Category: Statistics

BMC Med Imaging. 2025 May 26;25(1):185. doi: 10.1186/s12880-025-01730-0.

ABSTRACT

BACKGROUND: Age-related liver diffusion metrics changes have been described. We aim to further clarify these questions: 1) whether an age-related reduction of liver perfusion can be observed by DDVD (diffusion derived vessel density) in older males; 2) whether there is a male female difference in liver perfusion; 3) whether liver ADC values and spleen ADC values are correlated. It is known that, physiologically, males’ liver has a higher iron level (thus a shorter T2) than females’ liver; pre-menopausal females have a lower liver iron level (thus a longer T2) than post-menopausal females. The observations of this study will be interpreted with the recently gained knowledge of the T2 contribution to diffusion metrics.

METHODS: Included in this healthy volunteer’s study were 68 males (mean age:50.22 years, range: 25-70 years) and 43 females (mean age 45.56 years, range:20-71 years). DWI images with b-values of 0, 2, 10, 20, 60, and 600 s/mm² were acquired at 1.5T. DDVD were calculated with b = 0, b = 2, b = 10, and b = 20 s/mm² images. ADC were calculated with b = 0, b = 2, b = 60 and b = 600 s/mm² images.

RESULTS: There was a statistically significant age-related decline of liver DDVD values for females (p = 0.024). A similar trend was observed for males, though statistical significance was not achieved (p = 0.113). Liver DDVD values were all higher in females than in males (p < 0.001). There was a statistically significant age-related decline of liver ADC values both for males (ADC_(b0b600), p = 0.009) and for females (ADC_(b0b600), p = 0.016). Liver ADC values and spleen ADC values were positively correlated (ADC_(b0b600), r = 0.33 for males and 0.31 for females, p < 0.05). When the spleen ADC was used to normalize the liver ADC, then the age-related trend was largely removed, both for males and for females (p > 0.05).

CONCLUSION: Females have a larger liver perfusion volume than males. There is an age-related decrease of DDVD and ADC, both for males and females. Liver ADC values and spleen ADC values are positively correlated. These gender and age-related changes are unlikely mainly caused by the liver T2 relaxation time variations.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40420278 | DOI:10.1186/s12880-025-01730-0

BMC Nurs. 2025 May 26;24(1):598. doi: 10.1186/s12912-025-03243-1.

ABSTRACT

BACKGROUND: Workplace violence is a global public health concern, especially in developing nations. Nurses, due to the nature of their professional duties, often face an elevated risk of workplace violence. This risk is further exacerbated by the lack of adequate safety precautions and the presence of multiple potential perpetrators, making the work environment particularly hazardous for them.

OBJECTIVES: This systematic review explores workplace violence against nurses in Ethiopia, its prevalence, causes, Perpetrators of violence in the Nurses’ profession, consequences, influence on the profession, and strategies to prevent incidents based on relevant literature review.

REVIEW METHOD AND DATA SOURCES: The study sourced evidence from electronic databases like PubMed, Science Direct Scopus, Web of Science, and Google Scholar till January 30, 2024. The data was extracted from February 01-10 and later analyzed from February 15-March 15, and the report generation from March 15 to April 05, 2024, and reported findings per Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The study used pooled odds ratio and pooled proportion to assess exposure and outcomes. A meta-analysis was conducted using compressive met-analysis V4 packages, with forest plots for visual representation. Heterogeneity was evaluated using Cochran’s Q-test and I² statistic. Sensitivity analysis was performed by systematically excluding one study.

RESULT: In Ethiopia, workplace violence against nurses was a significant issue, with an incidence ranging from 26.7 to 64%. The most common form of violence was verbal abuse, followed by physical, psychological, and sexual harassment. Factors like age, gender, marital status, job type, work environment, and staffing levels contribute to the issue. Over half of nurses change shifts due to concerns about violence, community dissatisfaction, unsatisfactory treatment, and challenging nurse-patient relationships.

CONCLUSION: The prevalence of WPV among nurses in Ethiopia is increasing. Nurses face a high risk of workplace violence due to direct patient contact and the nature of the profession. Thus, healthcare organizations can work towards creating a safer and more supportive environment for nurses, enforce a zero-tolerance policy, improve patient-nurse relationships, and provide psychological support to ultimately reduce the prevalence of workplace violence and ensure the well-being of healthcare professionals.

PROSPERO REGISTRATION NUMBER: CRD42024601317.

PMID:40420275 | DOI:10.1186/s12912-025-03243-1

Lipids Health Dis. 2025 May 26;24(1):191. doi: 10.1186/s12944-025-02618-2.

ABSTRACT

OBJECTIVE: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is an established biomarker for metabolic and inflammatory disorders but has received little attention in relation to osteoarthritis (OA). This investigation examines the UHR‒OA risk correlates.

METHODS: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2016. Descriptive analyses, univariate and multivariate logistic regression models, as well as generalized additive and segmented regression models were used to investigate the nonlinear correlation and threshold effect of UHR-OA.

RESULTS: A total of 20,727 U.S. adults were included, 2,900 of whom (13.99%) were diagnosed with osteoarthritis (OA). A nonlinear relationship with a significant threshold effect was observed between the UHR and OA. When the UHR was less than 0.109, it was strongly inversely related to OA (OR = 0.028, 95% CI: 0.002-0.345, P < 0.01). The odds ratio increased when the UHR surpassed 0.109 but was not statistically significant (OR = 0.625, 95% CI: 0.162-2.421, P > 0.05). According to the unadjusted logistic regression model, the UHR was not significantly correlated with OA (P > 0.05). Following adjustment for confounders, including sex, age, ethnicity, education, marriage, BMI, income, hypertension, diabetes, coronary heart disease, and hypercholesterolemia, a notable inverse relationship emerged (OR = 0.259, 95% CI: 0.093-0.718, P < 0.01). Univariate linear regression studies revealed an intense inverse relationship between UA and HDL-C (OR = -3.2, 95% CI: -3.3 to -3.0, P < 0.001). In addition, stratified studies revealed that the negative relationships between the UHR and OA were more pronounced in elderly individuals (≥ 50 years old), women, drinkers, non-Hispanic whites, individuals with higher education levels and individuals without metabolic disorders (those with no hypertension, diabetes, coronary heart disease, or hypercholesterolemia) and did not show obvious heterogeneity in smoking status, BMI, marriage, or income level.

CONCLUSIONS: This study revealed a nonlinear relationship between the UHR and OA, with a threshold at UHR = 0.109. Below this level, the UHR was significantly negatively associated with OA, especially in older adults (≥ 50 years old), females, drinkers, non-Hispanic Whites, and those with an education level above high school, or no metabolic diseases.

PMID:40420274 | DOI:10.1186/s12944-025-02618-2

BMC Nurs. 2025 May 26;24(1):596. doi: 10.1186/s12912-025-03266-8.

ABSTRACT

INTRODUCTION: Nurse burnout negatively impacts patient care quality, safety, and outcomes, while harming nurses’ mental health, job satisfaction, and retention. It also imposes financial burdens on healthcare organizations through absenteeism, reduced productivity, and higher turnover costs, highlighting the need for research to address these challenges. The umbrella review methodology was selected to integrate evidence from multiple systematic reviews and meta-analyses, offering a broad and in-depth summary of existing research to guide practice and policy. This approach equips stakeholders with a holistic understanding of the multifaceted impacts of nurse burnout, facilitating the design of effective interventions that support nurses, enhance healthcare delivery, and optimize patient outcomes. Consequently, this umbrella review aims to evaluate the global prevalence and contributing factors of nurse burnout.

METHODS: This umbrella review included 14 systematic reviews and meta-analyses identified from various databases. The quality of each study was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR II). Data were extracted using Microsoft Excel and analyzed with STATA 17.0. Heterogeneity was measured using Higgin’s I² Statistics, and summary prevalence estimates were calculated with the Der Simonian-Laird random-effects model. Meta-regression and subgroup analyses were conducted to identify the source of high heterogeneity. Publication bias was assessed using funnel plots and Egger’s regression test, with the former providing a visual assessment of bias and the latter offering a statistical method to detect asymmetry.

RESULTS: The global prevalence of nurse burnout was evaluated in three areas: emotional exhaustion (33.45%, 95% CI 27.31-39.59), depersonalization (25.0%, 95% CI 17.17-33.00), and low personal accomplishment (33.49%, 95% CI 28.43-38.55). Emotional exhaustion was most common among nurses working during the COVID-19 pandemic (39.23%, 95% CI 16.22-94.68). Oncology nurses experienced the highest rate of depersonalization (42%, 95% CI 16.71-77.30), while nurses in intensive care units reported the highest rate of low personal accomplishment (46.02%, 95% CI 43.83-48.28).

CONCLUSIONS: Nurse burnout is prevalent worldwide, often marked by a sense of low personal accomplishment. Several factors contribute to this issue, including role conflict, negative emotions, family problems, moral distress, stress, commuting distance, predictability of work tasks, and workplace advancement.

PMID:40420259 | DOI:10.1186/s12912-025-03266-8

BMC Oral Health. 2025 May 26;25(1):795. doi: 10.1186/s12903-025-06205-w.

ABSTRACT

BACKGROUND: Occlusion plays a crucial role in maintaining masticatory function and temporomandibular joint (TMJ). Single implant supported restorations are widely used for posterior tooth replacement, but they require careful occlusal adjustment due to the absence of periodontal ligament. Digital occlusal analysis methods, such as digital impressions and Occlusense, provide quantitative assessments of occlusal contacts and force distribution. However, their accuracy and clinical relevance remain uncertain.

METHODS: In this prospective clinical study, occlusal force distribution was evaluated before and after placement of single implant supported restoration using the Medit i700 intraoral scanner and OccluSense system. Measurements were performed before and after prosthesis under standardised conditions. Occlusal contact areas and force distributions were analysed using CloudCompare and ImageJ software. Statistical analysis was performed using Kruskal-Wallis test and Kendall’s Tau-B correlation analysis.

RESULTS: A total of 20 patients were included in the study. Post-restoration measurements revealed significant changes in occlusal force distribution in different segments of the dental arch (p < 0.001). Strong correlations were observed between Medit and OccluSense measurements (p < 0.001).

CONCLUSION: Single-unit implant restorations significantly alter the occlusal force distribution, affecting not only the restored tooth but also the adjacent and opposing teeth. Both Medit i700 and OccluSense provided valuable information, with OccluSense providing a more detailed representation of occlusal force density. These findings suggest that digital occlusal analysis methods can help optimise occlusal adjustments for implant restorations.

TRIAL REGISTRATION: The current study was registered in ClinicalTrials.gov (ID: NCT06862973) First posted: 07/03/2025. Retrospectively registered.

PMID:40420258 | DOI:10.1186/s12903-025-06205-w

Respir Res. 2025 May 26;26(1):199. doi: 10.1186/s12931-025-03243-4.

ABSTRACT

BACKGROUND: Mindfulness-based interventions (MBIs) are effective in improving mental and physical health in various chronic conditions. While the GOLD 2024 report recommends MBIs for chronic obstructive pulmonary disease (COPD), scientific evidence in this specific population is scarce. This prospective randomised controlled pilot study investigated the feasibility of an 8-week digital MBI and its preliminary effects on mental and physical health in COPD.

METHODS: Psychologically burdened COPD patients (63 ± 7 years, 61% female, FEV1% 41 ± 19) were randomly allocated to the MBI group (n = 14; daily 10-15-minute audio-guided meditation via smartphone) or a waitlist control group (n = 16). Primary outcomes included the intervention’s feasibility (dropouts, MBI usage rates, interview and questionnaire responses) and its preliminary effects on symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS). Secondary outcomes included its preliminary effects on the COPD Assessment Test (CAT), Chronic Respiratory Disease Questionnaire (CRQ-SAS), Perceived Stress Scale (PSS-10), and biological stress markers. Exploratory outcomes included momentary subjective stress, anxiety, and dyspnoea after meditating.

RESULTS: The results indicated that the intervention was feasible (81% usage rate; 93% and 71% found the MBI enjoyable and helpful, respectively), with 21% dropout. A statistically significant intervention (time x group) effect was found for anxiety (HADS-A, p =.010, η_p² = 0.11) and emotional functioning (CRQ-SAS, p =.004, η_p² = 0.14), but not for depression (HADS-D, p =.060, η_p² = 0.06) or any other secondary outcome after 8 weeks. Momentary subjective stress (p <.001, η_p² = 0.75), anxiety (p =.022, η_p² = 0.75), and dyspnoea (p <.001, η_p² = 0.70) were significantly reduced after meditating.

CONCLUSIONS: The digital MBI was feasible, with preliminary effects indicating improvements in anxiety and emotional functioning after 8 weeks as well as momentary outcomes after meditating. Future large-scale trials should further assess the effectiveness of digital MBIs in this context. However, the findings suggest that digital MBIs might be promising and effective low-threshold add-on treatments in clinical settings.

TRIAL REGISTRATION: The article has been preregistered at ClinicalTrials.gov (identifier: NCT04769505, date: 23rd February 2021).

PMID:40420253 | DOI:10.1186/s12931-025-03243-4

Scand J Psychol. 2025 May 26. doi: 10.1111/sjop.13127. Online ahead of print.

ABSTRACT

Elevated psychological stress reactions among healthcare workers during the COVID-19 pandemic necessitated a need to better understand their possible impact on sickness absence (SA). The study aimed to describe the relation between SA related to mental health problems and symptoms of psychological stress among healthcare workers during the COVID-19 pandemic. We further aimed to identify whether latent profiles of psychological stress reactions exist within the same population. In this observational registry-based study, survey data between May 2020 and March 2021 and SA register data between May 2019 and February 2023 were collected from 1245 Swedish healthcare workers. Differences between symptoms of burnout, depression, anxiety, PTSD, sleep disturbance, lack of detachment, and lack of recovery among groups with no, few (< 90), or many (≥ 90) SA days were analyzed with Kruskal-Wallis tests. Interrelations between symptoms of psychological stress were identified using latent profile analysis. Compared to healthy participants, participants with SA days (in total 6.3%) reported more severe symptoms of psychological stress, were younger, and more likely to work as assistant nurses. Furthermore, they displayed a higher degree of previous SA (prior to the pandemic). No statistically significant differences between groups with few (< 90) and many (≥ 90) days of SA in symptoms were noted. Four latent profiles of psychological stress were identified, but they differed only in the level of experienced symptoms. We conclude that different symptoms of psychological stress are highly interrelated among healthcare workers during a crisis. Although many healthcare workers may experience elevated symptoms in relation to the crisis, it will not necessarily lead to serious mental health problems requiring SA.

PMID:40420252 | DOI:10.1111/sjop.13127

BMC Sports Sci Med Rehabil. 2025 May 26;17(1):130. doi: 10.1186/s13102-025-01169-4.

ABSTRACT

OBJECTIVE: To comprehensively assess the rehabilitation efficacy of telerehabilitation compared with other traditional rehabilitation therapies in postoperative hip fracture patients.

DATA SOURCES: Seven electronic databases: PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP Databases, were searched from inception until October 2023.

STUDY SELECTION: Two independent reviewers selected randomized controlled trials (RCTs) that assessed the efficacy of telerehabilitation intervention approach to postoperative hip fracture rehabilitation. An outcome measure related to hip function, functional independence, anxiety levels, walking ability, quality of life, and treatment adherence were eligible.

DATA EXTRACTION: Two reviewers independently used the Cochrane Risk of Bias 2 (RoB 2) tool for risk of bias and data extraction. RevMan 5.4 and Stata 15.1 were used for statistical analysis.

DATA SYNTHESIS: Seventeen RCTs (n = 1577) met the inclusion criteria. Compared to the usual care group, the telerehabilitation group demonstrated a noteworthy enhancement in hip function, as evidenced by the Harris Hip Score (SMD = 1.05, 95% CI (0.64, 1.45)). Significant improvements in functional independence (Functional Independence Measure: SMD = 1.38, 95% CI (1.08, 1.68)), adherence to rehabilitation treatment (Medical Compliance Behavior Scale: SMD = 1.23, 95% CI (0.71, 1.76)), and quality of life (SMD = 1.04, 95% CI (0.42, 1.65)) were also observed in the telerehabilitation group. However, no statistically significant distinction was observed in anxiety improvement (as assessed by the Self-Rating Anxiety Scale: SMD = -0.67, 95%CI (-1.65, 0.31)) or in terms of walkability (Timed Up and Go Test: SMD = -0.06, 95% CI (-0.32, 0.20)) when compared to the usual care group. This may be related to patient participation, differences in telerehabilitation interventions, and inconsistent follow-up durations among different studies.

CONCLUSIONS: Current evidence suggests that telerehabilitation may help improve hip function, increase functional independence, and improve treatment adherence in patients after hip fracture surgery. Nonetheless, it does not demonstrate a significant impact on reducing patients’ anxiety or improving their walking ability.

PMID:40420240 | DOI:10.1186/s13102-025-01169-4

BMC Med Educ. 2025 May 26;25(1):778. doi: 10.1186/s12909-025-07303-7.

ABSTRACT

BACKGROUND: Medical education is highly demanding, leading to stress, burnout, and anxiety. In this context, accomplishment-progress toward meaningful goals-emerges as a key factor in student well-being. However, its impact on the well-being of medical students, particularly in India, remains underexplored.

OBJECTIVE: This study aims to explore the role of accomplishment in the wellbeing of Indian medical students and to examine how it relates to other elements of PERMA + . We hypothesized that higher levels of accomplishment would correlate with better well-being across other PERMA + dimensions, and that gender differences would influence the relationship between accomplishment and well-being.

METHODS: We conducted a cross-sectional study at Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India, from April to October 2023. A total of 364 medical students participated, completing a pre-designed and pre-validated questionnaire that assessed their sense of accomplishment in three areas: progress toward goals, achievement of important goals, and the ability to handle responsibilities. We used statistical analyses including Chi-square, t-tests, and Pearson correlation tests to analyze the data.

RESULTS: The sample was predominantly made up of students aged 20-22 years (62.4%), with a significant proportion being female (66.2%). Males reported significantly higher levels of accomplishment compared to females. We found that accomplishment was strongly linked to other well-being factors such as engagement (0.379**), relationships (0.386**), meaning (0.487**), health (0.287**), and happiness (0.359**). However, there was no significant link between accomplishment and negative emotions or loneliness.

CONCLUSION: The findings suggest that fostering accomplishment should be prioritized in medical education to support student resilience. Gender differences in accomplishment, with males reporting higher levels, highlight potential challenges for female students, such as societal pressures and academic workload. Addressing these disparities through targeted interventions, like mentorship programs and inclusive support systems, could promote a more equitable learning environment.

PMID:40420220 | DOI:10.1186/s12909-025-07303-7

Chin Med. 2025 May 26;20(1):70. doi: 10.1186/s13020-025-01120-2.

ABSTRACT

BACKGROUND: Allergic rhinitis (AR) is a common allergic condition characterized by frequent sneezing, nasal congestion, nasal itching and rhinorrhea. Chinese medicine formula Yu-Ping-Feng Powder with Variation (YPV) is an empirical formula modified from an ancient Chinese medicine formula named Yu-Ping-Feng Powder, which is widely used for the treatment of allergic diseases such as AR and asthma.

PURPOSE: To evaluate the efficacy and safety of YPV on AR patients with the lung and spleen Qi deficiency type using a randomized, double-blind, placebo-controlled clinical trial (RCT).

STUDY DESIGN AND METHODS: Between April 2022 and June 2023, a total of 58 participants were recruited and randomly allocated to receive either YPV (n = 29) or placebo (n = 29) for 8 consecutive weeks. The changes of the Total Nasal Symptom Score (TNSS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) or the Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores at week 8 were used as the primary outcomes. The secondary outcomes included (1) the change of TNSS at weeks 4, 12 and 16; (2) the RQLQ or the PADQLQ scores at weeks 4, 12 and 16; (3) the change of frequency of AR episodes and their severity Visual Analog Scale (VAS) at weeks 4, 8, 12 and 16; (4) the changes of the gut microbiota composition in stool samples at week 8; and (5) adverse events related to the study treatment.

RESULTS: YPV treatment could significantly improve the RQLQ score in AR patients at weeks 4, 8, 12, and 16 (p = 0.05, p = 0.04, p = 0.04 and p = 0.03, respectively), when compared with the placebo treatment. However, it did not improve the TNSS score at week 8 in AR patients when compared with the placebo group. In addition, YPV treatment could reduce the VAS score in AR patients at weeks 12 and 16 when compared with the placebo group, although the reductions were not statistically significant (p = 0.06 and p = 0.08, respectively). Importantly, no overt adverse effects were observed in both YPV and placebo groups.

CONCLUSION: YPV was well-tolerated and could effectively ameliorate multiple symptoms of AR and improve the quality of life of AR patients after 8-week treatment. Trial registration ClinicalTrials.gov, NCT04976023. Registered 26 July 2021, https://clinicaltrials.gov/study/NCT04976023?cond=The%20Effects%20of%20Using%20Yupingfeng%20Powder%20with%20Variation%20for%20the%20Treatment%20of%20Allergic%20Rhinitis&rank=2.

PMID:40420199 | DOI:10.1186/s13020-025-01120-2