Tag: statistics

Head Face Med. 2025 Nov 15;21(1):76. doi: 10.1186/s13005-025-00552-3.

ABSTRACT

STUDY OBJECTIVES: Functional orthopedics induces mandibular advancement caused by neuromuscular adaptations. These adaptations can affect the position of the hyoid bone and may contribute to the amount of skeletal outcomes. The skeletal response is triggered by the quality and quantity of growth as well as muscular reactions. The aim of this clinical trial was to evaluate the hyoid bone position before and after functional orthodontic treatment.

METHODS: This prospective cohort study included 31 patients (mean age: 12.3 ± 0.9 years) with skeletal class II meeting the following inclusion criteria: ANB > 4°, > ½ Class II molar relationship, overjet > 6 mm, neutral/horizontal growth pattern, and CVMS II-III. All patients were treated with the Sander Bite Jumping Appliance (BJA) with wear time monitored through microsensors. Lateral cephalograms were taken at baseline (t0) and after 1 year (t1). Linear and angular hyoid measurements were analyzed. Statistical analysis was performed using IBM SPSS (v29.0.2.0), employing paired t-tests and an exploratory post hoc grouping based on total mandibular length changes (Δco-pg), with significance set at p < 0.05.

RESULTS: BJA therapy resulted in a significant more superior and anterior position of the hyoid in all patients. A greater increase in Δco-pg at t1 was associated with a more pronounced hyoid shift, while patients with a less Δco-pg showed a more inferior hyoid position at t0 and a greater tendency towards a vertical growth pattern.

CONCLUSION: A more inferior initial hyoid position was associated with limited mandibular advancement, suggesting a potential anatomical link to airway physiology, warranting further investigation into its implications for OSA risk.

CLINICAL TRIAL REGISTRATION: German Clinical Trials Register (DRKS); URL: http://www.germanctr.de; Identifier: DRKS00021090; registration date: 12.03.2020.

PMID:41241749 | DOI:10.1186/s13005-025-00552-3

Pilot Feasibility Stud. 2025 Nov 15;11(1):142. doi: 10.1186/s40814-025-01720-7.

ABSTRACT

BACKGROUND: In India, newly married young women (18-25 years of age) face high rates of unintended pregnancy. Poor sexual and reproductive health knowledge combined with restrictive social norms leads to adverse pregnancy outcomes among young women, while limited female autonomy prevents them from accessing accurate healthcare information and support. We examined the feasibility and acceptability of TARANG, a life skills and reproductive health empowerment intervention developed for and with young newly married women using a community-engaged approach.

METHODS: We report the findings from a convergent mixed-methods, single-group cluster pilot study in Rajasthan, India. We recruited 42 newly married women as participants in our study. Of these, 41 participants (retention rate = 97.6%) completed both baseline and endline surveys in July 2023 and January 2024, respectively. The intervention comprised 16 weekly sessions. Attendance was tracked electronically. We assessed three primary outcomes: feasibility (proportion completing ≥ 50% sessions), acceptability (proportion satisfied/somewhat satisfied), and usefulness (proportion finding TARANG useful/somewhat useful). Twelve participants were interviewed to understand intervention acceptance and usefulness, and 6 program staff and moderators were interviewed to understand implementation barriers. We analyzed quantitative data using descriptive statistics and qualitative data using thematic analysis.

RESULTS: Thirty-five participants completed at least one session, with 73.8% attending at least half of the sessions (6 did not attend any sessions). Among those who attended at least one session, 97.1% were satisfied/somewhat satisfied, and 100% found the intervention useful/somewhat useful. Qualitative findings revealed participants’ appreciation for open discussions on sensitive topics like family planning. The intervention filled knowledge gaps in family planning methods, fostered social connections through rapport building, enhanced sense of agency, and improved relationships with mothers-in-law and husbands. Implementation barriers included women’s workload, cultural norms of extended stays at natal homes, and the need for intense rapport building. These insights informed intervention refinements, including session modifications, increased engagement strategies, and integration of educational videos.

CONCLUSION: Our pilot study demonstrated high acceptability and feasibility, with multiple benefits for young, newly married women. Our findings informed adaptations to enhance TARANG’s delivery and satisfaction. The effectiveness of TARANG will be tested in a larger cluster randomized controlled trial currently underway.

TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov (NCT06320964). Registered retrospectively on 13 March 2024, https://clinicaltrials.gov/study/NCT06320964.

PMID:41241746 | DOI:10.1186/s40814-025-01720-7

BMC Med Educ. 2025 Nov 15;25(1):1606. doi: 10.1186/s12909-025-07990-2.

ABSTRACT

BACKGROUND: Educational escape rooms are an innovative pedagogical approach to encourage proactive learning among students. This study assessed the learning outcomes and student satisfaction with escape room-based teaching at a medical school in Germany.

METHODS: An interdisciplinary escape room was created based on learning goals from the fields of psychiatry, infectious diseases, and communication skills. The gameplay was repeated eight times and pre-post intervention questionnaires were used to assess knowledge gain of participants. Pre- and post-test scores were analyzed using t-tests and correlation analyses to examine their relationships with gender, age, and semester. Evaluation feedback was summarized with descriptive statistics (mean, SD). Three open-text questions recorded qualitative comments, which were analyzed thematically.

RESULTS: Overall, 45 students (female = 82.2%; male = 17.8%; M_age=24.04 years, SD_age=3.45) fulfilled inclusion criteria. The mean post-test score (M = 71.71, SD = 5.03) was significantly higher (t = 8.65, p < .001) than the mean pre-test score (M = 65.07, SD = 5.29). Female students scored higher than male students in pre-tests (r = .306, p = .041) and post-tests (r = .440, p = .002). A higher semester of study correlated with higher pre-test scores (r = .536, p < .001) and higher post-test scores (r = .411, p = .006). Students rated the teaching method as “good” (M = 1.58; SD = 0.53) and “recommendable to peers” (M = 1.20; SD = 0.45), “fun to play” (M = 1.22; SD = 0.52), and “relevant for teaching” (M = 1.24; SD = 0.48). Students mentioned collaborative teamwork as the best characteristic of escape room teaching and suggested comprehensive briefing and debriefing sessions for improving future sessions.

CONCLUSIONS: Escape room-based teaching resulted in significant knowledge gain. Female gender was associated with higher pre- and post-test knowledge. Students at later stages of their studies had higher pre-test knowledge. The escape room was well perceived by medical students and considered an enjoyable learning environment for medicine-related topics.

PMID:41241744 | DOI:10.1186/s12909-025-07990-2

BMC Geriatr. 2025 Nov 15;25(1):908. doi: 10.1186/s12877-025-06710-1.

ABSTRACT

BACKGROUND: Valid and reliable physical performance tests are crucial for accurately assessing the physical performance of people with dementia (PwD) and for evaluating the effects of interventions. However, existing physical performance tests for PwD often show insufficient reliability. This study aims to investigate the reliability of physical performance tests of balance, mobility and lower limb strength and function that were specifically adapted for PwD.

METHODS: We conducted a reliability study with test-retest design and a one-week gap between tests among PwD living in nursing homes. Adaptations were made to either the instruction and administration, or the scoring of the three physical performance tests as follows: The Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) for balance (adaptations to administration and scoring), the Timed-Up and Go Test (TUG) and its five phases (standing up, walking, turning around, walking, sitting down) for mobility (adaptations to instruction, administration and scoring in terms of analysing the five phases separately, and the Sit-to-Stand test (STS) for lower limb strength and function (adaptations to instruction and administration). The tests were standardized in terms of cues used to administer and guide them. We assessed absolute reliability (Standard Error of Measurement; Coefficient of Variance, Minimal Detectable Change) and relative reliability (Intraclass correlation coefficient; weighted Cohen’s Kappa). The absolute and relative test-retest reliability of the PP tests was assessed.

RESULTS: We examined relative and absolute reliability values of PP tests in a sample of 26 PwD (mean age, 88 years; mean Mini Mental State Examination (MMSE) score, 14). No statistically significant differences were found between baseline and retest. Relative reliability values ranged from 0.258 to 0.505 for balance (FICSIT), 0.011 to 0.860 for mobility (TUG), and 0.506 to 0.678 for lower limb strength and function (STS). Absolute reliability values as indicated by the coefficient of variation (CV) ranged from 23.5 to 92.8.

CONCLUSIONS: Adaptations regarding test administration and/ or scoring did not improve reliability values as compared to the original test versions. TUG test phases showed the highest reliability values for the gait phases. Future adaptations should focus on reducing the cognitive component of demand during physical performance tests. Assistive technologies such as augmented reality could improve test reliability by providing more consistent and controlled test environment.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00019205, retrospectively registered, registration date: 11 November 2019.

PMID:41241740 | DOI:10.1186/s12877-025-06710-1

Scand J Trauma Resusc Emerg Med. 2025 Nov 15;33(1):185. doi: 10.1186/s13049-025-01512-1.

ABSTRACT

BACKGROUND: Tranexamic acid is an established drug in the treatment of bleeding trauma patients. Concerns have been raised over possible complications of tranexamic acid regarding thromboembolic events as serious complications during the treatment of severely injured patients.

METHODS: In our study we retrospectively analyzed data from 2015-2019 of multiply injured patients receiving tranexamic acid during distinguished treatment periods from the TraumaRegister DGU®. We statistically analyzed overall thromboembolic complications during hospital stay in the context of number of single-dose tranexamic acid administrations.

RESULTS: We report on 37,342 patients, of whom 1,151 (3.1%) suffered from thromboembolic events. Patients without tranexamic acid treatment suffered from thromboembolic events in 2.3%, prehospital and emergency department administration increased the incidence to 4.8% and 5.2%, respectively. Administering tranexamic acid twice or three times was associated with an increased incidence of 8.5% and 8.2%, respectively. In a multivariate logistic regression, we uniquely show an independently associated risk for thromboembolic complications with every consecutive administration of tranexamic acid (one application: odds ratio (OR) 1.56, p < 0.001; two applications: OR 1.79, p < 0.001; three applications: OR 1.50, p = 0.113).

CONCLUSIONS: In our study we report on an associated risk of thromboembolic events in multiply injured patients with every single time tranexamic acid was administered in our study. Thus, before a repetitive dose of tranexamic acid is administered checking for indication is advised and especially in multiply injured patients receiving repeated administrations of TXA starting a thromboprophylaxis, as soon as possible after the traumatic bleeding disorder is controlled, is important.

PMID:41241739 | DOI:10.1186/s13049-025-01512-1

Scand J Trauma Resusc Emerg Med. 2025 Nov 15;33(1):183. doi: 10.1186/s13049-025-01510-3.

ABSTRACT

BACKGROUND: Severe thoracic trauma in children is rare and often underestimated. While standardized protocols exist, the rarity of polytrauma in children may lead to uncertainties in their application. Thus, we aim to characterize severely injured children with significant thoracic trauma and identify age-dependent differences in prehospital and early clinical management.

METHODS: Patients documented by German hospitals between 2008 and 2023 in the TraumaRegister DGU^®, aged ≤ 20 years and sustaining at least serious chest injury (AIS_Thorax ≥ 3) were analyzed. Patients were grouped by age: 0-5 years, 6-12 years and 13-16 years and statistically compared; additional data from patients aged 17-20 years is provided. Demographic, clinical characteristics and treatment comparing the aforementioned groups were evaluated using descriptive statistics. In the group of 0-16 years old independent risk factors for mortality were scrutinized applying multiple logistic regression analysis.

RESULTS: A total of 5,040 severely injured patients were analyzed (310 patients aged 0-5 years, 475 aged 6-12 years, 984 aged 13-16 years and 3,271 in group 17-20 years). With increasing age, significantly more males were injured and mechanism of injury was significantly different between the age groups. During prehospital management significant age dependent differences were seen regarding helicopter emergency medical service treatment, intubation, chest tube placement, application of catecholamines or tranexamic acid. Significant differences were found in terms of injured body regions, where the youngest suffered most from leading thoracic injury and injury to the head while abdominal injury and injury to extremities happened significantly more often in the 13-16 years old. During treatment the 13-16 years old received more blood products, were more likely to undergo thoracic surgery and stayed longer on the respective wards. Multivariate logistic regression showed an independent association with a significant mortality risk for MAIS ≥ 4 (OR = 2.87; p = 0.03), polytrauma (OR = 3.09; p < 0.001) and the need for blood transfusion before admission to the intensive care unit (OR = 2.46; p < 0.001).

CONCLUSIONS: Treating severely injured children is always challenging, even more so when they have suffered critical trauma to the chest. With our results we offer starting points for age-dependent injury prevention and provide information to analyze and question current (pre-) hospital management protocols.

PMID:41241732 | DOI:10.1186/s13049-025-01510-3

BMC Microbiol. 2025 Nov 15;25(1):751. doi: 10.1186/s12866-025-04521-3.

ABSTRACT

BACKGROUND: Early gastrointestinal microbiota establishment is crucial for host metabolism and immune development, with delivery mode and breastfeeding playing key roles. Vaginal delivery promotes colonization by maternal vaginal and gut microbes, while Caesarean section delivery leads to exposures of environmental and skin-derived microbiota. Although maternal contributions have been studied, the role of paternal exposure in shaping infant microbiota remains underexplored. We hypothesized that both parents influence infant microbiota establishment and therefore investigated the contributions of maternal and paternal microbes, as well as delivery mode, on infant oral and fecal microbiota within 48 h of birth and at 1 month of age.

METHODS: We analysed the gut and oral microbiota of 264 pregnant women, 261 partners, and 266 infants using 16S rRNA gene amplicon sequencing. α-diversity (Shannon Index) was compared using Wilcoxon tests, and β-diversity (Bray-Curtis dissimilarity) was assessed with PERMANOVA and PERMDISP. Principal component analysis (PCA) based on centered log-ratio (CLR)-transformed genus-level data was used for ordination and visualisation of taxonomic structure. Differentially abundant taxa across niches and delivery modes were identified using Kruskal-Wallis and Wilcoxon tests with false discovery rate (FDR) correction, followed by linear discriminant analysis (LDA). Putative amplicon sequence variant (ASV) sharing between infants and family members was explored using tree-based phylogenetic plots showing taxon presence and relative abundance across sample types. All analyses were performed in R using established packages.

RESULTS: Adults showed significantly higher microbial α-diversity than infants in both gut and oral samples. β-diversity analyses revealed distinct microbial community structures influenced by ecological niches and delivery mode. Within the first 48 h after birth, differential abundance analyses identified Lactobacillus crispatus in meconium and Blautia_A in oral swabs enriched in vaginally delivered infants. L. crispatus also emerged as a key marker of the vaginal microbiota in our cohort-wide comparison, while Blautia, typically a gut-associated genus, was also detected in parental rectal and meconium samples. This co-occurrence may reflect transient microbial seeding during vaginal delivery. However, due to the limited resolution of 16S rRNA gene sequencing, these patterns suggest ecological overlap rather than definitive evidence of vertical transmission.

CONCLUSIONS: Our findings demonstrate that delivery mode influences early gut and oral microbiota composition, with vaginal delivery associated with taxa also found in maternal samples. While we observed microbial continuity between infant and parental niches, we could not clearly distinguish partner-specific contributions-likely due to the limited resolution of 16S rRNA gene sequencing. These results highlight the importance of delivery-associated exposures in early microbial development and underscore the need for high-resolution approaches to better resolve microbial acquisition within families.

PMID:41241721 | DOI:10.1186/s12866-025-04521-3

Ann Surg Oncol. 2025 Nov 15. doi: 10.1245/s10434-025-18738-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The application of closed incision negative pressure therapy (ciNPT) systems over closed surgical incisions purportedly lowers postoperative complications; however, there is little evidence to support its use in oncoplastic breast surgery. The primary objective of this study was to compare major and minor wound complication rates in patients with breast cancer undergoing oncoplastic procedures, with and without the use of the ciNPT.

PATIENTS AND METHODS: A prospectively maintained database of patients undergoing breast conserving oncoplastic procedures with placement of ciNPT system at a single institution was queried. This cohort was compared with a retrospective contemporaneous control group receiving primary two-layered suture and skin adhesive closure only. Major complications included abscess/hematoma/seroma needing drainage, and wound breakdown or asymmetry requiring return to the OR. Minor complications included breast lymphedema/erythema, minor nipple necrosis, and wound breakdown or mild asymmetry not requiring return to OR. Analyses were performed using Chi-square test or Fisher’s exact test, where applicable, and univariate logistic regression models, with statistical significance set at p < 0.05.

RESULTS: Of 186 patients, there were 93 in the ciNPT and 93 in the control group. There were significantly fewer major complications in the ciNPT group (1.1% ciNPT versus 10.8% control, p = 0.010). There was no significant difference in the rates of minor complications, and no difference in complication rates based on comorbidities or tumor characteristics.

CONCLUSIONS: ciNPT decreases major postoperative wound complications in patients with breast cancer undergoing oncoplastic procedures. Minimization of major postoperative complications can help ensure the timely initiation of adjuvant therapy following breast conserving oncoplastic procedures.

PMID:41241710 | DOI:10.1245/s10434-025-18738-z

Spinal Cord. 2025 Nov 15. doi: 10.1038/s41393-025-01140-7. Online ahead of print.

ABSTRACT

STUDY DESIGN: Cohort study.

OBJECTIVES: To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation.

SETTING: Ontario, Canada.

METHODS: We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

RESULTS: We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30-40 years of age (aRR 1.54, 95% CI 1.42-1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80.

CONCLUSIONS: Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

PMID:41241697 | DOI:10.1038/s41393-025-01140-7

Metabolomics. 2025 Nov 15;21(6):174. doi: 10.1007/s11306-025-02376-3.

ABSTRACT

This study builds on a prior proof-of-concept metabolomic analysis of post-mortem pericardial fluid to assess its reproducibility and validate its utility for estimating the post-mortem interval. Sixty-five pericardial fluid samples were collected during medico-legal autopsies in two different Forensic Medicine Institutes with post-mortem intervals spanning 16 to 199 h. Samples underwent liquid-liquid extraction and ¹H NMR analysis, quantifying 50 metabolites. Multivariate statistical analyses were employed to develop post-mortem interval estimation models, controlling for age to minimize its confounding effects. Reproducibility was confirmed, with 92% of metabolites showing high similarity (cosine similarity ≥ 0.90) in 23 re-analyzed samples, demonstrating robust intra-laboratory consistency. For post-mortem intervals of 16 to 100 h, the regression model achieved presented a prediction error of 16.7 h, identifying nine key predictors, including choline, glycine, citrate, betaine, ethanolamine, glutamate, ornithine, uracil, and β-alanine. For intervals of 16 to 130 h, the prediction error was 23.2 h, and for 16 to 199 h, it was 42.1 h. A classification model distinguishing intervals below 48 h from those above 48 h showed high accuracy for detecting longer intervals, with key predictors including aspartate, histidine, and proline. These findings underscore the stability and reproducibility of pericardial fluid metabolomics, establishing its potential as a reliable forensic tool for post-mortem interval estimation, particularly beyond 48 h, with significant implications for forensic investigations.

PMID:41241694 | DOI:10.1007/s11306-025-02376-3