Tag: statistics

JMIR Mhealth Uhealth. 2025 May 20;13:e53586. doi: 10.2196/53586.

ABSTRACT

BACKGROUND: Anticoagulation management is important in preventing complications in patients undergoing cardiac valve replacement. The development of mobile apps offers new opportunities for the management of long-term anticoagulants. However, there is a lack of randomized controlled trials evaluating the effectiveness, safety, cost-effectiveness, and user demand for internet-based anticoagulation management.

OBJECTIVE: This study aimed to evaluate the efficacy, safety, and cost-effectiveness of a 3-month warfarin dose adjustment mobile app Alfalfa compared to offline management in patients postcardiac valve replacement. We also explored the app’s feasibility on user satisfaction and demand.

METHODS: This study was a randomized controlled trial with assessments conducted at baseline and at a 3-month follow-up. Participants were eligible if they had been on warfarin therapy for at least 3 months, received warfarin management either through the Alfalfa app or through pharmacist-led anticoagulation outpatient clinic visits, consented to regular follow-ups, and had not experienced serious bleeding or thrombotic events in the 3 months before warfarin treatment. A P value of ≤.05 was considered statistically significant.

RESULTS: A total of 405 participants were included in the analysis. The time in therapeutic range was significantly higher in the Alfalfa app group than in the offline group (66.46% vs 46.65%, P<.001). Participants in the Alfalfa app group had a higher monitoring frequency (8.14 vs 4.47, P<.001) and a greater percentage of international normalized ratio values within the target range (896/1660, 53.98% vs 346/899, 38.49%; P<.001) than those in the offline group. In addition, the Alfalfa app group exhibited lower rates of subtherapeutic (235/1660, 14.16% vs 152/899, 16.91%; P<.05) and extreme subtherapeutic international normalized ratio values (273/1660, 16.45% vs 186/899, 20.69%; P<.05) than the offline group. However, the incidence of minor bleeding was higher in the Alfalfa app group (12/204, 5.9% vs 3/201, 1.5%; P=.02). In terms of cost-effectiveness, the Alfalfa app group had a significantly lower average cost per test (42.37 vs 78.3, P<.001), average time per test (47.42 vs 90.74, P<.001), and cost-effectiveness ratio (385.9 vs 662.9) than the offline group. A total of 86 participants completed the satisfaction questionnaire, and the vast majority of participants expressed high levels of satisfaction with the Alfalfa App, while also providing further suggestions for improvement.

CONCLUSIONS: The integration of “Internet+Pharmacy Care” using the Alfalfa App can improve the effectiveness of warfarin anticoagulation management in patients following heart valve surgery. The Alfalfa app provides a more efficient, secure, and cost-effective solution to warfarin management than traditional offline methods.

PMID:40393057 | DOI:10.2196/53586

JMIR Form Res. 2025 May 20;9:e72659. doi: 10.2196/72659.

ABSTRACT

BACKGROUND: Controlling glycated hemoglobin (HbA1c) levels can be challenging for patients with type 2 diabetes mellitus (T2DM). Peer support promotes HbA1c control, and a digital peer-supported app designed for group interactions may enable patients with T2DM to encourage one another to achieve better HbA1c outcomes. However, no studies have investigated the use of digital peer-supported apps to control HbA1c levels in patients with T2DM.

OBJECTIVE: This pilot study aimed to explore the effects of a digital peer-supported app on HbA1c control in patients with T2DM.

METHODS: This prospective single-arm pilot study enrolled patients with T2DM who owned smartphones and visited medical institutions in Japan. During the 3-month intervention, participants used a digital peer-supported app in addition to receiving standard care. This app allowed participants to share activity logs and concerns via a chat function to improve HbA1c levels through mutual engagement and encouragement. The primary outcome was the change in HbA1c levels, measured at health care facilities at baseline and after 3 months. The secondary outcomes were body weight and blood pressure, with the most recent data obtained from hospitals and clinics. Physical activity (≥1 hour/day) was assessed at the same time points using a self-reported questionnaire.

RESULTS: The study included 21 participants with a median age of 56 (IQR 51-61) years, of which 13 (61.9%) were female. After using the digital peer-supported app for 3 months, the participants’ HbA1c levels significantly decreased from 7.1% (SD 0.6%) at baseline to 6.9% (SD 0.1%) (P=.04). Similarly, participants’ body weight decreased from 70.7 (SD 12.7) kg to 69.9 (SD 12.4) kg (P =.004) through app use. Although blood pressure decreased slightly from 128.2 (SD 12.5) mm Hg to 126.0 (SD 12.9) mm Hg, this change was not statistically significant (P=.20). Additionally, the proportion of participants engaged in ≥1 hour of daily physical activity significantly increased from 23.5% (n=4) to 58.5% (n=10) (P=.03).

CONCLUSIONS: In addition to receiving standard clinical care, the use of a digital peer-supported app may significantly lower HbA1c levels in patients with T2DM by promoting healthy behaviors.

PMID:40393047 | DOI:10.2196/72659

PLoS One. 2025 May 20;20(5):e0320466. doi: 10.1371/journal.pone.0320466. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aimed to estimate the accuracy of the underlying Cause of Death (CoD) in the original death certificate, compared with a gold standard certificate based on information from clinical records and relatives, in population deceased in Colombia during 2021.

METHODS: A sample size of 806 deaths across 92 municipalities in Colombia were estimated from the pool of 326,833 original certificates provided by the National Department of Statistics. A two-stage stratified random sample with replacement was employed for selection. Information from medical records of the deceased and, when necessary, interviews with relatives or witnesses were used to determine CoDs on the gold standard certificate. We analyzed and compared the underlying CoD of the original and standard death certificates to estimate the level of accuracy. Measures of concordance, patterns of false positives and negatives, and a kappa value were utilized as metrics to evaluate the death certificates quality.

RESULTS: Information was obtained from 776, representing 96% of the desired sample. The concordance between original and gold standard certificates, categorized according to the ICD-10 chapters, was found in 74%. Higher levels of agreement were observed for “codes for special COVID-19 situations” (kappa = 0.84) and neoplasms (kappa = 0.84). Higher levels of agreement were observed for “codes for special COVID-19 situations” (kappa = 0.84) and neoplasms (kappa = 0.84). Overestimation was identified for “circulatory system diseases” (Chapter IX); “pregnancy, childbirth and puerperium” (Chapter XV); “signs, symptoms, and poorly defined conditions” (Chapter XVIII) and “diseases of the respiratory system” (Chapter X), while underestimation in “diseases of the genitourinary system” (Chapter XIV) among CoD. The most significant variations in the fraction of mortality due to specific CoDs corresponded to “codes for special situations COVID-19”.

CONCLUSIONS: The level of concordance between the original and gold standard death certificates was deemed adequate. However, improvements in the death certification process in Colombia are recommended, emphasizing the enhancement of training programs for health professionals.

PMID:40393038 | DOI:10.1371/journal.pone.0320466

PLoS One. 2025 May 20;20(5):e0324855. doi: 10.1371/journal.pone.0324855. eCollection 2025.

ABSTRACT

INTRODUCTION: Optimal nutrition during early childhood is essential for growth, cognitive development, and overall health. Animal source foods(ASF) provide essential nutrients like high-quality protein, iron, zinc, calcium, and vitamin B12, which are vital for the physical and cognitive development of young children and to reduce the burden of malnutrition. In Ethiopia malnutrition among children under five remains a significant public health issue. Many children are suffering from chronic and acute undernutrition. This study provides the first spatial analysis of animal source foods consumption among children aged 6-23 months.

OBJECTIVES: The aim of this study is to investigate the spatial distribution of ASF consumption and its associated factors among children aged 6-23 months in Ethiopia using data from the Ethiopia miniDHS 2019.

METHODOLOGY: A cross-sectional study design was used using mini-DHS 2019 data among children aged 6-23 months. Descriptive statistics were used to summarized the study population characteristics and ASF consumption prevalence. Spatial analysis techniques, including Geographical mapping and Moran’s I statistic assessed the spatial distribution of ASF consumption. Geographically weighted regression analyses identified socio-economic, demographic, and geographic factors associated with ASF consumption.

RESULTS: The study found that 47.7% of Ethiopian children aged 6-23 months consume ASF. Children in regions like Amhara, Tigray, Benishangul-Gumuz, western SNNPR, and Gambela are less likely to consume these foods. Factors linked to higher ASF consumption include mothers with more education, smaller families, households following the Orthodox religion, and wealthier families..

CONCLUSION AND RECOMMENDATIONS: According to this study finding animal source food consumption among Ethiopian children aged 6-23 months is relatively low. The finding revealed the significant regional disparities of ASF consumptions. Factors associated with ASF consumption include maternal education, household size, wealth, and religion. Efforts should focus on working to increase maternal education, providing and expansion of family planning services, and increasing affordability of ASF through economic improvement of households. In addition strengthening food supply chains and integrating ASF promotion into healthcare are also essential for improving child nutrition. Interventions in low-consumption areas should address specific local needs to effectively boost ASF consumption and improve child nutrition outcomes.

PMID:40393037 | DOI:10.1371/journal.pone.0324855

PLoS One. 2025 May 20;20(5):e0323176. doi: 10.1371/journal.pone.0323176. eCollection 2025.

ABSTRACT

BACKGROUND: The adequate interpretation of findings in systematic reviews can be affected by the lack of information on the language of the examined studies. The study sought to assess the reported information on restrictions set on the language of primary studies examined in systematic reviews published in dentistry. The study also investigated associations between the characteristics of the systematic reviews and language restrictions.

METHODS: A comprehensive search was conducted in the Web of Science database for systematic reviews in the field of dentistry. Abstracts published from the inception of the database up to 24 February 2023 were included and relevant information was extracted. Only abstracts published in English were included. Logistic regression analyses were performed to examine the association between the characteristics of the systematic reviews and the presence of language restrictions. Additionally, a random sample of 9.2% of the full texts was reviewed to identify differences in the reporting of language restrictions between the abstract and the full texts.

RESULTS: A total of 3922 abstracts were initially retrieved, and 3465 abstracts were included in the analysis based on the eligibility criteria. Approximately 79% (2739) did not report any language information. Only 7% (238) of the abstracts declared no language restrictions in the primary studies selected. Meta-analysis conducted, journal type, reporting of primary study design, actual number of words in abstracts and the country and continent of first authors affiliation were statistically significantly associated with language restrictions of the systematic reviews. However, the absence of information about language restriction appears to be a poor indicator of reporting or not language restriction in the full-text of the article.

CONCLUSIONS: Abstracts of systematic reviews in dentistry frequently underreport language restrictions applied to the primary studies examined. Various characteristics of systematic reviews are significantly associated with these restrictions, highlighting inconsistencies in reporting practices.

PMID:40393036 | DOI:10.1371/journal.pone.0323176

Int J Prosthodont. 2025 May 20;0(0):1-17. doi: 10.11607/ijp.9363. Online ahead of print.

ABSTRACT

PURPOSE: To compare the vertical microgap of complete arch implant supported frameworks (ISF) obtained from one intraoral scanner (IOS) and two different photogrammetry (PG) systems.

MATERIALS AND METHODS: An edentulous mandibular model with four implants (BioHorizons) served as reference. Multi-unit abutments (BioHorizons) were inserted and torqued to 30 Ncm. A digital reference cast (Control group) was obtained by scanning the model with a laboratory scanner (inEosX5, Dentsply Sirona). Three test groups were investigated: PS (Primescan, Dentsply Sirona), ICam (ICam4D, Imetric4D Imaging Sàrl), and PIC (PIC System, PIC Dental). All scans were exported as Standard-tessellation language (STL) files and virtual bars were designed and milled out of titanium (n=2 per test group). The modified Sheffield test was used to quantitatively assess vertical microgaps. Differences between all groups were analyzed using Kruskal-Wallis test (a=0.05). Analysis of variance (ANOVA) was used to compare vertical microgaps at each respective implant position across groups (a=0.05).

RESULTS: Mean vertical microgaps varied across acquisition devices, with lowest values in the control group (22.65±7.279 µm), followed by ICam (24.10±7.991 µm), PIC (30.52± 9.809 µm), and PS (33.21±13.84 µm). Statistically significant differences were detected between Control and PS as well as Control and ICam. No statistically significant difference occurred between the two PG groups. Vertical microgaps were the highest at implant site 44, predominantly observed in groups PS and PIC.

CONCLUSIONS: Frameworks fabricated from digital impressions of PG groups showed lower vertical microgaps than those fabricated using the IOS.

PMID:40393035 | DOI:10.11607/ijp.9363

PLoS One. 2025 May 20;20(5):e0320789. doi: 10.1371/journal.pone.0320789. eCollection 2025.

ABSTRACT

Alzheimer’s disease (AD) causes a progressive decline in memory, along with impairments in other cognitive abilities. The main pharmacological target for Alzheimer’s disease (AD) treatment is acetylcholinesterase (AChE), a biochemical enzyme belonging to the cholinesterase (ChE) family. In the search for novel hit compoundswith potential as future Alzheimer’s therapies, a series of carbamates derivatives were designed and evaluated using computational approaches including QSAR modeling, molecular docking, ADMET profiling, and molecular dynamics simulations. The following study focused on the development of a QSAR model with satisfactory statistical properties. ADMET analysis on the designed ligands, demonstrated good pharmacokinetic properties. Molecular docking identified M6 as a promising AChE binder with a docking score of -11.200 kcal/mol, while the Donepezil control returned a docking score of -10.800 kcal/mol. The validity of the docked complex was confirmed using molecular dynamics simulations, where the trajectory plots of M6 were found to be stable and consistent over 100 ns intervals. The enclosed study highlights M6 as a novel chemical starting point (CSP) (i.e., hit compound) targeting AChE as a potential therapeutic strategy against AD.

PMID:40393030 | DOI:10.1371/journal.pone.0320789

PLoS One. 2025 May 20;20(5):e0322644. doi: 10.1371/journal.pone.0322644. eCollection 2025.

ABSTRACT

Roadkill is a global issue contributing to biodiversity decline which is increasingly recognized by scientists and decision-makers. In Cyprus, a biodiversity hotspot with one of the highest road densities in Europe, the impact of roads on wildlife has been largely overlooked due to the absence of life-threatening collisions. We analysed data from a 10-year roadkill dataset (2013-2022) collected systematically by the Department of Public Works across 27 main roads, primarily aimed at driver safety. Due to the absence of spatial attributes for roadkill locations, the dataset was analysed to identify taxonomic, seasonal, and temporal roadkill trends in Cyprus for the first time. A total of 1,985 roadkill incidents were recorded, involving seven wildlife taxa: foxes (44%), birds (26%), hedgehogs (11.5%), snakes (7%), hares, rats, and lizards. Most roadkill occurred in the Nicosia district (65%). Statistical analyses using chi-square tests with post-hoc Bonferroni corrections revealed strong associations between road types and taxa. Fox and bird roadkill incidents were most common on highways, while hedgehogs and snakes were frequent on secondary interurban or rural roads. Roads near protected areas exhibited higher roadkill frequencies than highways. A positive relationship between traffic volume and roadkill risk was evident, with higher traffic roads posing greater risks. Seasonal patterns showed increased roadkill during spring and summer, peaking in June. This synthesis provides crucial insights into roadkill patterns, offering guidance for conservation and mitigation actions. However, the current monitoring system, focused on driver safety, is inadequate for comprehensive roadkill reporting. Key limitations, such as the absence of spatial data and weaknesses in the protocol, have been identified, with recommendations for improvement proposed to enhance future monitoring efforts.

PMID:40393015 | DOI:10.1371/journal.pone.0322644

Bol Med Hosp Infant Mex. 2025;82(2):121-128. doi: 10.24875/BMHIM.24000110.

ABSTRACT

BACKGROUND: Eosinophilic esophagitis (EoE) is an immuno-allergic disease characterized by esophageal dysfunction and eosinophilic infiltration of the esophagus. Its prevalence has increased, making it the leading cause of dysphagia and food impaction in children and adolescents. Understanding the approach taken by pediatric gastroenterologists in different regions is crucial.

METHOD: Multicenter and cross-sectional observational study, carried out through a virtual questionnaire during 2022, answered voluntarily and anonymously. Percentage descriptive statistics were performed.

RESULTS: 118 responses were obtained. Approximately 3% of physicians diagnose up to two cases of eosinophilic esophagitis per year. About 55.9% performed 3-4 biopsies in the upper and lower thirds of the esophagus for diagnosis. Initial treatments in patients without stenosis: proton pump inhibitors (PPI) 33.9%, triple therapy (TT) (PPI + diet + topical corticosteroids [TCSs]) 26.27%, and combined (diet + PPI) 21%. Patients with stenosis: TT 52.58%, combined (TCSs + PPI) 13.4%. Initial dietary treatment: according to allergy tests 26.2%, empirical exclusion of 6-8 foods 25.4%, and 2-4 foods 23.7%. The first endoscopic control is performed at 8 and 12 weeks in 46.6% and 38%, respectively. 52% referred to an allergist and 47.4% to nutrition. About 48.3% do not monitor basal cortisol in corticosteroid treatment for more than 3 months.

CONCLUSION: The diagnostic and therapeutic approach in EoE is heterogeneous. Dietary treatment shows the exclusion of a large number of foods and monitoring the prolonged use of corticosteroids is not a common practice.

PMID:40393006 | DOI:10.24875/BMHIM.24000110

Bol Med Hosp Infant Mex. 2025;82(2):129-137. doi: 10.24875/BMHIM.24000117.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) prevalence has increased in prevalence worldwide. T1DM is characterized by negative changes in glycemic control (e.g., increased risk of hypoglycemia) and moreover negatively impacts the quality of life and muscle function of the pediatric population with the disease.

METHOD: seven participants of the Hospital Dr. Exequiel González Cortés (age 11 [10-13] years, 4 male and 3 female) participated in a 12-week, twice-weekly concurrent training program plus continuous glucose monitoring (CGM). The participants underwent the following assessments: anthropometric measurements (weight, height, and BMI), glycemic control (Glycated hemoglobin [HbA1c], hypoglycemic events diaries, time in range, and glycemic diaries), muscle function (standing broad jump, prone plank, 10 maximum repetitions [10RM] squat, and chest press), quality of life (Kidscreen-27 questionnaire), and aerobic capacity (20 m shuttle run test). Statistical analysis used the Shapiro-Wilk test (normality), one-way Analysis of variance (differences between months), and paired t-test (pre-post differences).

RESULTS: The HbA1c increased (p = 0.047). Muscle function improved in standing broad jump (p = 0.03), prone plank (p = 0.01), 10RM squat (p = 0.03), and 10RM chest press (p = 0.01). Quality of life increased in physical function (p = 0.03) and total score (p = 0.01). The running distance in the 20 m shuttle run test increased (p = 0.01).

CONCLUSION: The concurrent training program plus CGM is effective in improving quality of life, muscle function, and running capacity in the pediatric population with T1DM.

PMID:40393004 | DOI:10.24875/BMHIM.24000117