Tag: statistics

Health Sci Rep. 2025 Nov 9;8(11):e71475. doi: 10.1002/hsr2.71475. eCollection 2025 Nov.

ABSTRACT

BACKGROUND AND AIMS: The burden of chronic kidney disease (CKD) progression remains notably high among patients with CKD, resulting to adverse clinical outcomes. However, there is scarcity of data on CKD progression in patients with cardiorenal anaemia syndrome (CRAS). This study aimed to examine the clinical profile and identity the determinants of CKD progression in patients with CRAS.

METHODS: We conducted a descriptive post-hoc prospective observational study using data from a previously completed prospective cohort study between August 2023 and April 2024 at the cardiology clinic of Benjamin Mkapa Hospital, Dodoma. Adult patients (≥ 18 years) diagnosed with CRAS were included. Baseline demographic and clinical data were analysed. CKD progression was determined based on changes in estimated glomerular filtration rate (eGFR) within 6 months. Determinants of CKD progression were determined and analysed. During exploratory analyses, both descriptive and inferential methods were employed. A statistical significance set at two-sided p-value < 0.05.

RESULTS: A total of 112 patients with CRAS with the mean age of 57.84 (14.53 S.D) years were analysed. At baseline, 54.5% (61/112) were ≤ 60 years, and 56.2% (63/112) being female. The median creatinine was 171 (96-351) mmol/L with a mean _eGFR of 35.2 (14.46 SD) miL/min/1.73 m². Most patients, 60.7% (68/112) were in CKD stage 3, and 51.8% (58/112) presented with moderate to severe increased albuminuria. Over the 6-month follow-up, CKD progression was observed in 53.57% (60/112). Determinants were included advanced age: 3.62 (95% CI, 1.35-9.65; p = 0.010); albuminuria: 2.78 (95% CI, 1.08-7.16; p = 0.034); poor functional cardiac status (NYHA class III/IV): 6.44 (95% CI, 2.04-20.27; p < 0.001) and iron deficiency: 9.11 (95% CI, 2.92-28.47; p < 0.001).

CONCLUSION: There is high burden of CKD progression among patients with CRAS. Therefore, targeted intervention is beneficial to retard CKD progression in this high-risk population.

PMID:41221420 | PMC:PMC12598097 | DOI:10.1002/hsr2.71475

Health Sci Rep. 2025 Nov 10;8(11):e71447. doi: 10.1002/hsr2.71447. eCollection 2025 Nov.

ABSTRACT

BACKGROUND AND AIMS: Childbirth as a physiological phenomenon is painful. Fear and anxiety about labor pain increase the likelihood of women choosing cesarean delivery. Nonpharmacological interventions may enhance maternal comfort during labor. This study investigated the effect of chewing gum on anxiety and labor pain.

METHODS: Studies from 2000 to 2024 were identified through searches of Web of Science, PubMed, Scopus, Google Scholar, and Embase, with no restrictions on language or geographical location. Meta-analysis using Stata v17 employed a random-effects model to calculate standardized mean differences (SMD) with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I ² statistic.

RESULTS: An analysis of five trials (326 women, high to low quality, varying inclusion criteria) showed that chewing gum for 20 min in active and second phases significantly reduced pain and anxiety. Pain scores were lower in the gum-chewing group during the active (SMD: -1.23, 95% CI: -2.30 to -0.16, p < 0.00, I ² = 93.97%) and transition phases (SMD: -1.63, 95% CI: -2.35 to -0.90, p = 0.00, I ² = 85.17%) and anxiety scores were also reduced (SMD: -1.44, 95% CI: -1.03 to 3.92, p < 0.00, I ² = 98.41% and SMD: -0.55, 95% CI: -0.79 to -0.30, p = 0.00, I ² = 0.00%, respectively).

CONCLUSION: Chewing gum use may reduce labor pain and anxiety and shorten labor duration, according to this study. However, more rigorous research is necessary to confirm these findings.

PMID:41221416 | PMC:PMC12598193 | DOI:10.1002/hsr2.71447

J Orthop Surg Res. 2025 Nov 11;20(1):989. doi: 10.1186/s13018-025-06423-6.

ABSTRACT

BACKGROUND: Avascular necrosis (AVN) is a severe complication following pediatric femoral neck fractures (PFNFs). Identifying risk factors for AVN is critical for guiding timely treatment and follow-up. However, prior studies report inconsistent associations. This systematic review and meta-analysis aimed to identify risk factors associated with AVN after PFNFs.

METHODS: A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, and the Cochrane Library through April 30, 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between potential risk factors and AVN. Leave-one-out sensitivity analyses, meta-regression, and subgroup analyses were performed.

RESULTS: Thirty-four studies comprising 1332 pediatric patients (1340 fractures) were included. Older age (≥ 12 years; RR = 1.40, 95% CI 1.09-1.82), Delbet type I/II fractures (RR = 1.96, 95% CI 1.60-2.39), initial displacement (RR = 2.98, 95% CI 2.04-4.35), and poor reduction quality (RR = 2.43, 95% CI 1.46-4.05) were significantly associated with increased AVN risk. Gender, injury mechanism, time to reduction, and reduction method showed no overall association. Meta-regression identified follow-up duration as a significant moderator. Subgroup analyses of long-term follow-up (≥ 5 years) revealed that delayed reduction increased AVN risk (RR = 2.63, 95% CI 1.35-5.11), while closed reduction and internal fixation (CRIF) reduced risk compared to open reduction (RR = 0.40, 95% CI 0.24-0.65). Subgroup differences between long-term and short-term follow-up were both statistical significant.

CONCLUSIONS: Older age, Delbet type I/II classification, initial displacement, and poor reduction quality are significant predictors of AVN following PFNFs. Early reduction and CRIF may provide superior long-term outcomes. Further high-quality prospective studies with extended follow-up are needed to confirm these findings.

PMID:41220016 | DOI:10.1186/s13018-025-06423-6

Sr Care Pharm. 2025 Nov 1;40(11):472-480. doi: 10.4140/TCP.n.2025.472.

ABSTRACT

Objective To assess the acceptability and perceived utility of the Minnesota Effective Medication Self-Management Toolkit (MEMSMT) four-step approach among participants in the Virginia Commonwealth University (VCU) Mobile Health and Wellness Program (MHWP). Methods Student pharmacist-led focus groups explored medication-related challenges faced by older adults and the perceived utility of the MEMSMT. Participants were recruited from four affordable senior apartment communities served by MHWP. Demographic characteristics of participants were collected and summarized using descriptive statistics. After an explanation of the four-step approach, participants shared their experiences with medication self-management. They then completed the Medication Self-Management Self-Efficacy Checklist and were asked, “Do you believe that the Minnesota Effective Medication Self-Management Toolkit’s four-step approach can help individuals successfully manage their medications?” Comments regarding medication issues were documented and categorized according to the four aspects of self-medication management evaluated by the MEMSMT: indication, effectiveness, safety, and convenience of use. This study was approved as exempt research by Virginia Commonwealth University’s Institutional Review Board (IRB), protocol HM20029554, titled “Effective Medication Self-Management at Low-Income Senior Housing.” Results Five focus groups included 40 participants who took an average of 7.5 ± 5.2 medications daily. Most participants were Black (85%), female (70%), and had low health literacy (44%). The average age of participants was 72.2 years (SD ± 7.1). Examples of medication challenges were categorized as related to indication, effectiveness, safety, or convenience. Based on responses to the Medication Self-Management Self-Efficacy Checklist, participants expressed high confidence in their medication self-management skills. A vast majority of participants (94%) reported that using the MEMSMT four-step approach can help individuals successfully self-manage their medications. Conclusion Participants perceive the four-step process in the MEMSMT as a useful approach to improving medication self-management among residents of low-income senior apartment communities in the Richmond metropolitan area. Further evaluation of the Medication Self-Management Self-Efficacy Checklist is warranted.

PMID:41220009 | DOI:10.4140/TCP.n.2025.472

Arch Public Health. 2025 Nov 12;83(1):271. doi: 10.1186/s13690-025-01762-6.

ABSTRACT

BACKGROUND: Previous studies have demonstrated the importance of obesity and insulin resistance in increasing the risk of cardiovascular and metabolic diseases. However, few studies have demonstrated the association between visceral fat and cardiometabolic multimorbidity (CMM). In addition, the interaction of visceral fat and insulin resistance on CMM and the predictive value of the combination of the two remain incompletely understood.

OBJECTIVE: This study aims to investigate the relationships among novel obesity indices, the TyG index, and the CMM and to evaluate the predictive value of composite indices that combine obesity indices with the TyG index for CMM risk, thereby providing a basis for developing refined and multidimensional intervention strategies.

METHODS: We used data from the China Health and Retirement Longitudinal Study (CHARLS), including baseline information collected in 2011 and follow-up data gathered in 2015 and 2018, which included 9162 participants. The associations between the obesity indices, TyG and CMM were investigated via Cox regression models, Kaplan-Meier curves, the MacKinnon product distribution method, interaction effect analyses, ROC analysis and related indicators (NRI, IDI).

RESULTS: Among the study population, 1530 participants (16.70%) developed CMM. Cox regression analysis indicated significant associations of obesity indices and the TyG index with CMM (P < 0.001). TyG mediated over 20% of the associations between obesity indices and CMM. The interaction effects between obesity indices and TyG on CMM were the most significant. The CVAI showed the best predictive performance among the obesity indices in this study, and the combination of obesity indices and the TyG index showed enhanced prediction performance for CMM (P < 0.001).

CONCLUSION: Our study demonstrated that the composite index constructed by combining novel obesity indices with TyG significantly improved the accuracy of predicting CMM risk in middle-aged and elderly individuals, underscoring the critical role of maintaining a healthy weight and enhancing insulin sensitivity in the prevention of CMM.

PMID:41219986 | DOI:10.1186/s13690-025-01762-6

BMC Public Health. 2025 Nov 11;25(1):3904. doi: 10.1186/s12889-025-25216-4.

ABSTRACT

BACKGROUND: Research analysing central obesity and cardiometabolic diseases among residents in multiethnic areas in western China is relatively rare. The purpose of this study was to explore the epidemiological features of and correlations between central obesity and cardiometabolic disease clustering in residents of Xinjiang aged 40 years and older.

METHODS: Data from the “China Chronic Disease and Risk Factor Surveillance (CCDRFS)” program, which covered 8 districts in Xinjiang from 2013 to 2023, were used, and data were collected via questionnaires, body measurements and laboratory tests. Chi-square tests and binary logistic regression were used for statistical analysis in SPSS 26.0.

RESULTS: A total of 10,908 participants (46.21% male, 53.79% female) were included in this study. The prevalence of central obesity was 81.49% and was higher among women. The prevalences of mild and severe disease were 34.31% and 47.18%, respectively. The prevalence of cardiometabolic disease clustering was 40.95%. Factors such as sex, age, urban‒rural distribution, and education level were associated with the prevalence of central obesity and cardiometabolic disease clustering. The prevalence of central obesity showed a continuous increasing trend over time, whereas the clustering of major cardiometabolic diseases decreased first but then increased. The prevalence of cardiometabolic diseases increased with increasing central obesity in men and women and in the overall population. Multivariate analysis revealed that after adjustment for age, urban‒rural distribution and education level, the risk of having two major cardiometabolic diseases was 1.860 (95% confidence interval [95% CI]: 1.533-2.257) and 3.658 (95% CI: 3.035-4.409) times greater, respectively, in men with mild and severe central obesity than in men with noncentral obesity, while the corresponding values were 1.758 (95% CI: 1.439-2.147) and 3.000 (95% CI: 2.480-3.629), respectively, in women. The risk of having three or more major cardiometabolic diseases was 2.415 (95% CI: 1.730-3.371) and 5.552 (95% CI: 4.039-7.632) times greater in men with mild and severe central obesity, respectively, than in men with noncentral obesity, and the corresponding values were 2.130 (95% CI: 1.476-3.075) and 5.570 (95% CI: 3.958-7.838), respectively, in women.

CONCLUSION: Central obesity and cardiometabolic disease clustering is significant in Xinjiang’s middle-aged and elderly population. The risk of cardiometabolic disease clustering is greater in people with central obesity, especially those with greater waist circumference. The prevalence of related diseases has increased significantly and demands attention in terms of prevention and control.

PMID:41219984 | DOI:10.1186/s12889-025-25216-4

Harm Reduct J. 2025 Nov 11;22(1):184. doi: 10.1186/s12954-025-01319-4.

ABSTRACT

BACKGROUND: It is critical that a range of harm reduction supplies are available through Ontario’s Public Health Units (PHU) to meet the varying needs of people who use drugs. Therefore, we assessed geographic variation in opioid-related deaths and the distribution of these harm reduction supplies among 34 PHUs in Ontario, Canada.

METHODS: We conducted a population-based repeated cross-sectional study using publicly available administrative datasets between January 1, 2019, and December 31, 2022. Rates of opioid-related deaths and the distribution of harm reduction supplies (inhalation supplies, naloxone, and needles provided) were calculated per PHU. Small area rate variation statistics including the extremal quotient (EQ) were used to assess variation across PHUs in 2022.

RESULTS: Over the study period, the quarterly number of opioid-related deaths increased by 40.6% (3.2 to 4.5 per 100,000) in Ontario. The distribution rate of all harm reduction supplies increased, although there was considerable variation by type of supply. For example, the EQ ranged from 34.7 for naloxone to 1,610.6 for foil. In 2022, there were three PHUs with significantly higher rates of opioid-related deaths compared to the provincial average. In general, these PHUs also had significantly higher distribution rates of naloxone, needles, and inhalation supplies.

CONCLUSIONS: Across Ontario, there is high variability in harm reduction supply distribution and opioid-related mortality. Regions with elevated opioid-related death rates also had high supply distribution rates, suggesting that efforts are concentrated in regions with particular need. To minimize harms related to substance use, ongoing efforts are needed to ensure a clear understanding of community-based needs for harm reduction services.

PMID:41219973 | DOI:10.1186/s12954-025-01319-4

Hum Genomics. 2025 Nov 12;19(1):131. doi: 10.1186/s40246-025-00848-0.

ABSTRACT

BACKGROUND: Mandibular hypoplasia, Deafness, Progeroid features, and Lipodystrophy (MDPL) syndrome is a very rare genetic disorder linked to variants in the POLD1 gene, which encodes the catalytic subunit of DNA polymerase delta, a key enzyme involved in DNA replication and repair. Most patients carry a recurrent in frame deletion (p.Ser605del) within the active site of the p125 subunit. Despite its rarity, understanding the functional consequences of the Ser605del variant has broad implications for aging-related diseases and genome stability.

METHODS: We combined structural modelling, molecular dynamics simulations, and protein-protein interaction (PPIs) analyses to evaluate the impact of Ser605del in the catalytic activity of DNA polymerase delta. Bioinformatic tools were applied to characterize its interaction network. RT-q PCR and Western Blot were performed to assess expression levels of POLD1, TRF1, and PARP1 in human dermal fibroblasts (HDFs) of three MDPL patients of different ages. Cells were monitored at different passages, both in basal condition and after damage by X irradiation. POLD1/TRF1 interaction was confirmed by immunoprecipitation analyses.

RESULTS: Using molecular docking, molecular dynamics simulations and thermodynamic analyses, we found that Ser605del affects the DNA-binding site, impairing dTTP binding. The deletion alters short linear motifs involved in protein-protein interactions (PPIs), allowing the acquisition of a F/Y-X-L-X-P (FSLYP) consensus sequence with TRF1, a telomeric protein. In silico analyses highlighted a stronger interaction between the Ser605del POLD1 variant and TRF1. Experiments on MDPL fibroblasts confirmed a stronger POLD1-TRF1 binding and revealed dysregulation of PARP1, involved in telomere maintenance. Following X-ray irradiation, aimed at exacerbating the cellular phenotype, we observed a decreasing trend in these markers, which reached statistical significance particularly in one older patient.

CONCLUSIONS: We identified a novel short linear motif (FSLYP) in the Ser605del POLD1 protein that mediates abnormal interaction with TRF1, revealing a structural and functional link between POLD1 and telomere biology, contributing to premature aging phenotypes. This work provides new insights into MDPL pathogenesis and lays the foundation for future research into aging-related therapies.

PMID:41219970 | DOI:10.1186/s40246-025-00848-0

BMC Pulm Med. 2025 Nov 11;25(1):518. doi: 10.1186/s12890-025-03986-2.

ABSTRACT

BACKGROUND: Sputum culture conversion is an important predictor of treatment response and patient outcome in pulmonary multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). However, the determinants of time to culture conversion and its association with treatment regimens among MDR/RR-TB patients in Southwestern Oromia remain poorly understood. This study aimed to determine the time to initial sputum culture conversion and associated factors among pulmonary MDR/RR-TB patients in Southwestern Oromia, Ethiopia.

METHODS: We conducted a retrospective follow-up study on 168 MDR/RR-TB patients who had initiated treatment and followed up between 2013 and 2023 at centers in the Southwestern Oromia region of Ethiopia. A semi-structured data collection tool was used to extract demographic, clinical and bacteriological data. The median time to sputum culture conversion was analysed using Kaplan‒Meier survival curves. Bivariate and multivariate Cox proportional hazards regression analyses were employed to identify factors associated with delayed time to sputum culture conversion. A p-value less than 0.05 was considered statistically significant.

RESULTS: Of the 168 participants, 85.7% (144) achieved culture conversion during a total follow-up of 397.8 person-months. Among those converted, 48.6% (70/144) achieved conversion within two months, 42.4% (61/144) within three to four months, and 9% (13/144) after four months of treatment. The median time to sputum culture conversion was 62 days (IQR: 32-92). The median time to culture conversion was longer for smear-positive samples (63 days, IQR: 32-93 days) than for smear-negative samples (59 days, IQR: 30-90 days, chi² = 6.68, P value = 0.0098). Patients receiving a shorter MDR/RR-TB regimen were twice as likely to achieve culture conversion faster than those receiving longer regimens (aHR = 1.85, 95% CI: 1.11-3.08, P = 0.019).

CONCLUSION: The median time to initial sputum culture conversion was 62 days, which was lower than the 4-month threshold considered a potential indicator of treatment failure according to the World Health Organization. MDR/RR-TB patients with HIV coinfection, higher baseline smear grades and those on longer treatment regimens were shown to have a delayed time to culture conversion. Attention should be given to these patients during their MDR/RR-TB treatment course to reduce delays in culture conversion and improve treatment outcomes.

PMID:41219969 | DOI:10.1186/s12890-025-03986-2

Biomed Eng Online. 2025 Nov 11;24(1):134. doi: 10.1186/s12938-025-01437-x.

ABSTRACT

OBJECTIVE: To systematically review and compare the clinical efficacy and impact on fertility function between laparoscopic surgery and methotrexate treatment for tubal pregnancy.

METHODS: Five English databases and four Chinese databases were systematically searched from the database establishment to January 31, 2024, and a meta-analysis was conducted using Review Manager 5.3.

RESULTS: Ten articles were included, with a total of 1,034 study patients. The meta-analysis showed that compared with a single intramuscular injection of methotrexate, laparoscopic surgery for tubal pregnancy was associated with a significantly higher tubal patency rate [OR = 2.47, 95% CI 1.72-3.53, P < 0.001]; and a significantly higher spontaneous pregnancy rate [OR = 2.10, 95% CI 1.28-3.46, P = 0.003]; and a shorter time for serum HCG levels to return to normal [MD = -7.10, 95% CI – 7.84-6.36, P < 0.001]. However, there was no statistically significant difference in treatment success rate between the two treatment methods [OR = 1.88, 95% CI 0.53-6.69, P = 0.33], and no statistically significant difference in recurrent EP rate [OR = 1.09, 95% CI 0.41-2.87, P = 0.87].

CONCLUSION: Compared with a single intramuscular injection of methotrexate, laparoscopic surgery for tubal pregnancy is associated with better fertility function in the future, while the difference in clinical efficacy needs further exploration.

PMID:41219963 | DOI:10.1186/s12938-025-01437-x