Category: Statistics

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09736-0. Online ahead of print.

ABSTRACT

BACKGROUND: Postgraduate dental education is a demanding process characterized by increased clinical responsibility and academic expectations. While psychological distress among undergraduate dental students has been widely studied, evidence regarding postgraduate populations remains limited. This study aimed to assess levels of stress, anxiety, and depression among postgraduate dental students and to examine their associations with sociodemographic factors.

METHODS: A cross-sectional observational study was conducted among 192 postgraduate dental students. Data were collected using a demographic questionnaire and the Depression Anxiety Stress Scale-21 (DASS-21). Subscale scores were multiplied by two for comparability with standard severity classifications. Statistical analyses included Cronbach’s alpha, Pearson correlation, and linear regression. Multiple regression models were used to assess associations between psychological variables and sociodemographic factors. Group comparisons were performed using t-tests and one-way ANOVA with Scheffé post hoc tests.

RESULTS: Significant positive associations were observed among stress, anxiety, and depression (p < .001). In multiple regression analysis, stress (β = 0.543, p < .001) and anxiety (β = 0.317, p < .001) were significantly associated with depression, accounting for a substantial proportion of the observed variance (R² = 0.696). Participants with “normal” perceived financial status tended to show higher distress levels than those with “good” status, although this association did not reach statistical significance in multivariable analysis. No significant differences were found for training year, specialty, residence, or smoking status. The majority of participants were classified within the normal range across all DASS-21 subscales.

CONCLUSIONS: Stress, anxiety, and depression are closely interrelated among postgraduate dental trainees. Psychological distress appears to be associated with individual and perceived contextual factors; however, these associations were not consistently supported in the multivariable model and should therefore be interpreted with caution.

PMID:42351166 | DOI:10.1186/s12909-026-09736-0

Plant Methods. 2026 Jun 25. doi: 10.1186/s13007-026-01554-1. Online ahead of print.

ABSTRACT

Wheat is one of the most important cereals worldwide, yet significant gaps remain in our understanding of genetic variability in root traits, especially those associated with deeper rooting that support resource acquisition in challenging environments. Root traits are typically controlled by many genes with small effects and often display low heritability. Our aim was to develop a statistical approach to analyse root variation across soil depth and to determine where genetic differences in root intensity are most detectable. An experiment was conducted at the RadiMax semi-field facility, which is designed to measure deep root systems. Five years of phenotypic data recorded each June produced observations from 1500 rows. Each row captured root intensity across the soil profile from 0.6 m to 2.6 m, enabling detailed analysis of vertical root distribution. Across the five years, 513 winter wheat cultivars were grown in the facility, and among those 409 were genotyped with SNP chips. Depth-resolved regression models with random coefficients were used to quantify genetic and non-genetic variation in root intensity across soil depths, while accounting for spatial variation between rows. Random variation within rows was found to be constant across depths. The models showed that genetic variance for cumulative root intensity increased substantially below 1.1 m, with the deepest layers exhibiting the largest differences between wheat lines. Narrow-sense heritability of point measurements peaked at approximately 1.5 m ([Formula: see text]).

PMID:42351160 | DOI:10.1186/s13007-026-01554-1

BMC Med Educ. 2026 Jun 25. doi: 10.1186/s12909-026-09810-7. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial resistance is a major global public health threat, necessitating improved antibiotic stewardship. India’s Competency-Based Medical Education (CBME) framework requires robust methods to assess and cultivate clinical reasoning. This study evaluated a rule-based Digital Case-Based Learning (DCBL) module with algorithm-triggered formative feedback for antibiotic-stewardship decision-making among undergraduate medical learners.

METHODS: A quasi-experimental, single-group pre-post study evaluated three rule-based DCBL micro-cases (upper respiratory tract infection [URTI], urinary tract infection [UTI], and acute watery diarrhoea) in 271 third- and fourth-phase MBBS learners at a tertiary-care teaching hospital in South India. Script Concordance Test (SCT) performance was assessed using parallel pre- and post-test forms. Usability and workload were measured using the System Usability Scale (SUS) and two NASA Task Load Index (NASA-TLX) items.

RESULTS: Overall SCT scores changed from 5.65 +/- 4.73 to 6.05 +/- 4.48 (mean change = 0.40; 95% CI: -0.41 to 1.21; p = 0.33; Cohen’s d = 0.059). The UTI case showed a statistically significant domain-specific improvement (mean change = 0.58; p = 0.003; Cohen’s d = 0.18), which falls below the conventional small-effect threshold. URTI and diarrhoea cases showed no significant change. The mean SUS score was 62.4 +/- 18.7; 76.0% of learners rated platform usability as average or good, with moderate cognitive workload.

CONCLUSION: A single-session rule-based DCBL intervention was feasible and acceptable in routine CBME teaching and showed a domain-specific SCT signal in the UTI case. The overall SCT change was not statistically significant and should not be interpreted as evidence of effectiveness or generalised across antibiotic-stewardship scenarios. Controlled, multisite, longitudinal studies are needed to confirm these preliminary findings.

PMID:42351153 | DOI:10.1186/s12909-026-09810-7

BMC Health Serv Res. 2026 Jun 25. doi: 10.1186/s12913-026-15002-2. Online ahead of print.

ABSTRACT

BACKGROUND: With the advancement of hierarchical diagnosis and treatment systems in China, primary healthcare institutions have become pivotal in delivering basic medical services. Accurate prediction and optimal allocation of healthcare resources are indispensable for improving service quality and ensuring the effective operation of the healthcare system.

METHODS: This research utilizes the Sparrow Search Algorithm (SSA) to optimize the hyperparameters of Backpropagation Neural Network (BPNN) and Long Short-Term Memory (LSTM) models, aiming to enhance their predictive performance for primary healthcare resource planning.

RESULTS: The findings demonstrate that the SSA-LSTM model significantly outperforms the SSA-BPNN model. Specifically, in predicting the number of primary healthcare institutions, the SSA-LSTM model reduces the root mean squared error (RMSE) by 45% (from 1.429 to 0.78765) and the mean absolute error (MAE) by 36.4% (from 0.99575 to 0.63306) on the test set. Across all prediction tasks, including personnel quantity and total health costs, the SSA-LSTM model achieves an average RMSE reduction of 23.5% and MAE reduction of 17.1% on the test set compared with SSA-BPNN. Similar improvements are evident in the training set, with RMSE and MAE decreasing by 19.2% and 15.4%, respectively.

CONCLUSION: The SSA-LSTM model offers robust data-driven decision support for healthcare policymakers. Its superior predictive accuracy enables dynamic adjustments to resource allocation, which is essential for bridging regional disparities in China’s primary healthcare system. By accurately forecasting key healthcare indicators, the model facilitates optimized staffing, institutional planning, and budget distribution, thereby laying a solid foundation for evidence-based resource optimization and enhancing the overall efficiency and equity of primary care services.

PMID:42351145 | DOI:10.1186/s12913-026-15002-2

BMC Med Ethics. 2026 Jun 25. doi: 10.1186/s12910-026-01542-z. Online ahead of print.

ABSTRACT

BACKGROUND: Ethical practice is central to patient trust, safety, and quality healthcare delivery. This study compared healthcare ethics knowledge and practice among doctors and nurses in two Ghanaian hospitals and identified factors associated with ethical practice.

METHODS: An analytical cross-sectional study was conducted among 382 doctors and nurses in two government hospitals in Ghana. Data were collected using a structured questionnaire assessing healthcare ethics knowledge and self-reported practice. Bivariate analysis was conducted using Chi-square tests and T-tests, while Random Forest analysis was applied to identify variables of relative importance to healthcare ethics (HCE) practice.

RESULTS: No statistically significant differences were observed between facilities in mean healthcare ethics knowledge (26.3 ± 2.83; p = 0.98) and practice (23.5 ± 2.94; p = 0.16) scores. Healthcare ethics knowledge was significantly positively associated with practice (p < 0.05). Random Forest analysis identified age, knowledge, education, and gender as the most important predictors of ethical practice based on variable importance rankings, with differences observed in their relative contribution across facilities.

CONCLUSION: Healthcare professionals demonstrated moderate-to-high knowledge and practice of healthcare ethics, with no significant institutional differences. Ethical practice was influenced by demographic and educational factors, highlighting the need for context-specific strategies. Strengthening ethical decision-making may require integrating structured and continuous ethics training into professional development, alongside mentorship approaches that reinforce ethical standards in clinical practice.

PMID:42351140 | DOI:10.1186/s12910-026-01542-z

BMC Nurs. 2026 Jun 26. doi: 10.1186/s12912-026-04868-6. Online ahead of print.

ABSTRACT

BACKGROUND: As healthcare settings become more culturally diverse, nursing and midwifery education needs to prepare students to provide culturally responsive care. Although intercultural sensitivity has received growing attention in health professions education, less is known about how it relates to negative attitudes such as xenophobia. This study examined levels of xenophobia and intercultural sensitivity among nursing and midwifery students and explored their relationships with selected sociodemographic and experiential characteristics.

METHODS: This descriptive cross-sectional study was conducted with 472 nursing and midwifery students enrolled at a state university in Mardin, Türkiye. Data were collected using a sociodemographic questionnaire, the Xenophobia Scale, and the Intercultural Sensitivity Scale. The data were analyzed using descriptive statistics, correlation analysis, and multiple regression analysis.

RESULTS: The students had moderate xenophobia scores and relatively high intercultural sensitivity scores, with mean values of 51.83 ± 12.74 and 88.25 ± 12.63, respectively. No significant relationship was found between total xenophobia and total intercultural sensitivity scores. Weak positive correlations were found between xenophobia and the interaction responsibility (r = 0.105, p = 0.023) and interaction carefulness (r = 0.243, p < 0.001) subdimensions of intercultural sensitivity. Xenophobia scores differed significantly by age, academic year, geographic region, and frequency of intercultural interaction, although the effect sizes were small (η² = 0.02-0.04). In the regression analysis, desire to live abroad remained a significant predictor of higher xenophobia scores (B = 5.834, p < 0.001).

CONCLUSIONS: Xenophobia and intercultural sensitivity do not appear to move together in a straightforward way among nursing and midwifery students. The findings suggest that being sensitive to cultural differences does not necessarily mean being free from xenophobic attitudes. Nursing and midwifery education may therefore benefit from addressing both aspects to better support the development of culturally responsive care.

PMID:42351138 | DOI:10.1186/s12912-026-04868-6

BMC Health Serv Res. 2026 Jun 25. doi: 10.1186/s12913-026-14870-y. Online ahead of print.

ABSTRACT

BACKGROUND: Innovation is increasingly necessary in primary care policy, and healthcare managers play a pivotal role in translating policy ambitions into practice and shaping organisational conditions that foster innovation. The aim of this study was to explore innovation activities and their contextual conditions in Swedish primary care, as perceived by primary care managers.

METHODS: A national cross-sectional mixed-methods survey was conducted across Swedish primary care centres. Quantitative data were analysed using descriptive statistics, while qualitative data were analysed using systematic text condensation.

RESULTS: In total, 392 of the 1,028 invited primary care managers responded to the questionnaire. Approximately 80% of primary care managers reported product, process or organisational innovations, reflecting relatively high innovation activity at primary care centres. Innovation ideas predominantly emerged from within the primary care centre, and managers viewed themselves as playing a central role in generating these ideas. Most innovation activities involved internal collaboration between staff groups (86%) and units (62%), with limited external collaboration (6%-12%). Leadership was central in engaging staff with innovation and cultivating an innovation-supportive culture. Managers provided time, space and organisational support for continuous competence development. However, organisational and resource constraints limited staff involvement in innovation, as primary care remains tightly bound to economic and production-related demands.

CONCLUSION: This study offers an overview of the innovation landscape in Swedish primary care from the perspective of primary care managers and contributes empirical knowledge on how innovation is understood and managed across different primary care contexts in Sweden. While Swedish primary care demonstrates strong engagement in innovation, the involvement of and collaboration with external stakeholders remain limited, underscoring the need for system-level strategies and processes to facilitate cross-sector innovation partnerships. Further research is needed on how system-level frameworks for collaboration and innovation can be established across the Swedish healthcare system, including primary care.

PMID:42351137 | DOI:10.1186/s12913-026-14870-y

BMC Vet Res. 2026 Jun 25. doi: 10.1186/s12917-026-05647-w. Online ahead of print.

ABSTRACT

BACKGROUND: Injection-site complications are a poorly recognised problem in small ruminant production in Ghana. The improper injection can lead to tissue damage, abscesses, fibrosis, drug residues, lower meat quality and carcass condemnation, which can cause economic and public health issues. Veterinarians are legally qualified to give injections, but in practice, para-veterinarians and animal herders often do so, as they are in close contact with livestock and are often responsible for immediate animal care. The aim of this study was to evaluate the knowledge, attitudes and practices of animal health providers on injection-site complications in Kumasi, Ghana.

METHODS: A comparative cross-sectional study was carried out among 230 respondents including veterinarians (59), para-veterinarians (18), animal herders (143) and meat handlers (10) with a structured questionnaire. Descriptive statistics and Chi-square tests were used to collect and analyse data on knowledge, attitudes, anatomical injection-site preferences and injection practices. Retrospective abattoir records from January to August 2025 were also reviewed to determine the prevalence and distribution of injection-site lesions in slaughtered small ruminants.

RESULTS: Occupation, age, gender, years of experience, and formal training were significantly associated with the level of knowledge (p < 0.05). Veterinarians had the highest awareness of injection-site complications and correct anatomical injection sites, whereas animal herders had lower awareness, especially about tissue necrosis, contamination-related infections, and improper drug absorption. The neck area was the most common site for intramuscular injection by veterinarians, while the thigh and gluteal muscles were the most common sites for para-veterinarians and animal herders. A total of 100 injection-site lesions were found in 43,483 slaughtered animals during abattoir inspection, with lesions mainly located in the thigh area. There was a significant association between formal training and positive attitudes with good injection practices (p < 0.05).

CONCLUSION: There were significant differences in knowledge and practices about injection-site complications among animal health providers in Kumasi. Injection administration by para-veterinarians and herders, and inappropriate injection-site selection, may be factors in the lesions seen during meat inspection. Injection safety, meat quality and animal welfare can be enhanced through targeted training and inclusive veterinary extension programs that engage all livestock handlers.

PMID:42351133 | DOI:10.1186/s12917-026-05647-w

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09779-3. Online ahead of print.

ABSTRACT

BACKGROUND: Measles is a highly contagious infectious disease. The importance of vaccinating healthcare workers (HCW) and medical students as future HCW is underlined by the numerous measles outbreaks in health institutions. We aimed to assess the factors associated with complete vaccination, and measles serological status in relation to vaccination history among medical students in Catalonia (Spain).

METHODS: A cross-sectional study was conducted among medical students attending four university teaching-units during the 2023-2024 and 2024-2025 academic years. Medical students completed a questionnaire and provided blood samples for measles IgG testing. Associations between positive serology, vaccination status, and independent variables (age, sex, country of birth, degree year, future speciality, vaccination attitudes, and measles vaccination history) were assessed using the odds ratio (OR) and 95% confidence interval (CI).

RESULTS: Of the 255 participants, 79.2% were female, 92.5% were aged ≤ 24 years and 94.9% had received a complete schedule of two doses of measles vaccine. A complete vaccination schedule was associated with being a 5th-year student (aOR 5.26; 95% CI 1.43-20.48). Serological results were positive in 200 students (78.7%), and associated with none of the independent variables. Positive serology was observed in 79.3% and 58.3% of Spanish-born and non-Spanish-born students, respectively (aOR 0.38; 95%CI 0.12-1.27), but the difference was not statistically significant.

CONCLUSIONS: A high proportion of medical students in our sample had received two doses of measles vaccine. In line with public health recommendations, medical students as future HCW should be required to provide documented proof of two doses of measles-containing vaccine prior to starting clinical training.

PMID:42351131 | DOI:10.1186/s12909-026-09779-3

BMC Oral Health. 2026 Jun 26. doi: 10.1186/s12903-026-08896-1. Online ahead of print.

ABSTRACT

BACKGROUND: This prospective CBCT case series evaluated the pattern of maxillary molar movement during sequential distalization with clear aligners and vertical attachments, without adjunctive Class II elastics or skeletal anchorage, and assessed associated orthodontically induced inflammatory root resorption.

METHODOLOGY: Ten maxillary quadrants from seven adult patients with Class II molar relationships were included. All patients were treated using a standardized sequential molar distalization protocol with clear aligners. CBCT scans were obtained at baseline (T0) and immediately after completion of molar distalization (T1). Linear crown and root positional changes, as well as molar root length changes, were assessed using three-dimensional CBCT superimposition. Descriptive statistics and paired t-tests were used, with significance set at P < 0.05.

RESULTS: The maxillary first and second molars demonstrated significant distal displacement at the mesiobuccal cusp tips: 1.24 ± 0.64 mm and 1.02 ± 0.82 mm, respectively. Root apex displacement was limited, suggesting crown-dominant distal movement rather than true bodily distalization. The maxillary central incisors showed significant labial incisal-edge displacement of 1.93 ± 1.27 mm, while root apex position remained stable, indicating partial anterior anchorage loss under the tested protocol. Small but statistically significant reductions in molar root length were detected, ranging from 0.19 ± 0.21 mm to 0.47 ± 0.68 mm.

CONCLUSIONS: Within the limitations of this exploratory prospective case series, sequential maxillary molar distalization with clear aligners and vertical attachments produced modest crown-dominant distal molar movement. Mild anterior anchorage loss was observed under a protocol without adjunctive elastics or skeletal anchorage. Molar root length reductions were small and remained below 1 mm. Larger controlled studies incorporating planned vs. achieved movement analysis are required.

PMID:42351123 | DOI:10.1186/s12903-026-08896-1