Category: Statistics

BMC Pediatr. 2026 Jun 4. doi: 10.1186/s12887-026-07026-8. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood physical disability and is frequently accompanied by comorbidities such as epilepsy and feeding difficulties. In many low-resource settings, hospital-based evidence describing CP clinical subtypes, associated impairments, and care patterns is limited, constraining service planning for rehabilitation and pediatric neurology. We aimed to describe the clinical spectrum, associated impairments, interventions, and documentation patterns of CP at two tertiary referral hospitals in Zambia’s Copperbelt Province.

METHODS: We conducted a multi-centre, hospital-based retrospective record review of children with clinically documented CP at Arthur Davison Children’s Hospital (ADCH), Ndola, and Kitwe Teaching Hospital (KTH), Kitwe. CP motor subtype (spastic, dyskinetic, ataxic, mixed) and topographical distribution were extracted where documented. Associated impairments (including epilepsy) and management (rehabilitation and medications) were recorded based on explicit documentation, with undocumented fields treated as missing rather than absent. Categorical variables were summarized as frequencies and percentages. Between-hospital comparisons used chi-square or Fisher’s exact tests. Statistical significance was set at α = 0.05.

RESULTS: A total of 195 children with CP were identified (ADCH n = 150; KTH n = 45). This study did not estimate incidence or prevalence. Among records with documented subtype, spastic CP predominated at both sites, while dyskinetic CP was the second most frequently documented subtype and accounted for a higher proportion at ADCH than at KTH. CP motor subtype distributions differed significantly between hospitals (χ²=8.28, p = 0.041). Topographical distribution did not differ significantly (χ²=2.51, p = 0.285), with quadriplegia most commonly recorded at both sites. Epilepsy prevalence differed markedly among records with documented epilepsy status (KTH 40.0% vs. ADCH 84.1%; Fisher’s exact p = 0.000025; OR for KTH vs. ADCH = 0.126). Physiotherapy was frequently documented at both hospitals. Documentation completeness varied substantially across sites, particularly for epilepsy status, associated impairments, and functional severity measures (GMFCS) at ADCH.

CONCLUSIONS: In this hospital-based cohort from Zambia’s Copperbelt Province, CP subtype patterns differed between ADCH and KTH, and epilepsy was highly prevalent (especially at ADCH), underscoring the need for integrated rehabilitation and epilepsy services. Substantial variability in documentation completeness suggests a systems-level opportunity to standardize CP assessment and recording to support clinical management and service planning.

PMID:42243818 | DOI:10.1186/s12887-026-07026-8

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08790-w. Online ahead of print.

ABSTRACT

BACKGROUND: Removal of impacted mandibular third molars is associated with postoperative discomfort and delayed bone healing. Er:YAG laser osteotomy has been proposed as a minimally invasive alternative to conventional rotary instrumentation.

AIM: To compare Er:YAG laser osteotomy and conventional rotary osteotomy regarding postoperative radiographic bone density and clinical healing outcomes following impacted mandibular third molar removal (pain, edema, and trismus).

METHODS: Twenty-four patients (n = 24) were randomized equally (laser n = 12; rotary n = 12). CBCT scans were obtained preoperatively and at 3 months for voxel-based grayscale bone density assessment. Standardized 3D ellipsoid VOIs were used. A single trained examiner performed all CBCT measurements twice, two weeks apart (ICC > 0.90). Postoperative pain, edema, and trismus were clinically assessed.

RESULTS: Immediate postoperative bone density showed no significant difference between groups (p = 0.319). At 3 months, bone density was significantly higher in the laser group compared with the rotary group (median: 310.7 vs. 270.0; p = 0.017), with a moderate effect size (r = 0.477). Bone density significantly increased over time in both groups (p = 0.002), with a significantly greater increase observed in the laser group (p = 0.017). Pain scores on day 2 were significantly lower in the laser group (p = 0.020). Edema and trismus showed significant improvement over time within both groups, with no statistically significant differences between groups. Operation time was significantly longer in the laser group.

CONCLUSION: Er:YAG laser osteotomy was associated with lower postoperative pain and higher radiographic grayscale values at 3 months compared with rotary osteotomy. Edema and trismus improved over time in both groups, with no significant differences between the two techniques.

CLINICAL RELEVANCE: Er:YAG laser may improve patient comfort by reducing postoperative pain and may be associated with improved radiographic bone healing. However, further studies are needed to confirm its long-term effects on bone density.

TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT07297043). Registered 09 December 2025 (retrospective).

PMID:42243813 | DOI:10.1186/s12903-026-08790-w

BMC Med. 2026 Jun 5. doi: 10.1186/s12916-026-04965-y. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia (PE) is a pregnancy-specific complication characterized by defective spiral artery remodeling, notably due to the abnormal retention of differentiated vascular smooth muscle cells (VSMCs). Although elevated CD81 levels in the placenta and maternal circulation contribute to this impairment, the definite mechanisms remain elusive. This study aimed to investigate how CD81 overexpression in extravillous trophoblasts (EVTs) contributes to defective VSMC dedifferentiation within uterine spiral arteries, as well as the involved molecular mechanisms.

METHODS: Placental basal plates from severe preeclampsia (sPE) patients and non-PE controls were immunostained for CD81 and VSMC markers. A placental restricted CD81 overexpression mouse model was constructed to evaluate PE-like phenotype and placental pathology. Primary decidual stromal cells (DSCs) and natural killer (dNK) cells were applied to investigate how CD81-overexpressing EVTs interact with them to suppress VSMC dedifferentiation. Additionally, antagonistic and rescue experiments were conducted to identify the function of the key molecules involved.

RESULTS: The proportion of retained differentiated VSMCs in spiral arteries was significantly higher in sPE patients than in normal pregnancies, and was positively correlated with CD81 expression on EVTs. Similarly, pregnant mice with placental restricted CD81 overexpression exhibited PE-like phenotype and showed persistent VSMC retention in spiral arteries. In vitro, conditioned medium (CM) from DSCs pretreated with medium from CD81-overexpressing EVTs increased the expression of differentiated VSMC markers, which was associated with reduced insulin-like growth factor 2 (IGF2) levels in DSCs. Notably, exogenous IGF2 supplementation reversed this effect.

CONCLUSIONS: CD81 upregulation on EVTs prevents VSMC dedifferentiation through a DSC-dependent mechanism. This study represents a pioneering effort to reveal the crucial role of interplay between EVTs, DSCs, and VSMCs in facilitating VSMC dedifferentiation, thereby enabling the completion of spiral artery remodeling.

PMID:42243812 | DOI:10.1186/s12916-026-04965-y

BMC Med Educ. 2026 Jun 4. doi: 10.1186/s12909-026-09591-z. Online ahead of print.

ABSTRACT

BACKGROUND: Medical students often face significant psychological and lifestyle challenges during examination periods, including sleep disruption, increased caffeine intake, altered dietary habits, low physical activity, and higher tobacco use. These behaviors may influence academic performance, yet evidence remains inconsistent.

METHODS: A cross-sectional study was conducted from April to October 2025 among 403 medical students from five universities in Palestine. Data were collected via an Arabic-language, self-administered online questionnaire covering sociodemographic, dietary and beverage habits, smoking, sleep, and physical activity. Academic performance was self-reported for the last two semesters. Statistical analysis included correlation, Mann-Whitney U, and regression models to assess relationships between lifestyle behaviors and academic performance.

RESULTS: Participants reported low sleep duration (< 7 h/day: 89.3%) and low physical activity (19.1%). Caffeine intake was moderate, with most students consuming ≤ 1 cup/day of traditional or instant coffee. Waterpipe smoking was more prevalent than cigarette or e-cigarette use and increased during exams. Regression analysis revealed small but significant negative associations between traditional coffee and tea consumption and average grades. Other dietary habits, energy drinks, sleep, and exercise were not significantly associated with average grades. Waterpipe use was unexpectedly positively associated with average grades, likely due to confounding factors.

CONCLUSION: Examination periods are associated with unhealthy behaviors among medical students, particularly increased caffeine and tobacco use, short sleep, and low physical activity. Among these, only coffee and tea consumption showed a small negative impact on academic performance.

PMID:42243807 | DOI:10.1186/s12909-026-09591-z

BMC Palliat Care. 2026 Jun 4. doi: 10.1186/s12904-026-02176-z. Online ahead of print.

ABSTRACT

BACKGROUND: Globally, breast cancer is the most common cancer among women, with 2.3 million women newly diagnosed in 2020. In Africa, most women present with advanced disease necessitating nurse-led palliative care interventions. This study pilot tested a nurse-led palliative care programme for women receiving palliative chemotherapy for breast cancer at a teaching hospital in the Volta Region of Ghana.

METHODS: An intervention design and pre-test post-test approach was used. The primary outcome focused on unmet palliative care needs and secondary outcomes included pain, quality of life, and spiritual needs, measured by means of the Symptoms Distress Scale (SDC), Brief Pain Inventory (BPI), Spiritual Needs Questionnaire (SpNQ), and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer Module 45 items (EORTC QLQ-BR45). Census sampling entered 31 women in the programme but only 24 completed it. Descriptive statistics were used to analyzed the data and the Wilcoxon signed-rank test, with significance set at p ≤ 0.05, compared the medians of the two samples. The study was registered with Pan African Clinical Trial Registry (PACTR202509735988120) on September 29th, 2025.

RESULTS: Results showed positive outcomes post-intervention. Symptom distress decreased from x̄ 2.98 to x̄ 1.97, pain severity reduced from x̄ 9.34 to x̄ 2.75, and quality of life improved from x̄ 2.79 to x̄ 1.94. Spiritual needs increased from x̄ 1.04 to x̄ 3.00.

CONCLUSION: The study provided evidence that a nurse-led palliative care programme, based on the care needs of women with advanced breast cancer receiving palliative chemotherapy in the Volta Region of Ghana, lessened symptom distress, pain and improved quality of life.

PMID:42243806 | DOI:10.1186/s12904-026-02176-z

BMC Surg. 2026 Jun 4. doi: 10.1186/s12893-026-03899-9. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal anatomical sites for temperature monitoring that most closely correlates with cerebral temperature remain debated in cardiac surgery, particularly during cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) and subsequent rewarming. This experimental study aimed to identify the monitoring site best correlated with intracerebral temperature during the rewarming phase and to assess whether some sites may underestimate cerebral rewarming, thereby increasing the risk of undetected hyperthermia.

METHODS: The study was conducted in six male Landrace pigs (≈58 kg) undergoing CPB with a 45-min DHCA at 18 °C, followed by a gradual rewarming phase. Temperature was monitored throughout the procedure at seven anatomical sites (jugular, bladder, esophageal, rectal, nasopharyngeal, venous, and arterial) and compared with direct intracerebral temperature measured using a Pt1000 probe inserted into the cerebral parenchyma. Correlation analyses were performed between peripheral and intracerebral temperature measurements.

RESULTS: Jugular temperature demonstrated the strongest correlation with intracerebral temperature (r = 0.975), with no statistically significant difference between jugular values and cerebral temperature (p = 0.2189). In contrast, a significant discrepancy was observed between cerebral and esophageal temperatures (p = 0.0247), indicating differences in thermal kinetics during the early rewarming phase. No cases of cerebral hyperthermia were observed.

CONCLUSIONS: This study demonstrated that jugular temperature most accurately reflects cerebral temperature during the rewarming phase of CPB following DHCA. Esophageal and nasopharyngeal measurements, although commonly used, may underestimate cerebral temperature during early rewarming, potentially increasing the risk of cerebral hyperthermia. These findings underscore the value of multisite temperature monitoring and highlight the importance of understanding the mechanisms underlying cerebral thermal dynamics.

PMID:42243805 | DOI:10.1186/s12893-026-03899-9

BMC Med Inform Decis Mak. 2026 Jun 5. doi: 10.1186/s12911-026-03612-z. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the effectiveness of deep learning algorithms in simulating standard acquisition time images from shortened acquisition times in ¹⁸F-FDG PET/CT imaging, thereby optimizing both image quality and radiopharmaceutical use.

METHODS: We evaluated 322 patients who underwent ¹⁸F-FDG PET/CT, simulating half-dose conditions and reconstructing images at acquisition times of 30 s, 45 s, 60 s, 75 s, and 90 s while maintaining identical bed positions and anatomical coverage. Images were reconstructed using a residual U-Net architecture with data augmentation to enhance training. Image quality was assessed using a 5-point Likert scale, inter-reader consistency with Cohen’s kappa, and quantitative metrics (PSNR, SSIM, MAE, MSE, RMSE) to compare pre- and post-processing conditions, validating the model’s effectiveness. Lesion detectability was specifically assessed by counting detectable lesions before and after processing, evaluated by two senior nuclear medicine physicians to ensure consistency. Statistical analyses employed Wilcoxon signed-rank tests and kappa statistics, considering p-values less than 0.05 as statistically significant.

RESULTS: Deep learning significantly improved image quality scores in the half-dose group from 3.45 ± 0.48 to 4.33 ± 0.55 and enhanced kappa values from 0.76 to 0.82 (p < 0.05). Quantitative metrics demonstrated marked improvements, with SSIM values rising from 0.75 to 0.87 and PSNR from 37.65 dB to 41.37 dB in half-dose scenarios. Similarly, in the 30s model, SSIM increased from 0.73 to 0.84 and PSNR from 35.38 dB to 40.15 dB. Lesion detectability in small lesions improved by up to 16.3% in shortened acquisition conditions, effectively enhancing the detection of critical pathological features.

CONCLUSIONS: The application of deep learning models in PET/CT imaging may improve scan efficiency and reduce radiopharmaceutical usage while maintaining image quality without apparent loss of diagnostic information. These findings support the potential of AI-enhanced imaging protocols to reduce patient radiation exposure and improve clinical workflow efficiency.

PMID:42243803 | DOI:10.1186/s12911-026-03612-z

BMC Public Health. 2026 Jun 4. doi: 10.1186/s12889-026-27726-1. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the effect of menstrual knowledge, and of menstrual education interventions, on broader dimensions of menstrual health. We assessed factors associated with menstrual knowledge and attitudes, and the association of menstrual knowledge with menstrual health related outcomes among female Ugandan adolescents enrolled in the control arm of a menstrual health intervention trial.

METHODS: We conducted a secondary data analysis of longitudinal data from control arm participants in a cluster-randomised trial conducted in Ugandan secondary schools. Endline data were collected one year after baseline. We identified baseline factors associated with the menstrual knowledge and attitudes at endline, and estimated associations of menstrual knowledge items with menstrual practice needs and menstrual confidence at endline, using random-effects Poisson and linear regression analyses to estimate adjusted incidence rate ratios (aIRR) and mean differences (aMD) respectively.

RESULTS: Among 1453 female and 317 male participants in 30 control arm schools who completed both baseline and endline surveys, there was evidence of small associations between better menstrual knowledge at endline with better baseline knowledge (both male and female participants), and in females only, being in a private school (aIRR = 1.05, 95%CI 1.00-1.11), and knowledge about menstruation prior to menarche (aIRR = 1.08, 95%CI 1.03-1.14). Positive attitudes towards menstruation at endline were associated with baseline positive attitudes (male and female participants), and with knowledge prior to menarche (aIRR = 1.10, 95%CI 1.01-1.21). Participants with better knowledge scores had better menstrual experiences (Menstrual Practice Needs Scale: aMD = 0.19, 95%CI 0.08-0.30, p < 0.001 for high versus low knowledge scores).

CONCLUSIONS: Female adolescents who know about menstruation before menarche have slightly greater menstrual knowledge and positive attitudes towards menstruation. In turn, menstrual knowledge is associated with fewer unmet menstrual practice needs. Future interventions should consider tailoring educational content to address specific knowledge gaps and cultural attitudes and include boys.

TRIAL REGISTRATION NUMBER: ISRCTN45461276 Registration date: 16/09/2021.

PMID:42243798 | DOI:10.1186/s12889-026-27726-1

BMC Pulm Med. 2026 Jun 4. doi: 10.1186/s12890-026-04386-w. Online ahead of print.

ABSTRACT

BACKGROUND: Prompt detection and isolation of active Pulmonary Tuberculosis(PTB) are critical to prevent hospital transmission. In Ethiopia, evidence on PTB isolation practices in high-risk settings is limited. This study assessed the median time to isolation and factors associated with delays in a teaching hospital emergency department.

METHODS: All adult GenXpert-confirmed active PTB patients diagnosed in the emergency outpatient (acute care) department of a Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia, between November 2021 and March 2024, were included. Data were extracted from the electronic medical records database. Delay in isolation was defined as failure to isolate a patient suspected or confirmed to have infectious tuberculosis (TB) at the first point of contact in the study hospital (triage). The Multivariable analysis using the Cox proportional hazards model was used to determine the statistically significant predictors of delayed isolation of active PTB with P-values < 0.05.

RESULTS: Seventy-five patients with a mean age of 32 years were included. The median time to isolation for active PTB was two days (interquartile range: 1-4 days). More than half (58.7%) of patients were isolated within two days. In the Multivariable Cox regression analysis, several factors were associated with a longer time to isolation: acute cough (Hazard Ratio, HR: 0.43; 95% CI: 0.23-0.80), requirement for supplemental oxygen (HR: 0.46; 95% CI: 0.23-0.89), non-cavitary lesion on chest radiograph (HR: 0.46; 95% CI: 0.25-0.85), intravenous antibiotic use (HR: 0.46; 95% CI: 0.33-0.97), abnormal white blood cell count (HR: 0.27; 95% CI: 0.13-0.56), and weekend emergency department visits (HR: 0.46; 95% CI: 0.25-0.84).

CONCLUSIONS: This study found that clinical and laboratory factors, as well as the timing of hospital visits, were associated with delayed isolation of active PTB patients in the emergency department. These findings highlight key areas for improving timely isolation in the acute care setting.

CLINICAL TRIAL REGISTRATION NUMBER: The study is purely observational. Thus, the clinical trial registration number is not applicable.

PMID:42243793 | DOI:10.1186/s12890-026-04386-w

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08759-9. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate and accessible screening tools for periodontitis are essential for early detection and disease prevention. This study evaluated a non-invasive diagnostic approach integrating sociodemographic data, self-reported oral health (SROH) questionnaires, and salivary biomarkers, using both conventional statistical and machine learning (ML) predictive models.

METHODS: Seventy-seven adults completed a validated SROH questionnaire and provided saliva samples for quantification of six biomarkers: interleukins (IL-1β, IL-6), tumour necrosis factor (TNF-α), matrix metalloproteinases (MMP-8, MMP-9), and metallothionein (MT). Participants were clinically classified as having (i) periodontal health, (ii) gingivitis, or (iii) periodontitis. Predictive models were developed using Logistic Regression (LR), Random Forest (RF), and Naive Bayes (NB) across three feature sets: (i) SROH, salivary biomarkers and sociodemographic, (ii) SROH and salivary biomarkers, (iii) SROH and sociodemographic and (v) SROH alone. Model performance was assessed using 10-fold cross-validation and standard evaluation metrics.

RESULTS: The RF model trained on SROH, and salivary biomarkers achieved the highest accuracy with area under the receiver operating characteristic curve (AUC = 0.856), with superior precision (70.13%), sensitivity (0.701) and lower error rates (RMSE = 0.371) compared with NB (AUC = 0.795) and LR (AUC = 0.724) models in detecting periodontitis.

CONCLUSIONS: This non-invasive, SROH and biomarker-integrated approach shows potential as a first-line screening and referral tool in primary care and population-based settings where comprehensive periodontal examination is not routinely available. Further validation in larger, more diverse populations is warranted to support clinical translation.

PMID:42243783 | DOI:10.1186/s12903-026-08759-9