Tag: statistics

BMC Surg. 2025 Aug 31;25(1):402. doi: 10.1186/s12893-025-03133-y.

ABSTRACT

BACKGROUND: Elevated lactate levels are reliable biomarkers of tissue hypoperfusion and metabolic stress. However, their prognostic significance in extensive burn patients undergoing early excision and grafting (EEG) remains unclear. This study aimed to evaluate the prognostic value of perioperative lactate levels in predicting clinical deterioration following EEG in patients with extensive burns.

METHODS: In this retrospective cohort study, adult burn patients with ≥ 50% total burn surface area (TBSA) or ≥ 20% full-thickness burns treated between March 2021 and September 2023 were included. Patients were categorized into Deterioration and Non-Deterioration groups based on changes in Sequential Organ Failure Assessment (SOFA) scores. Statistical analyses included univariate and multivariate logistic regression, as well as receiver-operating characteristic (ROC) curve analysis.

RESULTS: Of 82 patients, 37.8% were classified into the Deterioration Group. Compared with the Non-Deterioration Group, these patients presented with a significantly higher burn index (BI), larger surgical area, and greater intraoperative blood transfusion volumes. Temporal trends in lactate levels appeared to differ between groups: lactate levels peaked on POD1 and returned to baseline by postoperative Day 3(POD3) in the Non-Deterioration Group, whereas they remained persistently elevated in the Deterioration Group. Among all perioperative time points, lactate levels on POD3 were significantly higher in the Deterioration Group (2.88 ± 0.65 mmol/L vs. 2.27 ± 0.68 mmol/L, p < 0.001) and were independently associated with clinical deterioration clinical deterioration (OR 2.97, 95% CI 1.18-8.71, p = 0.031). POD3 lactate levels demonstrated the highest discriminatory performance for identifying postoperative deterioration (AUC = 0.761, 95% CI 0.656-0.866).

CONCLUSIONS: Among perioperative lactate levels in patients undergoing EEG for extensive burns, POD3 lactate levels were significantly associated with clinical deterioration and may serve as a useful marker to guide early risk assessment and supportive interventions.

PMID:40887618 | DOI:10.1186/s12893-025-03133-y

BMC Psychol. 2025 Aug 31;13(1):994. doi: 10.1186/s40359-025-03374-9.

ABSTRACT

BACKGROUND: Social support is essential for the self-management of type 2 diabetes mellitus (T2DM); no specific measure of the quality of social support has been designed and tested for people with T2DM. Having a validated questionnaire that is culturally and linguistically appropriate in this field would nurture research in this area and contribute to better patient health outcomes.

AIMS: This study investigated the psychometric features of the Autonomy in Relatedness Inventory (ARI) among individuals with T2DM in Jordan.

METHODOLOGY: We used a secondary dataset on self-management and outcomes of individuals with T2DM to examine the psychometric properties of the ARI. The ARI’s items’ overall reliability was assessed using internal consistency (Cronbach’s alpha). Exploratory Factor Analysis (EFA) was used to evaluate the validity of the ARI. Confirmatory factor analysis (CFA) was performed using structural equation modeling (SEM) to test the yielded factors.

RESULTS: The ARI demonstrated high reliability (Cronbach’s alpha value was 0.90) and validity in T2DM patients. Convergent validity of the ARI was established. The findings showed that ARI was strongly correlated with functional social support (r = .61, p < .001), in addition to negative correlations with depression (r= -.26, p < .001), anxiety (r= -.18, p < .001), and stress (r= -.24, p < .001). Regarding the factor structure of ARI, two latent factors were determined using a scree plot and EFA.

CONCLUSION: ARI provides a psychometrically sound method for measuring autonomy and relatedness in T2DM patients in Jordan.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40887609 | DOI:10.1186/s40359-025-03374-9

Eur J Med Res. 2025 Aug 31;30(1):829. doi: 10.1186/s40001-025-03128-8.

ABSTRACT

PURPOSE: Triglyceride glucose-body mass index (TyG-BMI) represents a combined measure to evaluate insulin resistance and predict cerebral and cardiovascular disease risk and the resulting negative consequences. Nevertheless, the prognostic value of TyG-BMI for predicting outcomes, such as mortality, among critically ill patients in the intensive care unit (ICU-CIP) remains understudied. Our study seeks to ascertain the relation between all-cause mortality (ACM) and TyG-BMI among ICU-CIP, regardless of specific diseases, to recognize individuals at high risk and enhance prediction strategies.

METHODS: The data were acquired from the Medical Information Mart for Intensive Care (MIMIC)-IV database, version 3.2, and estimated the TyG-BMI, incorporating fasting blood glucose, fasting triglycerides, and BMI. The formula used was ln{[fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)]/2} × BMI. Herein, we included all first-time admitted adult patients, evaluated their TyG-BMI., and conducted a 1:1 propensity score matching (PSM) approach to address possible confounding variables. The critical TyG-BMI level influencing patient survival was determined utilizing maximally selected rank statistics. Kaplan-Meier survival analysis along with multivariate Cox proportional hazards (PH) regression models were utilized to estimate the impact on short- and long-term ACM. Furthermore, restricted cubic spline (RCS) methods explored the linear or non-linear relation between TyG-BMI and ACM, with additional knowledge acquired from interactions and analyses of subgroups.

RESULTS: A total of 9,175 ICU-CIP was included; after PSM, the analysis involved 3,642 matched participant pairs. Cox PH fully adjusted regression models demonstrated a significant correlation between higher TyG-BMI (≥ 239.54) and decreased 90 day ACM, both before (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.69-0.85) and after PSM (HR 0.76; 95% CI 0.68-0.85). Comparable associations were observed for 30 day, 180 day, and 365 day ACM. Post-PSM, RCS analysis revealed a negative L-shaped non-linear relation between both short- and long-term ACM and TyG-BMI. Notably, significant interaction effects were noticed in age, race/ethnicity, and hypertension subgroups, while no interaction effects were found in diabetes and gender subgroups.

CONCLUSION: TyG-BMI is a novel, non-invasive predictor of mortality in ICU-CIP. These findings may inform risk stratification and public health strategies, although validation in diverse populations is warranted.

PMID:40887601 | DOI:10.1186/s40001-025-03128-8

BMC Health Serv Res. 2025 Sep 1;25(1):1161. doi: 10.1186/s12913-025-13284-6.

ABSTRACT

BACKGROUND: Arterial hypertension is one of the leading causes of premature death worldwide. In the care of patients with hypertension, digital tools – such as apps or wearables – can potentially help in prevention to facilitate lifestyle changes or to improve blood pressure control. In hypertension care in Germany, digital applications are only sporadically used by patients and recommended by physicians. This study, therefore, investigates the following questions: What preventive measures do hypertension patients use to manage their condition? What barriers can be identified? How is the use and acceptance of digital technologies for behavioural prevention?

METHODS: We conducted semi-structured interviews with 31 patients with arterial hypertension in Germany. The interviews were conducted either in person or by phone and were analysed using Qualitative Content Analysis.

RESULTS: Some interviewees use digital tools for prevention regularly, while others never do. Others have used them in the past or occasionally. Several facilitators and barriers to health behaviours and the use of digital tools were identified. These include the interviewees’ comorbidities, their routines, habits and preferences, as well as their attitude towards technological innovations. Their work situation, their financial resources and the support – or lack thereof – they receive from physicians and from their social environment also play a role. Furthermore, there are differences in the attribution of responsibility among the interviewees. While some attribute responsibility for health to the individual, others emphasise the relevance of aggravating and supportive conditions.

CONCLUSIONS: The findings indicate which factors influence the use of digital prevention tools by patients with hypertension. As described in the context of the digital divide and the inequality paradox of prevention, socioeconomic factors play a significant role in both health behaviour and the use of digital prevention tools. Some patients with hypertension may benefit from the use of digital prevention tools if appropriate conditions are created. During implementation, care should be taken to avoid exacerbating existing inequalities.

TRIAL REGISTRATION: DRKS00029761 (registration date july 27th 2022).

PMID:40887595 | DOI:10.1186/s12913-025-13284-6

BMC Oral Health. 2025 Aug 31;25(1):1387. doi: 10.1186/s12903-025-06734-4.

ABSTRACT

OBJECTIVE: To determine the characteristics of anxiety at five different points during tooth extraction, explore the relationship between anxiety and pain, and identify predictors of overall anxiety.

METHODS: A cross-sectional study was conducted among 302 patients undergoing tooth extraction. Anxiety levels were evaluated using a modified dental anxiety scale (MDAS) at five time points: pre-extraction night (T1), hospital waiting period (T2), local anesthesia administration (T3), extraction procedure (T4), and post-extraction (T5). Repeated-measures ANOVA, one-way ANOVA and Pearson correlation analysis were employed to evaluate temporal variations in anxiety levels and their associations with baseline characteristics and pain perception at each assessment point; Chi-square tests and binary logistic regression modeling were used to identify significant predictors of overall anxiety levels.

RESULTS: The cohort (mean age 31.3 ± 11.4 years; 60.3% female) demonstrated distinct anxiety patterns throughout the extraction process. Anxiety levels peaked during T3 and T4, followed by a significant post-operative reduction (T5; p < 0.05). Pain (69.5%) and bleeding (67.9%) emerged as the most frequently reported anxiety-inducing factors. Analysis of the correlation between baseline characteristics and anxiety at each time point revealed that younger patients (16-30 years) had smaller anxiety increases during procedures vs. older groups (p = 0.01). Married individuals showed earlier anxiety reduction than unmarried (p = 0.01). Mandibular/bimaxillary extractions and longer durations (> 10 min) correlated with higher intraoperative anxiety (p < 0.05). On the other hand, predicted pain intensity strongly correlated with anxiety at T1-T4 (p < 0.01), while actual pain linked to T4-T5 anxiety (p < 0.01). Postoperative pain showed the strongest association with T5 anxiety (p < 0.001). Risk factor analysis based on overall anxiety levels found that females (OR = 1.76), unemployed individuals (OR = 3.81), and mandibular/bimaxillary extractions (OR = 2.11-2.70) were independent predictors of high overall anxiety. Finally, a prediction model was established. Based on this model, a female unemployed patient with a mandibular third molar had an estimated 72% probability of experiencing anxiety.

CONCLUSIONS: Dental anxiety peaks during invasive procedural phases and is influenced by demographic, clinical, and pain anticipation. The identified risk factors (female, unemployment, mandibular procedures) highlight targets for preoperative interventions. Addressing pain expectations and optimizing patient communication may mitigate anxiety, particularly in high-risk groups.

CLINICAL RELEVANCE: This study reveals the anxiety characteristics during the perioperative period of tooth extraction. These insights offer essential evidence for clinicians to identify and address anxiety, ultimately enhancing patient care. Additionally, these findings highlight the importance of effective pain control in developing anxiety management strategies in clinical practice.

TRIAL REGISTRATION: the registration number is ChiCTR2400086891, dated July 15, 2024.

PMID:40887586 | DOI:10.1186/s12903-025-06734-4

BMC Oral Health. 2025 Aug 31;25(1):1391. doi: 10.1186/s12903-025-06678-9.

ABSTRACT

BACKGROUND: Root surface biomodification (RSB) enhances tissue attachment by removing the smear layer, facilitating collagen fibril formation, and promoting clot formation and stabilization. This study aimed to evaluate the efficacy of injectable platelet-rich fibrin (i-PRF), an autologous blood product, as a potential adjunct to ethylenediaminetetraacetic acid (EDTA) for RSB in gingival fibroblast attachment and proliferation in vitro.

METHODS: Dentin discs (4 mm in diameter) underwent root surface debridement to remove damaged cementum. The discs were treated with 24% EDTA, followed by the application of i-PRF for 1, 3, 5-min. Enamel matrix derivatives (EMD) were used as a positive control (5 min application), while untreated discs served as the negative control. Cell viability was assessed using the XTT assay. Cellular morphology was examined via scanning electron microscopy (SEM), and cytoskeletal organization was analyzed using fluorescence microscopy (FM) analysis. Intracellular and extracellular alkaline phosphatase (iALP/eALP) gene expression levels were evaluated. Data was analyzed using ANOVA.

RESULTS: XTT analysis revealed no statistically significant difference in cell viability between the i-PRF and the EMD groups at different time points. Actin filament organization was evident in the i-PRF 3-min group and became more pronounced in the i-PRF 5-min and the EMD groups. The i-PRF 3-min, i-PRF 5-min, and the EMD groups exhibited a spindle-shaped fibroblast morphology. No statistically significant difference was observed in iALP levels between the i-PRF 5-min and the EMD groups (p > 0.001). The EMD group exhibited the highest eALP level (p < 0.001), while the i-PRF 3-min and 5-min groups demonstrated the second highest levels.

CONCLUSION: The application of i-PRF for 5 min following EDTA treatment appears to enhance gingival fibroblast proliferation, attachment, and ALP expression. The effectiveness of i-PRF may vary depending on the duration of the application. Therefore, in vitro data from i-PRF followed by EDTA application to dentin surfaces may be useful for further development of in vivo and clinical approaches.

PMID:40887584 | DOI:10.1186/s12903-025-06678-9

BMC Public Health. 2025 Aug 31;25(1):2985. doi: 10.1186/s12889-025-24221-x.

ABSTRACT

BACKGROUND: In China, community-dwelling older adults with intrinsic capacity (IC) impairments often turn first to primary care centers, where they face increasingly complex health needs. Given the high prevalence of IC impairment among older adults in Chinese communities, there is a pressing need to explore context-specific, nurse-led multi-domain interventions to support functional ability and healthy aging.

DESIGN: A parallel-group, cluster randomized trial conducted in September 2023, involving 86 older adults from two distinct communities.

METHODS: Participants were randomly assigned to either a 14-week nurse-led multidomain intervention or usual care. Intrinsic capacity-including composite IC, and the domains of locomotion, cognition, vitality, psychological well-being, and sensory function-was assessed at baseline (T0), immediately post-intervention (T1), and one month post-intervention (T2). Statistical analyses included descriptive and inferential tests.

RESULTS: Data from 81 participants were analyzed. The intervention group showed significantly higher IC scores than the control group at both T1 and T2 (T1: t = 6.607, P < 0.001; T2: t = 7.118, P < 0.001). Significant between-group (F = 38.948, P < 0.001), time (F = 19.753, P < 0.001), and interaction effects (F = 36.830, P < 0.001) were observed. Improvements were noted in the locomotion, cognition, and vitality domains (P < 0.05), while no significant changes were found in psychological or sensory domains (P > 0.05).

CONCLUSION: The nurse-led multidomain intervention effectively enhanced intrinsic capacity, particularly in locomotion, cognition, and vitality, but had limited impact on psychological and sensory domains. Further research is warranted to optimize intervention strategies for improving IC among community-dwelling older adults.

PMID:40887583 | DOI:10.1186/s12889-025-24221-x

Respir Res. 2025 Aug 31;26(1):264. doi: 10.1186/s12931-025-03331-5.

ABSTRACT

BACKGROUND: Pulmonary infections, ranging from mild respiratory issues to severe multiorgan failure, pose a major global health threat. The immune response in community-acquired pneumonia (CAP) and COVID-19 influences disease severity and outcomes, but molecular pathogenesis differs across pathogens. Comparisons of plasma cytokine profiles between CAP and COVID-19 are limited. Analyzing these profiles with machine learning and bioinformatics could reveal subtle patterns and improve our understanding of immune responses in both conditions.

METHODS: We conducted a novel case-control study to profile cytokine levels in patients with CAP and COVID-19. Age- and sex-matched cohorts included 39 patients with CAP, 39 with COVID-19, and 20 healthy controls. We measured 384 plasma cytokine levels using proximity extension assays and analyzed differences between cohorts with conventional statistical methods, bioinformatics and machine learning.

RESULTS: Median ages of the cohorts were comparable (P = 0.797). COVID-19 patients exhibited a higher prevalence of hematologic disease (P = 0.047), increased corticosteroid use (P = 0.040), and reduced antibiotic use (P = 0.012). Clinical outcomes, including mortality, ICU admission, invasive mechanical ventilation, renal replacement therapy, acute respiratory distress syndrome, and acute kidney injury, were similar between groups. Both cohorts showed comparable absolute circulating cytokine profiles but distinct profiles relative to healthy controls. Machine learning identified a model of twelve cytokines that distinguished CAP from COVID-19 with a classification accuracy of 0.71 (SD 0.20). Gene ontology and enrichment analysis revealed differences in cytosolic and nuclear functions, intracellular signaling, stress responses, and cell cycle processes between patient cohorts and healthy controls. Enriched GO pathways showed that CAP pathways were positively associated with leukocyte counts and ARDS development, while COVID-19 pathways were negatively associated with ARDS and positively with platelet counts.

CONCLUSIONS: This case-control study provides insights into cytokine profiles related to CAP and COVID-19 pathogenesis. Although absolute circulating cytokine levels showed no significant differences between the groups, machine learning identified a model of twelve proteins that effectively distinguished the cohorts. Gene ontology and enrichment analyses also revealed distinct dysregulated pathways with differing associations with clinical variables in each cohort. These findings underscore the complexity and variability of cytokine responses in pulmonary infections.

PMID:40887575 | DOI:10.1186/s12931-025-03331-5

Sports Med. 2025 Sep 1. doi: 10.1007/s40279-025-02251-0. Online ahead of print.

ABSTRACT

BACKGROUND: There is a lack of data and its systematic organisation relating to the physical performance qualities of women’s football players across the performance scale (i.e. level of competition categorised into unique tiers).

OBJECTIVES: (1) To establish meta-analytic estimates for select assessment protocols across seven physical qualities (cardiorespiratory fitness, sprint time, acceleration time, change of direction, lower limb power, lower limb strength, and maximal velocity), and (2) to investigate the moderating effect of participant tier; collectively providing normative benchmarking data.

METHODS: A systematic literature search of four databases (Pubmed, SportDiscuss, Scopus, and Web of Science) for studies published between 2003 and 2023 was conducted, with a secondary search for studies published until August 2024. Studies were considered for inclusion if they were published in English, the population was female football players with a minimum mean age of 16 years and the studies reported descriptive data from selected testing protocols. All study designs were eligible, excluding acute interventions such as training or supplementation. Performance scale (i.e. participant tier) of the study participants was categorised into four distinct levels (Tier 2 to Tier 5) using a modified version of the Participant Classification Framework, with Tier 5 representing world-class athletes. Study risk of bias assessment was conducted using an adapted version of the Downs and Black tool. Means and standard deviations were analysed using mixed-effects, multilevel hierarchical models to obtain pooled estimates, 90% confidence intervals (CIs) and prediction intervals (PIs). Meta-regression of modifying effects for participant tier was conducted, and comparisons were expressed as standardised mean differences.

RESULTS: The final dataset included 1855 estimates from 982 groups across 288 studies. The moderating effect of participant tier was assessed where adequate data permitted. Yo-Yo Intermittent Recovery Test Level 1 (YYIRL1) demonstrated moderate-to-large improvements when progressing from Tier 2 to Tiers 4 and 5 (combined; [b = 170 to 354 m]); similar improvements were observed for velocity attained during the 30-15 Intermittent Fitness Test when directly comparing Tier 2 to Tiers 4 and 5 (b = 2.5 km·h^-1). Sprint time decreased when progressing between tiers, with a moderate-to-large reduction for both 20 m (b = – 0.17 to – 0.22 s) and 30 m (b = – 0.32 to – 0.47 s) time when comparing Tier 2 with Tier 3 and Tiers 4 and 5, respectively. Moderate-to-large improvements in jump height were observed for squat jump (SJ; restricted arm movement) between participant tiers (b = 3.6 to 6.2 cm) and similarly for countermovement jump (CMJ) when comparing Tier 3 with Tiers 4 and 5 for restricted (b = 3.3 cm) and unrestricted arm movement (b = 8.8 cm).

CONCLUSIONS: Normative benchmarks that are useful for athlete profiling and development, talent identification, and training program design have been established from a very large sample of studies and athletes. These findings highlight the role of sprinting ability, lower limb power and intermittent aerobic capacity in differentiating athletes across the performance scale. Field-based tests, particularly those assessing intermittent fitness, demonstrated the greatest difference in performance between each of the participant tiers, suggesting that these pragmatic tests are effective at capturing the physical performance of women’s football players. A limitation of this study is the variability introduced by the heterogeneity across studies in testing protocols, sample sizes and competition levels, which may have influenced the results.

REGISTRATION: Prospective protocol registration can be found in Open Science Framework and is available through: https://doi.org/10.17605/OSF.IO/8W3JH .

PMID:40887564 | DOI:10.1007/s40279-025-02251-0

Musculoskelet Surg. 2025 Aug 31. doi: 10.1007/s12306-025-00920-x. Online ahead of print.

ABSTRACT

PURPOSE: Avascular necrosis (AVN) of the humeral head is a relatively frequent complication after proximal humerus fractures (PHF), often leading to poor outcomes and reoperation. This study investigates both non-modifiable (fracture type, trauma energy, age, sex, Charlson comorbidity index) and modifiable (surgical access, bone graft use, reduction quality) risk factors for post-operative AVN in Neer 3-4-part PHFs.

METHODS: Patients with Neer 3-4-part PHFs treated using angular stable plates and followed for at least 6 months were included. Clinical and radiographic elements were evaluated. Statistical analysis was performed with SPSS 26, evaluating the data by both descriptive and univariate analyses.

RESULTS: Among 121 patients (mean age 63, mean follow-up 10.1 months), 8 developed AVN (6.6% incidence). Only 50% of AVN cases occurred within the first 15 months of follow-up. AVN was significantly associated with 4-part fractures (p = 0.050), medial hinge disruption (p = 0.022), tuberosity comminution (p = 0.003), failure to restore the cervico-diaphyseal angle (p = 0.022), and residual varus/valgus deformity (p = 0.01). The presence of a bone graft suggested a fourfold-increased risk of AVN (OR = 4.219).

CONCLUSIONS: The present study confirms that the risk of necrosis is predicted by the type of fracture, as well as by the quality of fixation. Age, sex and CCI of the patient, varus/valgus fracture displacement, glenohumeral dislocation and energy of the trauma did not suggest the risk of AVN. These findings underscore the importance of meticulous surgical techniques to address these factors and potentially reduce the incidence of AVN.

LEVEL OF EVIDENCE III: Prospective cohort study.

PMID:40887556 | DOI:10.1007/s12306-025-00920-x