Category: Statistics

BMC Res Notes. 2026 Jun 26. doi: 10.1186/s13104-026-07923-2. Online ahead of print.

ABSTRACT

OBJECTIVES: Identifying children at highest risk for deterioration during evaluation for septic shock in emergency department (ED) settings remains challenging. Soluble CD25 (sCD25), a hemophagocytic lymphohistiocytosis (HLH) diagnostic criterion, has been associated with sepsis mortality in ICU settings. This study aimed to determine whether sCD25 is associated with adverse outcomes in children undergoing initial septic shock evaluation in a pediatric ED. We also sought to compare sCD25 in patients with septic shock, infection without sepsis, and HLH.

RESULTS: Children with HLH demonstrated significantly higher sCD25 levels [25,800 pg/mL (IQR: 1620-42,300)] compared with those with septic shock [5200 pg/mL (IQR: 2500-20,600)] or infection [5500 pg/mL (IQR: 2200-12,500)]. No statistical differences were observed between septic shock and infection groups; however, a subset of septic shock patients exhibited sCD25 elevations comparable to HLH patients. These patients experienced severe outcomes, including 100% PICU admission, 50% vasoactive support requirement, and prolonged hospitalization (16 days). Bloodstream infections were associated with the highest sCD25 levels. These findings suggest sCD25 elevation may be associated with adverse outcomes in children with septic shock. Larger studies are warranted to validate sCD25 as a prognostic marker for children with septic shock.

PMID:42363221 | DOI:10.1186/s13104-026-07923-2

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09776-6. Online ahead of print.

ABSTRACT

BACKGROUND: Widening participation in medicine is a key societal priority. To improve representation of non-traditional applicants, UK medical schools use contextual admissions, although definitions of under-represented groups vary across institutions. This study examined the educational and training trajectories of one such group-mature non-graduates. We aimed to determine whether their progression was comparable to that of school-leavers and graduate entrants, whether they progressed through medical school non-inferiorly, and whether they were equally likely to secure postgraduate training posts.

METHODS: Data on UK medical students and resident doctors (2007-2015) were extracted from the UK Medical Education Database (UKMED). Undergraduate performance (Educational Performance Measure (EPM), Prescribing Safety Assessment (PSA), Foundation Programme Situational Judgement Test (FP-SJT) and postgraduate performance (Membership of the Royal College of Physicians, MRCP and MRCGP Applied Knowledge Test, MRCGP AKT), Annual Review of Competency Progression (ARCP), and obtaining an offer for a Level 1 training post) were compared across the three groups using multivariate statistical analyses, including Kruskal-Wallis tests where appropriate.

RESULTS: Across all measures of undergraduate academic attainment (EPM, PSA and FP-SJT) and postgraduate examination performance (MRCP Part 1, Part 2 and PACES), mature non-graduates performed less well than school-leavers or graduates. They were more frequently released from training (ARCP Outcome 4) and received higher numbers of Developmental ARCP outcomes. Mature non-graduates were also less likely to receive an offer for competitive specialty training on their first application; however, the likelihood of them applying exclusively to General Practice did not differ from that of school-leavers or graduates.

CONCLUSIONS: Although performance differences persist for a subset of widening-participation candidates named here as mature non-graduates, they still progress through training, obtain Certificates of Completion of Training, and contribute to the medical workforce. Further research is needed to examine how their life experience and non-traditional educational trajectories influence their long-term practice.

PMID:42363203 | DOI:10.1186/s12909-026-09776-6

BMC Ophthalmol. 2026 Jun 26. doi: 10.1186/s12886-026-05035-w. Online ahead of print.

ABSTRACT

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries. Smoking is the only modifiable risk factor and is associated with faster AMD progression. While Age-Related Eye Disease Study (AREDS) supplements are recommended for intermediate AMD, their impact on visual acuity over time remains unclear.

OBJECTIVE: To describe baseline disparities and visual acuity trajectories in patients with intermediate dry AMD stratified by AREDS use and smoking status.

DESIGN: Retrospective observational study of patients with intermediate dry AMD conducted under IRB protocol 22-0267. Data collected from January 1, 2014 to January 1, 2024.

SETTING: Single academic medical center.

PARTICIPANTS: A total of 450 patients (759 eligible eyes) with intermediate dry AMD (ICD code H35.3192) were included. Patients were stratified by smoking status and AREDS use. Participants with fewer than three ophthalmology visits during the 10-year study period were excluded.

EXPOSURE: AREDS supplementation (AREDS1 or AREDS2) and smoking status (current/former vs. never).

MAIN OUTCOMES AND MEASURES: Visual acuity measured in Logarithm of the Minimum Angle of Resolution (LogMAR) at first and final clinic visits. ANOVA, Chi-square tests, and mixed effect regression models were used for analysis. Changes in LogMAR over time were calculated descriptively.

RESULTS: Among 450 patients (mean age, 82.32 years), 255 were smokers (423 eyes) and 195 were non-smokers (336 eyes). Baseline vision was better in non-smokers (mean LogMAR 0.28; SD 0.28) and smokers (mean LogMAR 0.30; SD 0.33) taking AREDS compared to non-smokers (mean LogMAR 0.48; SD 0.44) and smokers (mean LogMAR 0.45; SD 0.47) not taking AREDS (P < 0.0001). All groups experienced visual acuity decline from baseline with no significant differences in final visual acuity among the groups in a mean follow up period of 3.62 years. In a sub-analysis of greater than 5 years follow up mean years of 6.93 ± 1.55 years), a statistically significant difference in final LogMAR values across groups was observed (p = 0.033). The Smokers & AREDS group demonstrated the best final visual acuity (mean 0.39, SD 0.40), followed by Smokers & No-AREDS (mean 0.44, SD 0.43), Non-smokers & AREDS (mean 0.46, SD 0.47), and Non-smokers & No-AREDS (mean 0.72, SD 0.60).

CONCLUSIONS AND RELEVANCE: These results suggest that less than 5 years AREDS users had larger decline in vision from baseline, protective associations of AREDS supplementation may become more discernible over longer follow-up horizons. Real-world observational findings should be interpreted cautiously and do not contradict AREDS efficacy shown in randomized trials.

PMID:42363196 | DOI:10.1186/s12886-026-05035-w

BMC Pediatr. 2026 Jun 26. doi: 10.1186/s12887-026-07212-8. Online ahead of print.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is widely used in preterm infants to reduce ventilator-associated lung injury. However, nasopharyngeal suctioning during NIV is an invasive procedure that may cause pain, stress and physiological instability in preterm infants. This study aimed to compare the effects of less invasive suction protocol and conventional nasopharyngeal suctioning on pain and physiological stability in preterm infants receiving non-invasive ventilation.

METHODS: This randomized controlled trial was conducted in a tertiary neonatal intensive care unit. Preterm infants with a gestational age of 32^0/7 to 36^6/7 weeks who required NIV were eligible. A total of 100 infants were randomly assigned to either the less invasive suction protocol group (n = 50) or the conventional suction group (n = 50). Pain was assessed using the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and skin color were recorded before suctioning, during the procedure, and 10 min after completion. Between-group comparisons were performed using appropriate parametric or non-parametric statistical tests, with p < 0.05 considered statistically significant.

RESULTS: Baseline demographic and clinical characteristics were comparable between groups. During suctioning, infants in the less invasive suction protocol group had significantly lower HR and higher SpO₂ levels compared to the conventional group (p < 0.05). The proportion of infants with pink skin color was significantly higher in the less invasive suction protocol group. N-PASS pain scores during the procedure were significantly lower in the less invasive suction protocol group (p < 0.05). No significant differences were observed between groups in RR measurements at any time point.

CONCLUSIONS: The less invasive suction protocol reduced procedural pain and supported physiological stability in preterm infants receiving NIV. Minimizing airway manipulation may contribute to safer and more developmentally supportive care in neonatal intensive care units.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT07111611), registered on 08 August 2025 (retrospectively registered).

PMID:42363180 | DOI:10.1186/s12887-026-07212-8

Malar J. 2026 Jun 26. doi: 10.1186/s12936-026-06014-8. Online ahead of print.

ABSTRACT

Malaria remains a significant public health challenge in Bangladesh with ongoing transmission driven primarily by Plasmodium falciparum and Plasmodium vivax. Understanding its current prevalence and parasite distribution is essential for guiding control and elimination strategies. This study aims to estimate the pooled prevalence of malaria and its major parasite species across the country. A comprehensive literature search was conducted in PubMed, Science Direct, EMBASE and Google Scholar for studies published between 2005 to 2025. Eligible studies were assessed for quality using the Joanna Briggs Institute (JBI) tool. Pooled prevalence estimates were calculated using random-effects models while heterogeneity and inconsistencies were evaluated using the I² index and Cochran’s Q-test. Publication bias was assessed with funnel plots and Egger’s test. Of 10,152 identified studies, 14 met inclusion criteria. The pooled malaria prevalence in Bangladesh was 16% (95% CI 6%-37%) with high heterogeneity (I² = 99.6%, p = 0). Subgroup analyses showed prevalence’s of 14% (95% CI 9%-21%) for P. vivax, 80% (95% CI 68%-88%) for P. falciparum and 7% (95% CI 4%-13%) for mixed infections. Malaria prevalence was higher in males (20%, 95% CI 7%-47%) than females (12%, 95% CI 3%-35%). Funnel plot asymmetry was observed but Egger’s test indicated no significant publication bias. Sensitivity analyses confirmed the robustness of the findings. However, the findings should be interpreted with caution as reliance on microscopy and rapid diagnostic tests may have limited the detection of non-falciparum, mixed-species and submicroscopic malaria infections. This study highlights the substantial malaria burden in Bangladesh, driven mainly by P. falciparum and P. vivax and underscores the need for targeted, species-specific and gender-sensitive interventions to accelerate malaria control and elimination.

PMID:42363176 | DOI:10.1186/s12936-026-06014-8

Int J Equity Health. 2026 Jun 26. doi: 10.1186/s12939-026-02918-8. Online ahead of print.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, socially disadvantaged populations in France faced higher risks of infection and severe forms of COVID-19, particularly among marginalized groups such as Travellers, a population predominantly composed of nationals residing in either static or mobile caravans. In France, few studies have investigated Travellers’ experiences and preventive behaviours, with existing research limited to a small number of epidemiological outcomes prior to the pandemic. This study addresses this gap by exploring how living conditions and social exclusion shaped Travellers’ experiences of the pandemic and their responses to government measures.

METHODS: We conducted a sequential explanatory mixed-methods study, combining questionnaires and semi-structured interviews among Travellers in the region of Nouvelle-Aquitaine, France. Quantitative data assessed health status, prevention practices including COVID-19 vaccination and living conditions. Qualitative data provided deeper insight into Travellers’ experiences, perceptions and attitudes towards the government’ handling of the health crisis. Questionnaire data were analysed using descriptive statistics and multivariable logistic regression to identify factors associated with COVID-19 vaccination (≥ 1 dose). Interview data were analysed using Braun and Clarke’s six-phase thematic analysis framework.

RESULTS: Among 406 participants, 52.6% reported probable COVID-19 infection (based on a positive test or clinical symptoms) since the onset of the pandemic, of whom 9.2% reported to have been hospitalized. 30.0% of participants reported COVID-19 vaccination compared with 85% in the French general population. Vaccination was associated with being a woman, older age, living in stable housing, prior measles-mumps-rubella vaccination, receiving clear information from health authorities, and trust in the French government’s pandemic response. Interviewees reported that overcrowded, underserved living conditions hindered adherence to preventive measures, while fear of infection disrupted social interactions, increased feelings of confinement, and heightened psychological distress.

CONCLUSIONS: The COVID-19 pandemic disproportionately impacted Traveller communities in France, with structural vulnerabilities increasing both exposure and severe outcomes. These findings highlight the need for inclusive public health responses to avoid increasing preexisting health inequalities in future pandemic crisis. Effective strategies should integrate community perspectives, engage healthcare and social professionals, and tailor vaccination approaches to the specific vulnerabilities and socio-historical contexts shaping behaviours in marginalised populations.

PMID:42363165 | DOI:10.1186/s12939-026-02918-8

BMC Med Inform Decis Mak. 2026 Jun 26. doi: 10.1186/s12911-026-03655-2. Online ahead of print.

ABSTRACT

BACKGROUND: Toxic encephalopathy (TE) is a serious neurological complication among critically ill patients and is associated with considerable disability and mortality. Early risk prediction is essential for timely intervention and improved outcomes. However, evidence on prognostic modeling in TE remains limited. The primary objective of this study was to develop and validate a prognostic nomogram for predicting 28-day mortality in critically ill patients diagnosed with TE and to evaluate its clinical utility.

METHODS: Adult patients diagnosed with TE were retrospectively selected from the MIMIC-IV database based on relevant International Classification of Diseases (ICD) codes. Baseline demographic, clinical, and laboratory variables were extracted, and candidate predictors were selected through univariate logistic regression analyses based on clinical relevance and statistical significance. Subsequently, a multivariable logistic regression model was developed and presented as a nomogram. The value of the predictive model was evaluated using the area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA). Its potential clinical applicability was further assessed with a clinical impact curve (CIC).

RESULTS: A total of 3039 patients with TE were included, among whom 526 (17.3%) died within 28 days. The cohort was randomly divided into training and validation cohorts at a 7:3 ratio. The final model incorporated age (OR = 1.022, 95% CI: 1.013-1.032), heart rate (OR = 1.007, 95% CI: 1.001-1.013), hemoglobin (OR = 0.904, 95% CI: 0.852-0.958), albumin (OR = 0.677, 95% CI: 0.546-0.836), PaO₂ (OR = 0.998, 95% CI: 0.996-0.999), SOFA score (OR = 1.094, 95% CI: 1.043-1.148), APACHE II score (OR = 1.038, 95% CI: 1.011-1.066), and acute kidney injury (OR = 1.520, 95% CI: 1.132-2.501). The nomogram exhibited acceptable discriminative ability, with AUC values of 0.750 (95% CI: 0.725-0.776) and 0.757 (95% CI: 0.715-0.799) in the training and validation cohorts, respectively, along with satisfactory calibration. Furthermore, decision curve analysis (DCA) and clinical impact curve (CIC) results supported its clinical utility for individualized risk stratification.

CONCLUSION: Utilizing the MIMIC-IV database, we constructed and validated a prognostic nomogram to predict 28-day mortality in critically ill patients with TE. This tool may help clinicians identify high-risk individuals and optimize monitoring and supportive care.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42363142 | DOI:10.1186/s12911-026-03655-2

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09766-8. Online ahead of print.

ABSTRACT

BACKGROUND: Although oxygen therapy (OT) is a fundamental and life-saving intervention in the management of hypoxemia, it may lead to serious complications when applied incorrectly or in an uncontrolled manner. The aim of this study is to evaluate the knowledge levels and attitudes of healthcare professionals working in a tertiary hospital in Somalia regarding OT administered to non-intubated patients.

METHODS: This descriptive cross-sectional study was conducted between 17 February and 2 March 2025 at Mogadishu Recep Tayyip Erdoğan Training and Research Hospital. A structured 23-item survey evaluating knowledge and attitudes related to OT was administered face-to-face to healthcare professionals consisting of nurses, resident physicians, and attending physicians. Knowledge levels were classified as poor (< 60%), moderate (60-79%), and good (≥ 80%) based on the percentage of correct responses. p < 0.05 was considered statistically significant.

RESULTS: A total of 195 healthcare professionals participated in the study (42.6% nurses, 35.9% resident physicians, and 21.5% attending physicians). Overall, 49.2% of the participants (95% CI: 42.2% – 56.2%) reported knowing how to administer OT, though knowledge levels were predominantly poor across all professional groups regarding specific technical parameters, and 70% of nurses and 90% of physicians stated that OT training should be received (p = 0.223). The rate of receiving training before starting duty was higher among nurses (71.1%) than among residents (44.3%) (p = 0.003). As training sources, nurses more frequently reported school and orientation training, while attending physicians more frequently reported conferences/course programs (p < 0.001). Guideline use rates were similar across groups and were generally limited. Knowledge levels regarding low- and high-flow OT systems, indications, and monitoring parameters were poor in all groups. Knowledge of oxygen toxicity was higher among physicians than nurses (p = 0.001), and no significant difference was found among the groups in terms of awareness of morbidity and mortality (p = 0.189).

CONCLUSIONS: This study provides descriptive and hypothesis-generating data highlighting significant knowledge gaps regarding OT among healthcare professionals in a resource-limited setting. The findings suggest a critical need for standardized protocols and continuous training programs, though future prospective studies are required to determine the causal relationships between these knowledge gaps and actual clinical practice or patient outcomes.

PMID:42363139 | DOI:10.1186/s12909-026-09766-8

BMC Pregnancy Childbirth. 2026 Jun 26. doi: 10.1186/s12884-026-09463-w. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies indicate that negative body image adversely affects the physical and psychological well-being of pregnant women and undermines family harmony, thereby jeopardizing maternal and infant health. Despite its significant impact, this issue has received scant scholarly attention in China. Body image is not formed in isolation; according to the socio-cultural model, it is constructed through the dynamic interplay of socio-cultural context, family interactions, media messages, and social comparisons. Therefore, it is imperative to investigate the current status and influencing factors of body image among pregnant women in China to establish an evidence base for developing culturally targeted interventions.

METHODS: An exploratory sequential mixed-methods design was employed. Phase 1 involved semi-structured in-depth interviews with 17 pregnant women, analyzed using reflexive thematic analysis to develop themes. Phase 2 consisted of a questionnaire survey with 160 pregnant women, utilizing a self-designed questionnaire, the Chinese version of the Body Image in Pregnancy Scale (BIPS), the Perceived Social Support Scale (PSSS), and the Simplified Coping Style Questionnaire (SCSQ). SPSS 25 was utilized for statistical analysis. The qualitative findings directly informed the focus and variable selection for the quantitative phase.

RESULTS: Three qualitative themes emerged: key factors influencing body image, consequences and outcomes of body image, and the desire for recognition and support. Quantitatively, body image dissatisfaction was moderate (BIPS score: 97.78 ± 15.57). Multiple linear regression identified greater gestational weight gain (β = 0.691, p = 0.008), lower family support (β = -0.804, p = 0.015), and parity (β = -6.819, p = 0.022) as significant predictors of poorer body image. Qualitative insights provided contextual depth to these statistical associations.

CONCLUSIONS: Body image dissatisfaction was moderate among Chinese pregnant women and is influenced by weight gain, family support, and parity. The exploratory sequential design allowed for a deep understanding of lived experiences before quantitative measurement, ensuring the relevance of the measured constructs. Interventions should focus on weight management education and enhancing family support, particularly for first-time mothers, while also addressing and challenging the broader socio-cultural expectations surrounding unrealistic body ideals during pregnancy and the postpartum period.

PMID:42363134 | DOI:10.1186/s12884-026-09463-w

BMC Womens Health. 2026 Jun 26. doi: 10.1186/s12905-026-04623-8. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer remains a major public health concern in Tunisia. Despite national efforts, significant gaps persist in women’s knowledge and uptake of early detection practices. Understanding the determinants of these behaviors is critical for improving screening coverage. This study aimed to identify factors associated with breast self-examination (BSE) and mammography screening among women attending primary healthcare centers in Monastir, Tunisia.

METHODS: We conducted a cross-sectional study in the governorate of Monastir from May to October 2023. Data were collected using a structured questionnaire specifically developed for the study objectives. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of BSE and mammography uptake. Data were analyzed using IBM SPSS statistics version 21.

RESULTS: Among 439 women included, 80.6% reported awareness of BSE as an early detection method and 53.1% reported performing it monthly. In multivariate analysis, awareness of BSE (Adjusted odds ratio: AOR = 6.38; 95% CI: 3.41-11.90), having a family history of breast cancer (AOR = 2.03; 95% CI: 1.07-3.87) and older age (AOR = 1.042; 95% CI: 1.024-1.060) were independent associated factors with BSE practice. Among 192 women aged over 45 years, 35% had undergone mammography at least once. In multivariate analysis, the factors associated with mammography screening were BSE practice (AOR = 2.60; 95% CI: 1.22-5.55) and the knowledge of the recommended age for mammography initiation (AOR = 2.28; 95% CI: 1.17-4.45).

CONCLUSION: The practice of BSE and especially mammography among participants remains relatively low. Targeted education and awareness-raising efforts are therefore essential to increase the use of breast cancer screening and early detection methods.

PMID:42363129 | DOI:10.1186/s12905-026-04623-8