Category: Statistics

Einstein (Sao Paulo). 2025 Aug 11;23:eAO1476. doi: 10.31744/einstein_journal/2025AO1476. eCollection 2025.

ABSTRACT

OBJECTIVE: This study compared the productivity of prison oral health teams during the COVID-19 crisis (2020-2022) with the previous three-year period (2017-2019) to identify the number and type of dental procedures performed.

METHODS: We employed an ecological and retrospective study using Primary Care Health Information System data. We analyzed data from all municipalities that reported the productivity of Prison Primary Care Teams from 2017 to 2022, totaling 418 municipalities distributed across all five Brazilian regions. Data pertaining to 15 oral health procedures were collected and subsequently grouped into five categories: preventive, urgent, extraction, periodontics, and restorative. The data revealed a non-normal distribution and were evaluated using the Wilcoxon test.

RESULTS: The findings revealed inequality between regions, with the productivity of several municipalities being close to or equal to zero. Although the number of restorative procedures reduced in both periods (2017-2019 and 2020-2022), it was not statistically significant. However, statistically significant increases were observed, with the exception of restorative and periodontal procedures. Urgent and extraction procedures prevailed over restorative and periodontal treatments.

CONCLUSION: Access to Brazilian oral health procedures for inmates is low and remained unaffected by the pandemic, maintaining similar characteristics with increased productivity during that period.

PMID:40802374 | DOI:10.31744/einstein_journal/2025AO1476

JMIR Hum Factors. 2025 Aug 13;12:e71912. doi: 10.2196/71912.

ABSTRACT

BACKGROUND: Bring your own device (BYOD) adoption in health care improves clinician productivity, but introduces cybersecurity risks due to weak security controls, human error, and policy circumvention. Existing security frameworks and models are technocentric, while overlooking sociotechnical factors such as clinician behavior, workflow integration, and organizational culture. This misalignment reduces their effectiveness in health care settings. In addition, hospitals vary in structure, resources, and BYOD use, necessitating a flexible yet structured approach to assess security maturity and prioritize improvements, which is lacking in existing models.

OBJECTIVE: This study aims to develop and pilot a hospital BYOD security maturity model that integrates technical, policy, and human factors for a structured assessment and improvement of BYOD security in health care.

METHODS: This study used mixed methods action research to design and pilot a hospital BYOD security maturity model. Surveys and interviews with IT managers and clinicians shaped the model, which was trialed at a public metropolitan hospital in Victoria, Australia. Participants completed a maturity assessment and joined a 90‑minute co‑design workshop that prioritized 6 key domains and proposed improvements. Descriptive statistics and thematic analysis guided refinements to improve clarity and usability.

RESULTS: The model was initially developed with 22 domains across 3 key dimensions: technology, policy, and people, each structured across 5 maturity levels to support systematic progression in hospital BYOD security. On the basis of participant feedback during the refinement process, 2 training-related domains were merged, resulting in a final model with 21 domains. The technology dimension includes domains such as identity, access, and authentication management; device security; and clinical communication, ensuring technical controls align with hospital policies and workflows. The policy dimension focuses on governance, covering areas such as BYOD strategy, regulatory compliance, and incident response, to establish clear security guidelines and enforcement mechanisms. The people dimension addresses human factors, including security awareness training, stakeholder involvement, and security culture, fostering staff engagement and adherence to security protocols. A maturity assessment survey conducted at a public metropolitan hospital in Victoria, Australia, revealed an overall maturity level of 2.04. Key areas for improvement included identity and access management, clinical communication security, and governance transparency. A 90-minute co-design workshop identified challenges and proposed solutions for the top 6 priority domains. Recommendations included implementing single sign-on, defining a formal BYOD strategy, enhancing secure communication tools, and improving stakeholder engagement.

CONCLUSIONS: The model can serve as a valuable tool for hospitals and policy makers, offering actionable recommendations to strengthen BYOD security. The pilot implementation demonstrated its practical applicability, helping the hospital identify security gaps and develop a road map for structured enhancements. Further validation across diverse health care settings will enhance its adaptability and long-term impact.

PMID:40802372 | DOI:10.2196/71912

Cad Saude Publica. 2025 Aug 8;41(7):e00153623. doi: 10.1590/0102-311XEN153623. eCollection 2025.

ABSTRACT

This study aims to evaluate the impact of the search for internet health information by patients on the doctor-patient relationship and satisfaction of both physicians and patients. In total, 200 patients of a tertiary hospital in Brazil and a convenience sample of 92 physicians were included. The questionnaires applied consisted of statements concerning the study’s objective; answers were given on a 5-point Likert scale. We conducted a descriptive analysis and used nonparametric tests to verify statistical differences in perception between subgroups of interest. In this study, 85.6% of internet users searched for internet health information but were skeptical about the information they found. They were mostly positive about the doctor-patient relationship; however, they desired greater engagement in health decisions. Overall, physicians tended to have a slightly positive view about internet health information impact on patients’ health despite some possible harmful effects. However, they believe that search for internet health information causes unnecessary fear and concern in patients, reduces doctor’s work efficiency, and that internet health information is not accurate or reliable. The massive search for internet health information has led to significant changes in the doctor-patient communication model. Both parties have demands to be addressed: patients need more reliable information; and physicians must adapt to these changes in a way that neither diminishes their autonomy as healthcare providers nor worsens the doctor-patient relationship. Hopefully, physicians could play a central role in educating patients and indicating adequate sources of information.

PMID:40802358 | DOI:10.1590/0102-311XEN153623

JMIR Res Protoc. 2025 Aug 13;14:e75982. doi: 10.2196/75982.

ABSTRACT

BACKGROUND: Cerebral infarction, a life-threatening neurodegenerative disease, is one of the leading causes of disability and death. The recovery phase is a critical period for patients to regain cognitive ability, memory, and motor functions and to improve their ability to perform daily activities. Over the past 10 years, we have applied Qizhi Jieyu pill in the treatment of patients in the recovery phase of cerebral infarction. We retrospectively analyzed clinical data from 152 patients and found preliminary results suggesting that Qizhi Jieyu pill may help alleviate clinical symptoms, improve quality of life, and reduce the recurrence of cerebral infarction. However, the lack of high-quality clinical evidence supporting its efficacy and safety has limited its widespread clinical application.

OBJECTIVE: This protocol describes a randomized controlled trial aiming to evaluate the efficacy and safety of Qizhi Jieyu pill in patients during the recovery phase of cerebral infarction.

METHODS: This study adopts a multicenter, randomized controlled clinical trial design. A total of 126 patients aged 30-70 years in the recovery phase of cerebral infarction will be recruited and randomly assigned in a 1:1 ratio to either the study group (n=63, receiving conventional treatment plus Qizhi Jieyu pill) or the control group (n=63, receiving conventional treatment alone). The intervention period will last 12 weeks, and the total follow-up period will be 48 weeks. The primary outcome is the change in the National Institutes of Health Stroke Scale score at week 48. Secondary outcomes include changes in traditional Chinese medicine syndrome scores, the recurrence rate of cerebral infarction, and modified Rankin Scale scores. Adverse events will be recorded and used to assess the safety profile. All data analyses will be performed according to a prespecified statistical analysis plan.

RESULTS: The study received ethics approval on March 3, 2025, from the Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (2025-025-KY-01) and was registered on April 6, 2025. Participant recruitment began on April 10, 2025, and is expected to be completed by December 31, 2025. Final results will be published by December 31, 2026.

CONCLUSIONS: This study is the first randomized controlled clinical trial to evaluate the efficacy and safety of Qizhi Jieyu pill in the treatment of patients during the recovery phase of cerebral infarction. It will contribute to the development of integrated treatment strategies, potentially leading to broader clinical adoption, by providing a high-quality, evidence-based treatment option for clinical practice.

TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry ITMCTR2025000653; https://itmctr.ccebtcm.org.cn/mgt/project/view/2028021950497347405/false.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/75982.

PMID:40802347 | DOI:10.2196/75982

Rev Bras Epidemiol. 2025 Aug 8;28:e250045. doi: 10.1590/1980-549720250045. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze data from the Information System for Monitoring the Quality of Water for Human Consumption (Sisagua) to develop an environmental health indicator that assesses the risk of pesticide residues in drinking water.

METHODS: This is an ecological epidemiological study using retrospective data. Information on the Limit of Detection (LOD), Limit of Quantification (LOQ), and Maximum Permissible Value (MPV) of pesticide residues in drinking water, recorded by municipalities in the state of Paraná between 2014 and 2020, was analyzed. Descriptive and inferential statistical approaches were employed, including tests of association, correlation, and hypothesis testing, as well as probability analysis, through spatial and temporal analyses.

RESULTS: A Pesticide Threshold Weighting Indicator (iPLA) was developed, with an explanatory capacity of variability greater than 77%. The risk-attributable variable was mainly related to the MPV, which received the highest weighting, while the LOD and LOQ were assigned lower weights.

CONCLUSION: The iPLA demonstrated the ability to represent pesticide concentration levels in drinking water. The risk categories defined by the indicator – controlled, silent, and alert – represent a highly useful tool for public health surveillance, as they enable the identification of local drinking water risk levels to human health. Moreover, the iPLA supports public management in implementing control actions and improvements in the quality of water for human consumption.

PMID:40802345 | DOI:10.1590/1980-549720250045

J Health Organ Manag. 2025 Aug 14:1-15. doi: 10.1108/JHOM-03-2024-0116. Online ahead of print.

ABSTRACT

PURPOSE: This study sought to examine the impact of human resource management (HRM) on the performance of healthcare employees in selected Jordanian healthcare centers. It explores how specific HRM practices, including leadership, communication, technology adoption, teamwork, decision-making, motivation and promotions, influence employee performance.

DESIGN/METHODOLOGY/APPROACH: Data were collected using an online survey questionnaire from a randomized sample of 100 healthcare employees working in King Abdullah University Hospital and Jordanian University Hospital. The questionnaire was adapted from validated instruments used in previous research studies and tested for internal consistency of the items using Cronbach’s reliability test. Pearson correlations, linear regression and descriptive statistics tools were conducted using SPSS version 25 and were used to analyze the data. A minimum sample size of 200 was initially calculated; however, only 100 completed responses were received, which may impact statistical power.

FINDINGS: The healthcare employees scored an adequate level of job performance (M = 2.57; standard deviation = 0.43). The ability to remain active while performing work (2.64) and to complete specified work on time (2.61) and commitment and adherence to the regulations and hours of work (2.61) were the leading attributes of work performance. Moreover, healthcare employees’ performance was influenced by leadership and communication patterns, technology, teamwork, decision-making, motivation and promotions. Overall, HRM also had a significant summative impact on the performance of healthcare employees (p < 0.05).

RESEARCH LIMITATIONS/IMPLICATIONS: The cross-sectional research design renders it unsuitable for establishing causal relationships between variables. A sample size of N = 100 limits the generalizability of the findings obtained. Researchers should use either longitudinal or mixed-methods research methodologies to examine temporal changes and get deeper insights on HRM effectiveness.

PRACTICAL IMPLICATIONS: Enhancing healthcare HRM policies requires strengthening leadership frameworks and implementing modern communication systems, leading to improved worker performance and superior service quality.

ORIGINALITY/VALUE: The study offers valuable insights into HRM practices in the Jordanian healthcare sector, integrating HRM theories with healthcare management to offer actionable recommendations for hospital managers and policymakers.

PMID:40802306 | DOI:10.1108/JHOM-03-2024-0116

J Appl Oral Sci. 2025 Aug 11;33:e20250229. doi: 10.1590/1678-7757-2025-0229. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the effects of dealcoholized red wine supplementation on blood cells and the redox state in male rats with established apical periodontitis (AP).

METHODOLOGY: Thirty-two male Wistar rats were assigned to one of four groups: control (C), dealcoholized red wine (DRW), red wine (RW), and alcohol (AL). AP was induced, and supplementation was administered for 30 days, starting 30 days after AP induction. At the end of the 60th day, the maxillae were removed for AP radiographic analysis and blood was collected for blood cell and redox state analysis. Statistical tests were applied (p<0.05).

RESULTS: The C and DRW groups showed higher weight gain percentages (p<0.05). The DRW and AL groups exhibited the smallest and the largest periapical lesion areas, respectively (p<0.05). The RW and DRW groups showed similar red blood cell parameters to the C group but different from the AL group (p<0.05). Lymphocyte counts were smaller in the DRW and RW groups compared to the AL and C groups (p<0.05), and the neutrophil count was lower in the AL group (p<0.05). No significant differences were found in monocytes and in lipid and protein oxidative damage. Superoxide dismutase activity was lower in the AL group (p<0.05). The DRW group presented a higher glutathione concentration compared to the RW and AL groups (p<0.05).

CONCLUSION: DRW reduced periapical lesion size and altered the blood profile by reducing the lymphocyte count and increasing the concentration of endogenous antioxidants such as GSH in male rats with established AP.

PMID:40802305 | DOI:10.1590/1678-7757-2025-0229

Codas. 2025 Aug 11;37(4):e20240216. doi: 10.1590/2317-1782/e20240216pt. eCollection 2025.

ABSTRACT

PURPOSE: To evaluate the effectiveness of the adapted Cycles approach to telepractice and family engagement in the treatment of children with speech sound disorder (SSD).

METHODS: Ten children aged 5:0 to 7:8 years with a diagnosis of SSD participated. Two multiple baseline assessments and two post-treatment assessments were conducted. Effectiveness was measured by comparing pre- and post-intervention percentage of consonants correct (PCC), percentage of consonants correct revised (PCC-R), Process Density Index (PDI), and the number of phonological processes with occurrence >25% and the intervention effect size (ES). Family perceptions of daily training were obtained via digital interview and Likert scale. Subjects were randomly distributed to G1: two weekly online sessions with the speech therapist, and G2: half the sessions conducted by the caregiver trained by the speech therapist. Both groups received 12 sessions and performed daily speech training.

RESULTS: All participants showed increased PCC, PCC-R, and decreased PDI and number of phonological processes with occurrence >25%, with ES ranging from small to large. There was a trend towards statistical significance (ES G2 > G1). All caregivers reported high child interest in activities and ease of execution, with a positive family experience (Likert=4) training the child’s speech using digital resources.

CONCLUSION: The effectiveness of the proposed approach ranged from medium to high. The performance of the groups was similar, with a trend towards greater effectiveness for G2, which focused on family involvement. Parental training resulted in good engagement in sessions and daily training.

PMID:40802299 | DOI:10.1590/2317-1782/e20240216pt

Rev Bras Enferm. 2025 Aug 8;78Suppl 2(Suppl 2):e20240337. doi: 10.1590/0034-7167-2024-0337. eCollection 2025.

ABSTRACT

OBJECTIVES: to analyze the challenges and interferences experienced in reconfiguration of daily life and work of senior professors working remotely during the COVID-19 pandemic.

METHODS: qualitative research, with 15 professors from different levels of education. Snowball sampling and individual interviews were carried out, with structured and semi-structured questions. Analysis was simple statistical, percentage and lexicographic using Alceste software.

RESULTS: age ranged from 60 to 78 years, with a majority of women and difficulties in starting remote classes. There were more hours of work with overload, physical health problems due to a sedentary lifestyle and mental health problems.

FINAL CONSIDERATIONS: learning to use technology was understood as reinventing oneself as a professor. Collaborative work was a strategy to overcome challenges, and there was little psychological support from institutions. There is a clear need for investment in updating teaching staff and greater assistance to older teachers in their difficulties to overcome limitations.

PMID:40802295 | DOI:10.1590/0034-7167-2024-0337

JAMA Dermatol. 2025 Aug 13. doi: 10.1001/jamadermatol.2025.2790. Online ahead of print.

ABSTRACT

IMPORTANCE: Melasma, a complex and clinically challenging facial pigmentary disorder, lacks in vivo pathologic tools for definitive diagnosis and accurate efficacy assessment.

OBJECTIVE: To use 2-photon microscopy (TPM) for noninvasive pathologic detection of melasma and therapeutic response monitoring to hydroquinone cream, 2%.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, evaluator-blinded, observational study consisting of 2 sequential phases was conducted at the Dermatology Outpatient Clinic of China-Japan Friendship Hospital from January to September 2024. The study population included patients aged 18 to 60 years with clinically diagnosed melasma who were not treated for the condition in the past 3 months, without other facial dermatoses, free of malignant disease history, and not pregnant and nonlactating.

EXPOSURE AND INTERVENTION: In the first phase, participants underwent noninvasive TPM 3-dimensional imaging of lesional and perilesional areas. In the second phase, all participants were treated with hydroquinone cream, 2% twice daily for 12 weeks.

MAIN OUTCOMES AND MEASURES: In phase 1, the main outcome was TPM pathologic features. In phase 2, the main measures were modified Melasma Area and Severity Index (mMASI) scores, dermoscopic scores, and TPM indexes at baseline and weeks 4, 8, and 12.

RESULTS: The TPM images of 120 lesional and perilesional areas from 60 patients (57 female individuals, 3 male individuals; median [IQR] age, 39.5 [37.0-45.8] years) were analyzed. Compared with the perilesions, melasma lesions showed increased melanin across all epidermal layers (stratum corneum: median [IQR], 1 [0-2] vs 0 [0-0]; stratum granulosum: median [IQR], 1 [1-2] vs 0 [0-0]; superficial stratum spinosum: median [IQR], 2 [1-3] vs 1 [1-1]; deep stratum spinosum: median [IQR], 3 [2-3] vs 2 [1-2]; stratum basale: median [IQR], 3 [3-4] vs 2 [2-3]) in a mottled distribution, reduced viable epidermal thickness (median [IQR], 43.5 [39.0-48.0] µm vs 48.0 [43.9-54.0] µm; median difference, -4.50; 95% CI, -6.58 to -3.70), flattened rete ridges (94.17%; 95% CI, 88.45%-97.15% vs 69.17%; 95% CI, 60.42%-76.73%), increased activated (median [IQR], 2 [1-2] vs 1 [1-1]; median difference, 1; 95% CI, 0.70-1.00) and pendulous (median [IQR], 0 [0-1] vs 0 [0-0]) melanocytes at the dermal-epidermal junction (DEJ), and more severe solar elastosis (median [IQR], 2 [2-3] vs 2 [1-2]) (all P<.001). Among them, 53 patients (88.3%) completed 12 weeks of hydroquinone treatment, the mean mMASI scores and dermoscopic pigmentary scores decreased by 29.81% (95% CI, 22.75%-36.72%; P < .001) and 36.16% (95% CI, 30.07%-42.25%; P < .001), respectively, after treatment. TPM showed significant decreases in melanin content of each epidermal layer (stratum corneum: median [IQR], 1 [1-2] vs 1 [0-1]; stratum granulosum: median [IQR], 2 [1-2] vs 1 [0-1]; superficial stratum spinosum: median [IQR], 2 [2-3] vs 1 [1-2]; deep stratum spinosum: median [IQR], 3 [3-3] vs 2 [2-3]; and stratum basale: median [IQR], 3 [3-4] vs 2 [2-3]; all P < .001) and activated melanocytes at the DEJ (median [IQR], 2 [2-2] vs 1 [1-2]; P < .001) after treatment, but no statistical changes in pendulous melanocytes or solar elastosis during treatment.

CONCLUSIONS AND RELEVANCE: This observational study found that TPM may offer a new paradigm in pigmentary disorder management by enabling in vivo detection of pathologic features and assessment of cellular-level treatment responses.

PMID:40802269 | DOI:10.1001/jamadermatol.2025.2790