Tag: statistics

J Nepal Health Res Counc. 2025 Oct 17;23(2):369-376. doi: 10.33314/jnhrc.v23i02.4703.

ABSTRACT

BACKGROUND: Hospitals play a crucial role in disaster response, but they often face resource challenges. Hospital disaster preparedness, involving plans and procedures, is vital to ensure they can handle emergencies effectively. Nepal has identified 25 Hub Hospitals to coordinate disaster response, highlighting the importance of organized disaster management planning in saving lives. This study assesses disaster preparedness in these designated hospitals.

METHODS: This observational study conducted in December 2023 is a secondary analysis of data from a workshop held in 25 designated hub hospitals in Nepal. The workshop aimed to develop disaster preparedness plans. The study evaluates physical facilities, triage, planning, and available resources in these hospitals, categorizing variables related to beds, human resources, disaster plans, and more. Ethical approval was obtained.

RESULTS: Average hospital bed occupancy in ward was 80% and that of emergency was 92%. The average bed per province was 1272, nurses were 833, doctors were 521, paramedics were 181. Disaster plan was available in 21(84%) of the hospital. Out of 21 hospitals that had disaster plan, surge capacity activation plan was included in 18(86%), infectious disease outbreak plan in 14(67%) and fire safety plan in 7(33%) of the disaster plan. Blood bank was available in 16(64%) of the hospitals. One stop crisis management Centre was available in in 24(96%) hub hospitals, birthing and facility for caesarean section was available in all hospitals.

CONCLUSIONS: The study findings reveal varying levels of hospital preparedness in Nepal, including bed occupancy, staff, disaster plans, structural assessments, and available services.

PMID:41319068 | DOI:10.33314/jnhrc.v23i02.4703

J Nepal Health Res Counc. 2025 Oct 17;23(2):385-396. doi: 10.33314/jnhrc.v23i02.4692.

ABSTRACT

BACKGROUND: Neonatal mortality refers to the risk of death within the first month of life. This study investigates the key factors influencing neonatal mortality in Nepal between 2011 and 2016, focusing on changes over this period.

METHODS: Data for this research were sourced from the Nepal Demographic and Health Survey (NDHS) for the years 2011 and 2016. Neonatal mortality was the primary outcome variable. Key determinants examined included community-level factors (residence), socio-economic factors (maternal and paternal education, wealth index), maternal characteristics (age, pregnancy duration, antenatal care visits), infant characteristics (sex, birth order, birth interval, birth weight), delivery factors (assistance and location of delivery), and post-delivery factors (breastfeeding status, postnatal check-ups).

RESULTS: Statistical analysis utilized the Chi-squared test to identify significant relationships between determinants and outcomes, alongside a full logistic model based on treatment contrasts. Findings indicated that in 2011, the significant factors included pregnancy duration, postnatal checks, antenatal visits, and having twins. By 2016, important determinants shifted to the mother’s age, breastfeeding status, pregnancy duration, postnatal checks, and antenatal visits.

CONCLUSIONS: The study highlights that pregnancy duration, postnatal check-ups, and antenatal visits consistently influenced neonatal mortality across both surveys. Given the rarity of studies addressing program impacts on neonatal mortality, this research suggests conducting panel studies to better understand the slow decline of neonatal mortality in Nepal.

PMID:41319065 | DOI:10.33314/jnhrc.v23i02.4692

J Nepal Health Res Counc. 2025 Oct 17;23(2):397-403. doi: 10.33314/jnhrc.v23i02.4689.

ABSTRACT

BACKGROUND: Accurate mortality data is vital for public health planning and policy. In Nepal, non-standardized death certificates, often missing structured causal sequences and critical details, compromise data quality in the Civil Registration and Vital Statistics (CRVS) systems. Implementing the World Health Organization’s (WHO) Medical Certificate of Cause of Death (MCCoD) could enhance accuracy, strengthen mortality statistics, and facilitate evidence-based public health interventions.

METHODS: This retrospective study analyzed inpatient deaths occurring between 13 April 2024 to 15 December 2024. Demographic and clinical data were extracted from medical records. The leading causes of death were identified by analyzing International Classification of Diseases Eleventh Revision (ICD-11) coded data using the Digital Open Rule Integrated cause of death Selection (DORIS) tool. Additionally, the study assessed documentation errors, predominant causes of in-hospital mortality, and evaluated the accuracy of cause-of-death reporting in the Health Management Information System (HMIS).

RESULTS: The study analyzed 564 death certificates and corresponding medical records. Chronic liver disease was the leading underlying cause of death (UCOD) accounting 11.17% of total deaths. No certificate was entirely error-free, with nearly all (99.9%) failing to document the time interval between symptom onset and death. Approximately 59% contained unclear abbreviations, while 99.7% listed multiple causes in a single line without proper sequencing. Only 2% followed a causal sequence as: immediate, antecedent, and UCOD. Additionally, inaccurately reported cardiopulmonary arrest as the UCOD in HMIS.

CONCLUSIONS: Hospital death certification remains critically substandard, undermining mortality data quality. Prioritizing WHO’s MCCoD implementation and clinician training would significantly improve accuracy, supporting SDG targets for reliable cause of death reporting.

PMID:41319064 | DOI:10.33314/jnhrc.v23i02.4689

J Nepal Health Res Counc. 2025 Oct 17;23(2):274-281. doi: 10.33314/jnhrc.v23i02.4905.

ABSTRACT

BACKGROUND: Maternal satisfaction is higher in the midwife-led model than in other models of maternity care. The objective of this study was to compare maternal satisfaction with childbirth services, receiving care in the birthing center, and the labor room.

METHODS: A cross-sectional descriptive comparative research design was used for the study to compare the satisfaction of 70 postnatal mothers delivered in the birthing center (midwifery-led model) with 70 postnatal mothers delivered in the labor room (obstetrician-led model) of Paropakar Maternity and Women’s Hospital. The study population comprised postnatal mothers with normal deliveries, selected using non-probability purposive sampling technique. Data were collected using a pretested structured interview.

RESULTS: The median satisfaction score of the respondents delivered in the birthing center is higher (96.88%) than in the labor room (77.66%) with a statistical significant (p-value <0.001).

CONCLUSIONS: Almost all the mothers who delivered their newborns at the birthing center were more satisfied with the childbirth services provided by midwives compared with the services provided in the labor room led by other healthcare providers. Therefore, the midwifery-led model should be expanded to improve maternal satisfaction with the childbirth service.

PMID:41319061 | DOI:10.33314/jnhrc.v23i02.4905

Br J Educ Psychol. 2025 Nov 30. doi: 10.1111/bjep.70050. Online ahead of print.

ABSTRACT

BACKGROUND: Youth with neurodevelopmental disorders are at risk for school failure, but little is known about the contextual factors influencing academic achievement.

AIMS: Drawing on a bioecological system framework, we examined how ADHD and autism, parental educational attainment and aspects of the parent-child relationship influence educational achievement at the end of primary school, and to what extent these factors have independent as opposed to interactive effects on educational achievement.

SAMPLE: A total of 12,477 twins born 1994-2005 from Sweden.

METHODS: ADHD and autism were assessed at age nine with a structured telephone interview with parents. Among participants, n = 996 and n = 249 met screening criteria for ADHD and autism, respectively. At age 15, data on parent-child relationships and parental educational attainment were gathered. Children’s school grades and eligibility for upper secondary school were obtained from a register, and used as main outcome measures. Multiple regression models with interaction terms were used to explore if the effects of family-related factors differed in students with or without ADHD or autism.

RESULTS: ADHD or autism was associated with low academic achievement, as were all the family-related variables in multiple regression models (all p < .005). However, there was no statistical evidence (all p > .005) that the influence of family-related variables differed (i.e., were either less or more important in the prediction of educational achievement) in students with or without ADHD or autism.

CONCLUSIONS: Results were in keeping with a bioecological model of non-interacting multiple risks for educational underachievement in students with ADHD and/or autism.

PMID:41319052 | DOI:10.1111/bjep.70050

Brief Bioinform. 2025 Nov 1;26(6):bbaf634. doi: 10.1093/bib/bbaf634.

ABSTRACT

Enhancer-enhancer interactions (EEIs) are critical regulatory components in transcriptional networks but remain computationally challenging to predict. While enhancer-promoter interactions have been extensively studied, EEIs remain comparatively underexplored. We developed ETNet (Enhancer-enhancer Interaction Explainable Transformer Network), a deep learning architecture integrating convolutional neural networks with Transformer modules to predict EEIs from DNA sequences. Evaluation across three cell lines (GM12878, K562, MCF-7) demonstrated superior performance compared to existing methods including EnContact, with statistical significance confirmed through DeLong tests across six cell lines. Rigorous validation through cross-validation and enhancer-level data partitioning confirmed robust generalization. ETNet exhibited effective cross-cell type transfer learning and showed transferability to enhancer-promoter interaction tasks, providing exploratory evidence for shared chromatin interaction principles. Feature attribution analysis recovered cell-type-specific regulatory motifs consistent with known transcription factors and revealed computational evidence for super-additive cooperative mechanisms, with cooperativity negatively correlating with sequence similarity-patterns representing hypothesis-generating observations requiring experimental validation. Proof-of-concept analysis demonstrated how single-nucleotide polymorphisms in JAK-STAT pathway genes may influence predicted interactions through motif alterations. ETNet advances computational approaches for studying enhancer interactions and provides a framework combining predictive capability with exploratory interpretability.

PMID:41319043 | DOI:10.1093/bib/bbaf634

Clin Transl Allergy. 2025 Dec;15(12):e70130. doi: 10.1002/clt2.70130.

ABSTRACT

BACKGROUND: Chat Generative Pre-Trained Transformer 4 (ChatGPT-4) represents an advancing large language model (LLM) with potential applications in medical education and patient care. While Allergen Immunotherapy (AIT) can change the course of allergic diseases, it can also bring uncertainty to patients, who turn to readily available resources such as ChatGPT-4 to address these doubts. This study aimed to use validated tools to evaluate the information provided by ChatGPT-4 regarding AIT in terms of quality, reliability, and readability.

METHODS: In accordance with EAACI clinical guidelines about AIT, 24 questions were selected and introduced in ChatGPT-4. Independent reviewers evaluated ChatGPT-4 responses using three validated tools: the DISCERN instrument (quality), JAMA Benchmark criteria (reliability), and Flesch-Kincaid Readability Tests (readability). Descriptive statistics summarized findings across categories.

RESULTS: ChatGPT-4 responses were generally rated as “fair quality” on DISCERN, with strengths in classification/formulations and special populations. Notably, the tool provided good-quality responses on the preventive effects of AIT in children and premedication to reduce adverse reactions. However, JAMA Benchmark scores consistently indicated “insufficient information” (median = 0-1), primarily due to absent authorship, attribution, disclosure, and currency. Readability analyses revealed a college graduate-level requirement, with most responses classified as “very difficult” to understand. Overall, ChatGPT-4 demonstrated fair quality, insufficient reliability, and difficult readability for patients.

CONCLUSIONS: ChatGPT-4 provides generally well-structured responses on AIT but lacks reliability and readability for clinical or patient-directed use. Until specialized, reference-based models are developed, healthcare professionals should supervise its use, particularly in sensitive areas such as dosing and safety.

PMID:41319041 | DOI:10.1002/clt2.70130

Hum Brain Mapp. 2025 Dec 1;46(17):e70422. doi: 10.1002/hbm.70422.

ABSTRACT

Human arousal is essential to survival and mediated by the ascending arousal network (AAN) and its connections. It spans from the brainstem to the diencephalon, basal forebrain, and cerebral cortex. Despite advances in mapping the AAN in adults, it is unexplored in fetal and early infant life, especially with high-resolution magnetic resonance imaging techniques. In this study, we conducted-for the first time-high-resolution ex vivo diffusion MRI-based analysis of the AAN in seven fetal, infant, and adult brains, incorporating probabilistic tractography and quantifying connectivity using graph theory. We observed that AAN structural connectivity becomes increasingly integrated during development, progressively reaching rostrally during the first postconceptional year. We quantitatively identified the dorsal raphe (DR) nucleus and ventral tegmental area (VTA) as AAN connectivity hubs already in the fetus persisting into adulthood. The DR appears to form a local hub of short-range connectivities, while the VTA evolves as a long-range global hub. The identified connectivity maps advance our understanding of AAN architecture changes due to normative human brain development, as well as disorders of arousal, such as coma and sudden infant death syndrome.

PMID:41319039 | DOI:10.1002/hbm.70422

Ann Afr Med. 2025 Nov 20. doi: 10.4103/aam.aam_335_25. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Ankylosing spondylitis (AS) poses considerable challenges for anesthesiologists due to its effect on spinal anatomy and potential airway difficulties. The characteristic ossification and vertebral fusion – commonly referred to as a “bamboo spine” – leads to rigidity and impaired spinal mobility, often complicating neuraxial anesthetic techniques. This study aimed to assess whether a preprocedural ultrasound-assisted approach improves the success rate of dural puncture with fewer needle attempts compared to the traditional landmark-guided technique in patients with altered spinal anatomy due to AS.

METHODOLOGY: Sixty American Society of Anesthesiologists physical status I and II patients aged 18-60 years with AS, scheduled for elective total hip arthroplasty, were enrolled and randomly divided into two equal groups. Group I received ultrasound-assisted subarachnoid blocks, whereas Group II underwent the conventional landmark-based approach. Hemodynamic parameters, total number of needle attempts, and the time required to administer the block were recorded. The primary outcome was the number of attempts for successful dural puncture. Secondary outcomes included time taken and postprocedural complications.

RESULTS: Group I (ultrasound-guided) demonstrated a significantly higher first-attempt success rate compared to Group II. Although the ultrasound method showed a slightly increased procedural duration, the difference was not statistically significant, and postprocedural complications were comparable.

CONCLUSION: Ultrasound guidance notably improves first-pass success rates for subarachnoid block in patients with AS, making it a valuable technique for spinal anesthesia in such cases.

PMID:41318896 | DOI:10.4103/aam.aam_335_25

Eur Spine J. 2025 Nov 30. doi: 10.1007/s00586-025-09646-7. Online ahead of print.

ABSTRACT

PURPOSE: Pedicle screw loosening (PSL) is a significant complication in transforaminal lumbar interbody fusion (TLIF), often associated with poor bone quality. This study evaluates the predictive value of MRI-based pedicle bone quality (PBQ) and vertebral body quality (VBQ) scores for PSL, hypothesizing that PBQ is a stronger predictor than VBQ.

METHODS: This retrospective cohort study analyzed 394 patients who underwent TLIF between January 2018 and January 2021. Preoperative PBQ and VBQ scores were derived from sagittal T1-weighted MRI images. The primary outcome measure was PSL, which was evaluated in accordance with established radiographic criteria. Secondary outcomes included fusion rates and patient-reported outcomes. Statistical analyses included receiver operating characteristic curves to determine predictive accuracy and multivariate logistic regression to identify other risk factors for PSL.

RESULTS: PBQ demonstrated superior predictive performance for PSL relative to VBQ, with higher sensitivity (75.93% vs. 50.00%) and specificity (92.31% vs. 87.06%). In addition, PBQ yielded higher positive predictive value (78.85% vs. 59.34%) and negative predictive value (91.03% vs. 82.18%). The discriminative ability of PBQ was further supported by a larger area under the ROC curve (0.894, 95% CI: 0.856-0.932) compared with VBQ (0.722, 95% CI: 0.664-0.781). Independent risk factors associated with PSL included advanced age, lower hip bone mineral density T-scores, longer fusion constructs, and reduced fusion rates. Furthermore, patients who developed PSL reported significantly higher postoperative back pain scores.

CONCLUSION: MRI-derived PBQ and VBQ scores independently predict PSL, with PBQ demonstrating superior performance. Incorporating PBQ into preoperative planning may improve surgical decision-making and potentially enhance outcomes in patients with reduced bone strength. Additionally, lower hip BMD T-scores, reduced fusion rates, longer fusion constructs, and advanced age were identified as significant risk factors for PSL.

PMID:41318873 | DOI:10.1007/s00586-025-09646-7