniques across various parameters and propose optimization recommendations.

METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) clinical database were collected and underwent thorough cleaning and standardization. Key variables such as operative time, Length of Stay (LOS), and postoperative functional status were extracted for analysis. A predictive model was developed and trained using the random forest machine learning algorithm based on postoperative recovery data. The model’s performance was validated using a test dataset, and statistical analyses were conducted to compare the surgical outcomes and postoperative recovery between RA-TKA and C-TKA.

RESULTS: The machine learning model’s predictions indicate that RA-TKA surpasses C-TKA in all surgical outcome metrics, exhibiting superior means and variances. Furthermore, RA-TKA demonstrates better postoperative functional status, lower Complication Rate (CR), and a higher modified frailty index (mFI), suggesting enhanced and quicker recovery for RA-TKA patients.

CONCLUSION: The evaluation results derived from machine learning algorithms suggest that RA-TKA may offer advantages over C-TKA in several crucial metrics. These findings provide valuable insights that could inform future efforts to optimize surgical procedures and postoperative care in clinical practice.

PMID:39955539 | DOI:10.1186/s13018-025-05518-4

World J Surg Oncol. 2025 Feb 15;23(1):55. doi: 10.1186/s12957-025-03705-5.

ABSTRACT

BACKGROUND: To explore the risk factors of post pancreatectomy diabetes mellitus (PPTDM)in pancreatic ductal carcinoma (PDAC) patients and the value of perioperative fasting blood glucose (FBG) level expression on the long-term survival after surgery.

MATERIALS AND METHODS: Between December 2015 and December 2019, a cohort of 509 patients diagnosed with PDAC and undergoing resection at our hospital was analyzed. They were stratified into two groups, Control group (Control) and study group (PPTDM), depending on the onset of postoperative diabetes mellitus. We analyzed the survival rates at 6 months, 12 months and 24 months post-operation in the two groups. We use univariate and logostic multivariate regressions to analyze the risk factors for PPTDM. ROC curve analysis was conducted to assess the diagnostic significance of perioperative FBG levels regarding patients’ long-term survival rates. The Kaplan-Meier method was employed to assess the impact of both preoperative and postoperative FBG levels on the survival rates within 24 months for each patient group.

RESULTS: The comparison of general clinical data between the two groups shows marginal differences without statistical significance(P > 0.05); Patients in PPTDM group had significantly higher BMI, preoperative jaundice proportion, larger tumor diameter, higher TNM stage and higher proportion of distal pancreatectomy (DP), with P values of 0.023, 0.010, 0.040, 0.012 and 0.005, respectively. The levels of preoperative FBG and postoperative FBG in PPTDM patients exhibited statistically significant elevation compared to the control group (P < 0.05). There were no significant differences in surgery-related indicators between the two groups in operative time, number of dissected positive lymph nodes, total number of dissected lymph nodes, intraoperative blood loss and other related data (P > 0.05). Hospitalization duration of PPTDM patients was longer than control group (P = 0.047). PPTDM group had significantly higher expression concentrations of BUN, Cr, TG, LDL and Apo-B factors (P = 0.023, 0.024, 0.013, 0.045 and 0.017). 17 patients (5.03%) died in the PPTDM group and 4 patients (2.35%) in control group which had significantly difference (P = 0.020). In univariate and logostic multivariate regression analysis indicated tumor size, jaundice, BUN, Cr, TG, LDL, Apo-B concentrations and DP approach were significantly correlated to the risk for PPTDM (P < 0.05). ROC curve analysis results showed combining of preoperative and postoperation FBG showed the highest diagnostic efficacy, followed by postoperation FBG and preoperative FBG. The AUC areas of the three groups were 0.745, 0.623 and 0.588, respectively, and the critical values of the three groups were 9.81/9.95 mmol/L, 10.18 mmol/L and 10.23 mmol/L, respectively, with statistical significance (P < 0.05). Results were considered statistically significant if the p-value was less than 0.05.

CONCLUSION: PPTDM stands as a significant postoperative complication following pancreatic cancer surgery, characterized by a high incidence and severity. Several risk factors have garnered considerable attention among clinical surgeon. PPTDM may be an influential factor in postoperative prognosis of pancreatic cancer. The expression levels of preoperative and postoperative blood glucose hold diagnostic value for the long-term prognosis of pancreatic cancer patients. Early regulation and intervention by surgeons concerning perioperative FBG could potentially mitigate the risk of PPTDM.

PMID:39955538 | DOI:10.1186/s12957-025-03705-5

Genet Med. 2025 Feb 12:101375. doi: 10.1016/j.gim.2025.101375. Online ahead of print.

ABSTRACT

PURPOSE: AUTS2-related syndrome is a condition characterized by developmental delay, autism spectrum disorder, and intellectual disability. From alternative promoters AUTS2 encodes two distinct long and short isoforms encoding a putative transcriptional activator.

METHODS: Through a European collaborative study, we collected clinical and genotype data on the largest AUTS2- related syndrome cohort of 58 patients harboring genomic rearrangements or single nucleotide variants (SNVs).

RESULTS: Pathogenic SNVs were recurrently found in individuals from different countries, suggesting mutational hotspots. Independent from the underlying defect at the AUTS2 locus, we observed that autistic behavior, hyperactivity, learning difficulties and speech delay are common features of AUTS2- related syndrome. Among patients with SNVs, individuals carrying pathogenic variants affecting both the longer and the shorter AUTS2 transcripts showed a recognizable phenotype with microcephaly, brachycephaly, micro-retrognathia, broad nasal base and anteverted nares. Behavioral disorders were statistically more common in patients with variants affecting only the longer isoform. Arthrogryposis and stiff movements were only noticed in patients with SNVs.

CONCLUSION: This study provides a comprehensive clinical characterization of AUTS2- related syndrome, unravels few genotype-phenotype correlations and it suggests that disruption of the two distinct AUTS2 transcripts has a different impact on clinical phenotype.

PMID:39953909 | DOI:10.1016/j.gim.2025.101375