Tag: statistics

BMC Public Health. 2025 Apr 5;25(1):1288. doi: 10.1186/s12889-025-22527-4.

ABSTRACT

BACKGROUND: Pregnancy in individuals with diabetes and/or hypertension, especially when undiagnosed, untreated, or uncontrolled, can result in severe consequences, including maternal and child mortality. Contraception is crucial for the management of pregnancy in individuals with diabetes and/or hypertension. However, the decision-making and experiences related to contraception use among this population in low- and middle-income countries are poorly understood. This study aims to explore the barriers to contraception use among sexually active men and women living with diabetes and/or hypertension.

METHODS: We conducted a qualitative study using the empirical phenomenological approach. We interviewed participants diagnosed with diabetes and/or hypertension, as well as stakeholders involved in providing care to individuals living with at least one of these two conditions and family planning service providers. Semi-structured interview guides were used, and data were collected through four focus group discussions, four in-depth interviews, and ten key informant interviews. All interviews were transcribed and analysed thematically.

RESULTS: People living with diabetes and/or hypertension encounter misunderstandings and various barriers when it comes to using contraception. These experiences were categorised into four main themes and nine sub-themes. The themes identified were: (i) lack of awareness/inadequate knowledge and misunderstanding, (ii) social and religious beliefs, (iii) barriers to available and affordable contraceptives, and (iv) lack of coordination between facilities providing family planning services and treatment and management for diabetes and/or hypertension.

CONCLUSION: Findings provide a comprehensive understanding of the complexities and considerations involved in contraceptive use-related decision-making among individuals with diabetes and/or hypertension. These findings can be used in policymaking and programme development to promote contraceptive use and improve the reproductive health outcomes of this population.

PMID:40188336 | DOI:10.1186/s12889-025-22527-4

BMC Public Health. 2025 Apr 5;25(1):1289. doi: 10.1186/s12889-025-22126-3.

ABSTRACT

BACKGROUND: There is growing evidence that exposure to particulate matter (PM) is associated with impaired cognitive function. However, limited studies have specifically examined the relationship between PM exposure and domain-specific cognitive function.

METHODS: This study involved 2,668 female participants from the Lifestyle and Healthy Aging of Chinese Square Dancer Study. Global cognitive function was assessed using a composite Z-score derived from four tests: the Auditory Verbal Learning Test (AVLT), Verbal Fluency Test (VFT), Digit Symbol Substitution Test (DSST), and Trail Making Test-B (TMT-B). These tests evaluated specific cognitive subdomains: memory (AVLT), language (VFT), attention (DSST), and executive function (TMT-B). PM concentrations were estimated using a Random Forest (RF) model, which calculated the average concentrations over 1-year and 3-year periods at a high grid resolution of 1 × 1 km. Mixed linear regression was employed to explore the association between PM exposure and cognitive function.

RESULTS: After adjusting for basic socio-demographic factors, a 10 mg/m³ increase in 3-year exposure to PM₁₀ was significantly associated with a decrease in the DSST score by -0.05 (95% confidence interval [CI]: -0.11, 0) and an increase in the TMT-B score by 0.05 (95% CI: 0.01, 0.1). When further adjusting for gaseous pollutants (SO₂, NO₂, and O₃), even stronger associations were observed between 3-year exposure to either PM_2.5 or PM₁₀ and performance in both global cognition and specific cognitive subdomains. Specifically, in the DSST subdomain, a 10 µg/m³ increase in 1-year PM₁₀ exposure was associated with a decrease in the score by -0.10 (95% CI: -0.15, -0.04). Age-stratified analyses further indicated that older participants were consistently more vulnerable to PM exposure. Notably, 3-year exposure to both PM_2.5 and PM₁₀ was linked to declines in DSST scores across both middle-aged and older age groups.

CONCLUSION: Ambient PM exposure was significantly associated with performance in global cognitive function and specific cognitive domains among Chinese females. Female populations over 65 years old were more susceptible to the adverse effects of PM_2.5 and PM₁₀. Among the four subdomains, the DSST showed the strongest association with PM exposure, even at earlier ages, suggesting that impaired attention may serve as an early warning sign of cognitive decline.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40188325 | DOI:10.1186/s12889-025-22126-3

BMC Med Res Methodol. 2025 Apr 5;25(1):89. doi: 10.1186/s12874-025-02527-z.

ABSTRACT

BACKGROUND: Traditional statistical methods assume normally distributed continuous variables, making them unsuitable for analysis of prevalence proportions. To address this problem, two commonly utilized variance-stabilizing transformations (logit and Freeman-Tukey) are empirically evaluated in this study to provide clarity on the optimal choice among these transforms for researchers.

METHODS: Simulated datasets were created using multiple Monte Carlo simulations, with varying input parameters to examine transformation estimator performance under varying scenarios. Additionally, the research delved into how sample size and proportion influenced the variability of the Freeman-Tukey transform. Performance was evaluated for both single prevalence proportions (coverage, interval width and variation over sample size) as well as for meta-analysis of prevalence (absolute mean deviation of pooled proportions, coverage and interval width).

RESULTS: For extreme proportions we found that the Freeman-Tukey transform provides better coverage and narrower intervals compared to the logit transformation, and for non-extreme proportions, both transformations demonstrated similar performance in terms of single proportions. The variability of Freeman-Tukey transformed proportions with sample size is only seen when the range of proportions under scrutiny are very small (~ 0.005), and the variability of the Freeman-Tukey transform’s value occurs in the third decimal place (0.007). In meta-analysis, the Freeman-Tukey transformation consistently showed lower absolute deviation from the population parameter, with narrower confidence intervals, and improved coverage compared to the same meta-analyses using the logit transformation.

CONCLUSION: The results suggest that the Freeman-Tukey transform is to be preferred over the logit transformation in the meta-analysis of prevalence.

PMID:40188320 | DOI:10.1186/s12874-025-02527-z

Insights Imaging. 2025 Apr 5;16(1):83. doi: 10.1186/s13244-025-01957-z.

ABSTRACT

OBJECTIVES: To compare imaging differences between bleeding and non-bleeding angiomyolipoma with respect to the proportion and attenuation of the angiomyogenic component and the occurrence and size of aneurysms.

MATERIALS AND METHODS: CT scans and angiographies preceding 58 consecutive embolisations at two institutions from 1999 to 2018 were analysed retrospectively. Tumour volume was measured by contouring the angiomyolipoma on CT scans. The partial volume of the angiomyogenic component (blood vessels and smooth muscle relative to fatty tissue) was derived using attenuation threshold values measured in Hounsfield Units.

RESULTS: Bleeding angiomyolipoma exhibited a significantly higher proportion of angiomyogenic component (23%) than non-bleeding angiomyolipoma (8%) (p = 0.042). Angiomyolipoma with 0-5% angiomyogenic component had a lower risk of bleeding compared to those with ≥ 5% angiomyogenic component (13% vs 42%). Mean attenuation values of angiomyogenic components did not differ between bleeders and non-bleeders. Aneurysms were observed in 24% of angiomyolipoma during angiography. No statistically significant association was found between the occurrence of aneurysms and bleeding, neither when all aneurysms were included nor when only aneurysms ≥ 5 mm were considered. Tuberous sclerosis patients had larger tumours (11.4 cm vs 6.0 cm), but no significant difference in bleeding was observed (p = 0.53).

CONCLUSIONS: A higher proportion of the angiomyogenic component in bleeding renal angiomyolipoma suggests a possible association with bleeding. Angiomyolipoma with less than 5% angiomyogenic components may represent a subgroup with a reduced risk of bleeding. Our findings do not confirm the widely accepted assumption that aneurysms significantly increase the risk of bleeding.

CRITICAL RELEVANCE STATEMENT: Measuring the angiomyogenic component in renal angiomyolipoma could help address current knowledge gaps and aid in the more efficient selection of patients for therapeutic interventions.

KEY POINTS: Identifying risk factors for bleeding beyond tumour size is important. Very low angiomyogenic component tumours may have reduced bleeding risk. The presence of aneurysms may not significantly increase bleeding risk. Reporting angiomyogenic proportion on CT may aid in treatment decisions.

PMID:40188309 | DOI:10.1186/s13244-025-01957-z

Tech Coloproctol. 2025 Apr 5;29(1):93. doi: 10.1007/s10151-025-03135-1.

ABSTRACT

BACKGROUND: Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure.

METHOD: A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.

RESULTS: Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I² = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD – 0.17, 95% CI – 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD – 0.34, 95% CI – 0.55, – 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31).

CONCLUSION: CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.

PMID:40188299 | DOI:10.1007/s10151-025-03135-1

Ann Surg Oncol. 2025 Apr 5. doi: 10.1245/s10434-025-17176-1. Online ahead of print.

ABSTRACT

BACKGROUND: Statistical cure, defined as achieving life expectancy comparable with that of disease-free individuals, has not been specifically investigated in hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC), which accounts for more than 50% of the global HCC burden. This study aimed to develop a cure model for HBV-HCC after hepatectomy using matched HBV carriers and the general population as reference groups.

METHODS: From a Chinese multicenter database, HBV-HCC patients who underwent curative-intent hepatectomy were retrospectively reviewed. Independent prognostic factors were identified through Cox regression. A spline-based cure model was applied using two reference populations: matched Chinese HBV carriers (from Shanghai Center for Disease Control and Prevention) and the general population (from the National Bureau of Statistics).

RESULTS: The study analyzed 740 HBV-HCC patients. The following eight independent risk factors were identified: preoperative high viral load (hazard ratio [HR] 1.27), Child-Pugh grade (HR 1.21 and 1.43), multiple tumors (HR 1.70), tumor size greater than 5.0 cm (HR 1.47), macrovascular invasion (HR 3.33), microvascular invasion (HR 1.25), intraoperative blood transfusion (HR 1.21), and postoperative HBV reactivation (HR 1.89). The overall cure probability was 21.2% versus that for HBV carriers and 11.1% versus that for the general population. Risk stratification identified distinct groups relative to HBV carriers. Low risk (64.2%) showed an initial cure rate of 30.3% and achieved a 95% cure probability by 8.6 years, whereas high risk (10.5%) showed negligible cure probability.

CONCLUSIONS: This first HBV-HCC-specific cure model demonstrated that statistical cure is achievable for a subset of patients after hepatectomy. Risk stratification identifies patients with varying cure probabilities, providing valuable guidance for personalized treatment strategies and surveillance protocols.

PMID:40188279 | DOI:10.1245/s10434-025-17176-1

Eur Arch Otorhinolaryngol. 2025 Apr 5. doi: 10.1007/s00405-025-09346-4. Online ahead of print.

ABSTRACT

PURPOSE: Vibrant Soundbridge (VSB) is an active middle ear implant that serves as a solution for people unable to use conventional hearing aids properly. Surgical techniques for VSB implantation have progressively advanced, improving its outcomes. Traditionally, VSB processor activation transpires around four weeks after the surgery to provide enough healing; however, contemporary practices in cochlear implant and bone-anchored hearing device activations indicate reduced waiting times. The purpose of this research is to explore the feasibility, safety, and advantages of early VSB activation.

METHODS: This prospective study was conducted in two phases. In phase one, the patients only attempt using the device on the first business day after surgery and then return in 4 weeks for a complete and standard fitting and device use. In the second phase, participants had a thorough fitting and began using the device on a regular basis the first working day after surgery. Feasibility, safety, and audiological results were assessed throughout both phases.

RESULTS: Early activation was successfully achieved in all patients in the early group without significant complications. When comparing the audiological examination and fitting parameters between the initial session the day after surgery and the one-month follow-up, there was no statistically significant change.

CONCLUSION: The study emphasizes the possibility for early VSB activation, which might minimize wait times and enhance patient satisfaction without compromising device function. Further study is required to validate these results in broader groups and investigate long-term consequences.

PMID:40188275 | DOI:10.1007/s00405-025-09346-4

Environ Monit Assess. 2025 Apr 5;197(5):514. doi: 10.1007/s10661-025-13962-2.

ABSTRACT

Malaria remains a significant global health concern which continues to pose a life-threatening risk globally. The disease, transmitted by Anopheles mosquitoes acting as vectors, requires favorable environments for effective transmission. These environments are influenced by factors such as meteorological conditions and vegetation cover; a number of which have been examined in this study and incorporated into modeling the observed malaria incidence. This method provides a solution for common data inconsistencies encountered in healthcare and epidemiological research, while also offering predictions on incidence rates, thereby enabling more informed decision-making processes. A multivariate statistical modelling approach using the Vector Autoregressive (VAR) model has been employed, enabling dynamic analysis of all relevant parameters simultaneously. The environmental information obtained from satellite and reanalysis datasets, along with the recorded malaria cases in Dhalai district, Tripura, India, were evaluated for causality, refined, and subsequently utilized in the modelling process. The model’s reliability was assessed by comparing its short-term forecast with actual data using a number of accuracy metrics, revealing a mean absolute percentage error of 1.16% and a correlation coefficient of 0.721 between the testing and forecasted malaria incidence data. These observations highlight the model’s effectiveness in accurately capturing the variations in malaria incidence and its predictive capability. Notably, this model has yet to be widely utilized, which presents a unique opportunity for further exploration in other regions. Such studies could significantly contribute to the development of more targeted and effective control measures.

PMID:40188273 | DOI:10.1007/s10661-025-13962-2

Sci Rep. 2025 Apr 5;15(1):11716. doi: 10.1038/s41598-025-95595-6.

ABSTRACT

Despite extensive research studying the opinions on vaccination since the outbreak of COVID-19, the dynamics of temporal opinion shifts of individuals and their possible origins have been rarely studied. Here, we explore the possible influence of social interactions (retweet network) on individual’s opinion shift related to vaccinations based on large-scale Twitter data in Japan. We use an opinion score which calculates the fraction of pro-, neutral and anti-vaccine tweets to measure the dynamic changes of individual opinions, and identify statistically significant communities based on retweet network. By tracking individual’s dynamic opinion and its community affiliation, our study highly suggests that the opinion shifts are largely influenced by the user’s Twitter community. That is, if users are within the anti-vaccine (or pro-vaccine) community, they exhibit a significantly higher likelihood of changing their position and adopt an anti-vaccine (or pro-vaccine) stance. We also find that the anti-vaccine community’s influence appears to persist longer than the pro-vaccine community.

PMID:40188270 | DOI:10.1038/s41598-025-95595-6

Sci Rep. 2025 Apr 5;15(1):11733. doi: 10.1038/s41598-025-96189-y.

ABSTRACT

In the study of stroke symptoms, a significant unresolved issue remains: What are the similarities and differences in the use of three symptom dimensions-occurrence, severity, and distress-and symptom burden to identify symptom clusters, and which level is recommended for constructing symptom clusters? This study aimed to identify the number and types of symptom clusters in stroke patients on the basis of these dimensions and to determine the most suitable dimension for extracting symptom clusters. Data were collected from 656 stroke patients via a convenience sampling method at a tertiary-level hospital in Wuhan, China, between August 2023 and March 2024. Exploratory factor analysis was conducted to extract symptom clusters on the basis of the three dimensions of the symptom experience scale and symptom burden. Four similar symptom clusters were identified: the mood disturbance symptom cluster, the physical symptom cluster, the cognitive dysfunction symptom cluster, and the slurred speech and choking cough symptom cluster. The symptom of “fatigue” within the physical symptom cluster was not identified only in the dimension of distress (with a percentage agreement of 83.3%), whereas the symptom composition of other clusters remained consistent across all three symptom dimensions (with a percentage agreement of 100%). Moreover, all four symptom clusters exhibited high consistency in terms of both occurrence and symptom burden, regardless of whether the symptom with the highest factor loading or the overall symptom composition was considered. The use of symptom occurrence and symptom burden is recommended for identifying symptom clusters in stroke patients. Subsequently, trajectory studies of symptom clusters and symptom network analyses should be conducted on the basis of these two dimensions to establish a solid theoretical foundation for future clinical interventions and related scientific research.

PMID:40188267 | DOI:10.1038/s41598-025-96189-y