Tag: statistics

BMC Med. 2025 May 6;23(1):262. doi: 10.1186/s12916-025-04090-2.

ABSTRACT

BACKGROUND: People living with dementia (PlwD) have a 1.4 times higher risk of hospitalization than people living without dementia. Hospital admissions lead to negative consequences for PlwD and people living with mild cognitive impairment (PlwMCI). Housing models such as shared-housing arrangements (SHAs), which are predominantly used by PlwD, enable care-dependent people to experience daily life as ordinary as possible. However, studies are needed to show how complex non-pharmacological interventions affect hospital admissions, especially in the SHAs setting.

METHODS: The longitudinal, multicenter, cluster-randomized, controlled, and prospective mixed methods study from April 1, 2019, to December 31, 2022, was part of the German DemWG study and included a waitlist control group design. The multicomponent complex intervention consisted of (a) education of nursing staff in the SHAs-at the beginning of the study, (b) digital education of general practitioners-at the beginning of the study, and (c) the multimodal, psychosocial group intervention MAKS-mk + -structured application of MAKS-mk + between t0 (baseline) and t1 (after 6 months). Longitudinal data were collected at three survey times t0-t2 (t2 at another 6 months follow-up). The primary outcome parameter-hospital admission-was assessed using the nursing documentation. Poisson-models with hierarchical random effects were used for statistical analysis.

RESULTS: Nationwide, 97 SHAs with 341 residents participated at t0. Within the longitudinal observation period (12 months, t0-t2), data from 236 participants at t1 and 168 participants at t2 with mild cognitive impairment or mild to moderate dementia were evaluated. In the intention-to-treat sample, the adjusted Poisson-model showed that participants in the intervention group (IG, n = 201) had a significantly lower number of hospital admissions at t1 than participants in the control group (CG, n = 140) (p-value = 0.048; CI = 0.22; 0.99). Beyond t1-“open phase” of the study, no further statistically significant long-term effects of the IG could be identified (p-value ≤ 0.498; CI = 0.25; 1.98).

CONCLUSIONS: The complex intervention significantly reduced the number of hospital admissions for PlwD and PlwMCI in the “structured phase” of DemWG. This leads to significant improvements in the nursing care and living situation for PlwD and PlwMCI. Since the intervention has been proven to have positive effects and can be easily integrated into SHAs, regular and nationwide integration into everyday care should be given greater consideration.

TRIAL REGISTRATION: ISRCTN89825211 (Registered prospectively, 16 July 2019).

PMID:40325380 | DOI:10.1186/s12916-025-04090-2

BMC Health Serv Res. 2025 May 5;25(1):643. doi: 10.1186/s12913-025-12816-4.

ABSTRACT

BACKGROUND: In the Netherlands, the annual expenditure on HIV care was reported as €202 million in 2019, with about 70% allocated to antiretroviral therapy (ART). The introduction of generic antiretroviral medications (ARVs) in 2017 has offered potential cost-saving opportunities in healthcare. Understanding the financial implications of incorporating generic ART into the Dutch healthcare system is crucial to determine its impact.

METHODS: We used data from the Foundation for Pharmaceutical Statistics (SFK), covering 98% of all community and outpatient clinic pharmacies across the Netherlands. This dataset contained medication information from 2016 to 2022. Medication data were classified using the Anatomical Therapeutic Chemical Classification with Defined Daily Dose (ATC/DDD) system. Cost analysis was based on Dutch drug prices ( www.medicijnkosten.nl ) for a specified period, and the data were processed using IBM SPSS.

RESULTS: In the Netherlands, people with HIV receiving ART increased from 20,072 to 24,573 between 2016 and 2022. HIV medication expenditure was €190 million euros in 2016, with generic medication at 6% DDDs. After an increase in 2017, a subsequent decrease in total HIV medication expenditure led to an overall cost of €181 million in 2022 (-5.1% compared to 2016). Simultaneously, the proportion of DDDs dispensed as a generic increased to 16-32% over the years. This could be linked to 97% compliance with generic substitutions for ARVs where a generic equivalent was available. Notably, the cost per patient per year has declined from €9,488 in 2016 to €7,352 in 2022 (-22.5% compared to 2016). Some of the potential cost-savings through generic substitution were not utilized because of the 20% point increase in the use of novel branded single-tablet regimens (STRs).

CONCLUSIONS: Our analysis showed high compliance with generic substitution of ARVs in the Netherlands. The increased use of generic ARVs was accompanied by an almost 10% reduction in overall expenditure on ART despite a significant increase in the number of patients in care in the Netherlands during this period. A significant contributing factor to ART costs appears to be the high percentage of prescribed patented Single-Tablet Regimens (STRs). These findings underscore the complex dynamics of pharmaceutical expenditures in the Dutch healthcare system.

PMID:40325377 | DOI:10.1186/s12913-025-12816-4

Gen Hosp Psychiatry. 2025 Apr 30;95:80-92. doi: 10.1016/j.genhosppsych.2025.04.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Multimorbidity, the co-occurrence of multiple health conditions, is increasingly recognised as a significant public health concern. While the association between multimorbidity and suicidal thoughts is well-documented, its relationship with suicidal behaviour remains underexplored. This study aims to quantify the association between multimorbidity and both suicide attempts and suicide mortality.

METHODS: We searched Medline, PsycINFO, and Scopus databases for studies published from January 1990 up to July 2024. We applied prespecified eligibility criteria to select studies for inclusion. To assess the risk of bias, we used the Mixed Methods Appraisal Tool. We conducted meta-analyses using random-effects models and assessed heterogeneity with Cochran’s Q and I² statistics. We evaluated publication bias using funnel plots and Egger’s test. Sub-group analysis was conducted incorporating potential moderator variables.

RESULTS: Out of 2202 identified records, 38 studies were included in the analysis. Participants with multimorbidity were over five times more likely to attempt suicide compared to those without multimorbidity (pooled odds ratio [OR] = 5.31; 95 % confidence interval [CI] = 3.98, 7.09; I² = 94.9 %). Multimorbidity was associated with an 83 % increased likelihood of suicide mortality (pooled OR = 1.83; 95 % CI = 1.21, 2.77; I² = 99.9 %). Mental multimorbidity was associated with the highest odds of suicide attempts (OR = 6.96; 95 % CI = 4.94, 9.81; I² = 81.8 %), with higher odds also observed in studies with single disease comparator (OR = 6.16; 95 % CI = 3.68, 10.31; I² = 95.5 %), and across both high income and low-middle income regions. For suicide mortality, significant associations were found in studies assessing physical-mental multimorbidity (OR = 2.32; 95 % CI = 1.14, 4.71; I² = 99.8 %), studies from Europe/USA and Asia, and those using a mixed comparator group, with additional significant effects noted by study design, publication year, covariate adjustment, and risk of bias.

CONCLUSIONS: Multimorbidity significantly increases the risk of both suicide attempts and suicide mortality. We recommend enhanced suicide risk assessment among patients with multiple chronic conditions, especially when mental health diagnoses are present.

PMID:40324313 | DOI:10.1016/j.genhosppsych.2025.04.008

Comput Biol Med. 2025 May 4;192(Pt A):110230. doi: 10.1016/j.compbiomed.2025.110230. Online ahead of print.

ABSTRACT

A cardiac digital twin is a virtual replica of a patient-specific heart, mimicking its anatomy and physiology. A crucial step of building a cardiac digital twin is anatomical twinning, where the computational mesh of the digital twin is tailored to the patient-specific cardiac anatomy. In a number of studies, the effect of anatomical variation on clinically relevant functional measurements like electrocardiograms (ECGs) is investigated, using computational simulations. While such a simulation environment provides researchers with a carefully controlled ground truth, the impact of anatomical differences on functional measurements in real-world patients remains understudied. In this study, we develop a biventricular statistical shape model and use it to quantify the effect of biventricular anatomy on ECG-derived and demographic features, providing novel insights for the development of digital twins of cardiac electrophysiology. To this end, a dataset comprising high-resolution cardiac CT scans from 271 healthy individuals, including athletes, is utilized. Furthermore, a novel, universal, ventricular coordinate-based method is developed to establish lightweight shape correspondence. The performance of the shape model is rigorously established, focusing on its dimensionality reduction capabilities and the training data requirements. The most important variability in healthy ventricles captured by the model is their size, followed by their elongation. These anatomical factors are found to significantly correlate with ECG-derived and demographic features. Additionally, a comprehensive synthetic cohort is made available, featuring ready-to-use biventricular meshes with fiber structures and anatomical region annotations. These meshes are well-suited for electrophysiological simulations.

PMID:40324309 | DOI:10.1016/j.compbiomed.2025.110230

J Environ Radioact. 2025 May 4;287:107712. doi: 10.1016/j.jenvrad.2025.107712. Online ahead of print.

ABSTRACT

Radon is a by-product of decayed uranium and thorium isotopes, which are naturally occurring radionuclide with extremely long half-lives. It is rated as the second cause of lung cancer after tobacco cigarette smoking. This study assesses knowledge and awareness of health risks associated with radon among undergraduate students at Mkwawa University College of Education (MUCE) by using questionnaires. A structured questionnaire with 36 items was administered to 403 respondents at MUCE. Information was collected on the demographic variables of the respondents as well as knowledge and awareness of health risks associated with radon among undergraduates at MUCE. Data were analysed by using descriptive statistics. Respondents included 204 (50.6 %) females and 199 (49.4 %) males. Findings revealed that 257 (63.8 %) of the respondents had no knowledge of radon gas and had not even heard about it before this study, while only 146 (36.2 %) of the respondents had heard about radon gas. Moreover, 285 (70.7 %) of the respondents were not aware that radon gas can cause health effect, and only 118 (29.3 %) of the respondents were aware about health effect of radon gas. Likewise, only 145 (36 %) of the respondents were aware about the risks of radon gas, while 258 (64 %) of the respondents were not aware about the risk of radon as the second cause of lung cancer after tobacco smoking. This study suggests the need to increase public education and awareness campaigns on radon and its associated risks.

PMID:40324307 | DOI:10.1016/j.jenvrad.2025.107712

Medicine (Baltimore). 2025 May 2;104(18):e42300. doi: 10.1097/MD.0000000000042300.

ABSTRACT

The epidemic of HIV/AIDS, also known as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), continues to be a major global public health concern with significant economic ramifications. East Africa is one of the severely hit regions. The East African economy suffers hugely due to the cost emanating from management of HIV infection. This review offers a thorough analysis of the financial burden of HIV/AIDS treatment, including direct medical costs, infrastructure costs for healthcare, social and indirect costs, and long-term sustainability difficulties. By examining epidemiological statistics, trends in healthcare spending, and socioeconomic factors, we clarify the complex financial environment surrounding HIV/AIDS. The paper also looks at ways to deal with these issues, highlighting the value of cooperation between governments, medical professionals, civil society organizations, and the global community. A thorough literature search that involved a wide range of credible sources, including academic databases (like PubMed, Google scholar, Science Direct, JSTOR), research repositories, government reports, and publications from nongovernmental organizations. It is possible to lessen the economic cost of HIV/AIDS and enhance results for impacted people and communities by making investments in prevention, treatment, and support services while addressing underlying structural concerns.

PMID:40324279 | DOI:10.1097/MD.0000000000042300

Medicine (Baltimore). 2025 May 2;104(18):e42261. doi: 10.1097/MD.0000000000042261.

ABSTRACT

Patients with metastatic malignant melanoma have a survival rate of less than one year. Nivolumab, a monoclonal antibody against programmed cell death 1 (PD-1) receptor, has improved survival in patients without BRAF mutations. The HALP score, calculated from hemoglobin, albumin, lymphocyte, and platelet levels, provides information about a patient immune and nutritional status. High HALP scores have been associated with a better prognosis in various cancers. This study aimed to investigate the effect of high HALP scores on response to nivolumab treatment in patients with metastatic malignant melanoma. A retrospective study was conducted on 44 patients with metastatic malignant melanoma treated with nivolumab at Adana City Training and Research Hospital between 2014 and 2021. Patients who received dabrafenib-trametinib before nivolumab treatment were excluded. The HALP scores were calculated using laboratory parameters before the first nivolumab treatment. Statistical analyses were performed using SPSS version 25.0. The study included 22 female and 22 male patients with a mean age of 61.4 ± 15.6 years. Of the patients, 10 (27.2%) had a positive BRAF mutation, whereas 34 (77.3%) did not. The HALP score cutoff value was determined as 30.1. Patients with high HALP scores had significantly longer progression-free survival (PFS) and overall survival (OS) compared to those with low HALP scores (PFS: median 5.8 vs 3.1 months, P = .041; OS: median 54.9 vs 14.4 months, P = .005). In this study, we found that high HALP scores were significantly associated with longer PFS and OS in metastatic malignant melanoma patients receiving nivolumab treatment. HALP score was associated with both PFS and OS in patients with metastatic malignant melanoma treated with nivolumab. This immuno-nutritional parameter may be useful in various cancers; however, further prospective studies with larger patient cohorts are needed for clinical application.

PMID:40324274 | DOI:10.1097/MD.0000000000042261

Medicine (Baltimore). 2025 May 2;104(18):e42292. doi: 10.1097/MD.0000000000042292.

ABSTRACT

BACKGROUND: Early enteral nutrition (EEN) is the preferred nutritional strategy for critically ill patients in the intensive care unit (ICU). However, its implementation is often accompanied by various complications that can hinder the achievement of nutritional goals, thereby adversely impacting patient outcomes. To address these challenges, this study proposes an EEN protocol grounded in the principles of Enhanced Recovery After Surgery (ERAS), aiming to optimize nutritional support while minimizing enteral nutrition-related complications.

METHODS: A randomized controlled trial was conducted to develop an ERAS-based EEN protocol for intensive care patients. Using a quasi-experimental design and convenience sampling, 100 patients were randomized to either a control group receiving standard nutritional support or an intervention group receiving the ERAS-based protocol. Within 7 days of the intervention, outcomes – including calorie and protein intake, hemoglobin and albumin levels, gastrointestinal tolerance and ICU length of stay – were assessed and compared between groups.

RESULTS: After the intervention, the intervention group demonstrated significantly higher calorie intake [(1042.00 ± 232.58) kJ/d] and protein intake [(103.96 ± 13.52) g/d] than the control group [(876.30 ± 190.46) kJ/d and (97.00 ± 11.17) g/d] (P<.05). Initially, hemoglobin and albumin levels did not differ significantly between the 2 groups (P > .05). Post-intervention, the intervention group had higher hemoglobin [(117.16 ± 6.69) g/L] and albumin [(45.58 ± 3.23) g/L] levels compared to the control group [(106.98 ± 6.56) g/L and (41.78 ± 3.70) g/L] (P < .05). The intervention group had lower incidence rates of gastric retention (20.0%), diarrhea (12.0%), abdominal distension (14.0%), and gastrointestinal bleeding (6.0%) than the control group (38.0%, 22.0%, 32.0%, 12.0%). Gastric retention and abdominal distension incidence differences were statistically significant (P < .05). The intervention group’s ICU length of stay [(9.16 ± 3.48) d] was shorter than the control group’s [(11.86 ± 4.09) d] (P < .05).

CONCLUSION: The ERAS-based EEN protocol for ICU patients effectively improves nutritional status, improves gastrointestinal tolerance, reduces ICU length of stay, and contributes to better clinical outcomes in critically ill patients. These results provide a valuable reference for the implementation of EEN by ICU nurses.

PMID:40324272 | DOI:10.1097/MD.0000000000042292

Medicine (Baltimore). 2025 May 2;104(18):e42274. doi: 10.1097/MD.0000000000042274.

ABSTRACT

This study investigates the impact of complications associated with chronic obstructive pulmonary disease (COPD) on pulmonary function and inpatient medical expenditures in the Zhongshan region. A retrospective analysis of data from January 2012 to December 2021 was conducted, focusing on lung function and hospitalization expenses for COPD patients (n = 272). The included cases were initially categorized into a simple group (without comorbidities, n = 99) and a nonsimple group (with comorbidities, n = 173). Changes in lung function within each subgroup over a decade were evaluated, along with the average annual hospitalization rate, average duration of hospital stay, and mean hospitalization cost for COPD patients. A comparison between the simple group and the nonsimple group of COPD patient’s uncovered statistically significant distinctions (P < .05) in age, extent of lung function alteration, average annual hospitalization frequency, and average hospitalization cost. Moreover, multivariable logistic regression analysis showed that, after adjusted for age, sex, smoking, and hospitalizations, patients with comorbidities (nonsimple group) were independently associated with lung function changes (β = 4.048, 95% CI: 1.435-6.659, P = .003) compared to those without comorbidities (simple group). Comorbidities have a substantial impact on the lung function of COPD patients. Furthermore, they are associated with increased hospitalization frequency, elevated hospitalization costs, and a higher economic burden of hospitalization for COPD patients.

PMID:40324270 | DOI:10.1097/MD.0000000000042274

Medicine (Baltimore). 2025 May 2;104(18):e41939. doi: 10.1097/MD.0000000000041939.

ABSTRACT

BACKGROUND: Osteoporosis (OP) is the second most detrimental chronic disease, and thus novel diagnostic and therapeutic approaches are needed. In recent years, there has been an increased emphasis on the utilization of gut microbiota (GM) in the context of OP. However, a comprehensive bibliometric analysis on this subject is currently lacking. Furthermore, a deeper exploration of the role of GM in bone health is imperative, and there is a pressing need to foster international and inter-agency exchange and experience in this field. Accordingly, this study aimed to provide an overview of the research trends in this field and propose suggestions for related scientific and technological research and development.

METHODS: The Web of Science database was searched for articles related to both GM and OP. Statistical analyses and data visualization were performed using the EXCEL and CiteSpace software.

RESULTS: China exhibited the highest number of publications, followed by the United States. NUTRIENTS and Sichuan University were identified as the journal and institution, respectively, with the highest number of articles. Notably, the keywords “gut microbiota” and “bone loss” have been increasingly used in publications.

CONCLUSION: In conclusion, this study fills the existing gap in the literature and contributes valuable insights to the understanding of the relationship between GM and OP.

PMID:40324264 | DOI:10.1097/MD.0000000000041939