Category: Statistics

Harm Reduct J. 2025 May 30;22(1):93. doi: 10.1186/s12954-025-01245-5.

ABSTRACT

Harm-reduction strategies are interventions designed to mitigate the adverse effects of substance use, without requiring abstinence. Evidence supports the effectiveness and efficacy of harm reduction as a broad framework for addressing illicit drug use. To ensure the implementation of these measures, Center for Alcohol and Drug Research (KORFOR) was mandated by the Norwegian Directorate of Health in 2016 to annually assess municipalities’ adherence to harm-reduction guidelines. This study aims to present national trends in the distribution of harm-reduction equipment for the prevention of infectious diseases, specifically needles and syringes and smoking foil. We investigated the proportion of distributing municipalities, additional equipment distributed (naloxone, condoms and lubricants, disposable toothbrushes, and cookers, filters, disinfection swabs, sterile water, and ascorbic acid), and the population coverage. Our findings indicate an increased coverage in the distribution of harm-reduction equipment in Norway between 2016 and 2022. This positive trend demonstrates progress in addressing the negative consequences of drug use and aligns with Norwegian national strategies to mitigate drug-related harms. Future research should evaluate the effectiveness of these harm-reduction strategies and identify areas for improvement within the Norwegian context, especially related to use of opioid analgesics.

PMID:40448244 | DOI:10.1186/s12954-025-01245-5

Acta Epileptol. 2025 May 30;7(1):33. doi: 10.1186/s42494-025-00222-6.

ABSTRACT

BACKGROUND: Vagus nerve stimulation (VNS) has been widely used in the clinical treatment of epilepsy, while its effects on comorbidities in epilepsy remain incompletely elucidated. This study aimed to evaluate the impact of VNS on comorbidities and quality of life in adult patients with epilepsy.

METHODS: A longitudinal, multicenter cohort study was conducted from 2021 to 2024 among adult patients with epilepsy who underwent VNS implantation. We enrolled 128 participants from 83 hospitals. The inclusion criteria were patients over 18 years old, diagnosed with epilepsy according to the 2014 International League Against Epilepsy guidelines, and having complete data from at least two follow-up visits. Standard assessment tools, including diagnosis according to International Classification of Diseases, 10th Edition (ICD-10), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiexy Disorde-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31) were used to evaluate comorbidities and quality of life. Statistical analysis was performed using SPSS 26.0. The major clinical measurements were changes in the scales above before and after VNS implantation during follow-up. Generalized estimation model was applied to illustrate the effect over time an its relation to seizure control.

RESULTS: A total of 113 participants met the inclusion criteria. Baseline characteristics were comparable between the comorbidity and non-comorbidity groups in terms of gender, seizure onset, age at VNS implantation, seizure types, or the number of antiseizure medications used. Significant improvements were observed from the implantation to the end of follow-up. The PSQI score decreased from 5.43 ± 3.60 to 4.44 ± 3.14 (P < 0.01), indicating better sleep quality. Depressive symptoms (NDDI-E) and anxiety symptoms (GAD-7) decreased significantly, with scores dropping from 6.49 ± 4.67 to 4.83 ± 4.37 (P < 0.01) and from 7.15 ± 5.06 to 4.95 ± 3.69 (P < 0.01), respectively. The QOLIE-31 score increased from 54.40 ± 15.70 to 61.33 ± 16.19 (P < 0.01), suggesting improved quality of life. Further analysis indicated that in the early second postoperative follow-up (1 month after implantation), the scales had already improved significantly (P < 0.001 for PSQI and QOLIE-31, P = 0.006 for NDDI-E and GAD-7). We did not find any statistically significant difference between patients with comorbidity and those without on the efficacy of any scales in this study. The efficacy of VNS on the four scales above was related to follow-up time, with a slightly rebound at the last two follow-ups. The NDDI-E as well as the GAD-7 scores were related to better seizure control according to the GEE model. Higher stimulation currents over 1 mA did not improve the efficacy of VNS on the comorbid conditions.

CONCLUSIONS: VNS implantation significantly improved sleep quality, mental health, and overall quality of life in adult patients with epilepsy. Such effects could be observed shortly after the implantation and were mostly long-lasting. Further research is needed to validate its long-term effects.

PMID:40448234 | DOI:10.1186/s42494-025-00222-6

BMC Psychol. 2025 May 30;13(1):583. doi: 10.1186/s40359-025-02908-5.

ABSTRACT

BACKGROUND: Taking care of children with Leukemia leads to a burden and decreases their caregivers’ self-efficacy. This study aimed to evaluate whether training spiritual care program impacts the self-efficacy and burden of mothers having children with Leukemia.

METHODS: This randomized clinical trial was conducted on sixty-four mothers caring for their children with Leukemia, who were randomly allocated into eighteen blocks of 4 using computerized random allocation, 32 individuals were assigned to the intervention group and 32 to the control group. A training spiritual care program based on the Sound heart model was performed individually through four 30-45-minute face-to-face sessions during four weeks and a four-week follow-up. The setting was the chemotherapy department in Imam Reza educational, specialty and subspecialty clinic, affiliated with the Shiraz University of Medical Science. The data were collected using a demographic information form, the Caregiver self-efficacy questionnaire and the Caregivers Burden Inventory. The data were analyzed via descriptive and inferential statistics. All tests were two-tailed, and the statistical level was considered 0.05.

RESULTS: Before intervention, there was no significant difference between the control and intervention groups in terms of self-efficacy and the caregiver burden mean score (p > 0.05). However, after the intervention a significant difference was observed between the two groups in self-efficacy scores [95% CI: -80.37, -57.74] and Caregiver Burden scores [95% CI: 10.34, 20.28] (p < 0.001). Also, the mean scores of caregivers’ burden was decreased, and self-efficacy increased significantly from pre-intervention to post-intervention in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups. Also, there was a significant and reverse correlation between self-efficacy and caregiver burden (r = 0.678, P < 0.001).

CONCLUSION: Spiritual care program based on the Sound heart model improves self-efficacy and decreases caregivers’ burden in mothers of children with Leukemia. The use of this model is recommended for addressing the spiritual needs of mothers with children diagnosed with leukemia and for guiding health professionals in developing spiritual and healing care programs in clinical practice.

TRIAL REGISTRATION: IRCT20210410050924N1 Registration date 20,210,504.

PMID:40448233 | DOI:10.1186/s40359-025-02908-5

Eur J Med Res. 2025 May 31;30(1):431. doi: 10.1186/s40001-025-02707-z.

ABSTRACT

BACKGROUND: The ratio between erythrocyte distribution width and serum albumin (RAR) has gained recognition as a novel composite biomarker for inflammatory processes, though its clinical significance in Parkinson’s disease (PD) pathology requires further exploration. The purpose of this cross-sectional study was to investigate the relationship between RAR and PD.

METHODS: This epidemiologic investigation utilized data from participants enrolled in the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018. Study cohorts comprised PD-diagnosed individuals and matched controls. To elucidate the RAR-PD connection, we implemented three analytical strategies: multivariable-adjusted logistic regression models incorporating sample weights, restricted cubic spline (RCS) modeling for nonlinear relationships, and stratified analyses across demographic subgroups. Comparative assessment of inflammatory biomarkers’ discriminative performance was performed through ROC curve analysis, contrasting RAR against platelet-albumin ratio (PAR) and neutrophil-albumin ratio (NAR).

RESULTS: The analysis encompassed 31,848 adults (297 PD cases; 31,551 controls) from the NHANES database. Quantitative analysis revealed elevated RAR measurements in PD subjects compared to controls [3.28 (0.04) vs. 3.09 (0.01), P < 0.001]. Following covariate adjustment in weighted regression models, multivariable-adjusted analyses identified RAR as an independent predictor (adjusted OR = 1.40, 95% CI 1.06-1.85, P = 0.018). RCS modeling revealed nonlinear RAR-PD associations, peaking at 3.48 (inverted U-shape). Comparative ROC analysis confirmed RAR’s discriminative superiority over PAR and NAR in PD detection (P < 0.05).

CONCLUSIONS: As demonstrated by the research findings, RAR is strongly and independently associated with PD. RAR may serve as an indicator or screening tool for an increased risk of PD.

PMID:40448230 | DOI:10.1186/s40001-025-02707-z

Scand J Trauma Resusc Emerg Med. 2025 May 30;33(1):98. doi: 10.1186/s13049-025-01412-4.

ABSTRACT

BACKGROUND: Prehospital anaesthesia is a challenging procedure, and the outcome depends on the quality of the process. Hospital-acquired anaesthesia experience does not necessarily translate to high performance in the prehospital setting. We aimed to assess the quality and practice patterns in prehospital anaesthesia related to cumulative experience amongst new prehospital critical care physicians. In this study, we aimed to evaluate whether quality indicators for prehospital anaesthesia and related mortality improve as new prehospital critical care physicians become more experienced with this intervention.

METHODS: We conducted a registry-based observational study including all patients who underwent anaesthesia and airway management by physicians who started working in the national HEMS between January 2013 and August 2019. Patients were grouped and compared based on the provider’s cumulative case volume at the time of the mission: 1-10, 11-20, 21-40, 41-80 and > 80 cases. The association between cumulative experience and 30-day mortality was assessed using multivariate logistic regression analysis. Secondary outcomes included first-pass intubation success, post-intubation hypoxia and hypotension, the combined use of a neuromuscular blocking agent and anaesthetic, on-scene time, mechanical ventilation usage, and rates of normocapnia, hypoxia, and hypotension at handover.

RESULTS: 1,638 patients (median age 59, 64% male) were treated by 32 physicians. Median on-scene time decreased with increasing experience from 33 (interquartile range [IQR] 23-44) to 28 (IQR 19-38) minutes, P = 0.03. Higher experience was associated with increased use of mechanical ventilation (P < 0.001) and a combination of neuromuscular blocking agents and anaesthetics (P = 0.03). Other secondary outcomes did not show a statistically significant difference between the groups. Crude mortality decreased from 38 to 26% in the lowest to highest experience groups. In the multivariate logistic regression analysis, the same trend was still seen with the odds ratio of the highest experience group for 30-day mortality 0.59 (95% CI 0.38-0.94, lowest experience group as a reference).

CONCLUSIONS: In a prehospital critical care service, outcomes improve after a high number of prehospital cases, even when physicians with a solid foundation in in-hospital anaesthesia are employed. Limiting physician turnover may improve the quality of care.

PMID:40448224 | DOI:10.1186/s13049-025-01412-4

BMC Psychol. 2025 May 30;13(1):582. doi: 10.1186/s40359-025-02738-5.

ABSTRACT

BACKGROUND: This research protocol for the study ATICC (Addiction, Trauma and Immigration, prevention and Cross-Cultural support for care with the Grand Est youth network) aims to model the complex interrelations between trauma, substance use behaviors, migration and representations of mental health among vulnerable youth residing in Transitional Housing for Young Adults. This study focuses on a specific and underexplored population, many of whom have experienced traumatic events and/or complex migratory trajectories. The ultimate objective of this research is to develop transferable models of understanding that can inform the design of prevention and support programs tailored to this demographic.

METHODS/DESIGN: We adopt a tripartite methodology approach: (1) a cross-sectional study using standardized questionnaires to identify factors associated with substance use, trauma, and barriers to healthcare access; (2) an in-depth qualitative study based on semi-structured individual interviews with substance users, exploring their subjective experiences and perceptions related to substance use and mental health care; and (3) a longitudinal interventional study involving various configurations of focus groups open to residents of transitional housing structures, aiming to assess the impact of these group sessions on participants’ psychological well-being and attitudes toward care. Quantitative analyses will include descriptive and multivariate statistical tests using R, while qualitative data will be analyzed through thematic analysis with NVivo. The effectiveness of the group intervention will be evaluated using pre/post-tests, mixed models, and appropriate statistical corrections.

DISCUSSION: Analyses are expected to identify key psychosocial factors influencing addictive behaviors and mental health, highlight cultural and structural barriers to care, and assess the psychological benefits of the group intervention. The ATICC study aims to contribute to the development of culturally adapted prevention and support models for young adults in precarious situations. The results should assist healthcare professionals and policymakers in designing evidence-based interventions that effectively address the specific needs of this population.

TRIAL REGISTRATION: This study is registered with the Biomedical Research Identification Number (n°ID-RCB) assigned in France by the National Agency for the Safety of Medicines and Health Products (ANSM): 2024-A01534-43, and have received the approval from the committee for the protection of persons (CPP) Ile-de-France on November 18, 2024. Cette étude a également été déposée sur clinicaltrials (NCT06922721, date assigned April 10, 2025).

PMID:40448223 | DOI:10.1186/s40359-025-02738-5

Eur J Med Res. 2025 May 30;30(1):430. doi: 10.1186/s40001-025-02693-2.

ABSTRACT

BACKGROUND: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a recently developed lipid parameter, but there are insufficient studies exploring its relationship with early cognitive impairment in patients with acute mild stroke. This study aims to determine the potential association between NHHR and early cognitive impairment in patients with acute mild stroke. By collecting data from patients with acute minor ischemic stroke in hospital, we will analyze the relationship between NHHR and cognitive function in these patients.

METHODS: This study enrolled 817 acute ischemic stroke (AIS) patients (NIHSS ≤ 5), Cognitive function was assessed using Mini-Mental State Examination (MMSE) within 2 weeks, with cognitive impairment defined by education-stratified thresholds. Statistical analysis of the baseline was performed. Multivariate logistic regression was performed to analyze the association between NHHR and cognitive impairment, and Receiver Operating Characteristic Curve (ROC) analysis were performed to evaluate the predictive value.

RESULTS: Patients were classified into cognitive impairment group (n = 473) and normal cognition group (n = 344). NHHR in the cognitive impairment group was significantly higher than that in the normal group (3.24 ± 1.63 vs. 3.02 ± 1.43, P = 0.046). There were significant differences in age and education level. There was a dose-response relationship between NHHR quartiles and the incidence of cognitive impairment (trend test P = 0.021). Multivariate regression analysis showed that for each unit increase in NHHR, the risk of cognitive impairment increases by 13.2% (OR = 1.13, 95% confidence interval 1.02-1.25, P = 0.018). The predictive model constructed by combining age and education level has an area under the ROC curve(AUC) of 0.71 (95% confidence interval 0.67-0.74).

CONCLUSIONS: NHHR is an independent risk factor for early cognitive impairment in mild AIS patients. The NHHR-based model demonstrates moderate predictive accuracy, supporting its potential clinical utility.

PMID:40448222 | DOI:10.1186/s40001-025-02693-2

BMC Psychol. 2025 May 30;13(1):584. doi: 10.1186/s40359-025-02923-6.

ABSTRACT

BACKGROUND: Due to long working hours, shifts, poor working conditions, and high risk of exposure to traumatic incidents at work, healthcare workers (HCWs) are at high risk of developing mental health and wellbeing issues. Family members and close friends of HCWs are often the primary support source for the HCWs. However, while supporting the HCWs, family members’ and friends’ mental health and wellbeing may be impacted negatively. According to the findings of previous literature, family members of other high-risk workers may experience secondary traumatic stress. To date, there has been no research focusing on secondary traumatic stress in family members and friends of HCWs.

METHODS: In this cross-sectional, mixed-method study, we examined secondary traumatic stress and associated factors amongst 320 household members (family members and housemates) of HCWs in the UK using the Secondary Traumatic Stress Scale. We used multivariable linear regression to examine the predictors of secondary traumatic stress, specifically sex, age, job role of the HCW, and the relationship with the HCW. Then we used content analysis of responses to open-ended questions to explore the experiences of household members in-depth.

RESULTS: 33.8% of household members reported secondary traumatic stress within the severe range. Female spouses and partners of HCWs with clinical roles showed higher STS compared to male and other household members of HCWs with non-clinical roles. In our regression model, we found that being female, having a HCW household member with a clinical role, and being a spouse or a partner of a HCW were statistically significant predictors of high STS. Open-ended responses showed that household members reported that HCWs tended to be irritated, quieter/distant, anxious/stressed, in low moods, and exhausted after having a difficult day at work. These feelings and behaviours impacted the rest of the household members negatively.

CONCLUSION: This is the first study which has examined secondary traumatic stress amongst household members of HCWs. While trying to support the HCW, household members were at high risk of developing secondary traumatic stress. There are research implications to understand HCWs’ and their household members’ experiences better, including extending current research and conducting further research exploring secondary traumatic stress in HCWs’ household members, and factors associated with it, which go beyond the demographics examined here. There are also organisational and clinical implications to protect and support both HCWs and their household members, such as improved working conditions for HCWs and carefully planned psychological support for both HCWs and their household members.

PMID:40448215 | DOI:10.1186/s40359-025-02923-6

Reprod Health. 2025 May 31;22(Suppl 1):78. doi: 10.1186/s12978-025-01989-0.

ABSTRACT

BACKGROUND: Adolescent sexual and reproductive health (ASRH) is an integral part of the global health agenda. It is strongly featured in the universal health coverage (UHC) agenda of the sustainable development goals (SDGs). The need to expand ASRH services to accelerate progress on UHC is urgent in Africa, compared to other regions, given its youthful population and unmet ASRH needs. Limited access to ASRH services increases the risk and vulnerability of adolescents to poor health outcomes such as unintended pregnancies, high adolescent birth rate, poor birth outcomes, high maternal and neonatal mortalities and high exposure to sexually transmitted infections. The unavailability and inaccessibility of ASRH interventions to adolescents and young adults in most African countries, including Ghana, arise from several limitations, including inadequate funding of interventions, cultural barriers and norms, lack of education, and inadequate supplies of ASRH services and commodities, among others. However, gains from investments in ASRH interventions, especially following the implementation of the Millennium Development Goals, highlight the importance of identifying and prioritising adequate funding for effective ASRH interventions. This paper identifies priority ASRH interventions that can potentially advance the sexual and reproductive health (SRH) needs of adolescents in Ghana to accelerate progress towards UHC.

METHODS: Qualitative descriptive methods, combining literature review and stakeholder engagement, were used for this study. A literature review complemented by stakeholder engagement ensured the listing, ranking and validation of interventions.

RESULTS: Adapting an established framework designed by the West African Health Organization (WAHO) through stakeholders’ engagement process, the paper identifies four of seven priority interventions ranked and validated by stakeholders for addressing the SRH needs of adolescents in Ghana. Consistent with the literature, several interventions exist to address ASRH needs. The most effective priority or promising four interventions in Ghana, according to stakeholders, include adolescent health clubs programmes, girls’ empowerment programmes through comprehensive sexuality education, national capacity-building programmes to deliver high-quality integrated family planning and comprehensive maternal health services, and electronic health (eHealth)/digital health programmes.

CONCLUSION: Identifying effective priority interventions for addressing the SRH needs of adolescents is a consultative process facilitated by proven and valid frameworks adapted to align with specific country contexts.

PMID:40448192 | DOI:10.1186/s12978-025-01989-0

J Orthop Surg Res. 2025 May 30;20(1):552. doi: 10.1186/s13018-025-05837-6.

ABSTRACT

OBJECTIVE: To investigate the relationship between segmental motion and paraspinal muscle degeneration at the surgical level in patients with single-level lumbar degenerative disease (LDD) who have undergone either fusion or dynamic stabilization surgery.

METHODS: Patients treated with posterolateral intertransverse fusion (PITF group), Isobar TTL dynamic internal fixation (TTL group), or Isobar EVO dynamic internal fixation (EVO group) for single-level lumbar degenerative disease (LDD) between March 2012 and September 2020 were included in the study. Cases were selected with complete records and follow-up times ranging from 2 to 5 years, taking into account the effects of postoperative muscle edema and age-related muscle degeneration. The study compared operative time, intraoperative blood loss, preoperative and postoperative Oswestry Disability Index (ODI) scores, Lumbar Stiffness Disability Index (LSDI) scores, range of motion (ROM) at the surgical segment, cross-sectional area (CSA) of the paraspinal muscles, and functional cross-sectional area (FCSA) of the paraspinal muscles before and after surgery across all groups.

RESULTS: A total of 73 patients were included in this study: 23 in the PITF group, 26 in the TTL group, and 24 in the EVO group. There were no statistically significant differences among the three groups in terms of age, gender, follow-up duration, body mass index (BMI), preoperative lumbar VAS score, preoperative ODI score, and preoperative LSDI score (P > 0.05). Postoperative ODI scores were significantly higher in the PITF group compared to the TTL and EVO groups, with ODI scores demonstrating a moderate negative correlation with postoperative range of motion (ROM) of the surgical segment (Pearson’s r = -0.333, P < 0.004). A strong negative monotonic relationship was observed between ROM of the surgical segment and the rate of change in functional cross-sectional area (FCSA) of the paraspinal muscles across all groups, as evidenced by Spearman’s correlation coefficients (PITF: r = -0.766, P < 0.001; TTL: r = -0.818, P < 0.001; EVO: r = -0.865, P < 0.001) (Fig. 7). Multiple linear regression models confirmed that age, BMI, and gender had no significant effect on the rate of FCSA change. For the PITF, TTL, and EVO groups, the regression coefficients for ROM’s association with FCSA change were β = -0.653 (P < 0.005), β = -0.956 (P < 0.001), and β = -0.908 (P < 0.001), respectively. Similarly, postoperative LSDI scores were significantly elevated in the PITF group compared to the TTL and EVO groups, with LSDI scores exhibiting a strong negative correlation with postoperative ROM (r = -0.802, P < 0.001).

CONCLUSION: Compared to traditional decompression combined with rigid fusion surgery, decompression coupled with dynamic stabilization techniques can more effectively alleviate postoperative lumbar stiffness and functional impairment in patients. Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery.

PMID:40448178 | DOI:10.1186/s13018-025-05837-6