Category: Statistics

J Orthop Surg Res. 2025 Jun 16;20(1):590. doi: 10.1186/s13018-025-06008-3.

ABSTRACT

INTRODUCTION: The Both Column Fixation Corridor (BCFC) and Both Column Screws (BCS) represent innovative concepts in orthopedic surgery, yet they have not been extensively studied in the literature. This study aims to validate the BCFC as a consistent fixation pathway across genders, evaluate its axial fluoroscopic visualization, and investigate gender-specific anatomical variations for surgical planning.

MATERIALS AND METHODS: In this study, pelvic CT data from 400 adults (200 males, 200 females) were analyzed using Fujifilm-Synapse 3D software. In the initial step, axial fluoroscopic visualization of the corridor was simulated, and the optimal antegrade entry point (OAEP) was identified. Subsequently, virtual placement of anterior and posterior screws (aBCS, pBCS) was performed radiologically within the corridor. Measurements included screw thickness (R), length (L), distances to the spina iliaca anterior superior (SIAS-aBCS, SIAS-pBCS), and the caudo-cranial (CCT) and centro-lateral (CLT) fluoroscopic tilts required for axial visualization of the BCFC and its OAEP.

RESULTS: Fluoroscopic axial visualization of the BCFC and identification of the OAEP were successfully achieved in all models, enabling the placement of both anterior and posterior screws across genders. Measurements revealed the following average values for female and male pelvises, respectively: aBCS thicknesses were 6.5 ± 0.8 mm and 7.9 ± 0.9 mm (p < 0.001); lengths were 131.6 ± 8.8 mm and 146.8 ± 9.9 mm (p < 0.001); pBCS thicknesses were 6.5 ± 0.8 mm and 7.5 ± 0.7 mm (p < 0.001); lengths were 132.6 ± 9.7 mm and 148.3 ± 9.6 mm (p < 0.001); caudo-cranial tilts were 42.8°± 5.4 and 39.5°± 5.2 (p < 0.001); and centro-lateral tilts were 43.1°± 4.3 and 40.0°± 5.3 (p < 0.001). SIAS-pBCS distances were 38.5 ± 6.9 mm and 40.7 ± 7.5 mm (p = 0.003), while SIAS-aBCS distances were 29.7 ± 6.9 mm and 30.2 ± 6.7 mm (p = 0.467). All parameters, except for the SIAS-aBCS distance, exhibited statistically significant gender-specific differences.

CONCLUSION: The Both Column Fixation Corridor is a universally valid and consistent osseous fixation pathway present in both genders. It is suitable for the placement of two screws in pelvic and acetabular surgery, with careful consideration of gender-specific anatomical differences to optimize its application.

PMID:40524194 | DOI:10.1186/s13018-025-06008-3

ACS Appl Bio Mater. 2025 Jun 16. doi: 10.1021/acsabm.5c00697. Online ahead of print.

ABSTRACT

Advancements in cell-instructive biomaterials hinge on the precise design of their nanoscale topography, a critical factor in controlling cell-surface interactions. Nanofabrication techniques such as e-beam and nanoimprint lithography enable accurate nanopatterning on a wide range of materials. However, their limited applicability and scalability to medically relevant metals such as titanium, hinder the creation and modulation of precisely designed nanotopographies on metallic substrates to investigate structure-function relationships and clinical translation of nanotopographical surfaces for biomedical implants. In this context, anodization is a cost-effective, scalable method to nanopattern titanium and its alloys, producing arrays of TiO₂ nanotubes with precisely controlled diameters. Despite the significant advances in the understanding of how cells sense and respond to nanotubular surfaces, traditional diameter-focused research reliant on single-sized nanostructures restricts analysis to a narrow set of geometrical parameters and often overlook the spatial arrangement of nanotubes. To address these limitations, this study capitalizes on anodization to create scalable nanotubular gradients on titanium, introducing a high-throughput platform to explore the cellular response to a wide range of nanotopographical configurations within a single sample. Utilizing spatial metrics such as lacunarity, entropy, and fractal dimension, we characterized the structural complexity of the nanotubular surfaces, emphasizing geometrical considerations beyond the nanotube diameter in evaluating cellular response. In vitro assays with human MG63 osteoblastic cells revealed that more disordered, high-entropy regions significantly enhance cellular spreading and proliferation while promoting early osteogenic differentiation, evidenced by elevated RUNX2 and osteocalcin (OCN) expression. In contrast, mitochondrial activation and longer-term mineral deposition are elicited by more ordered nanotubular arrays. By streamlining the screening of nanotopographical features and enabling reproduction of user-selected designs as homogeneous surfaces, this gradient-based approach deepens mechanistic insights into structure-function relationships governing MG63 cell response to anodized titanium and offers a translatable framework for designing and evaluating nanotubular surfaces, shortening the gap between in vitro research and clinical applications.

PMID:40524179 | DOI:10.1021/acsabm.5c00697

Popul Health Metr. 2025 Jun 16;23(1):25. doi: 10.1186/s12963-025-00393-x.

ABSTRACT

BACKGROUND: Single-child families represent an expanded phenomenon in recent years due to prevailing socio-economic challenges. The single childbirth phenomenon can potentially cause negative population growth and undesirable effects on families. Thus, this study aimed to determine the prevalence (percent) of single-child families with an emphasis on interfering associated factors.

METHODS: For paper collection, valid databases of PubMed, Embase, ScienceDirect, Web of Science, Scopus, and Google Scholar search engine were systematically searched. All relevant studies were transferred to EndNote software (v.8) for duplicate detection. Primary and secondary screenings were applied and eligible studies enrolled for meta-analysis (CMA v.2). In this regard, the random effect model was employed and the I² index was used for heterogeneity assessment.

RESULTS: Following the examination of 33 studies, the prevalence (percent) of single-child families was found 41.3% (95% CI:33.1-49.9%). Meta-regression analysis revealed that following the acceleration in sample size and year of paper publication, the prevalence (percent) of single-child family increases and decreases (p < 0.05). Additionally, various influential factors effective on single-child families were listed as income status, financial difficulties, religious beliefs, educational level, and employment status.

CONCLUSION: According to the relatively high prevalence (percent) of single-child families and the influential impacts on families and communities, the findings of this study can provide valuable insights for policymakers to design appropriate policies and achieve demographic balance.

PMID:40524173 | DOI:10.1186/s12963-025-00393-x

BMC Pediatr. 2025 May 9;25(1):367. doi: 10.1186/s12887-025-05495-x.

ABSTRACT

BACKGROUND: Giving any things other than breast milk during the first 3 days after birth is a prelacteal feeding. Thus, providing anything other than breast milk to newborns has an impact on the prompt initiation and exclusive breastfeeding but a major issue in the developing countries. Therefore, the aimed to assess the determinants both individual and community level factors of given anything other than breast milk for neonates in Ethiopia.

METHODS: This study was a multilevel population-based cross-sectional conducted with total of weighted sample of 24,252 participants. The Ethiopian Demographic and Health Survey 2019 data were the source of secondary data analysis used in the study. The data was hierarchical; therefore we performed a multilevel analysis. In the multivariable analysis, variables with p-value < 0.05 were deemed substantially correlated with given anything other than breast milk for neonates.

RESULTS: In this study, respondents with Catholic religion followers [adjusted odds ratio (AOR) = 0.05; 95%CI: 0.12, 0.28] timely initiation of breast feeding [AOR = 4.44; 95%CI: 2.91, 6.74], Cesarean delivery usage [AOR = 3.94; 95%CI: 2.13, 7.13], and being in communities with pastoralist region [AOR = 6.39; 95%CI: 3.03, 11.62] were significant predictors of given anything other than breast milk for neonates.

CONCLUSION: This study found that giving anything other than breast milk to newborns was associated with both individual and community level characteristics, particularly among members of the Catholic Church, prompt commencement of breastfeeding, use of cesarean section delivery, and contextual region categories. Therefore, improving maternal health and early breastfeeding services should be strengthen. Furthermore, it is preferable to fairly distribute maternal services among regions and to focus on people living in pastoralist regions.

PMID:40524156 | DOI:10.1186/s12887-025-05495-x

BMC Palliat Care. 2025 Jun 16;24(1):165. doi: 10.1186/s12904-025-01767-6.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) nurses exhibit gaps in their knowledge, attitudes, and behaviors regarding palliative care. In China, there is a lack of standardized training programs for palliative care among ICU nurses, and corresponding research on the needs and impact of such training is also limited.

OBJECTIVE: Through the investigation and analysis of ICU nurses’ knowledge, attitudes, behaviors, and training needs regarding palliative care, this study explored the specific knowledge gaps and training needs of ICU nurses in palliative care.

METHODS: A convenience sampling method was employed to survey ICU nurses at 23 tertiary (tier-A) hospitals in Anhui Province, adhering to the specified criteria, between December 2023 and April 2024. The study utilized a general demographic survey and a comprehensive questionnaire to assess ICU nurses’ knowledge, attitudes, behaviors, and training requirements in palliative care.

RESULTS: Among the 693 ICU nurses surveyed, the scores for knowledge (73.67), attitude (77.1), behavior (75.84), and training needs (78.16) regarding palliative care were all below the middle level. Multivariate linear regression analysis indicated that gender, professional rank, prior attendance at death education or palliative care training, engagement with literature on death, experience caring for patients in advanced stages, and the number of terminally ill patients cared for in the past year significantly influence nurses’ knowledge, attitudes, behaviors, and training needs in palliative care (P < 0.05).

CONCLUSION: Training and education in palliative care should be enhanced for male and lower-level ICU nurses to address the specific knowledge gaps in this area. Chinese nursing managers should implement targeted and practical palliative care training programs to meet the specific training needs of ICU nurses.

PMID:40524152 | DOI:10.1186/s12904-025-01767-6

Popul Health Metr. 2025 Jun 16;23(1):27. doi: 10.1186/s12963-025-00384-y.

ABSTRACT

Many studies have recognized that a woman’s reproductive history influences the survival status of her fetus and the newborn. In the esteemed literature of demography, abundant evidence acknowledges the linkage between maternal exposure to offspring and their associated adult outcomes and the other way around. This study examines the link between maternal risk factors at birth and long-term outcomes for daughters in India. Using national health survey data, it focuses on three maternal risks: young age, high parity, and short birth intervals. Applying regression analysis to cohort data, the study finds these early-life disadvantages are associated with daughters experiencing stunted growth, undernutrition, child mortality, and low birth weight, as well as limited education and employment. Conversely, daughters of educated mothers have better outcomes, highlighting the importance of maternal education. The pseudo-cohort approach provides valuable longitudinal insights from cross-sectional surveys. The study underscores the need for policies promoting healthy reproductive practices and education access to improve long-term outcomes for women in India.

PMID:40524148 | DOI:10.1186/s12963-025-00384-y

JMIR Mhealth Uhealth. 2025 Jun 16;13:e71022. doi: 10.2196/71022.

ABSTRACT

BACKGROUND: New technologies from the field of mobile health (mHealth) are increasingly used to improve patient monitoring during rehabilitation. While in recent years, mobile phones, health apps, personal digital assistants, and smartwatches opened up new diagnostic and monitoring opportunities for patients, the development of innovative sensor devices, such as instrumented insoles, has now reached a sufficient level of usability with promising opportunities for clinical practice. According to research on the best method for monitoring recovery after musculoskeletal injury or surgery, the Patient-Reported Outcome Measurement Information System (PROMIS) and wearables such as instrumented insoles are among the most promising newer options. However, it is unknown how a patient’s health perception and improvements in instrumented insole-derived gait parameters correlate after surgery for tibial or malleolar fractures.

OBJECTIVE: This study aimed to compare the longitudinal trajectories in separate PROMIS (sub)scores with gait and further patient-specific parameters, as well as associations between PROMIS scores and gait parameters. It was also aimed to determine the influence of anthropometric parameters and comorbidities.

METHODS: A total of 85 patients (39 women and 46 men; average age 50.8, SD 17.1 years) requiring surgery after tibial or malleolar fractures were included in this prospective longitudinal observational study. In the hospital and during follow-up visits, the patients completed the PROMIS Global Health and Pain Interference questionnaires. During the same visits, individually fitted instrumented insoles with 16 pressure sensors, an accelerometer, and a gyroscope each were used to assess the maximal force, pressure distribution, and angular velocity during walking with data being recorded at 100 Hz. Statistical analyses were conducted using linear mixed effect models, pairwise Spearman correlation coefficients, and generalized additive models.

RESULTS: The gait parameters assessed via the instrumented insoles quickly improved during the first 3 months after surgery, followed by a slowing of further improvement. After surgery, the PROMIS scores increased or decreased to extrema that were reached after 6 weeks to 3 months, followed by a return to preinjury values. Between 3 and 6 months, no significant improvements in PROMIS scores were observed. Between 6 months and 1 year, the Physical Health and Mental Health scores still improved significantly (P=.003 in both cases). Men had better Physical Health and lower Pain Interference scores than women (P=.01 and P=.03, respectively). Hypertension had a negative effect on the Physical Health score (P=.03). The associations between the PROMIS score and gait parameters were strongest at approximately 3 months after surgery, predominantly between the Pain Interference score and gait parameters.

CONCLUSIONS: The patients’ perception improved later than the objective gait parameters obtained by instrumented insoles did. When the gait pattern improved, pain perception correlated with the gait parameters.

TRIAL REGISTRATION: German Clinical Trials Registry DRKS00025108; https://drks.de/search/en/trial/DRKS00025108.

PMID:40523278 | DOI:10.2196/71022

JMIR Res Protoc. 2025 Jun 16;14:e70076. doi: 10.2196/70076.

ABSTRACT

BACKGROUND: Maternal mental health disorders are associated with adverse maternal and infant health outcomes. Despite advances in screening and treatment, disparities in maternal mental health disorders continue to disproportionately affect Black mothers and birthing persons. While there are studies that have examined maternal mental health, a gap in research remains in understanding the protective and risk factors of Black maternal mental health in Canada. Identifying the risks and protective factors is critical for advancing equitable and inclusive policies and practices that promote maternal well-being and optimal outcomes for Black perinatal populations.

OBJECTIVE: This paper presents an outline of a study protocol that seeks to identify the protective and risk factors of Black maternal mental health and to engage Black mothers and birthing persons from the Greater Toronto Area in codesigning a culturally safe and inclusive best practices model to inform policy and interventions.

METHODS: The proposed study will use an exploratory 3-phase sequential mixed methods approach underpinned by the principles of health equity and community-based participatory research. Phase 1 will involve engaging Black mothers and birth persons (n=300) in a survey to examine the psychosocial determinants of Black maternal mental health, including depression, anxiety, discrimination, strong Black women trope, attitude toward seeking mental health, support, and stigma. In phase 2, we will conduct 6 focus groups and individual interviews (n=60) to explore the stressors in the context of Black mothers and birth persons’ everyday lives, psychosocial and support needs, and conditions that promote their resilience. Finally, phase 3 will engage Black women and birthing persons (n=30) in a codesign session using the concept mapping method to identify priority areas for action to inform policy and programming. We will use SPSS version 26 (IBM Corp) to analyze the survey data, drawing on both descriptive and inferential statistics. NVivo (Lumivero), a qualitative data analysis software, will be used to organize the data from phase 2 into meaningful themes informed by Braun and Clarke’s thematic analysis approach.

RESULTS: Ethics approval was granted in July 2024. Data collection for phase 1 started in December 2024 and will be completed in April 2025. Findings from phase 1 will inform phases 2 and 3 of this study, which will be conducted in the third quarter of 2025. We will disseminate the results of this study in the second and third quarters of 2025.

CONCLUSIONS: The findings will generate the much-needed knowledge to shift policy, practice, and research and support capacity building among Black mothers and birthing persons. In addition, the proposed study will contribute to informing policy initiatives and interventions at the health system and community level to advance mental health equity and build capacity among service providers to provide culturally safe and equitable mental health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/70076.

PMID:40523275 | DOI:10.2196/70076

JMIR Infodemiology. 2025 Jun 16;5:e69945. doi: 10.2196/69945.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been accompanied by an unprecedented infodemic characterized by the widespread dissemination of misinformation. Globally, misinformation about COVID-19 has led to polarized beliefs and behaviors, including vaccine hesitancy, rejection of governmental authorities’ recommendations, and distrust in health institutions. Thus, understanding the prevalence and drivers of misinformation is critical for designing effective and contextualized public health strategies.

OBJECTIVE: On the basis of a tailored survey on health misinformation, this study aims to assess the prevalence and distribution of COVID-19-related misinformation in Spain; identify population groups based on their beliefs; and explore the social, economic, ideological, and media use factors associated with susceptibility to misinformation.

METHODS: A cross-sectional telephone survey was conducted with a nationally representative sample of 2200 individuals in Spain. The study developed the COVID-19 Misinformation Scale to measure beliefs in misinformation. Exploratory factor analysis identified key misinformation topics, and k-means clustering classified participants into 3 groups: convinced, hesitant, and skeptical. Multinomial logistic regression was used to explore associations between misinformation beliefs and demographic, social, and health-related variables.

RESULTS: Three population groups were identified: convinced (1078/2200, 49%), hesitant (666/2200, 30.27%), and skeptical (456/2200, 20.73%). Conspiracy theories, doubts about vaccines, and stories about sudden death emerged as the most endorsed current misinformation topics. Higher susceptibility to misinformation was associated with the female sex, lower socioeconomic status, use of low-quality information sources, higher levels of media sharing, greater religiosity, distrust of institutions, and extreme and unstated political ideologies. Frequent sharing of health information on social networks was also associated with membership in the skeptical group, regardless of whether the information was verified. Interestingly, women were prone to COVID-19 skepticism, a finding that warranted further research to understand the gender-specific factors driving vulnerability to health misinformation. In addition, a geographic distribution of hesitant and skeptical groups was observed that coincides with the so-called empty Spain, areas where political disaffection with the main political parties is greater.

CONCLUSIONS: This study highlights the important role of determinants of susceptibility to COVID-19 misinformation that go beyond purely socioeconomic and ideological factors. Although these factors are relevant in explaining the social reproduction of this phenomenon, some determinants are linked to the use of social media (ie, searching and sharing of alternative health information) and probably the political disaffection of citizens who have stopped believing in both the ideologically centrist mainstream parties and the institutions that represent them. Furthermore, by establishing the profile and geographic distribution of the convinced, hesitant, and skeptical groups, our results provide useful insights for public health interventions. Specific strategies should focus on restoring institutional trust, promoting reliable sources of information, and addressing structural drivers of health misinformation linked to gender inequalities.

PMID:40523274 | DOI:10.2196/69945

J Med Internet Res. 2025 Jun 16;27:e65304. doi: 10.2196/65304.

ABSTRACT

BACKGROUND: The COVID-19 pandemic accelerated global telehealth adoption, prompting the South Korean government to temporarily legalize telemedicine in 2020 and subsequently launch a pilot program in 2023. As South Korea transitions to a postpandemic digital health environment, understanding the factors associated with willingness to use (WTU) and willingness to pay (WTP) for telemedicine and teleconsultation is essential for informing effective policy and service design. However, few studies have explored how preferences vary across clinical domains or user groups.

OBJECTIVE: This study examined the factors that influence WTU and WTP for telemedicine and teleconsultation across 5 clinical domains: dermatological, psychiatric, musculoskeletal, internal medicine, and cancer disorders.

METHODS: A cross-sectional survey was conducted among 552 participants aged 19-69 years in South Korea, selected through stratified sampling. Multiple logistic regression analysis was used to examine WTU and WTP, considering sociodemographic factors and previous telemedicine experience.

RESULTS: Participants’ age, residence, and previous telemedicine experience significantly influenced their WTU and WTP for telemedicine services. WTP increased with age for both telemedicine (P-for-trend=.02) and teleconsultation (P-for-trend=.001). Noncapital residents showed significantly higher WTU for teleconsultation than capital area residents (odds ratio [OR] 1.48, 90% CI 1.03-2.12; P=.07). Participants with previous telemedicine experience showed higher WTU for telemedicine (OR 4.07, 90% CI 1.84-9.04; P=.004) and teleconsultation (OR 2.21, 90% CI 1.21-4.06; P=.03), and higher WTP for telemedicine (OR 2.89, 90% CI 1.84-4.54; P<.001) and teleconsultation (OR 2.76, 90% CI 1.77-4.30; P<.001). WTU and WTP varied by clinical domain: psychiatric care showed the highest WTU (64.5%) and WTP (27.0%) for telemedicine, while cancer disorders showed higher WTU (48.6%) and WTP (24.8%) for teleconsultation than for telemedicine.

CONCLUSIONS: WTU and WTP for telemedicine and teleconsultation differ substantially depending on service type, clinical domain, and user characteristics. These findings highlight the importance of considering prior telemedicine experience, regional access disparities, and condition-specific care needs when designing digital health strategies. Accordingly, flexible, user-centered telehealth policies are needed to support service accessibility and equitable implementation in the post-COVID-19 era. The insights from this study can serve as a practical foundation for developing inclusive digital health systems in countries undergoing similar transitions.

PMID:40523273 | DOI:10.2196/65304