Tag: statistics

Risk Manag Healthc Policy. 2026 Jun 23;19:619944. doi: 10.2147/RMHP.S619944. eCollection 2026.

ABSTRACT

BACKGROUND: Although ischemic heart disease (IHD) and asthma are major contributors to the global disease burden, the geographical distribution patterns of their comorbidity and its macro-level drivers remain unclear. This study aims to analyze the global spatial distribution of IHD-asthma comorbidity and to identify the key risk factors driving this comorbid pattern.

METHODS: Based on a secondary analysis of the Global Burden of Disease Study 2021, this study categorized 204 countries and territories worldwide into three spatial patterns-namely “concordant type”, “IHD-dominant type”, and “asthma-dominant type”-using the quartile method of disability-adjusted life years (DALYs). A three-stage screening approach was employed to identify significant risk factors: random forest modeling combined with Shapley additive explanations was first used to rank and select candidate variables, followed by negative binomial regression analysis to confirm significant associations. Furthermore, population attributable fraction and a composite risk index were constructed to quantify cumulative exposure levels.

RESULTS: Approximately one-quarter of countries worldwide exhibit a “concordant pattern” of disease burden levels, primarily located in Asia, Africa, and Oceania. Thirteen significant risk factors were identified, with deficiency in omega-6 polyunsaturated fatty acids and iron deficiency being common risk factors for both diseases. Overall, 43.083% of IHD DALYs and 28.963% of asthma DALYs were attributable to the combined exposure to their respective risk factors.

CONCLUSION: The global joint burden of IHD and asthma exhibits substantial spatial heterogeneity, with particularly severe challenges in socioeconomically resource-limited regions of Africa and Asia. Comprehensive strategies integrating nutritional interventions, environmental improvements, and metabolic risk control are crucial for mitigating the global burden of cardiopulmonary comorbidities.

PMID:42371611 | PMC:PMC13310406 | DOI:10.2147/RMHP.S619944

Cancer Manag Res. 2026 Jun 24;18:611346. doi: 10.2147/CMAR.S611346. eCollection 2026.

ABSTRACT

BACKGROUND: Nutritional status is a recognized prognostic factor in oncology. However, its impact on patients with recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) treated with the PD-L1 inhibitor KL-A167 remains unclear.

METHODS: We conducted a secondary exploratory analysis of the KL-A167 trial, which included 153 patients with R/M NPC who had progressed after at least two lines of chemotherapy. Baseline nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, Nutritional Risk Index (NRI), and Prognostic Nutritional Index (PNI). The associations between these indices and survival outcomes, including overall survival (OS) and progression-free survival (PFS), were analyzed using Kaplan-Meier methods and Cox regression models.

RESULTS: Baseline nutritional status was associated with survival outcomes. In multivariable Cox analyses as continuous variables, higher CONUT, lower NRI, and lower PNI were all independently associated with worse OS (all p < 0.01), while higher CONUT and lower PNI were independently associated with worse PFS (both p < 0.01). In categorical analyses, high CONUT and low PNI were independently associated with worse OS, and high CONUT, low NRI, and low PNI were independently associated with worse PFS.

CONCLUSION: Baseline nutritional indices, particularly PNI, were associated with OS and PFS in patients with R/M NPC treated with the PD-L1 inhibitor KL-A167. Routine baseline nutritional screening may help identify high-risk patients before immunotherapy, although the clinical benefits of early nutritional interventions remain to be confirmed.

PMID:42371598 | PMC:PMC13310493 | DOI:10.2147/CMAR.S611346

3 Biotech. 2026 Jul;16(7):289. doi: 10.1007/s13205-026-04921-w. Epub 2026 Jun 27.

ABSTRACT

Whole-genome SNP data from 109 goats, including 55 indigenous Indian goats and 54 exotic goats, were analyzed to identify ancestry informative markers (AIMs) associated with climatic adaptation. After quality filtering, 41,254,122 SNPs were retained, and 10,000 SNPs were selected using F_ST, In, and delta statistics. A consensus approach identified 4,040 AIMs. Admixture analysis (K = 2) retained 43 individuals (17 cold-adapted and 26 hot-adapted) with ≥ 80% ancestry. Principal component analysis using 4,040 AIMs clearly separated climatic groups, with PC1 explaining 55.59% of the variance. Machine learning approaches refined AIMs for climatic classification. Random Forest identified 140 SNPs and achieved 100% test accuracy. Support Vector Machine selected 1,474 SNPs, Logistic Regression identified 241 SNPs, and k-Nearest Neighbors selected 147 SNPs, all achieving 100% test accuracy. XG-Boost selected 150 SNPs and achieved 89% test accuracy. After removing duplicates across models, 1,728 SNPs were retained for functional annotation. Validation using 706 shared markers in 54 exotic goats confirmed clear separation of hot- and cold-adapted populations. Variant annotation identified three key protein-coding genes: MSH5, PAPSS2, and SINHCAF. Missense variants in MSH5 (Ile581Val) and PAPSS2 (Ile225Val/Ile216Val) exhibited contrasting allele frequencies between climatic groups, while SINHCAF showed a synonymous variant (Ser153=) with distinct allele distribution patterns. Protein structural analysis revealed high-quality models, with > 90% residues in favoured Ramachandran regions. The MSH5 Ile581Val variant showed a stabilizing effect (ΔΔG = + 0.09 kcal/mol), whereas PAPSS2 variants (Ile225Val and Ile216Val) exhibited destabilizing effects (ΔΔG = – 0.72 and -1.24 kcal/mol) and moderate evolutionary conservation. Structural predictions further indicated that these variants were surface-exposed and potentially functionally relevant. These results highlight functionally important variants associated with climatic adaptation and demonstrate the effectiveness of integrating AIMs with machine learning to identify reduced marker sets. These findings further support the development of targeted, cost-effective SNP panels for climatic adaptation assessment and marker-assisted selection in goats.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-026-04921-w.

PMID:42371591 | PMC:PMC13310212 | DOI:10.1007/s13205-026-04921-w

Infect Drug Resist. 2026 Jun 24;19:585882. doi: 10.2147/IDR.S585882. eCollection 2026.

ABSTRACT

PURPOSE: Although albumin-based indices have prognostic value in older adults with community-acquired pneumonia (CAP), the predictive role of lactate dehydrogenase to albumin ratio (LAR) remains insufficiently explored. This study aimed to evaluate LAR as a predictor of CAP severity in patients aged ≥60 years.

PATIENTS AND METHODS: We conducted a retrospective cohort study of patients aged ≥60 years with CAP hospitalized from June 2022 to June 2025 at six secondary and tertiary academic hospitals in China. By stratifying patient into tertiles, we assessed the correlation between LAR and the severity of CAP. To explore the association between LAR and CAP severity, we employed logistic regression analyses, and subgroup analyses based on demographics and comorbidities to validate the robustness of our findings.

RESULTS: A total of 423 patients with CAP were included, of which 102 cases (24.1%) were severe community-acquired pneumonia (SCAP). The average age of the participants was 73.2±7.5 years, with 64.8% being male. Natural logarithm (ln) transformed LAR on admission was significantly linked to the severity of CAP in the unadjusted analysis [Odds Ratio (OR) 23.24; 95% Confidence Interval (CI) 12.09-44.69]. Following controlling for potential variables, the association remained statistically significant (OR 11.41; 95% CI 3.57-36.47). When ln transformed LAR was categorized into tertiles, the severity of CAP in the highest tertile (T3) was significantly higher compared to that in the lowest tertile (T1) (model 4: OR = 9.43, 95% CI: 2.22-39.97). Subgroup analyses supported the stability of these findings.

CONCLUSION: LAR may serve as a promising predictor of the severity of CAP and may assist clinicians in identifying high-risk individuals among CAP patients. Future research is warranted to further validate the predictive utility of LAR in different populations and investigate its potential applications in CAP management.

PMID:42371587 | PMC:PMC13310506 | DOI:10.2147/IDR.S585882

Front Pharmacol. 2026 Jun 15;17:1827330. doi: 10.3389/fphar.2026.1827330. eCollection 2026.

ABSTRACT

BACKGROUND: Fasting during Ramadan causes challenges for diabetes treatment, necessitating tailored counseling and adjustments for medication. Community pharmacists play a vital role in enhancing fasting safety, although their readiness has not been well investigated in southern Saudi Arabia. This study aimed to evaluate community pharmacists’ knowledge, attitudes, and practices (KAP) regarding diabetes management during Ramadan in the Aseer Region, and to identify perceived barriers and the need for additional training.

METHODS: A descriptive cross-sectional study was performed from February to May 2025 with 301 licensed community pharmacists in the Aseer Region. Participants were recruited through professional pharmacy social media platforms and pharmacy communication groups commonly used within the region. Data were collected utilizing a previously validated self-administered questionnaire. Descriptive and inferential statistics were conducted using SPSS v26, with a significance level set at p < 0.05. Inferential findings were interpreted cautiously as subgroup comparisons.

RESULTS: A total of 301 pharmacists participated. Knowledge of key safety measures during fasting was high, with 91.7% correctly identifying the blood glucose threshold (<60 mg/dL) requiring termination of fasting. Correct recognition of high-risk patients who should avoid fasting was reported for patients with recurrent hypoglycemia (88.7%) and elderly or unwell patients (87.4%). Knowledge related to medication regimen adjustment was lower, particularly in insulin dose modification, where 71.1% provided correct responses. In practice, more than 80% counseled patients on blood glucose monitoring and meal planning, while 63.8% addressed physical activity adjustments, and 68.1% counseled on medication regimen changes. The most frequently reported barriers were time constraints (85.7%), lack of updated training (84.7%), and inadequate counseling privacy (79.8%). Prior training was associated with higher knowledge and practice scores (p = 0.001). Pharmacists who attended training workshops demonstrated higher mean knowledge and practice scores than untrained pharmacists.

CONCLUSION: Community pharmacists in the Aseer Region demonstrated generally adequate knowledge and positive attitudes regarding diabetes management during Ramadan, particularly in fasting-safety counseling and patient education. However, important gaps remained in advanced medication regimen adjustment practices, especially insulin dose modification, as well as participation in structured public education activities. Continuing professional development programs focused on Ramadan-specific diabetes management and interprofessional collaboration may improve pharmacist-led diabetes care during Ramadan.

PMID:42371575 | PMC:PMC13310557 | DOI:10.3389/fphar.2026.1827330

Front Surg. 2026 Jun 15;13:1841574. doi: 10.3389/fsurg.2026.1841574. eCollection 2026.

ABSTRACT

OBJECTIVE: To discuss the clinical efficacy of the modified overlapping suture technique to treat horse-tail-like Achilles tendon tears.

METHODS: A retrospective analysis was conducted on data from 57 patients with horse-tail-like Achilles tendon tears treated with the overlapping suture technique from May 2020 to May 2024. Calculate the final Arner-Lindholm scores and compare the AOFAS scores, maximum plantar flexion angle, and dorsiflexion angle of the ankle joint before and after surgery, and record the muscle strength of the plantar flexor muscles of the ankle joint and compare it with that before the surgery.

RESULTS: On average, 57 patients completed follow-up within 2 years. One patient experienced delayed wound healing after surgery, two patients re-ruptured their Achilles tendons three weeks post-surgery due to accidental falls, and one patient had a contralateral Achilles tendon rupture 2-4 years post-surgery. In addition, there were no symptoms of peroneal nerve injury after the surgery. The excellent and good rate of the Arner-Lindholm score after surgery was 98.2%; the postoperative AOFAS scores were (92.56 ± 6.71) points, (95% CI, 90.81-94.30), which showed a significant difference compared to the preoperative score of (64.92 ± 9.08) points, (95% CI, 62.56-67.27) (p 0.00<0.01). The muscle strength of the plantar flexor group in the affected ankle joint post-surgery was (4.62 ± 1.7) grades (95% CI, 4.17-5.06), which showed no statistical significance compared to the healthy side (4.80 ± 1.3) grades (95% CI, 4.46-5.13) (p 0.527 > 0.05); however, there was a significant difference compared to the pre-surgery muscle strength of the plantar flexor group on the affected side (3.2 ± 0.7) grades (95% CI, 3.01-3.8) (p 0.00 < 0.01). In the final follow-up, the maximum plantar flexion angle of the affected ankle joint post-surgery was (37.1 ± 3.1)° (95% CI, 36.2-37.9)°, which showed no statistical significance compared to the maximum plantar flexion angle of the healthy side (38.3 ± 3.9)° (95% CI, 37.2-39.2)° (p 0.072 > 0.05); the dorsiflexion angle of the ankle joint post-surgery was (18.3 ± 2.2)° (95% CI, 17.7-18.8)°, which showed no statistical significance compared to the dorsiflexion angle of the healthy side (18.2 ± 1.4)° (95% CI, 17.8-18.5)° (p 0.773 > 0.05).

CONCLUSIONS: The modified overlapping suture technique can be used to treat patients with horse-tail-like Achilles tendon tears. After treatment, the motor function of their lower limbs can be restored. In addition, there are a few complications.

PMID:42371574 | PMC:PMC13310559 | DOI:10.3389/fsurg.2026.1841574

Nat Sci Sleep. 2026 Jun 24;18:597195. doi: 10.2147/NSS.S597195. eCollection 2026.

ABSTRACT

PURPOSE: The microbiota-gut-brain axis offers a novel framework for understanding insomnia; however, the hypothesis that specific immune pathways mediate the causal effects of gut microbial taxa on insomnia requires supporting genetic evidence. This study aimed to explore the genetic evidence supporting the causal interplay between the gut microbiota, immune phenotypes, and insomnia using large-scale genetic data.

PATIENTS AND METHODS: We employed two-sample bidirectional Mendelian Randomization (MR) using large-scale genome-wide association study (GWAS) summary statistics for gut microbiota, 731 immune cell phenotypes, and insomnia (FinnGen R12). Mediation analysis was conducted to quantify the specific indirect effects of immune cells.

RESULTS: We found suggestive genetic evidence linking 13 gut microbial taxa to insomnia risk. Notably, a directional divergence was observed within the Blautia genus at the species level, where Blautia A sp900066355 showed a robust protective association (surviving FDR correction), whereas other species within the genus increased risk at a nominal significance level (uncorrected P < 0.05). Furthermore, 17 immune phenotypes were found to be associated with insomnia. Exploratory mediation analysis suggested that monocytic myeloid-derived suppressor cells (M-MDSCs) may mediate the pathway linking the uncultured bacterium CAG-177 to insomnia, accounting for 10.7% of the total effect.

CONCLUSION: This study provides preliminary genetic evidence linking specific gut microbial taxa and immune phenotypes to insomnia risk, with Blautia A sp900066355 demonstrating robust protective effects. As a secondary hypothesis-generating observation, we propose a preliminary hypothesis that the depletion of protective M-MDSCs, rather than solely pro-inflammatory activation, may contribute to insomnia pathogenesis. Given the borderline statistical significance of this mediation finding, drawing direct therapeutic implications is currently premature.

PMID:42371562 | PMC:PMC13310490 | DOI:10.2147/NSS.S597195

Intest Fail. 2026 Feb 12;10:100361. doi: 10.1016/j.intf.2026.100361. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: A new role within an intestinal failure unit was devised, which involved training a dietitian to undertake the role of an Advanced Practitioner working within the medical team. In the United Kingdom, dietitians can only undertake supplementary prescribing qualifications, and this study evaluates the safety and effectiveness of this type of prescribing practice in an intestinal failure Advanced Practitioner role.

MATERIALS AND METHODS: All adult inpatients with types 2 and 3 intestinal failure were included. An appropriate clinical management plan was agreed by the multidisciplinary team and a medical and surgical consultant reviewed the prescriptions made, including the clinical indication and rationale. Descriptive statistical analysis was used and data presented as means (+/- standard deviation) for continuous variables and percentages for categorical variables.

RESULTS: A total of 1030 prescription episodes were made by the supplementary prescriber in the 6-month study period. Of these episodes, 96.2 % (n = 991) related to parenteral or intravenous fluid prescriptions; 13.6 % (n = 135) of which related to a combination of parenteral support and intravenous fluid prescriptions and 0.2 % (n = 2) of these episodes were for resuscitation purposes. No prescription amendments were required following a weekly review by the medical or surgical consultant.

CONCLUSION: This study demonstrates that a dietetic-based Advanced Practitioner in a busy intestinal failure unit effectively and safely incorporated supplementary prescribing into their role. Supplementary prescribing was used to initiate a range of prescriptions, as part of a clinical management plan, and all were deemed to be the optimal prescription choice for the indication identified.

PMID:42371560 | PMC:PMC13310593 | DOI:10.1016/j.intf.2026.100361

Intest Fail. 2026 Feb 7;10:100355. doi: 10.1016/j.intf.2026.100355. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Parenteral nutrition (PN) is essential for patients with intestinal failure (IF) but is associated with complications such as dysbiosis, small intestinal bacterial overgrowth, catheter-related infections, and intestinal failure-associated liver disease (IFALD). Growing evidence indicates that gut microbiota alterations contribute to the pathogenesis of these complications, supporting microbiota-oriented interventions as potential adjunctive therapies.

METHODS: Data sources: A structured literature search was conducted in PubMed, Web of Science, and Scopus from inception to December 2025.Study eligibility criteria: Clinical trials, observational studies, mechanistic studies, and relevant reviews evaluating gut microbiota features or microbiome-targeted interventions in IF or PN-dependent populations were included.Participants: Pediatric and adult patients with intestinal failure or short bowel syndrome, as well as relevant animal models.Interventions: Microbiota-oriented strategies, including probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT).Statistical analysis: Due to substantial heterogeneity in study design, interventions, and outcomes, meta-analysis was not performed; findings were synthesized qualitatively.

RESULTS: PN dependence was consistently associated with reduced microbial diversity, enrichment of Proteobacteria and Lactobacillaceae, and depletion of obligate anaerobes and short-chain fatty acid-producing taxa. Microbiota-oriented interventions demonstrated biological plausibility and microbiome modulation in selected studies; however, clinical benefits were variable and generally modest. Safety concerns, limited microbial engraftment, small sample sizes, and patient heterogeneity limited generalizability.

CONCLUSION: Gut microbiota dysbiosis plays a contributory role in PN-related complications of IF. Microbiota-oriented interventions are promising but remain unproven, underscoring the need for well-designed, stratified clinical studies to define efficacy, safety, and responsive patient subgroups.

PMID:42371558 | PMC:PMC13310592 | DOI:10.1016/j.intf.2026.100355

PeerJ. 2026 Jun 25;14:e21430. doi: 10.7717/peerj.21430. eCollection 2026.

ABSTRACT

BACKGROUND: Khat use is an increasing public health concern in Somaliland, linked to various mental, physical, social, and psychological problems.

OBJECTIVE: This study examined the effect of khat consumption on work performance among small business employees in the City-Center Market, Hargeisa, Somaliland.

METHODOLOGY: A quantitative cross-sectional design was employed, with purposive sampling of 150 male respondents. Data were collected through a structured Likert-scale questionnaire measuring khat consumption patterns and work performance. Reliability was confirmed using Cronbach’s alpha, and multiple linear regression analysis was applied to assess the predictive effect of khat consumption on work performance. Demographic and occupational variables (education level, marital status, employment type, type of khat commonly chewed, and age categories) were included as controls.

RESULTS: Regression analysis showed khat consumption was significantly associated with work performance (B = 0.774, β = 0.879, t = 15.062, p < 0.001). Higher levels of khat use were associated with lower work performance, while other variables including education level (p = 0.281), marital status (p = 0.548), employment type (p = 0.902), type of khat (p = 0.700), and age (p = 0.429) showed no statistically significant effects.

CONCLUSION: The study suggests that khat consumption may negatively influence employee productivity, while demographic and occupational factors appear to have limited influence. These findings highlight the importance of workplace awareness and policy measures aimed at reducing the potential adverse impact of khat use on work performance.

PMID:42371551 | PMC:PMC13310483 | DOI:10.7717/peerj.21430