Category: Statistics

Diabetol Metab Syndr. 2026 Jun 25. doi: 10.1186/s13098-026-02223-y. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Olanzapine is a widely used second-generation antipsychotic with well-established efficacy in the treatment of schizophrenia, bipolar disorder, and related psychiatric conditions. However, its use has been consistently linked to metabolic adverse effects, particularly disturbances in glucose regulation. This systematic review and meta-analysis aimed to quantitatively evaluate the effects of olanzapine on key diabetes-related biomarkers, fasting blood sugar (FBS), fasting insulin, and glycated hemoglobin (HbA1c), in human populations, using evidence derived exclusively from randomized controlled trials (RCTs).

METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase from inception to July 1, 2025, without language or date restrictions. Eligible studies were RCTs involving human participants that compared olanzapine with placebo or no treatment and reported pre- and post-intervention data for FBS, fasting insulin, or HbA1c. Study quality was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE framework. Pooled effect estimates were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs) using random-effects models. Subgroup, sensitivity, and publication bias analyses were performed to explore heterogeneity and assess result robustness.

RESULTS: Fifteen RCTs comprising 18 comparison arms were included in the meta-analysis. Olanzapine treatment was associated with a statistically significant increase in FBS (WMD: 2.618 mg/dL; 95% CI: 0.283 to 4.954) and fasting insulin levels (WMD: 3.636 µIU/mL; 95% CI: 1.964 to 5.307). In contrast, no significant change was observed in HbA1c levels (WMD: -0.029%; 95% CI: -0.284 to 0.226). Subgroup analyses suggested larger glycemic changes with higher doses (≥ 10 mg/day), longer treatment durations (≥ 12 weeks), and lower baseline body mass index, although these trends were not consistently statistically significant. Substantial heterogeneity was observed for FBS outcomes, whereas fasting insulin results were highly consistent across studies.

CONCLUSION: Olanzapine use is associated with modest but significant elevations in FBS and insulin levels, indicating early disturbances in glucose homeostasis and a potential risk of insulin resistance, while effects on HbA1c remain inconclusive. Clinically, this highlights the need for routine monitoring of glucose and insulin levels, early lifestyle interventions, and consideration of pharmacologic strategies in high-risk patients to prevent progression to diabetes. These findings underscore the importance of proactive metabolic monitoring and individualized risk assessment in patients receiving olanzapine.

PMID:42351181 | DOI:10.1186/s13098-026-02223-y

Int J Behav Nutr Phys Act. 2026 Jun 25. doi: 10.1186/s12966-026-01941-w. Online ahead of print.

ABSTRACT

BACKGROUND: An unhealthy diet, excessive screen time, low levels of physical activity and suboptimal sleep are known risk factors for childhood overweight and obesity (OW/OB). These energy balance-related behaviors tend to co-occur and combine into “lifestyle patterns” (LPs) that may have a synergistic effect on OW/OB. However, few studies have examined these LPs before preschool age, and none investigated the possible involvement of parental feeding practices (e.g., breastfeeding and timing of complementary feeding), non-screen leisure activities and sleep quality. We aimed to identify such LPs during the first 2 years of life and assess their associations with OW/OB at age 5 years and age at adiposity rebound (AR).

METHODS: Participants were children from the French nationwide ELFE (Etude Longitudinale Française depuis l’Enfance) birth cohort. We used principal component analysis of 18 items characterizing parental feeding practices and children’s energy balance-related behaviors (n = 13,121) to derive LPs. We analyzed the associations of LPs with OW/OB at age 5 years (International Obesity Task Force definition; n = 8,388) and age at AR (in days; n = 7,845) using multivariable logistic and linear regression models, respectively.

RESULTS: We identified three LPs: “Early complementary feeding, discretionary consumption, high screen time”, “Balanced diet, non-screen leisure activities”, and “Healthy feeding practices, low dairy consumption, suboptimal sleep” patterns. The first pattern was positively associated with OW/OB at age 5 years (OR [95% CI] = 1.09 [1.03, 1.16] per 1-SD increase) and inversely associated with age at AR (β [95% CI] = – 12.1 days [- 19.1; -5.0] per 1-SD increase). No association was observed for the second LP. For the third pattern, no clear evidence of associations was found, although the effect sizes were comparable to those of the first LP (OR = 1.07 [0.99; 1.15]; β = -7.6 days [- 15.5; 0.3] per 1-SD increase).

CONCLUSION: These results emphasize the perinatal period as a critical window for the emergence of interrelated lifestyle behaviors associated with OW/OB. They highlight the need for interventional studies to evaluate the effectiveness of early, integrated, multi-behavioral strategies to prevent childhood obesity.

PMID:42351177 | DOI:10.1186/s12966-026-01941-w

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