Category: Statistics

Int J Behav Nutr Phys Act. 2025 Feb 21;22(1):21. doi: 10.1186/s12966-025-01722-x.

ABSTRACT

BACKGROUND: The relationship between 24-hour (24-h) movement guidelines and frailty remains unclear. We aimed to investigate the associations between meeting 24-h movement guidelines and frailty and to conduct secondary analyses by age, gender, and ethnicity.

METHODS: In this study, we extracted data from the National Health and Nutrition Examination Survey (2007-2018) database. A total of 5,726 participants (50.25 ± 0.31 years) were included in this analysis, representing 38,240,356 noninstitutionalized U.S.

INDIVIDUALS: Three 24-h movement behaviors, namely, physical activity, sedentary behavior (SB), and sleep, were self-reported using the standardized questionnaires. The 49-item frailty index was used to measure frailty. Multivariable logistic regression models and trend tests were used to examine the associations between meeting 24-h movement guidelines and frailty. Sensitivity analyses were also conducted to ensure the robustness of our results.

RESULTS: The total age-adjusted prevalence of frailty was 30.5%. In the fully adjusted model, compared with not meeting any of the 24-h movement guidelines, the adjusted odds ratios (AORs) of frailty were 0.786 (95% CI: 0.545, 1.133), 1.161 (95% CI: 0.787, 1.711), and 0.915 (95% CI: 0.616, 1.358) for participants meeting only moderate to vigorous physical activity (MVPA), only SB, and only sleep guidelines, respectively, but no statistically significant differences were observed (all P values > 0.05). Participants who met the SB + sleep guidelines (AOR = 0.613, 95% CI: 0.423, 0.887), MVPA + sleep guidelines (AOR = 0.389, 95% CI: 0.255, 0.593), and MVPA + SB guidelines (AOR = 0.555, 95% CI: 0.383, 0.806) presented a significantly lower risk of frailty by 39%, 61%, and 45%, respectively. Meeting all 3 guidelines (AOR = 0.377, 95% CI: 0.264, 0.539) and meeting 2 guidelines (AOR = 0.527, 95% CI: 0.377, 0.736) were associated with a lower risk of frailty (P value < 0.001), showing a linear trend (P for trend < 0.001). The strength of these associations varied somewhat by age, gender, and ethnicity.

CONCLUSIONS: Significant associations between the 24-h movement guidelines and frailty were observed among U.S. adults. Future studies are warranted to examine the causality and trajectory of these associations.

PMID:39985025 | DOI:10.1186/s12966-025-01722-x

Health Qual Life Outcomes. 2025 Feb 21;23(1):17. doi: 10.1186/s12955-025-02340-8.

ABSTRACT

BACKGROUND: Estimation of health-related quality of life (HRQoL) in diabetic retinopathy (DR) patients is important to assess the impact of disease, to monitor the treatment outcomes, and conduct health technology assessments. The study aimed to measure the HRQoL in DR patients using the generic as well as disease specific instruments, identify the determinants of HRQoL, empirically investigate the concurrent validity between the QoL instruments, and to develop statistical approaches to map NEI-VFQ-25 (National Eye Institute- Visual Function Questionnaire- 25) composite score based on EQ-5D-5 L (EuroQol 5-dimensions 5-levels) utility values.

METHODS: A facility based cross-sectional study was carried out to measure the HRQoL of 300 DR patients using EQ-5D-5 L, EuroQol visual analogue scale (EQ-VAS), and NEI-VFQ-25 instruments. Mean HRQoL scores, along with DR state specific and visual acuity specific utility values were analysed. Pearson correlation coefficient was used to ascertain concurrent validity between NEI-VFQ-25 composite score and its sub-scale scores, EQ-5D-5L index value, and EQ-VAS score. Lastly, we evaluated statistical models using predictor sets based on the EQ-5D-5 L utility scores to estimate NEI-VFQ-25 scores.

RESULTS: The mean EQ-5D-5 L utility value for DR patients was 0.69 (95% CI: 0.65-0.73). The mean NEI-VFQ-25 composite score and EQ-VAS score were 61.1 (95% CI: 57.5-64.5), and 67.6 (95% CI: 65.6-69.5), respectively. Both EQ-5D-5 L and EQ-VAS had a strong concurrent validity with NEI-VFQ-25 composite score. ‘Tobit regression with log of composite score’ was assessed to the preferred model to predict the NEI-VFQ-25 composite score using EQ-5D-5L utility values.

CONCLUSION: Diabetic retinopathy has a decremental impact on quality of life, which increases with severity in vision loss. Both generic as well as disease-specific outcome measures are equally reliable to determine quality of life of patients with DR. The EQ-5D-5 L can be utilized for measurement of HRQoL in DR in clinical settings to optimize time of clinicians, with further derivation of NEI-VFQ-25 values through application of the crosswalk algorithm for predicting vision- related QoL.

PMID:39985016 | DOI:10.1186/s12955-025-02340-8

Respir Res. 2025 Feb 21;26(1):62. doi: 10.1186/s12931-025-03142-8.

ABSTRACT

BACKGROUND: This study provides a detailed analysis of respiratory tract infections (RTIs) and immunity levels against influenza and SARS-CoV-2 among soldiers and military personnel in Poland. Owing to their unique service environments, this occupational group is at high risk. During deployments, they often face adverse physical conditions, close living quarters, and exposure to both local and endemic pathogens. It particularly increases their susceptibility to RTIs, which remain a leading cause of illness worldwide.

METHODS: The study cohort included 379 participants aged between 19 and 60 years. We used polymerase chain reaction (PCR) techniques to detect 34 common respiratory pathogens and analyzed blood serum samples to assess the degree of immunity against the influenza A, B, and SARS-CoV-2 viruses. In 78.10% of the participants, at least one respiratory pathogen was detected.

RESULTS: Human rhinovirus (HRV) was the most common (8.71%), followed by SARS-CoV-2 (4.75%) and influenza A (H1N1) sw (2.90%). Staphylococcus aureus was the most prevalent bacterial pathogen (18.47%), with significant occurrences of Haemophilus influenzae (14.24%) and Klebsiella pneumoniae (9.76%). Additionally, 52.3% of those with coinfections had combinations of bacterial and viral pathogens, highlighting the complexity of diagnosing and managing these infections. We also assessed immunity levels, which focused on antibodies specific to influenza A/B and SARS-CoV-2 viruses. For all the results obtained, statistical analyses were performed. A weak positive correlation between age and levels of anti-influenza antibodies was observed, suggesting a slight increase in antibody levels with age. A total of 81.53% of the participants had received at least one dose of the SARS-CoV-2 vaccine. A significant correlation between the number of vaccine doses and higher anti-SARS-CoV-2 IgG antibodies was observed, indicating stronger immunity with more vaccinations.

CONCLUSIONS: This study underscores the importance of specialized health monitoring and preventive measures such as vaccinations to protect military personnel from RTIs and maintain their operational readiness. The detailed analysis of pathogen prevalence and immunity levels offers valuable insights into this occupational group’s health risks and needs.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:39985005 | DOI:10.1186/s12931-025-03142-8

BMC Oral Health. 2025 Feb 21;25(1):277. doi: 10.1186/s12903-025-05638-7.

ABSTRACT

BACKGROUND: Temporomandibular disorders (TMD) are frequently associated with anxiety, as this can increase the hyperactivity of the masticatory muscles, resulting in TMD-related pain and symptoms. The aim of this study was to assess the presence of TMD-related pain and symptoms associated with anxiety levels in Peruvian students in their final years of dental education.

METHODS: This analytical cross-sectional study of 273 Peruvian students in the final two years of dental education was conducted from October to December 2023. The Zung test was employed to diagnose anxiety, while the TMD-Pain Screener questionnaire was utilized to diagnose painful temporomandibular disorders (TMD). A Poisson regression model with robust variance using Adjusted Prevalence Ratio (APR) was employed to assess the prevalence of TMD-related pain and symptoms. The following variables were considered in the analysis: anxiety, sex, age, academic year, marital status, area of residence, type of housing, living with parents, and occupation. All statistical tests were conducted with a significance level of p < 0.05.

RESULTS: The prevalence of TMD-related pain and symptoms was 24.5%. The 0.7% of the sample exhibited very extreme levels of anxiety; 8.1% demonstrated severe anxiety; and 39.9% exhibited mild to moderate anxiety. Furthermore, dental students with severe to very extreme anxiety and with mild to moderate anxiety were 8.2 times and 3.8 times, respectively, more likely to present TMD-related pain and symptoms (APR = 8.18, 95% CI: 4.62-14.47 and APR = 3.84, 95% CI: 2.18-6.75, respectively), compared to those who did not have anxiety. Conversely, no significant association was observed between the presence of TMD-related pain and symptoms and sex, age, academic year, marital status, area of residence, type of housing, living with parents, or occupation (p > 0.05).

CONCLUSION: Almost a quarter of the students in their final years of dental education had TMD-related pain and symptoms. It was found that as the level of anxiety increased, from mild to moderate and from severe to very extreme, the likelihood of experiencing TMD-related pain and symptoms also increased significantly. On the other hand, gender, age, academic year, marital status, area of residence, type of housing, living with parents or occupation were not found to be influential factors in the presence of TMD-related pain and symptoms.

PMID:39984997 | DOI:10.1186/s12903-025-05638-7

BMC Nurs. 2025 Feb 21;24(1):203. doi: 10.1186/s12912-025-02817-3.

ABSTRACT

OBJECTIVES: This study was planned to compare the prone position and non-prone position groups and to evaluate arterial blood gas results, mechanical ventilator values and ventilator-associated pneumonia (VAP) status before, during, and after patients were brought back to the non-prone position.

DESIGN: This study is a randomized controlled trial with a parallel-group design and a 1:1 allocation ratio. A block randomisation method was used to ensure balanced allocation between two groups.

SETTING: The research was conducted in the 14-bed and 26-bed general ICUs of two private hospitals on the European side of Istanbul.

PARTICIPANTS: The 94 eligible participants were randomly divided into two groups. 52 participants were assigned to the prone position group, while 42 participants were assigned to the non-prone position group, which served as the control group. In the end, 40 participants were in each group.

INTERVENTION: The intervention involved placing patients in the prone position and monitoring their arterial blood gas results, mechanical ventilator values, and VAP status at multiple stages: before, during, and after returning them to the non-prone position. Each patient was followed for a minimum of 5 days.

RESULTS: The majority of the participants were male (51.2%) and aged 45-64 (48.8%). The comparison of experimental and control groups indicated statistically significant difference in saturation, FiO₂, inspiratory-expiratory tidal volume, and blood gas levels of the patients in the treatment group (p = 0.001; p < 0.01).

CONCLUSIONS: The change in the experimental group was greater than in the control group. In conclusion, the mechanical ventilator parameters and blood gas levels of the patients in the treatment group were better than those of the patients in the control group. It is recommended as an effective practice in patients receiving prone position mechanical ventilation (MV).

CLINICAL TRIAL REGISTRATION NUMBER AND REGISTRATION DATE: NCT05760716/ March 6, 2023 (This trial was registered retrospectively at ClinicalTrials.gov (Registration Number: NCT05760716) after its completion due to demanded revisions. The integrity of the data and adherence to the study protocol were ensured throughout. The trial adhered to ethical standards (ethics committee approval, informed consent) even if it was not registered prospectively).

PMID:39984994 | DOI:10.1186/s12912-025-02817-3

BMC Ophthalmol. 2025 Feb 21;25(1):87. doi: 10.1186/s12886-025-03921-3.

ABSTRACT

BACKGROUND: To compare anterior scleral thickness (AST) in Turkish patients with open-angle glaucoma (primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG)) with healthy controls.

METHODS: This prospective study involved 41 patients with PEG, 69 patients with POAG, and 46 healthy controls. We obtained spectral domain anterior segment optical coherence tomography (AS-OCT) images from the nasal and temporal quadrants and made AST measurements of 1 mm (AST), 2 mm (AST2), 3 mm (AST3), and 4 mm (AST4) posterior to the scleral spur (SS). Schlemm’s canal (SC) diameter and area measurements were performed using the ImageJ software. The results were compared statistically.

RESULTS: The average ASTs of the groups did not differ significantly (p > 0.05 for each). The analysis of the nasal SC diameter revealed a significant decrease in the POAG group in comparison with the PEG group, with no difference observed between the POAG and control groups (p = 0.038*). The mean nasal and temporal SC area was significantly smaller in the PEG and POAG groups compared with the control group (p < 0.001** and p < 0.001**, respectively).

CONCLUSIONS: There was no significant difference in nasal and temporal AST between groups; however, the SC area was found to be smaller in glaucoma groups compared with healthy controls. The present findings should be supported by further studies.

PMID:39984991 | DOI:10.1186/s12886-025-03921-3

BMC Pulm Med. 2025 Feb 21;25(1):85. doi: 10.1186/s12890-025-03553-9.

ABSTRACT

BACKGROUND: Nontuberculous mycobacterial pulmonary disease (NTM-PD) poses substantial diagnostic and management challenges, particularly among individuals with pre-existing lung conditions and/ or immunodeficiencies. NTM-PD can severely impair lung function and quality of life, potentially leading to both increased healthcare costs and mortality. There is a lack of comprehensive understanding of the disease burden and healthcare gaps from the patients’ perspective. The European NTM-PD Patient Disease Experience (ENPADE) survey aimed to collect insights into these aspects.

METHODS: The survey aim was addressed by several methods. First, an online questionnaire was carried out from July 2021 to February 2022 across eight European countries for quantitative data collection. Additionally, semi-structured qualitative patient interviews were conducted with a subset of patients, eliciting their insights on the aspects surveyed. Descriptive statistics were used for quantitative analysis and interview outcomes were categorised along the online questionnaire for qualitative analysis.

RESULTS: A total of 543 patients participated in the survey and 23 patients were interviewed. Satisfaction with care received before and after diagnosis was scored, on average, moderate with 32% “highly satisfied” patients and 25% “highly dissatisfied” patients across the aspects surveyed. Dissatisfaction was expressed particularly regarding referral and access to expert care, and information received on their disease and its management. Patients reported high restrictions in daily life (49%), work (31%), and social activities (43%), often leading to substantial emotional distress, such as experiencing an increase in feeling depressed or anxious (82%). Interviews with patients highlighted a need for improved disease information, faster diagnosis, and enhanced physician-patient relationships.

CONCLUSIONS: The ENPADE survey outcomes revealed dissatisfaction among patients with care and restrictions in daily life, work, and social activities, often leading to emotional distress. These findings underscore the need for improved disease information, standardised care, and enhanced physician-patient relationships with appropriate support measures.

PMID:39984983 | DOI:10.1186/s12890-025-03553-9

Trials. 2025 Feb 21;26(1):63. doi: 10.1186/s13063-025-08744-7.

ABSTRACT

BACKGROUND: Cardiovascular disease is a leading cause of death, with ischemic heart disease being a significant contributor. While percutaneous coronary intervention (PCI) effectively reduces mortality in myocardial infarction patients, its efficacy for unstable angina (UA) patients is controversial. Complications associated with PCI further limit application in UA. RIC is hypothesized to be an effective co-intervention that reduces PCI-related complications and may potentially enhance the efficacy of the PCI procedure itself.

METHODS: This is a pragmatic, prospective, dual-center, double-blind, randomized controlled clinical trial assessing the effect of remote ischemic conditioning (RIC) during percutaneous coronary intervention (PCI) on injury in unstable angina patients aged ≥ 18 years undergoing coronary angiography. Participants will be randomized to receive either RIC or Sham RIC, in addition to standard pharmacotherapy. Primary outcome includes periprocedural myocardial injury measured by hs-cTnT levels, while secondary outcomes encompass major adverse cardiovascular events, coronary artery lesions Gensini Score, arrhythmia, angina incidence, SAQ scores, ECG changes, and cardiac function assessed by two-dimensional echocardiography. The trial aims to recruit 574 participants and is scheduled to be initiated on 15 January 2024. We will conduct the primary statistical analysis using the intention-to-treat principle. Results from the trial will be presented as comparative summary statistics following the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

TRIAL REGISTRATION: ChiCTR2400079855, 15 January 2024.

PMID:39984971 | DOI:10.1186/s13063-025-08744-7

Health Res Policy Syst. 2025 Feb 21;23(1):24. doi: 10.1186/s12961-025-01295-y.

ABSTRACT

BACKGROUND: Responsiveness is a critical dimension of public health, focussing on how health systems address the needs, preferences and expectations of the population. It plays a central role in improving and maintaining the population’s health by ensuring timely, equitable and patient-centred healthcare services.

OBJECTIVE: In this study, we developed a mixed-methods model to assess healthcare system responsiveness from a public health perspective, integrating the insights of Iranian experts. The model identifies key factors such as intersectoral collaboration, health equity and community partnerships, which are essential for enhancing system responsiveness and ultimately improving health outcomes.

METHOD: In this study, conducted in 2024, we developed a mixed-methods model for assessing healthcare system responsiveness from a public health perspective, integrating the insights of Iranian experts. R software version 3.2.4 and the lavaan package were used for statistical analysis, considering the significance level of 0.05.

RESULTS: On the basis of the literature review, the main components of health systems’ responsiveness in the public health domain were extracted. The qualitative content analysis induced three different themes that affect health, which included payment mechanism (two subcategories of budget and incentive system), social determinants of health (three subcategories of intersectoral collaboration, community partnership and equity in health) and quality (three subcategories of timely provision of healthcare services, need-based service delivery and continuity of care). Finally, using structural equation modelling (SEM), a system of variables with causal relationships was developed. We found a statistically significant direct effect on intersectoral collaboration, health equity, payment mechanisms, timely delivery of services and need-based service provision. The strongest association was found for the payment system (β = 1.023, P ≤ 0.05). Model fit indices showed adequate fit.

CONCLUSIONS: Our developed model underscores the need for a comprehensive approach to healthcare system responsiveness, particularly focussing on public health services as foundational strategies for achieving universal health coverage. The results of our study revealed that a well-structured payment system and incentive mechanisms are critical for motivating healthcare professionals to deliver high-quality, timely and need-based services, ensuring sustainability in care provision. Beyond financial incentives, our model highlights the importance of health equity, intersectoral collaboration and community partnerships, which were identified as key drivers of responsiveness in healthcare systems. The findings indicate that fostering these elements not only strengthens healthcare delivery, but also supports the adaptation of services to meet diverse population needs effectively. In addition, the study emphasizes the innovative role of intersectoral collaboration in enhancing primary healthcare, which requires commitment across healthcare and non-health sectors. Our model introduces the concept of integrating community participation and resource allocation strategies into the healthcare system, thereby enhancing responsiveness. These strategies are anticipated to improve key health outcomes, such as life expectancy and maternal and child health indicators, by establishing robust healthcare networks that are more attuned to the health needs of the population.

PMID:39984955 | DOI:10.1186/s12961-025-01295-y

BMC Med Educ. 2025 Feb 21;25(1):288. doi: 10.1186/s12909-024-06607-4.

ABSTRACT

INTRODUCTION: Given the importance of the internship course in enhancing student capabilities, it seems necessary to employ appropriate techniques to manage and organize the training process. This research was conducted with the goal of identifying the essential data elements required for the development of an internship monitoring system in Health Information Technology.

METHODS: This qualitative research was conducted in 2022 using the Delphi technique. The study population consisted of professors from the Health Information Technology departments in medical universities in Iran (n = 85), selected through a convenience sampling method. The research instrument was a researcher-developed questionnaire, designed based on the approved educational curriculum, literature review, and analysis of existing systems. Its validity was confirmed by a panel of Health Information Technology experts, and its reliability was established with a Cronbach’s alpha coefficient of 0.83. The results of the Delphi rounds were analyzed and presented using descriptive statistical methods (Percent, Average, Standard deviation) with SPSS software, version 16.

RESULTS: Twenty professors from the Health Information Technology departments across the country participated in this research. The final model of the essential data elements for developing an internship monitoring system in Health Information Technology comprises five main data sections as follows: management data elements with three data axes, user data elements section with four data axes, functional data elements section with six data axes, output data elements section with two data axes, and key performance indicators section with five data axes.

CONCLUSION: In this research, a comprehensive set of essential data elements for developing an internship monitoring system in Health Information Technology was compiled. The proposed framework can facilitate the integration of data collection and provide a coherent approach to student evaluation.

PMID:39984926 | DOI:10.1186/s12909-024-06607-4