Tag: statistics

Stroke. 2025 Dec 22. doi: 10.1161/STROKEAHA.125.052763. Online ahead of print.

ABSTRACT

BACKGROUND: Robot-assisted gait training (RAGT) with wearable exoskeletons has the potential to enhance walking in patients with stroke; however, large-scale evidence is inconclusive. The aim of this study was to determine the effect of overground gait training using a torque-assisted exoskeleton in patients with subacute stroke on the recovery of ambulatory function.

METHODS: This international, multicenter, randomized controlled trial enrolled 151 patients with subacute stroke who presented with severe gait impairment but relatively preserved trunk control. Participants were randomized to the RAGT group (30 minutes of conventional gait training plus 30 minutes of exoskeleton) or the control group (60 minutes of conventional gait training), 5 times per week for 4 weeks. The primary outcome was the change in ambulatory function, assessed by the Functional Ambulation Category (FAC) before and immediately after the 4-week intervention. Secondary outcomes included the lower limb strength, balance function. Independent ambulation was reassessed 3 months after the intervention.

RESULTS: A total of 127 participants (56 female (44.1%), mean age, 60.1±13.6 years) completed the 4-week intervention. There were no serious adverse events related to the interventions, and dropout rates tended to be higher in the RAGT group without statistical significance. Both groups showed significant improvement in FAC after the intervention; however, no significant difference between groups (mean change (range), 3.0 (1-5) and 2.5 (1-4) in the RAGT and control group). Both groups exhibited significant gains in lower limb motor function; however, the RAGT group demonstrated a significantly greater improvement in lower limb strength (mean change, 15.9±14.2 and 11.1±11.2 in the RAGT and control group, P=0.034).

CONCLUSIONS: Overground gait training using an exoskeleton was not superior to conventional rehabilitation for improving ambulatory function in subacute stroke patients; however, it could provide additional lower extremity motor improvement. These findings suggest that the overground gait training with an exoskeleton might be a potential intervention for patients with subacute stroke.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05157347.

PMID:41424275 | DOI:10.1161/STROKEAHA.125.052763

Ann Afr Med. 2025 Dec 15. doi: 10.4103/aam.aam_575_25. Online ahead of print.

ABSTRACT

CONTEXT: Type 2 diabetes mellitus (T2DM) and hypertension are major chronic conditions affecting elderly populations globally, often combined with socioeconomic hardship and comorbidities, which can impair quality of life (QoL).

AIMS: The aim of this study was to assess the health-related QoL among elderly persons with type 2 diabetes and hypertension living in urban slums of Bengaluru and to identify socio-demographic, clinical, lifestyle, and comorbidity factors associated with QoL.

SETTINGS AND DESIGN: A community-based cross-sectional study was conducted among 255 elderly persons (age ≥60 years) with T2DM and hypertension using probability proportional to size sampling from 12 slums in the field practice area of a tertiary care hospital in Bengaluru, India. Methods and Materials: Data were collected on sociodemographic profile, clinical status, disease duration, comorbidities, lifestyle behaviors, and health-related QoL using domain-specific assessments.

STATISTICAL ANALYSIS USED: Statistical analysis included descriptive statistics, ANOVA/Chi-square tests, and Pearson correlation.

RESULTS: Of 255 participants, the mean age was 67.7 years. Almost half (47.1%) the participants reported poor QoL, predominantly in the social and psychological domains. The mean QoL score among the study subjects is 44.92 ± 7.6, which is below average. The highest score was 47.19 ± 14.6, seen in the physical domain, and the lowest mean scores were observed in social (42.96 ± 16.30) and psychological domains (43.92 ± 10.4).

CONCLUSIONS: The elderly with type 2 diabetes and hypertension in urban slums experience poor QOL influenced by sociodemographic, clinical, and lifestyle factors. Interventions emphasizing physical activity, diet adherence, comorbidity management, and social support are needed.

PMID:41424274 | DOI:10.4103/aam.aam_575_25

Glob Health Action. 2025 Dec;18(1):2599567. doi: 10.1080/16549716.2025.2599567. Epub 2025 Dec 22.

ABSTRACT

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseasemorbidity and mortality, affecting 25% of adults in Ghana. Access to adequate care is critical for effective hypertension management.

OBJECTIVE: Evaluate healthcare utilisation among patients with hypertension and identify determinants.

METHODS: Guided by the Andersen and Newman model, we examined predisposing, enabling, and need factors affecting HCU. Data were collected from 600 patients with hypertension, 19 in-depth interviews with health workers, and six focus group discussions with patients. Logistic regression was used for quantitative analysis, while qualitative data were analyzed thematically.

RESULTS: In all, 73% of patients with hypertension used health care. Key predisposing factors included age 70+ years (adjusted odds ratio [aOR]: 1.97, 95% CI: 1.06-3.69) and being female (aOR: 2.32, 95% CI: 1.53-3.54). Enabling factors included health insurance (aOR: 4.07, 95% CI: 2.04-8.20), closer proximity to referral facilities (aOR: 2.28, 95% CI: 1.44-3.65), and care at district hospitals (aOR: 3.37, 95% CI: 1.94-6.03). Need factors were not associated with HCU. Barriers included financial difficulties, reliance on alternative medicines, poor health-seeking behavior, delays, erratic medication supplies, and health insurance limitations.

CONCLUSIONS: This study finds high healthcare use (73%) among rural Ghanaian hypertension patients, mainly driven by demographic and structural factors. It highlights ongoing inequalities, especially among men. Interventions should focus on addressing gender issues, enhancing access to insurance, and strengthening district hospital services. Future research should evaluate the quality and consistency of hypertension care to improve health outcomes.

PMID:41424267 | DOI:10.1080/16549716.2025.2599567

J Community Psychol. 2026 Jan;54(1):e70076. doi: 10.1002/jcop.70076.

ABSTRACT

Scholars of youth civic development have assessed agency using a wide range of constructs, including motivation, efficacy, empowerment, and sociopolitical control. We propose a multidimensional framework and describe the development and validation of a measure of civic agency, conceptualized as competence, drive, individual power, and collective power. In Study 1, we developed a set of items and employed exploratory factor analysis with a pilot sample of adolescents (N = 295, M_age = 17.1, 65.4% youth of color, 47.9% female, 15.8% nonbinary), which supported our hypothesized four-factor model of civic agency. In Study 2, we conducted confirmatory factor analysis of our final items with a separate adolescent sample (N = 1120, M_age = 16.2, 73.0% youth of color, 55.7% female, 23.3% nonbinary), which demonstrated measurement invariance on race/ethnicity, gender, and age. In Study 3, we validated our scale in a sample of young activists (N = 342, M_age = 19.1, 57.6% youth of color, 72.6% female, 23.0% nonbinary). Confirmatory factor analysis supported a four-dimensional hierarchical structure and we established measurement invariance between adolescents and young adults. Overall, the 16-item Civic Agency Measure consistently demonstrated validity and reliability. We discuss the utility of our work for advancing sociopolitical development theory and supporting adolescents’ efforts for social change.

PMID:41424263 | DOI:10.1002/jcop.70076

Am J Hosp Palliat Care. 2025 Dec 22:10499091251409748. doi: 10.1177/10499091251409748. Online ahead of print.

ABSTRACT

IntroductionCancer is one of the leading causes of global mortality and imposes high costs on healthcare systems. In Brazil, a significant portion of resources is allocated to oncology, especially in the terminal phase. Palliative care has been associated with reduced hospital expenses and improved quality of life. This study aimed to compare direct medical costs in the last week of life of oncology patients receiving usual care (UC) or palliative care (PC).MethodsA retrospective cohort study conducted at Santa Rita Hospital (Porto Alegre, RS), using data from 2021. Patients over 18 years old, hospitalized for ≥7 days, whose death resulted from cancer progression, were included. The sample comprised 58 individuals: 41 in PC and 17 in UC. Direct medical costs included medications, procedures, laboratory and imaging exams, adjusted for inflation and converted to US dollars.ResultsDespite no statistically significant difference in the median of total cost (P = 0.4493), the median cost was lower in the PC group (USD 67.5) compared to the UC group (USD 91.5). Patients receiving palliative care had reduced costs related to procedures, laboratory tests, and imaging exams.ConclusionThe integration of palliative care was associated with reduced specific expenses and greater multidisciplinary support, indicating potential for resource optimization in oncology. These results reinforce the importance of systematic incorporation of this approach in the Brazilian context.

PMID:41424257 | DOI:10.1177/10499091251409748

Epigenomics. 2025 Dec 22:1-10. doi: 10.1080/17501911.2025.2606041. Online ahead of print.

ABSTRACT

AIMS: Environmental factors can alter DNA methylation (DNAm) levels, influence gene expression, and then change fasting glucose (FG) or hemoglobin A1c (HbA1c).

METHODS: Through analyzing DNAm data of 2366 Taiwan Biobank individuals aged between 30 and 70 years, I evaluated the role of DNAm in mediating the associations of seven non-genetic factors (BMI, chronological age, sex, smoking, drinking alcoholic beverages, education, and regular exercise) with FG and HbA1c.

RESULTS: Among 846,232 Cytosine-phosphate-Guanine (CpG) sites, the single-mediator model explored that 21, 15, 10, 3, 3, and 1 CpGs significantly mediated (p < 6.6E-9) the BMI-HbA1c, BMI-FG, sex-FG, age-FG, age-HbA1c, and drinking-HbA1c associations, respectively. The multiple-mediator model considered all significant mediators and selected the model with the smallest Akaike Information Criterion, and identified 8 CpGs that linked exposures (BMI, sex, age, and drinking) to diabetes indicators. Seven out of the 8 CpGs have been reported to be associated with diabetes, FG, HbA1c, or insulin resistance in previous epigenome-wide association studies.

CONCLUSION: Four of the 8 CpGs (cg19693031, cg04816311, cg00574958, and cg11024682) were associated with the expression of genes implicated in diabetes and metabolism, including the TXNIP, GPR146, CPT1A, and SREBF1 genes. These findings highlight the underlying epigenetic mechanism linking non-genetic factors with diabetes.

PMID:41424234 | DOI:10.1080/17501911.2025.2606041

Int J Gynaecol Obstet. 2025 Dec 22. doi: 10.1002/ijgo.70736. Online ahead of print.

ABSTRACT

T. Shokeir, and S. Mousa, “A Randomized, Placebo-Controlled, Double-Blind Study of Hysteroscopic-Guided Pertubal Diluted Bupivacaine Infusion For Endometriosis-Associated Chronic Pelvic Pain,” International Journal of Gynecology & Obstetrics 130, no. 3 (2015): 219-222, 10.1016/j.ijgo.2015.03.043. The above article, published online on 03 June 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. UK. Concerns were raised by a third party regarding the reproducibility of the results reported in Tables 2 and 3, including the p-values stated Table 3. The authors were asked to provide their raw data. However, they did not provide the requested data. Because of the incompatibility of the statistical results presented in the publication and without an adequate explanation by the authors, the editorial team and publisher consider the data and conclusions as unreliable, therefore the article must be retracted.

PMID:41424228 | DOI:10.1002/ijgo.70736

Vasc Endovascular Surg. 2025 Dec 22:15385744251410004. doi: 10.1177/15385744251410004. Online ahead of print.

ABSTRACT

BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.MethodsA comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.ResultsA total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, P < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, P = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.

PMID:41424201 | DOI:10.1177/15385744251410004

Global Spine J. 2025 Dec 22:21925682251407966. doi: 10.1177/21925682251407966. Online ahead of print.

ABSTRACT

Study DesignProspective cohort study.ObjectivePostoperative cerebrospinal fluid leakage (CSFL) is a common complication following thoracic spinal stenosis (TSS) surgery. This study aimed to evaluate the therapeutic effects of different fluid supplementation strategies on intracranial hypotension symptoms (IHS) caused by CSFL.MethodsPatients who developed CSFL after TSS surgery at a single center over a 3-year period were prospectively enrolled. All patients received standardized postural and drainage management. In addition, they were administered either low-sodium or high-sodium solution supplementation alongside standard medications. The incidence and severity of IHS and changes of blood electrolyte levels were compared between the two groups.ResultsThe incidence of IHS in low-sodium group is 57.5%, and in high-sodium group is 40% (P = .117). Although, there was no statistically significant difference in the improvement of IHS between the two fluid supplementation strategies. However, statistical differences in blood electrolyte levels were observed. On postoperative days 2 and 3, serum sodium levels were significantly lower in the low-sodium group (139.9 ± 2.08 vs 141.1 ± 3.1, P = .022; 140.0 ± 3.0 vs 141.25 ± 3.85, P = .034).ConclusionWhile high-sodium fluid supplementation tended to reduce the incidence of IHS following CSFL, the difference compared to low-sodium fluids was not statistically significant. Nonetheless, the observed differences in electrolyte level of sodium suggest a potential physiological impact. Further studies with larger sample sizes are needed to confirm these findings.

PMID:41424188 | DOI:10.1177/21925682251407966

Clin Psychol Psychother. 2025 Nov-Dec;32(6):e70208. doi: 10.1002/cpp.70208.

ABSTRACT

This study aimed to evaluate the factor structure, internal consistency and concurrent validity of the Italian version of the Metacognitions about Smoking Questionnaire (MSQ), utilizing the framework of the Self-Regulation Executive Function model. A total of 532 smokers completed the Italian-translated version of the MSQ, the Fagerstrom Test for Nicotine Dependence, the Severity Dependence Scale, the Depression Anxiety and Stress Scale-21. To test the factorial structure of the MSQ, a series of confirmatory factor analyses (CFAs) were run; correlational analyses and structural equation modelling (SEMs) approaches were undertaken to evaluate the concurrent validity. The 12-item MSQ with four factors was confirmed: positive metacognitions about cognitive regulation (PM-CR), positive metacognitions about emotional regulation (PM-ER), negative metacognitions about uncontrollability (NM-U) and negative metacognitions about cognitive interference (NM-CI). The MSQ showed an overall satisfactory fit index (TLI = 0.949, CFI = 0.963, RMSEA = 0.082 [0.064-0.101]). Internal consistency was satisfactory. MSQ factors are associated with higher nicotine/cigarette dependence and emotional distress, supporting the concurrent validity of the tool. Specific metacognitions about smoking were associated with different clinical outcomes related to smoking. A higher engagement on PM-CR and on NM-U was positively associated with nicotine/cigarette dependence. A higher engagement on PM-ER and NM-CI was associated with greater emotional distress. The 12-item Italian version of the MSQ could be a promising tool to assess specific metacognitions about smoking in both research and clinical contexts. Metacognitions about smoking may be a suitable therapeutic target to reduce the levels of nicotine/cigarette dependence and emotional distress among smokers.

PMID:41424176 | DOI:10.1002/cpp.70208