Tag: statistics

Hypertension. 2025 Oct 29. doi: 10.1161/HYPERTENSIONAHA.125.25202. Online ahead of print.

ABSTRACT

BACKGROUND: Midlife hypertension is linked to white matter injury and dementia, partly through cerebral small vessel disease. We examined how age and systolic blood pressure (SBP) affect progression of 2 cerebral small vessel disease markers, white matter hyperintensity volume (WMHv), and peak width of skeletonized mean diffusivity, in the SPRINT (Systolic Blood Pressure Intervention) and ACCORD (Action to Control Cardiovascular Risk in Diabetes) trials.

METHODS: We assessed age modification of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP treatment on peak width of skeletonized mean diffusivity (n=440) and asinh transformed WMHv (n=449) progression using linear mixed models in SPRINT using age as a continuous variable and by age group (≤65, 66-75, and >75 years). We performed similar analyses in ACCORD (n=172) on WMHv progression, continuously and in 2 age groups (≤65, 65-79 years).

RESULTS: In SPRINT, the overall interaction between age and SBP on WMHv change was not statistically significant (P=0.18). However, intensive SBP treatment demonstrated a stepwise greater longitudinal WMHv reduction with younger age ≤65 years (-0.19 [95% CI, -0.28 to -0.11]), 66 to 75 years (-0.11 [95% CI, -0.19 to -0.02]), >75 years (-0.06 [95% CI, -0.20 to 0.09]), corresponding to respective reductions of 75%, 34%, and 19%. Intensive treatment produced a similar pattern in peak width of skeletonized mean diffusivity progression, with a significant treatment effect in those ≤65 only (P=0.15 for overall treatment by age interaction). In ACCORD, intensive SBP-lowering was associated with reduced WMHv progression in the younger (≤65) compared with the older age group (P=0.038).

CONCLUSIONS: Intensive SBP control may be more effective in reducing white matter injury at younger compared with older ages.

PMID:41159258 | DOI:10.1161/HYPERTENSIONAHA.125.25202

Curr Med Res Opin. 2025 Oct 29:1-10. doi: 10.1080/03007995.2025.2580031. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare healthcare utilization and costs in RSV- and influenza-vaccinated vs unvaccinated and influenza-only vaccinated older, US adults in 2023.

METHODS: We used a retrospective, cohort study design and the Humana Healthcare Research database to identify individuals enrolled in a Medicare Advantage Prescription drug plan who received RSV vaccination from August 1, 2023 to December 31, 2023. Six-month follow-up through June 30, 2024 was indexed hierarchically on RSV vaccination, influenza vaccination (adults without RSV vaccination), or a primary care visit (adults without RSV and influenza vaccination). We used propensity score matching to adjust for baseline differences and generalized linear regression models to estimate difference-in-difference measures of all-cause inpatient stays, ED visits, outpatient visits, and healthcare costs in the 6 months following index compared with the 12-month baseline period.

RESULTS: RSV- and influenza-vaccinated individuals had lower ED utilization (16.1% vs 18.6%), fewer inpatient stays (5.1% vs 6.6%), and lower Per Person Per Month (PPPM) medical costs (-13.5%) compared with unvaccinated individuals. RSV- and influenza-vaccinated individuals had lower ED utilization (15.6% vs 16.6%), fewer inpatient stays (4.9% vs 5.4%), and lower PPPM medical costs (-4.7%) compared with those who were vaccinated against influenza only. All results were statistically significant at the p < 0.001 level.

CONCLUSIONS: At 6 months following RSV and influenza vaccination, there is a reduction in medical costs due to fewer inpatient stays and ED visits. This finding highlights the clinical and economic value of vaccination programs for reducing healthcare system burden and improving population health outcomes.

PMID:41159254 | DOI:10.1080/03007995.2025.2580031

Public Health Nurs. 2025 Oct 29. doi: 10.1111/phn.70032. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to examine the relationship between parents’ e-health literacy and attitudes toward childhood vaccination.

DESIGN: A descriptive-correlational study.

SAMPLE: The study included 396 parents of children aged 0 to 72 months, recruited between May and December 2022.

MEASUREMENTS: Data were collected using the Demographic Information Form, the E-Health Literacy Scale (E-HLS), and the Caregiver Vaccination Attitudes Scale (CVAS). Analyses were performed using SPSS (version 24).

RESULTS: The mean age of the parents was 30.13 ± 5.22 years. E-HLS scores differed significantly by education level (F = 6.914, p < 0.001, η² = 0.034), with higher scores among university-educated parents (29.72 ± 5.99) compared to those with secondary (26.86 ± 6.64) or primary education (27.48 ± 5.98). Economic status also showed significant differences in E-HLS (KW = 6.982, p = 0.03, ε² = 0.012); parents with good economic status (29.54 ± 5.89) scored higher than those with poor status (26.35 ± 4.32). A statistically significant but weak positive correlation was found between CVAS and E-HLS (r = 0.172, p < 0.001), indicating a small effect size.

CONCLUSIONS: This study showed that parents with higher e-health literacy tend to have more positive attitudes toward childhood vaccination. However, the relationship between these two variables was weak, suggesting only a limited association between e-health literacy and vaccination attitudes. In addition, parents with higher education and better economic status had higher e-health literacy scores. Due to the weak correlation observed, it is important for nurses to understand that increasing e-health literacy alone is unlikely to produce significant improvements in parental vaccination attitudes. Despite the weak correlation, these results may help guide future research exploring the broader context of vaccine attitudes among parents.

PMID:41159252 | DOI:10.1111/phn.70032

Laryngoscope. 2025 Oct 29. doi: 10.1002/lary.70064. Online ahead of print.

NO ABSTRACT

PMID:41159249 | DOI:10.1002/lary.70064

J Res Health Sci. 2025 Sep 15;25(4):e00662. doi: 10.34172/jrhs.9131. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: The urban poor represent a vulnerable population within society, particularly in terms of maternal health. Economic and access-related limitations often prevent this group from accessing healthcare services, especially in the institutional delivery process. This study aimed to analyze the barriers to institutional delivery among Indonesia’s poor urban society. Study Design: This study employed a cross-sectional design.

METHODS: Data were obtained from the 2023 Indonesian Health Survey, including 7,548 participants. Eight independent variables were analyzed, including age, education, marital status, employment, wealth, insurance, and parity, with institutional delivery used as the dependent variable. Binary logistic regression was employed for analysis.

RESULTS: Approximately 38.1% of Indonesian pregnant women had non-institutional deliveries. All age groups showed a higher likelihood of non-institutional delivery compared to those aged≥45. Lower education levels were associated with a heightened probability of choosing non-institutional delivery. Married women were 0.704 times less likely than divorced or widowed women to give birth in non-institutional settings (AOR: 0.704; 95% CI: 0.693-0.716). Unemployed women had 1.218 times higher likelihood of engaging in non-institutional delivery compared to employed women (AOR: 1.218; 95% CI: 1.1210-1.226). The poorest women were 0.973 times less likely than the poorer group to have non-institutional delivery (AOR: 0.973; 95% CI: 0.967-0.980). Uninsured women were 2.364 times more likely than insured women to give birth outside of healthcare institutions(AOR: 2.364; 95% CI: 2.345-2.379). Women with all other parity levels were less likely than grand multiparous women to have non-institutional deliveries.

CONCLUSION: Seven barrier factors to institutional delivery were younger age, low education, divorced/widowed marital status, unemployment, lower wealth status, lack of insurance, and grand multiparity.

PMID:41159206 | DOI:10.34172/jrhs.9131

J Res Health Sci. 2025 Sep 15;25(4):e00661. doi: 10.34172/jrhs.11317. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: Substance use is common among street adolescents and is strongly associated with sexual risk behavior as well as vulnerability to sexually transmitted infections. Therefore, this study was conducted to explore patterns of substance use and the association with sexual risk behavior among street adolescents in Central Java, Indonesia. Study Design: A cross-sectional study.

METHODS: In this cross-sectional study, data were collected from 248 street adolescents through face-to-face interviews using a validated questionnaire. Data analysis was conducted using descriptive statistics, chi-square tests, and multivariate logistic regression in SPSS version 25.0.

RESULTS: More than a quarter of adolescents reported engaging in high-risk sexual behavior. Heavy smoking, alcohol use, and frequent exposure to pornography were prevalent. Alcohol use was significantly associated with sexual risk behavior, with adjusted odds ratios ranging from 3.26 to 4.38 across Models I-III. Furthermore, frequent exposure to pornography showed a strong association, with odds ratios of 3.02 (Model I) and 4.20 (Model II). These associations remained significant after adjusting for demographic and behavioral variables.

CONCLUSION: Substance use, particularly alcohol consumption, and frequent exposure to pornography were significantly associated with sexual risk behavior among street adolescents. Therefore, interventions should be developed to address the specific needs of this population. Adolescents engaged in high-risk behavior, such as substance use and sexual risk behavior, required high attention and specific treatment options.

PMID:41159205 | DOI:10.34172/jrhs.11317

Front Neurol. 2025 Oct 13;16:1678379. doi: 10.3389/fneur.2025.1678379. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of 5 Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (left DLPFC) for consciousness recovery in children with disorders of consciousness (DOC) following traumatic brain injury (TBI).

METHODS: This randomized controlled trial included 98 pediatric patients aged ≥2 years with DOC after TBI, admitted to Kunming Children’s Hospital from January 2023 to July 2025. Patients were randomly divided into an experimental group (n = 49) and a control group (n = 49). The experimental group received 5 Hz rTMS targeting the left DLPFC (80% resting motor threshold, 1,000 pulses per session, totaling 20 min), combined with conventional rehabilitation therapy (once daily for 3 weeks). The control group received only conventional rehabilitation therapy. The primary efficacy outcomes included serum neuron-specific enolase (NSE) level, Coma Recovery Scale-Revised (CRS-R) score, Glasgow Coma Scale (GCS) score, and level of consciousness before and after treatment.

RESULTS: After 3 weeks of intervention, the experimental group demonstrated statistically significant improvements compared to both baseline status and the control group (p < 0.05). The experimental group demonstrated a significant reduction in serum NSE levels, a significant increase in CRS-R and GCS scores, and a significant improvement in the level of consciousness. No adverse events (including seizures) were observed throughout the treatment.

CONCLUSION: This study provided the first clinical evidence that the combined application of 5 Hz rTMS targeting the left DLPFC is a safe and effective intervention for promoting the recovery of consciousness in children with DOC following TBI. Significant improvements in behavioral scales (CRS-R, GCS) and reduced levels of the neurological injury marker (serum NSE) suggest that this protocol exerts dual effects of promoting arousal and neuroprotection. This novel treatment approach, designed based on the characteristics of pediatric neurological development, offers a promising non-invasive neuromodulation strategy for this challenging patient population, filling a critical evidence gap in this field.

PMID:41159198 | PMC:PMC12554438 | DOI:10.3389/fneur.2025.1678379

Endocrinol Diabetes Metab. 2025 Nov;8(6):e70121. doi: 10.1002/edm2.70121.

ABSTRACT

BACKGROUND: Recent human studies have indicated the beneficial effects of yacon on diabetes and metabolic syndrome; however, no meta-analysis has investigated the effects of yacon on glycemic control and lipid profiles.

METHODS: Searches were conducted in five databases-PubMed, Web of Science, Scopus, Google Scholar, Cochrane Library-and relevant randomised controlled trials (RCTs) until June 2024. The random-effects model was employed to compute the effect size, thereafter represented as a weighted mean difference (WMD) and a 95% confidence interval (CI). This study’s registration number in PROSPERO is CRD420251028504.

RESULTS: This study integrated seven RCTs with 239 participants. The results demonstrated that yacon consumption had no statistically significant effects on fasting blood sugar (FBS, p = 0.33), insulin levels (p = 0.76), homeostasis model assessment for insulin resistance (HOMA-IR, p = 0.42), total cholesterol (TC, p = 0.17), low-density lipoprotein (LDL, p = 0.12), high-density lipoprotein (HDL, p = 0.42), or triglycerides (TG, p = 0.75). However, subgroup studies indicated that yacon consumption reduced FBS levels over an exceeding 8-week duration in both sexes and in persons over 40. Furthermore, yacon intake resulted in a decrease in LDL-cholesterol levels for more than 8 weeks, particularly in women and individuals over 40. Additionally, it led to a decrease in LDL-cholesterol levels among women and individuals over 40 who consumed yacon for more than 8 weeks, and HDL-cholesterol levels increased in those aged 40 and above.

CONCLUSION: Overall, this meta-analysis indicates that yacon use in adults does not lead to significant improvements in lipid profiles or glycemic parameters.

PMID:41152200 | DOI:10.1002/edm2.70121

Colorectal Dis. 2025 Nov;27(11):e70291. doi: 10.1111/codi.70291.

ABSTRACT

AIM: Individual components of surgical quality in locally advanced rectal cancer (LARC) – circumferential and distal resection margins and mesorectal completeness – are known prognostic factors. However, their combined prognostic value as a composite score remains underexplored. This study aimed to evaluate the impact of a composite quality total mesorectal excision (TME) score on oncological outcomes, and how this effect may vary with intervals from neoadjuvant therapy (NAT) to surgery.

METHOD: This retrospective, multicentre cohort study included patients with LARC treated between 2005 and 2020 across six referral centres in the CRONOS study. Patients were categorised by the composite quality TME (successful/unsuccessful) and by the NAT-to-TME interval: short (≤8 weeks), intermediate (>8 to ≤12), or long (>12). Primary outcomes were locoregional recurrence (LR), systemic recurrence (SR), and overall survival (OS) in the unsuccessful group. The interaction between the composite score and NAT-to-TME interval was assessed as a secondary outcome.

RESULTS: Of 1485 patients, 191 (12.9%) had an unsuccessful composite quality TME. This was significantly associated with increased risk of LR (HR 4.63, 95% CI: 3.04-7.05), SR (HR 2.10, 95% CI: 1.56-2.81), and reduced OS (HR 2.31, 95% CI: 1.79-2.98). Short and intermediate intervals increased the risk of LR in the unsuccessful group (p_interaction = 0.06).

CONCLUSION: Patients with an unsuccessful composite quality TME are at high risk of recurrence and death. The link between shorter NAT-to-surgery intervals and poorer outcomes in this subgroup suggests that extending the interval beyond 12 weeks may help optimise results in selected patients.

PMID:41152188 | DOI:10.1111/codi.70291

Alzheimers Dement. 2025 Oct;21(10):e70864. doi: 10.1002/alz.70864.

ABSTRACT

INTRODUCTION: Evidence is needed to evaluate whether low vitamin B₁₂ from mid- to late life, either alone or in the presence of elevated folate, is associated with cognitive decline.

METHODS: Participants from the Framingham Heart Study without baseline dementia who had ≥ 2 measures of a three-component vitamin B₁₂ indicator (3cB₁₂) and neuropsychological factor scores were included (n = 1994; mean age: 60 years). Adjusted linear mixed effects models estimated annual changes in each factor score between 3cB₁₂ quartiles. Interaction by folate status was also evaluated.

RESULTS: Participants in the highest 3cB₁₂ quartile had slower declines in memory, executive function, and language compared to the lowest quartile (memory: β = 0.0071, 95% confidence interval [CI] = 0.003-0.01; executive function: β = 0.0056, 95% CI = 0.0009-0.01; and language: β = 0.0090, 95% CI = 0.004-0.01). Findings were largely robust by folate status (elevated: ≥ 20 ng/mL; non-elevated: 6-19 ng/mL).

DISCUSSION: Improving B₁₂ status in dementia-free older adults may help mitigate cognitive decline into later life.

HIGHLIGHTS: Higher vitamin B₁₂ status is associated with slower annual cognitive decline. Higher B₁₂ was linked with 0.05 to 0.09 standard deviation less cognitive decline over 10 years. B₁₂ and memory findings are robust for elevated, not non-elevated, folate status.

PMID:41152187 | DOI:10.1002/alz.70864