Tag: statistics

Nurs Health Sci. 2025 Mar;27(1):e70069. doi: 10.1111/nhs.70069.

ABSTRACT

Given the challenging circumstances of aging with disability, family caregivers (FGs) face significant strain. Resilience, however, is a crucial protective factor against adverse caregiving outcomes. The study thus aimed to determine the latent classes of resilience among FGs and examine how these classes are related to care burden and psychological distress. This was a cross-sectional descriptive study that included 248 FGs in China. Latent class analysis was conducted to determine the classes of resilience exhibited by FGs. The study revealed four distinct classes of resilience: the high resilience class, high tenacity but moderate strength-optimism class, moderate resilience but low autonomy class, and low resilience class. FGs with secondary caregivers and those who were older were more likely to be part of the high resilience class. Furthermore, caregivers in the high resilience class had significantly lower burdens, less psychological distress, and greater resilience. Therefore, family caregivers’ resilience can be classified according to characteristics; more attention should be given to caregivers who are younger and lack the support of secondary caregivers; and targeted interventions should be developed based on resilience classification characteristics.

PMID:40064541 | DOI:10.1111/nhs.70069

Nurs Open. 2025 Mar;12(3):e70168. doi: 10.1002/nop2.70168.

ABSTRACT

AIM: To determine the relationships among nurses’ fatigue, nurses’ performance and patient safety culture.

DESIGN: Cross-sectional study.

METHODS: A multicentre study was conducted with 308 nurses working in 14 medical and surgical wards from four teaching hospitals in Iran. The sampling method was stratified with a proportional allocation. Data were collected via a demographic form, the Occupational Fatigue/Exhaustion Recovery (OFER-15), the Nurse Performance Instrument (NPI) and the Hospital Survey on Patient Safety Culture (HSOPSC). The data were analysed via structural equation modelling (SEM).

RESULTS: Nurse fatigue was significantly inversely related to performance and patient safety culture (p < 0.001). Path analysis revealed that each unit of reducing nurses’ fatigue improved patients’ safety culture by 0.286 units and that each unit of improved nurse performance improved patients’ safety culture by 0.360 units. Additionally, each one-unit increase in a nurse’s fatigue could decrease his or her performance by 0.860 units. SEM analysis confirmed the mediating effect of nurses’ performance on the relationship between their level of fatigue and patient safety culture.

PRACTICE IMPLICATIONS: The proposed model can assist nursing managers and healthcare policymakers in developing practical strategies to mitigate and reduce nurses’ fatigue and, consequently, improve nurses’ performance and patient safety.

PATIENT OR PUBLIC CONTRIBUTION: All participants contributed to this research by completing self-reported scales.

PMID:40064530 | DOI:10.1002/nop2.70168

Eur J Heart Fail. 2025 Mar 10. doi: 10.1002/ejhf.3637. Online ahead of print.

ABSTRACT

AIMS: Clonal haematopoiesis (CH) is recognized as a significant risk factor for various non-haematologic conditions, including cardiovascular diseases. However, recent studies examining its relationship with heart failure (HF) have reported conflicting findings. To address these inconsistencies, the present meta-analysis aimed to evaluate the association of CH with the incidence and clinical outcomes of HF.

METHODS AND RESULTS: MEDLINE, Cochrane Library and Scopus were searched until 12 December 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using three-level mixed-effects meta-analyses. Participants (n = 57 755) with CH had significantly greater risk of new-onset HF compared to the non-CH group (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.35, p < 0.0001; I² = 0%), irrespective of a prior history of coronary artery disease. CH was also correlated with a higher risk of the composite outcome of all-cause mortality and hospitalization for HF (HHF) compared to the non-CH group in patients with established HF (HR 1.84, 95% CI 1.25-2.70, p = 0.002; I² = 0%). Specifically, CH was associated with a 95% higher risk of all-cause mortality (HR 1.95, 95% CI 1.54-2.47, p < 0.0001; I² = 0%), with a 3% increase in risk for every 1% increase in variant allele fraction. Participants with concomitant HF and CH had a 56% higher risk of HHF compared to non-CH HF patients (HR 1.56, 95% CI 1.05-2.33, p = 0.029; I² = 19%).

CONCLUSION: Clonal haematopoiesis is associated with an increased risk of incident HF and worse prognosis in individuals affected by HF. These findings highlight the potential of CH to contribute to a deeper understanding of HF, improve risk stratification, and support more personalized approaches to its management.

PMID:40064512 | DOI:10.1002/ejhf.3637

CMAJ. 2025 Mar 10;197(9):E236-E243. doi: 10.1503/cmaj.241282.

ABSTRACT

BACKGROUND: Whether people experiencing homelessness (PEH) have different COVID-19 outcomes than housed patients in Canada remains unclear. We sought to ascertain whether rates of in-hospital mortality, hospital admission, critical care admission, and mechanical ventilation differed between PEH and housed people with symptomatic SARS-CoV-2 infection.

METHODS: We conducted a propensity score-matched cohort study to compare the outcomes of PEH and housed patients presenting to emergency departments for acute symptomatic COVID-19. We used data from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. Covariates in our propensity score model included age, sex, comorbidities, substance use, vaccination status, previous do-not-resuscitate documentation, hospital type, province and calendar quarter of presentation to the emergency department, symptom duration, and severity of illness on presentation.

RESULTS: We found no difference in mortality for PEH (3%) compared with a propensity score-matched cohort of housed patients (3%) (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.43-1.74). We also found no difference in admission rates for PEH (44%) versus housed patients (45%). There was a reduced rate of critical care admission for PEH compared with housed patients (OR 0.66, 95% CI 0.44-1.00), and a trend toward decreased use of mechanical ventilation for PEH versus housed patients, which was not significant (OR 0.60, 95% CI 0.35-1.02).

INTERPRETATION: We found no difference in mortality for PEH with COVID-19 compared with those who were housed. A signal for reduced critical care admission among PEH may reflect differential treatment unrelated to clinical characteristics that we matched for. Future research on resource allocation during pandemics could shed light on potential inequities for vulnerable populations and how best to address them.

PMID:40064502 | DOI:10.1503/cmaj.241282

J Invertebr Pathol. 2025 Mar 8:108299. doi: 10.1016/j.jip.2025.108299. Online ahead of print.

ABSTRACT

This study aimed to determine 1) the effects of fungal filtrates containing secondary metabolites from five different isolates of four different Trichoderma species (Trichoderma afroharzianum, T. guizhouense, T. harzianum, and T. virens) grown in different liquid media [malt extract broth (MEB), potato dextrose broth (PDB), yeast peptone glucose (YPG), minimal medium (MM), czapek-dox broth (CDB)] on Tetranychus urticae female, and 2) the effects of Trichoderma filtrates obtained from YPG liquid media on the different biological stages of T. urticae in Petri dish and pot experiments. Results showed that the Trichoderma filtrates produced in the YPG medium exhibited the highest mortality rate of 67.6-83.1 % against T. urticae females at 7 days post-application (dpa) compared to other media. In Petri dish experiments, the mortality rates of Trichoderma filtrates on egg, larva, protonymph and deutonymph stages of T. urticae at 7 dpa were 54.0-57.8 %, 71.5-76.0 %, 72.5-79.8 % and 72.8-80.8 %, respectively. Significant differences were observed between the Trichoderma species and control (P < 0.01) but not among the Trichoderma species (P > 0.05). Trichoderma afroharzianum (83 %) and T. virens (84 %) showed the highest mortality rate on T. urticae adult females at 7 dpa and statistically significant differences were observed among Trichoderma species. Pot experiments revealed that the number of viable T. urticae eggs and mobile stages was significantly lower for T. afroharzianum (110.3 eggs, 105.8 mobile stages) and T. virens (118.5 eggs, 115.3 mobile stages) compared to the control (518.9 eggs, 452.5 mobile stages) at 7 dpa. Significant differences were observed between Trichoderma species and control, but not between T. afroharzianum and T. virens. These findings suggest that Trichoderma secondary metabolites are highly effective against economically important pest such as T. urticae, demonstrating their potential as bio-acaricides. Future research should focus on identifying the specific acaricidal compound(s) within these filtrates.

PMID:40064463 | DOI:10.1016/j.jip.2025.108299

Clin Chim Acta. 2025 Mar 8:120240. doi: 10.1016/j.cca.2025.120240. Online ahead of print.

ABSTRACT

This document describes the guidance on implementing and monitoring an IQC strategy that fulfills the requirements of the Standard ISO 15189:2022. It also explores the practical application of these principles in daily IQC processes within medical laboratories. The goal is to provide a practical, user-friendly resource that not only explains the Standard’s requirements but also equips laboratory professionals with the tools and knowledge needed to enhance diagnostic reliability. To support laboratory professionals in this task, this document follows the structure and content of the ISO 15189:2022 Standard and provides a risk-based approach in consideration of the practical needs for quantitative results. Specific aspects such as the selection and assessment of IQC materials, the definition of control frequency, the definition of acceptable limits, the application of statistical rules, results from different sources comparability and strategies for handling non-conformities, quality indicators and determination of uncertainty of measurement are discussed in depth. Where relevant, excerpts from the ISO 15189:2022 Standard are included, with clarifications and actionable recommendations to facilitate implementation. This document focuses on the crucial role of IQC in the accreditation process, particularly in the identification of risks, their mitigation through corrective actions and the implementation of improvements to prevent errors and control potential risks in the medical laboratory, ensuring patient safety in daily practice.

PMID:40064457 | DOI:10.1016/j.cca.2025.120240

Prev Med. 2025 Mar 8:108259. doi: 10.1016/j.ypmed.2025.108259. Online ahead of print.

ABSTRACT

OBJECTIVE: Rapidly phenotyping patients can inform public health action plans in new pandemics. This study aimed to derive meaningful SARS-CoV-2 reinfected patients’ phenotypes based on easily-available patient data and explore key epidemiological factors of reinfections.

METHODS: We conducted a retrospective study of a cohort of SARS-CoV-2 reinfected adults from the Basque Country between January 1, 2021 and January 9, 2022. Phenotypes were defined in an unsupervised manner with clustering algorithms, incorporating variables like age, Charlson score, vaccination status and pre-existing treatments and comorbidities. Subsequently, clinical characteristics of phenotypes were compared, and their behavioral differences were evaluated through generalized additive models. Finally, their association with clinical outcomes was assessed.

RESULTS: Four phenotypes were identified, which subsequently had a direct relationship with the risk levels for severe COVID-19 outcomes. The highest-risk group, phenotype 4, consisted of older adults -76 years, [62-85] (Median, [Interquartile range])- with multiple comorbidities and extensive baseline medication use. Phenotype 3 was slightly younger -64 years, [58-77]- but presented very low Charlson scores and few comorbidities, representing an intermediate-risk group. Phenotypes 1 and 2 were younger and healthier adults with similar clinical profiles. However, phenotype 1 showed a less protective attitude, with a higher rate of unvaccinated patients and shorter time intervals between infections.

CONCLUSIONS: We were able to classify reinfected patients into four distinct groups based on easily available variables, and these phenotypes had a direct relationship with COVID-19 clinical outcomes. Thus, rapidly phenotyping infected individuals can serve as a preventive public health strategy during new pandemics.

PMID:40064450 | DOI:10.1016/j.ypmed.2025.108259

J Steroid Biochem Mol Biol. 2025 Mar 8:106720. doi: 10.1016/j.jsbmb.2025.106720. Online ahead of print.

ABSTRACT

Vitamin D deficiency (VDD) is prevalent globally and in pediatric intensive care units, where it represents a modifiable risk factor that may impact patient recovery during hospitalization. Herein, we performed a retrospective analysis of serum samples from a phase-II randomized placebo-controlled trial involving a single large bolus of 10,000 IU/kg vitamin D3 ingested by critically ill children with VDD (25-OH-D < 50 nmol/L). Targeted and untargeted methods were used to comprehensively measure 6 vitamin D metabolites, 239 lipids, 68 polar metabolites, and 4 electrolytes using a multi-step data workflow for compound authentication. Complementary statistical methods classified circulating metabolites/lipids associated with vitamin D repletion following high-dose vitamin D3 intake (n=20) versus placebo (n=11) comprising a standard of care maintenance dose (< 1000 IU/day). There was a striking increase in median serum concentrations of 25-OH-D3 (4.7-fold), 3-epi-25-OH-D3 (24-fold) and their C3-epimer ratio (6.7-fold) in treated patients on day 3, whereas serum vitamin D3 peaked on day 1 (128-fold) unlike placebo. Treatment response differences were attributed to D3 bioavailability and C3-epimerase activity without evidence of hypercalcemia. For the first time, we report the detection of circulating 3-epi-D3 that was strongly correlated with vitamin D3 uptake (r = 0.898). Metabolomic studies revealed that vitamin D sufficiency (serum 25-OH-D >75 nmol/L) coincided with lower circulating levels of 3-methylhistidine, cystine, S-methylcysteine, uric acid, and two lysophosphatidylcholines 7 days after treatment. Rapid correction of VDD was associated with indicators of lower oxidative stress, inflammation, and muscle protein turn-over that may contribute clinical benefits in high-risk critically ill children.

PMID:40064426 | DOI:10.1016/j.jsbmb.2025.106720

J Nutr. 2025 Mar 8:S0022-3166(25)00154-3. doi: 10.1016/j.tjnut.2025.03.004. Online ahead of print.

ABSTRACT

INTRODUCTION: In Canada, those who are or who could become pregnant are recommended to consume a daily multivitamin containing 400 μg of folic acid to help prevent neural tube defects.

OBJECTIVES: To report the prevalence and determinants of folic acid-containing supplement use among females of childbearing age in Canada.

METHODS: Data were combined from cycles 2015/16 and 2017/18 of the maternal experiences module of the cross-sectional Canadian Community Health Survey, which was completed by females aged 15-55 years. Representative weighted estimates (means/percentages, 95% CI) were generated for folic acid-containing supplement use among all pregnant, non-pregnant, and lactating respondents. For those who had given birth in the preceding 5 years, estimates were also generated for supplement use in the 3 months before and first 3 months of their most recent pregnancy, and pre-pregnancy awareness of the link between folic acid and some birth defects. We examined associations with sociodemographic factors using multivariable logistic regression.

RESULTS: Overall, 16.5% (15.9-17.0%) of non-pregnant, 80.3% (77.1-83.5%) of pregnant, and 58.4% (54.8-61.9%) of lactating females aged 15-55 reported using a folic acid-containing supplement. Among those who had given birth in the preceding 5 years, 63.7% (62.2-65.1%) consumed a folic acid-containing supplement in the 3 months prior to pregnancy, while 89.9% (88.8-90.9%) did so during the first trimester. Lower prevalence of supplement use before or during pregnancy was reported among the 23.7% (22.4-25.1%) of respondents unaware of the relationship between folic acid and birth defects. Younger age, single marital status, lower educational attainment, income below the median, and smoking were associated with lower odds of awareness or supplement use.

CONCLUSION: While most females living in Canada reported using folic acid-containing supplements prior to and during pregnancy, use of these supplements among non-pregnant females of childbearing age is low, and sociodemographic inequalities exist.

CLINICAL TRIAL REGISTRY NUMBER: not applicable REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OF META-ANALYSIS: not applicable.

PMID:40064422 | DOI:10.1016/j.tjnut.2025.03.004

Pediatr Infect Dis J. 2025 Apr 1;44(4):333-341. doi: 10.1097/INF.0000000000004623. Epub 2024 Nov 8.

ABSTRACT

BACKGROUND: Knowledge regarding the impact of respiratory pathogen co-infection in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children seeking emergency department care is limited, specifically as it relates to the association between SARS-CoV-2 viral co-infection and disease severity and factors associated with co-infection.

METHODS: This secondary analysis included data from 2 prospective cohort studies conducted between March 2020 and February 2022 that included children <18 years of age tested for SARS-CoV-2 infection along with additional respiratory viruses in a participating emergency department. Outcomes included the detection rate of other respiratory viruses and the occurrence of severe outcomes (ie, intensive interventions, severe organ impairment and death).

RESULTS: We included 2520 participants, of whom 388 (15.4%) were SARS-CoV-2-positive. Detection of additional respiratory viruses occurred in 18.3% (71/388) of SARS-CoV-2-positive children, with rhinovirus/enterovirus being most frequently detected (42/388; 10.8%). In multivariable analyses (adjusted odds ratio and 95% confidence interval), among SARS-CoV-2-positive children, detection of another respiratory virus was not associated with severe outcomes [1.74 (0.80-3.79)], but detection of rhinovirus/enterovirus [vs. isolated SARS-CoV-2 detection 3.56 (1.49-8.51)] and having any preexisting chronic medical condition [2.15 (1.06-4.36)] were associated with severe outcomes. Among SARS-CoV-2-positive children, characteristics independently associated with an increased odds of any other viral co-infection included: age and delta variant infection.

CONCLUSIONS: Approximately 1 in 5 children infected with SARS-CoV-2 had co-infection with another respiratory virus, and co-infection with rhinovirus/enterovirus was associated with severe outcomes. When public health restrictions were relaxed, co-infections increased.

PMID:40063967 | DOI:10.1097/INF.0000000000004623