Tag: statistics

Cureus. 2025 Apr 23;17(4):e82824. doi: 10.7759/cureus.82824. eCollection 2025 Apr.

ABSTRACT

INTRODUCTION: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion. Limited data are available on its prevalence and characteristics in Yemen, a region facing socioeconomic challenges intensified by conflict. This study aimed to estimate the prevalence of CD and evaluate the demographic, clinical, and nutritional profiles of affected children.

METHODS: This five-year retrospective study analyzed data from 120 children diagnosed with CD at Al-Sabeen Hospital, Sana’a, Yemen, from January 2018 to December 2023. Children of any age and sex clinically suspected of having CD based on gastrointestinal (e.g., chronic diarrhea) and/or extraintestinal manifestations (e.g., failure to thrive) were included, with non-CD causes excluded via European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)-guided testing. Diagnosis followed the guidelines of the ESPGHAN guidelines, using transglutaminase 2 antibody (tTA-IgA) and endomysial antibody IgA (EMA IgA) levels, with biopsy recommended for tTA-IgA <10× the upper limit of normal. Data on demographics, nutritional status, clinical manifestations, and associations were collected via a structured questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with chi-square tests assessing significance (p<0.05).

RESULTS: Among 3,570 admissions, CD prevalence was 3.4% (n=120), with a female predominance (58.3%, n=70) and 70% (n=84) diagnosed before the age of one year (mean 12 ± 3.5 months). Malnutrition affected 60.0% of cases, significantly associated with rural residency (p=0.015), low family income (p=0.001), unprotected water sources (p=0.030), and incomplete vaccination (p<0.001). Chronic diarrhea (85.0%) and pallor (81.7%) were the most common manifestations. No significant associations were found for sex (p=0.705) or animal contact (p=0.053).

CONCLUSIONS: CD prevalence in Yemeni children exceeds the global average, with malnutrition being a major comorbidity linked to socioeconomic and environmental factors. Targeted screening, biopsy-confirmed diagnosis for ambiguous cases, and nutritional interventions are critical in conflict-affected settings such as Yemen. Future multicenter studies with genetic testing are recommended to enhance our understanding and management.

PMID:40416247 | PMC:PMC12100572 | DOI:10.7759/cureus.82824

JACC Cardiovasc Interv. 2025 May 21:S1936-8798(25)01447-5. doi: 10.1016/j.jcin.2025.05.028. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction appears to play a major role in the pathogenesis of Takotsubo Syndrome (TTS). However, the prognostic value of microvascular function measured in the acute phase of TTS is unclear.

METHODS: In a collaborative, pooled analysis of individual patient data from nine prospective TTS cohorts, invasive assessment of coronary microvascular function was performed, including the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and microvascular resistance reserve (MRR). The primary endpoint was all-cause mortality. Secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of all-cause death, recurrence of TTS, stroke, transient ischemic attack, or myocardial infarction.

RESULTS: One hundred and sixty six patients with TTS were included, in whom 130 (78%) had the typical (apical) TTS variant and 36 (22%) an atypical variant. During a median follow-up of 20.6 [4.3 – 60.0] months, all-cause mortality occurred in 17 patients (10.2%) and MACCE in 29 patients (17.5%). IMR, CFR, and MRR were associated with all-cause mortality. After adjustment for baseline differences, IMR was the only independent predictor of both all-cause mortality (aHR 3.9; 95% CI: 1.39-10.88, P = 0.010; c-statistic 0.817 (95% CI: 0.711-0.923)) and MACCE (aHR 2.6; 95% CI: 1.17-5.67; P = 0.018; c-statistic 0.719 (95% CI: 0.612-0.826)).

CONCLUSIONS: In this pooled analysis of individual patient data from nine prospective TTS cohorts, microvascular dysfunction measured in the acute phase, was associated with all-cause mortality. In particular, an elevated microvascular resistance, as assessed by IMR, was the only independent predictor of both mortality and MACCE.

PMID:40415182 | DOI:10.1016/j.jcin.2025.05.028

Alzheimers Dement. 2025 May;21(5):e70304. doi: 10.1002/alz.70304.

ABSTRACT

INTRODUCTION: We examined sex effects on amyloid positron emission tomography (PET) in a large cohort of patients evaluated for cognitive complaints in a “real-world” specialty setting.

METHODS: We analyzed 10,361 amyloid PET scans (51% females) from the Imaging Dementia-Evidence for Amyloid Scanning Study. Amyloid positivity was defined by either local visual read or central PET processing and quantification (≥ 24.4 Centiloids). Sex differences were examined using multilinear regression and logistic regression adjusted for age, comorbidities, and other demographic and clinical covariates.

RESULTS: Females had higher rates of positive amyloid PET visual reads (63% vs. 59%, P < 0.001) and higher Centiloids (CLs; median 48.7 vs. 36.8, p < 0.001). On logistic regression, females had higher odds ratios (ORs) for positive amyloid PET (visual read OR 1.20, 95% confidence interval [CI]: 1.11-1.31; CL threshold-based OR 1.37, 95% CI: 1.26-1.49; both p < 0.001).

DISCUSSION: Females with cognitive impairment showed higher amyloid PET positivity and greater amyloid burden. Further research is needed to explore mechanisms and treatment implications.

HIGHLIGHTS: Females exhibited higher rates of amyloid positron emission tomography (PET) positivity and higher amyloid burden than males. These sex effects were found in patients with both mild cognitive impairment (MCI) and dementia. Females also had higher rates of dementia and amnestic MCI, while males had higher rates of non-amnestic MCI and more cholinesterase inhibitor use.

PMID:40415175 | DOI:10.1002/alz.70304

J Sch Health. 2025 May 25. doi: 10.1111/josh.70016. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who depended on subsidized school meals at risk of hunger. In response, the US Department of Agriculture activated the Summer Food Service Program (SFSP) and Seamless Summer Option (SSO) program to provide emergency free school meals. This study examined organizations’ experiences implementing these programs from March 2020 to September 2021.

METHODS: The study utilized a mixed-methods approach, which included: (1) conducting in-depth interviews with managers at program sponsor agencies responsible for meal distribution (n = 9), and (2) distributing a survey to meal site managers (n = 41). We conducted thematic analyses of interviews and descriptive statistics for survey items.

RESULTS: Thematic analyses revealed challenges related to families’ ability to access meal sites and communication gaps between organizations, hindering meal program implementation. Sponsors highlighted the benefits of federal waivers enabling grab-and-go options and extended pick-up hours, which enhanced operations and family participation. Survey findings also showed that most sites regularly offered fresh produce and whole grains during the pandemic.

CONCLUSIONS: Continuing meal program flexibilities could boost family participation and expand equitable access to school meals during summers or school closures.

PMID:40415168 | DOI:10.1111/josh.70016

Aging Clin Exp Res. 2025 May 26;37(1):166. doi: 10.1007/s40520-024-02893-6.

ABSTRACT

BACKGROUND & AIMS: Previous studies have shown that antioxidants may be associated with risk of Alzheimer’s disease (AD). However, some findings have failed to demonstrate a significant correlation. To rigorously evaluate this relationship, a comprehensive review and meta-analysis were conducted.

METHODS: All relevant cohort studies reporting association between antioxidants intake (diet and/or supplement use) and AD risk were searched in 9 electronic databases and 4 registration platforms from their inception up to March 15, 2023. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using either a fixed-effects or random-effects model. Heterogeneity was assessed using I² statistics. Furthermore, a dose-response meta-analysis was conducted to explore potential dose-response relationships.

RESULTS: Eleven cohort studies were included. The pooled HRs of AD were 0.90 (95% CI = 0.60-1.34) and 0.94 (95% CI = 0.75-1.17) for the dietary intake of vitamin E, 0.90 (95% CI = 0.76-1.07) for the vitamin E supplement use. The pooled HRs of AD were 0.84 (95% CI = 0.76-0.93) and 0.60 (95% CI = 0.35-1.02) for the dietary intake of vitamin C, 0.85 (95% CI = 0.72-1.00) for the vitamin C supplement use. The pooled HRs of AD were 1.02 (95% CI = 0.85-1.22) and 0.86 (95% CI = 0.68-1.07) for the dietary intake of beta-carotene. Notably, no significant dose-response relationship was observed.

CONCLUSIONS: A high dietary intake of vitamin C (≥ 75 mg/d) was found to have a statistically significant impact on reducing the risk of AD. However, no significant association was observed between dietary intake of vitamin E or beta-carotene, or the use of vitamin E or vitamin C supplement use, and the risk of AD.

PMID:40415164 | DOI:10.1007/s40520-024-02893-6

Neurosurg Rev. 2025 May 26;48(1):445. doi: 10.1007/s10143-025-03616-9.

ABSTRACT

Spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer is an effective surgical option for traumatic brachial plexus injuries (BPIs) when nerve grafting is not applicable. It is performed via two approaches: anterior and posterior. Despite the theoretical advantages of the posterior approach, clinical trials have yielded variable outcomes. This study aimed to compare the outcomes of anterior and posterior approaches for SAN to SSN transfer in restoring the Range of motion (ROM) and strength of shoulder abduction and external rotation in BPIs. We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science to identify studies comparing anterior and posterior approaches for SAN to SSN transfer. Quality assessment was performed using the Cochrane RoB2 tool and Newcastle-Ottawa Scale. via RevMan 5.4, meta-analyses were conducted. We identified eight comparative studies with 311 patients (n = 140 for posterior transfer, n = 171 for anterior transfer). Both approaches showed comparable outcomes with statistically significant advantages to the posterior approach by a modest but meaningful difference in shoulder abduction ROM (MD: 8.98°, 95% CI: 1.19 to 16.78, P = 0.02, I² = 0%) and in the Modified Medical Research Council (MRC), The posterior approach was associated with 4.78 times higher odds of achieving a grade ≥ M3 on the MRC scale (OR: 4.78, 95% CI: 1.43 to 15.96, P = 0.01, I² = 0%). We suggest that when functional gains are a priority, surgeons consider the posterior approach while still accounting for patient/surgeon specific factors and injury details.

PMID:40415160 | DOI:10.1007/s10143-025-03616-9

Aging Clin Exp Res. 2025 May 26;37(1):169. doi: 10.1007/s40520-025-03065-w.

ABSTRACT

OBJECTIVE: This meta-analysis aimed to systematically assess whether physical activity (PA) can improve physical health(PH) and mental health(MH) in elderly.

METHOD: To conduct this meta-analysis, four databases were searched from the start to October 24, 2024 (Web of Science and PubMed in English, CNKI and Wanfang Data Knowledge Service Platform in Chinese). Eligibility criteria included (1) study populations aged ≥ 60 years of normal elderly, with no gender restrictions; (2) the experimental group included PA interventions; (3) the control group consisted of non-PA interventions or usual activities; (4) assessment results from health evaluation tools and psychological scales; (5) the research design was a controlled experimental study. The Cochrane bias risk tool was used to assess the quality of evidence for each study. Among 4,151 potential related articles, 9 met the criteria for inclusion in this review.

RESULTS: The PA intervention shows a high degree of statistical heterogeneity in the overall results for the PH of the elderly (I²=93.8%, p < 0.01). The effect size of the PA intervention on the PH of the elderly is 0.86 (95% CI: 0.08, 1.64), which is statistically significant. Subgroup analysis showed that in intervention frequency, the heterogeneity for interventions less than three times per week is low (I² = 25.6%); in intervention duration, interventions lasting less than 30 min is relatively high, the direction of the study results is quite consistent. The overall effect size is 2.32 (CI: 1.45, 3.20), indicating statistical significance; in overall intervention duration, the overall effect size for interventions lasting less than 12 weeks is (CI: 0.08, 1.59), while the effect sizes for the other two subgroups include 0, indicating non-significant results. The overall results for the MH of the elderly also exhibit a high degree of statistical heterogeneity (I²=95.3%, p < 0.01). The effect size of the PA intervention on the MH of the elderly is -0.22 (95% CI: -1.46, 1.03), which is not statistically significant. Subgroup analysis also showed no statistically significant differences. The PH and MH of the elderly may potentially improve through PA interventions, although further research is needed to clarify whether these benefits hold clinical significance beyond statistical significance.

CONCLUSION: PA interventions with a frequency of less than 3 times per week, each session lasting less than 30 min, and a total duration not exceeding 12 weeks may be more effective in improving the PH of the elderly. This study did not identify the optimal dosage for improving the MH of the elderly. These findings highlight the potential benefits of PA for PH in the elderly but underscore the need for more rigorous studies to determine optimal intervention parameters and to explore the clinical significance of PA for both PH and MH.

PMID:40415159 | DOI:10.1007/s40520-025-03065-w

Ann Surg Oncol. 2025 May 26. doi: 10.1245/s10434-025-17484-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions.

PATIENTS AND METHODS: We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I² statistics.

RESULTS: In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31).

CONCLUSIONS: Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.

PMID:40415155 | DOI:10.1245/s10434-025-17484-6

CNS Drugs. 2025 May 25. doi: 10.1007/s40263-025-01193-5. Online ahead of print.

ABSTRACT

BACKGROUND: Levodopa, dopamine agonists (DA) and monoamine oxidase inhibitors (MAOI) are all approved first-line therapies for Parkinson’s disease (PD), as monotherapy or in combination. Data on their use in the early management of patients with PD in real-life are lacking. Our objective was to assess the impact of early therapeutic strategies on the development of motor and neuropsychiatric complications using a nationwide PD cohort.

METHODS: NS-PARK is a cohort of patients with PD recruited between 2011 and 2021 from 26 expert centres for PD in France. We analysed the patients with less than 5-years disease duration and no motor complications at inclusion. We used interval censoring survival models to assess the associations between therapeutic strategies (levodopa monotherapy, levodopa alternative therapies or levodopa combinations) and motor fluctuations, dyskinesia, impulse control and related behaviours (ICRBs), apathy, psychosis/hallucination and daytime sleepiness. Analyses were adjusted for sex, age, disease duration, dopaminergic dose and disease severity.

RESULTS: We included 1722 patients (38.4% female, median age 67.7 years). At inclusion, 41% received levodopa monotherapy, 31% received levodopa alternative therapies and 28% received levodopa combinations. Compared with levodopa monotherapy, levodopa alternative therapies were associated with a lower dyskinesia risk (hazard ratio (HR) 0.48, 95% confidence interval (CI)[0.28-0.84]), but there was no significant difference in motor fluctuations. Both levodopa alternative and combinations therapies increased ICRBs risk (HR 4.06, 95% CI [2.48-6.67]; HR 5.16, 95% CI [3.00-8.86]) and decreased apathy risk (HR 0.36, 95% CI [0.26-0.49]; HR 0.52, 95% CI [0.39-0.69]). No association was found with psychosis/hallucination or daytime sleepiness.

CONCLUSIONS: In this real-life cohort, our data supported an association between levodopa alternative therapies and a lower risk of dyskinesia and apathy, but a higher risk of ICRBs compared with levodopa monotherapy.

GOV IDENTIFIER: NCT04888364. Registered June 2021.

PMID:40415148 | DOI:10.1007/s40263-025-01193-5

Clin Rheumatol. 2025 May 26. doi: 10.1007/s10067-025-07496-8. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic sclerosis (SSc), is an autoimmune disease that affects multiple organs. Although physician’s Global Assessment (PGA) has been proved to be a useful tool in assessing the risk of outcomes in SSc patients, reliable grading criteria for SSc remain lacking. Early cardiac involvement particularly remains a diagnostic challenge.

OBJECTIVES: This study aims to assess the differences of clinical and cardiac magnetic resonance (CMR) in SSc patients with different duration and states, as indicated by PGA, identifying risk factors indicating potential cardiac involvement.

METHODS: SSc patients aged 18-70 years old without cardiac symptoms were recruited and underwent CMR at 3.0 T. PGA score was used to grade the SSc disease state: mild, the PGA score ranged from 0 to 1; and moderate/severe, the PGA score ranged from 1 to 3. The relationship between PGA and myocardial T1 values was analyzed using Spearman correlation coefficient. The inter-rater agreement in assessing PGA and the agreement between PGA and European Systemic sclerosis study group activity index (EScSG-AI) were evaluated using Kappa analysis. Linear regression analyses were conducted to evaluate the association between PGA and myocardial native T1 values.

RESULTS: Weak correlation was found between myocardial native T1 values and PGA score (r = 0.379, P = 0.002), particularly in SSc patients in moderate/severe disease state (r = 0.336, P = 0.008). Univariate linear regression analysis revealed that PGA was significantly associated with myocardial native T1 value (β, 15.316; 95%CI, 29.699-90.971; P < 0.001). Multivariate regression analysis showed that the association between PGA and myocardial native T1 value remained statistically significant after adjusting age and sex (model 1: β, 14.788; 95% CI, 35.257-94.461; P < 0.001), age, sex and myositis (model 2: β, 61.110; 95% CI, 32.177-90.043; P < 0.001), and age, sex, myositis, disease duration (model 3: β, 63.895; 95% CI 33.281-94.519; P < 0.001).

CONCLUSION: PGA was associated with myocardial native T1 values in asymptomatic SSc patients, suggesting that PGA might be a useful tool to evaluate subclinical myocardial involvement of SSc. Key Points • The Physician’s Global Assessment (PGA) may offer a low-cost, non-invasive method for identifying subclinical myocardial involvement in SSc patients, potentially enhancing screening and disease management. • These findings provide a basis for further longitudinal studies with larger cohorts to validate the role of PGA in predicting cardiac outcomes in SSc.

PMID:40415132 | DOI:10.1007/s10067-025-07496-8