Tag: statistics

F S Rep. 2025 May 9;6(3):270-279. doi: 10.1016/j.xfre.2025.05.002. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: To examine the utility of semen parameters and sperm mitochondrial DNA copy number (mtDNAcn) to predict couples’ time to pregnancy (TTP).

DESIGN: This study assessed the predictive power of sperm mtDNAcn and 34 semen parameters. Two composite semen quality indices (SQIs) were developed; an unweighted ranked-sperm quality index (ranked-SQI) derived from only semen parameters and a weighted sperm quality index generated using machine learning via elastic net (ElNet-SQI). Discrete-time proportional hazard models, logistic regression, and receiver operating characteristic (ROC) analyses were used to evaluate the predictive ability of achieving pregnancy at 3, 6, and 12 months, and the overall TTP.

SUBJECTS: The participants included 281 men from the Longitudinal Investigation of Fertility and the Environment study, a large preconception general population cohort designed to explore factors affecting conception.

EXPOSURE: Sperm mtDNAcn, 34 semen parameters, unweighted ranked-SQI, and a machine learning-based weighted SQI were evaluated for the ability to predict pregnancy.

MAIN OUTCOMES MEASURES: The main outcome measures were the overall time taken to achieve pregnancy and the likelihood of achieving pregnancy within 3, 6, or 12 months of trying to conceive.

RESULTS: For individual semen measures, sperm mtDNAcn was most predictive of pregnancy at 12 menstrual cycles in ROC analyses (area under the curve [AUC], 0.68; 95% confidence interval [CI], 0.58-0.78). Among multiparameter biomarkers, ElNet-SQI (comprised of 8 semen parameters and mtDNAcn), demonstrated the highest AUC, 0.73; 95% CI, 0.61-0.84) for pregnancy status at 12 cycles. Furthermore, ElNet-SQI was the most strongly associated with TTP than any other individual or combinations of semen parameters (fecundability odds ratio [FOR], 1.30; 95% CI, 1.14-1.45; P=6.0∗10^-5).

CONCLUSION: Sperm mtDNAcn is associated with multiple conventional and detailed semen parameters. Moreover, a composite machine learning ElNet-SQI that included mtDNAcn and several semen parameters had the highest predictive ability of pregnancy. These results indicate that sperm mtDNAcn can serve as a biomarker of overall sperm fitness and likelihood of reproductive success.

PMID:41054723 | PMC:PMC12496432 | DOI:10.1016/j.xfre.2025.05.002

Reprod Health. 2025 Oct 6;22(1):184. doi: 10.1186/s12978-025-02070-6.

ABSTRACT

BACKGROUND: This study explores the awareness and predictors of knowledge regarding sexually transmitted diseases among early adolescents (ages 11-15) in the Koforidua Municipality.

METHODS: The study was designed as convergent parallel mixed-methods research hinged on an analytical cross-sectional and descriptive phenomenological design. In all, 373 adolescents were surveyed, obtaining varied insights across different demographic groups, with an additional 10 interviews conducted for qualitative analysis. Quantitative data were analyzed using descriptive statistics and multilevel logistic regression, while the qualitative data were thematically analyzed.

RESULTS: Two-thirds (67.3%) of early adolescents reported awareness of STDs. 134(53.4%) out of the 251 early adolescents who were aware of STDs opted to test for them. HIV (M = 1.33, SD = 0.699), and Gonorrhea (M = 1.55, SD = 0.827) were the most commonly recognized infections but misconceptions about Syphilis (M = 1.94, SD = 0.929), Chlamydia (M = 2.49, SD = 0.778), Genital wart (M = 2.35, SD = 0.854) and Hepatitis (M = 2.36, SD = 0.755) as types of STDs were dominant. Early adolescents in Junior High School -JHS1 (AOR 0.307 (95.0% CI 0.111-0.847 p = 0.023), JHS 2 (AOR 0.201 (95.0% CI 0.070-0.579 p = 0.003), JHS 3 (AOR 0.134 (95.0% CI 0.043-0.414 p = 0.00) were less likely to know STDs compared to those in primary six. Early adolescents who had never dated (AOR 0.705 (95.0% CI 0.423-1.173 p = 0.014) were also less likely to know about STDs compared to those who had ever dated.

CONCLUSION: The findings highlight the need for the Ghana Education Service to integrate comprehensive sexual health education into primary and junior high school curricula to improve STD knowledge among early adolescents.

PMID:41053753 | DOI:10.1186/s12978-025-02070-6

Malar J. 2025 Oct 6;24(1):318. doi: 10.1186/s12936-025-05433-3.

ABSTRACT

BACKGROUND: Effective malaria control in under-five children depends on caregivers seeking timely medical care. However, despite available healthcare services, many caregivers do not utilize health facilities, undermining malaria control efforts. This study assessed care-seeking behaviour of caregivers for suspected malaria in under-five children and associated factors in a southwest state of Nigeria.

METHODS: A cross-sectional analytical study was conducted in Ondo State, Southwestern Nigeria. The study areas were Ifedore, Ondo East, and Idanre Local Government Areas (LGAs) randomly selected from the eighteen LGAs in Ondo state. A multistage sampling technique was used to select participants and data was collected using a structured questionnaire. Descriptive and inferential statistics were applied to analyse the data, with logistic regression identifying significant predictors of care-seeking behaviour of caregivers of under-five children at p-value < 0.05.

RESULTS: The study included 301 caregivers of under-five children, predominantly aged 26-45 years (69.4%), males were 50.8% compared to females (49.2%) and 66.1% residing in rural areas. While 84.4% of caregivers identified infected mosquito bites as the cause of malaria, and 98.3% recognized fever as a main symptom, only 51.2% demonstrated good overall knowledge of malaria and symptoms in under-five children. Although 94.0% of caregivers suspected malaria in their under-five children within 12 months prior to the study, however, only 9.3% visited a health facility for treatment of their under-five children. In contrast, 37.4% purchased drugs from patent medicine vendors and pharmacies, while 25.2% used herbs for home management. Bivariate analysis showed significant associations between health facility visits and being a female caregiver (p = 0.009), urban residence (p = 0.002), residing within 5 km of a facility (p = 0.021), and good malaria knowledge (p = 0.033). Multivariate logistic regression indicated that female caregivers (aOR = 3.32, 95% CI 1.29-8.54), urban residents (aOR = 4.25, 95% CI 1.72-10.48), residing within 5 km of a health facility (aOR = 3.38, 95% CI 1.03-11.07), and those with good malaria knowledge (aOR = 4.16, 95% CI 1.61-10.77) were significant predictors of visiting a health facility for malaria care for under-five children with suspected malaria by caregivers.

CONCLUSION: The study revealed low utilization of health facilities by caregivers seeking malaria treatment for under-five children with suspected malaria. Therefore, targeted community awareness campaigns are recommended to encourage caregivers to seek prompt, facility-based malaria care for under five children. Furthermore, in hard-to-reach or underserved rural areas with limited access to healthcare services, training and sensitization programmes for caregivers on appropriate home-based management of malaria including the use of pre-packaged artemisinin-based combination therapies are recommended.

PMID:41053751 | DOI:10.1186/s12936-025-05433-3

Lipids Health Dis. 2025 Oct 6;24(1):309. doi: 10.1186/s12944-025-02732-1.

ABSTRACT

BACKGROUND: The triglyceride-glucose index (TyG) and C-reactive protein (CRP) are key biomarkers on clinical diagnosis, each related to lung dysfunction. However, the relationship of both indexes with the risk of chronic obstructive pulmonary disease (COPD) is still unclear. This study purposes to focus on the individual and joint associations of TyG and CRP levels with COPD risk.

METHODS: This cohort study utilized baseline TyG and CRP data from the UK Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) for COPD risk associated with TyG and CRP levels were calculated through Cox regression models. Receiver operating characteristic (ROC) curves were conducted to determine the optimal cut-off values for TyG and CRP, which were combined into a joint variable. Kaplan-Meier (KM) method was utilized to analyze cumulative hazard, while joint analysis was employed for evaluating the joint risk. Stratified and sensitivity analyses were also performed to assess the associations within subgroups, and mediation effect of TyG on COPD risk via CRP levels was assessed.

RESULTS: This study enrolled 385,523 individuals, with 10,515 COPD cases were recorded in follow-up. Compared to the lowest quintile, individuals with higher TyG and CRP had increased risk of COPD (all HRs > 1.00). The optimal cut-off values of TyG and CRP were 7.14 and 1.88 mg/L, and we found that the simultaneous elevation of both TyG and CRP significantly increased the risk of COPD. Moreover, the joint effect was stronger in participants younger than 60 years old, males, smokers or passive smokers, those with body mass index (BMI) < 25.0 kg/m², and those without baseline diabetes, asthma, or a family history of respiratory diseases (P _{for interaction} < 0.05). Moreover, the effect of TyG on COPD was significantly mediated by CRP, explaining almost 15.6% of this influence.

CONCLUSIONS: These results underscored the individual and joint effects of TyG and CRP upon COPD risk, indicating their usefulness as biomarkers for early risk assessment.

PMID:41053749 | DOI:10.1186/s12944-025-02732-1

BMC Health Serv Res. 2025 Oct 6;25(1):1308. doi: 10.1186/s12913-025-13151-4.

ABSTRACT

BACKGROUND: This study describes and compares the utilisation rates of specialist mental health and addiction (MH) services between different refugee groups and the New Zealand (NZ) resident population.

METHODS: Using linked data in Statistics NZ’s Integrated Data Infrastructure, we identified 23,709 individuals with an asylum seeker or refugee visa who stayed in NZ for at least 6 months. Logistic regression models compared the use of MH services between different refugee groups (quota refugees, convention refugees, family reunification, and asylum seekers). We conducted cox regression hazard models to investigate the time to the first service use between refugee groups and a sample of NZ resident population, including NZ-born and overseas-born individuals.

RESULTS: Adjusting for age, sex, ethnicity, neighbourhood deprivation, and time spent in NZ, we found that asylum seekers, family, and convention refugees were less likely to utilise MH services than quota refugees. The following groups had higher odds of utilising MH services: females compared with males (OR = 1.46, 95%CI = 1.35, 1.59) and those living in more deprived neighbourhoods compared with less deprived areas (OR = 1.27; 95%CI = 1.18, 1.38). Quota refuges were more likely to use MH services compared to the NZ-born group (HR = 1.94, 95%CI = 1.86, 2.03). Convention, family and asylum seekers were less likely to utilise MH services than the NZ-born population (HR = 0.82; [95% CI = 0.76, 0.89], HR = 0.54; [95% CI = 0.46, 0.64], and HR = 0.71, [95%=0.59, 0.86], respectively). We found that quota refugees’ primary source of MH service use was NGOs whereas for other refugee sub-groups, it has been District Health Boards.

CONCLUSION: The use of MH services differed between refugee groups. Quota refugees were more likely to utilise services, mainly from NGOs, with women and those who lived in the most deprived areas more likely to use MH services. These results have policy implications, such as improving early service accessibility for all refugee sub-groups.

PMID:41053745 | DOI:10.1186/s12913-025-13151-4

BMC Surg. 2025 Oct 6;25(1):453. doi: 10.1186/s12893-025-03201-3.

ABSTRACT

BACKGROUND: This study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application.

METHODS: A retrospective analysis was conducted on 101 patients who underwent laparoscopic radical resection(LAR) for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into three groups: 26 in the ileum group (using terminal ileal stents) ,54 in the in situ group (using rectal in situ covered stents) and 21 in the control group. Preoperative, surgical, and postoperative data were compared among the three groups.

RESULTS: No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage or other complications. The in situ group showed no statistically significant differences from the control group in the postoperative hospital stay(12.6 ± 3.7 vs. 11.4 ± 2.9days, p > 0.05 ), total cost of hospitalization (48903.58 ± 7094.14 vs. 82205.77 ± 12222.41yuan, p > 0.05). Moreover, the ileum group in these comparisons performed worse than the control group. After incorporating data related to stoma closure surgery, the in situ group and ileum group showed significant advantages in overall hospitalization costs(59085.88 ± 7460.79 vs. 48903.58 ± 7094.14 vs. 81418.32 ± 11186.78yuan, p < 0.05), and the in-situ group also had shorter overall hospital stay(17.6 ± 5.0 vs. 22.2 ± 4.0days, p < 0.05).

CONCLUSIONS: Both fecal diversion methods showed acceptable rates of postoperative anastomotic leakage and can avoid a second stoma closure surgery. The in situ covered stent method seemed better as it not only saved hospitalization time and costs but also made postoperative management simpler and more efficient.

PMID:41053739 | DOI:10.1186/s12893-025-03201-3

Cardiovasc Diabetol. 2025 Oct 6;24(1):385. doi: 10.1186/s12933-025-02915-1.

ABSTRACT

BACKGROUND: Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.

AIM: This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.

METHODS: Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.

RESULTS: We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.

CONCLUSIONS: This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.

PMID:41053738 | DOI:10.1186/s12933-025-02915-1

BMC Pulm Med. 2025 Oct 6;25(1):454. doi: 10.1186/s12890-025-03921-5.

ABSTRACT

BACKGROUND: Lung cancer is a leading cause of cancer-related mortality worldwide. Accurate staging of mediastinal lymph nodes is a crucial step in determining appropriate treatment approaches. Current noninvasive diagnostic methods do not provide sufficient accuracy to confidently decide on surgery without histological confirmation. Our study aimed to develop a artificial intelligence model for the precise prediction of N2 lymph node metastasis.

METHODS: We retrospectively analyzed 1489 patients who underwent standard cervical mediastinoscopy at our department, including 472 patients diagnosed with non-small cell lung cancer. We developed three distinct prediction models for N2 lymph node station metastasis: one using standard statistical analysis, another utilizing an image processing deep learning algorithm with thoracic CT, and the third employing various machine learning methods with clinicopathological and radiological data. We compared diagnostic accuracy, area under the curve (AUC), sensitivity, and specificity rates, as well as the F1-score of all models.

RESULTS: Linear discriminant analysis, quadratic discriminant analysis, Gaussian naive Bayes, and artificial neural networks all surpassed 90% accuracy. The linear support vector machine demonstrated the highest performance, with an accuracy of 95.7%, an AUC of 93.5%, and an F1-score of 92%, respectively and outperformed the logistic regression-based statistical model, which reached an accuracy of 90.6% and an AUC of 85.7%.

CONCLUSION: Machine learning models outperformed standard statistical analysis models in predicting N2 lymph node metastasis. Implementing these machine learning prediction models might greatly improve the accuracy of mediastinal lymph node metastasis detection, thereby enhancing clinical decision making and patient outcomes.

PMID:41053734 | DOI:10.1186/s12890-025-03921-5

Reprod Health. 2025 Oct 7;22(1):187. doi: 10.1186/s12978-025-02162-3.

ABSTRACT

BACKGROUND: Maternal and child mortality remains a global public health challenge. Thus, countries, including Tanzania, have adopted different cost-effective models, especially antenatal care (ANC) to improve maternal and child health (MCH). Despite the early timing of ANC visits having a great implication for ensuring improved MCH services, Tanzania has disproportionately experienced late ANC visits among pregnant women. This has entailed conducting an institutional-based study in Western Tanzania, Kasulu Town Council (KTC) to ascertain whether demographic socio-economic and maternal characteristics imply the persistence of late ANC visits using robust methods.

METHODS: An institutional cross-sectional study design was conducted in KTC, Kigoma Region using an embedded mixed-method approach from March-April 2020. Quantitative data was collected from 320 women with children aged 0-6 months attending postnatal services. A total of 40 participants were involved in the qualitative study through in-depth interviews with healthcare providers and focus group discussions held with pregnant women and women with children aged 0-6 months. Descriptive statistics and multivariate binary logistic regression were used to determine the characteristics associated with the timing of ANC visits among pregnant women. Furthermore, thematic analysis was used to generate themes triangulated with quantitative results.

RESULTS: Findings revealed that 32.2% of pregnant women attended ANC visits in the first trimester. Early ANC was associated with maternal age (AOR = 1.839, 95% Cl: 1.023, 3.303), being accompanied by a partner (AOR = 2.165, 95% Cl: 1.256, 3.733), and awareness of the danger signs (AOR = 2.079, 95% Cl: 1.172, 3.687) and parity (AOR = 2.164, 95% Cl: 1.091, 4.291). Little association was noted in the knowledge of ANC timing (AOR = 0.564, 95% Cl: 0.320, 994) and household income (AOR = 0.529, 95% Cl: 0.281, 0.995). Qualitative data indicated that low rate of early ANC initiation was attributed to a lack of support from partners and accompanied to ANC visits, insufficient knowledge of the timing of early ANC visits, and socio-cultural beliefs.

CONCLUSION: Results confirmed that early ANC visit in KTC is low. Revealed associated factors act as a bridge to improve maternal and newborn health and contribute to achieving Sustainable Development Goal no 3, which targets maternal mortality of less than 70 deaths per 100,000 live births and neonatal mortality of 12 per 1000 live births by 2030. Proposed integrated interventions can potentially ensure that women, regardless of pregnancy status, are encouraged to receive early ANC utilisation during the first trimester to receive antenatal care before delivery to improve maternal and newborn health.

PMID:41053705 | DOI:10.1186/s12978-025-02162-3

BMC Public Health. 2025 Oct 6;25(1):3344. doi: 10.1186/s12889-025-24189-8.

ABSTRACT

BACKGROUND: Prisoners are considered a vulnerable group in terms of health risks and limited access to health services. This study aimed to determine the health perceptions and health-promoting behaviors of Turkish prisoners, examine the relationship between these factors, and identify the predictors of health perceptions and health-promoting behaviors as a cross-sectional design.

METHODS: This cross-sectional study was conducted between November 2023 and January 2024 with 234 prisoners convicted of criminal offenses in two open penal institutions in Eskişehir, Turkey. Data were collected using a sociodemographic information form, the Health Perception Scale, and the Healthy Lifestyle Behaviors Scale II. Statistical analyses included Independent Samples t-test, One-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis to identify the predictors of health perceptions and health-promoting behaviors.

RESULTS: The mean score of health perception among the prisoners was 51.43 ± 7.66, and the mean score of healthy lifestyle behaviors was 130.41 ± 26.90. A positive but weak correlation was found between health perception and healthy lifestyle behaviors (r = .319; p < .001).

CONCLUSIONS: The findings highlight the importance of evaluating prisoners’ health perceptions and health-related behaviors. Prison nurses are recommended to routinely assess these factors and implement targeted interventions to support healthy lifestyle changes in prison populations.

PMID:41053702 | DOI:10.1186/s12889-025-24189-8