Category: Statistics

J Orthop Surg Res. 2026 May 7. doi: 10.1186/s13018-026-06902-4. Online ahead of print.

ABSTRACT

BACKGROUND: The standard metal working channel in percutaneous translaminar endoscopic discectomy (PTED) creates a significant visual “blind spot,” presenting a particular challenge during surgery for prolapsed lumbar disc herniation (PLDH). This obstruction can result in semi-blind surgical maneuvers, elevating the risk of neural injury and incomplete fragment removal. To overcome this fundamental limitation, we developed a novel transparent visual channel (TVC) and assessed its clinical performance.

METHODS: In a retrospective comparative study, we analyzed 65 patients with PLDH who underwent PTED, utilizing either the novel TVC (n = 29) or the conventional metal working channel (n = 36). Key metrics for comparison included surgical field of view (quantified using the structural similarity index measure [SSIM]), total operation time, frequency of intraoperative neurophysiological monitoring alerts, standard perioperative clinical indicators, complication rates, and patient-reported outcomes (Visual Analog Scale [VAS] for pain, Oswestry Disability Index [ODI], and MacNab criteria).

RESULTS: The TVC group demonstrated a significantly larger and more consistent surgical field of view, evidenced by a markedly higher SSIM (98.2% ± 1.1% vs. 54.6% ± 8.3%, P < 0.05). Operative efficiency was improved in the TVC group, with a significantly shorter mean operation time (83.2 ± 9.7 min vs. 97.5 ± 8.9 min, P < 0.05). Critically, the use of the TVC was associated with enhanced intraoperative safety, as indicated by a significant reduction in the number of intraoperative neurophysiological monitoring alerts during neural decompression (2 vs. 11, P < 0.05). Both groups exhibited significant and comparable improvements in VAS scores, ODI scores, and MacNab outcomes at follow-up, with no statistically significant differences between the groups (P > 0.05).

CONCLUSION: The novel transparent visual channel effectively converts the PTED procedure from a semi-blind technique to a fully visualized one. This material innovation delivers direct clinical advantages by improving intraoperative safety through reduced neural irritation and increasing procedural efficiency, all while maintaining the excellent clinical outcomes associated with standard PTED. This study substantiates the TVC as a significant advancement in endoscopic spine surgery instrumentation, directly addressing a core visual constraint of the established technique.

PMID:42098825 | DOI:10.1186/s13018-026-06902-4

Environ Health. 2026 May 7;25(1):44. doi: 10.1186/s12940-026-01290-y.

ABSTRACT

BACKGROUND: The health impacts of extreme temperatures have been extensively studied through epidemiological models. However, limited attention has been paid to the specification of these models, particularly regarding input structure and model selection. Although exposure metrics and statistical techniques have evolved over time, a comprehensive synthesis of the variables included in these models, and the rationale behind their inclusion, is still lacking. This gap limits the comparability of studies and may compromise the robustness of temperature-health evidence.

METHODS: We conducted a systematic review of peer-reviewed studies published between 2014 and 2024 that employed quantitative epidemiological models to estimate the association between extreme temperatures and health outcomes. Following PRISMA guidelines, we selected 119 studies through searches conducted in Scopus, PubMed, and Web of Science. Each study was analysed in terms of spatial coverage, modelling framework, and model inputs. Inputs were classified into six functional groups: thermal exposures; environmental covariates (including both non-thermal meteorological variables and air pollutants); temporal controls; socio-demographic factors; health system indicators; and built environment characteristics.

RESULTS: Substantial heterogeneity was observed in both input selection and model specification. Daily mean temperature was the dominant exposure metric, though rarely justified over alternatives. Environmental covariates were inconsistently included: while relative humidity was frequent, other meteorological modifiers and air pollutants were often omitted without clear rationale. Temporal adjustments were common but heterogeneous. Distributed lag non-linear models were the prevailing framework, varying greatly in lag structure, spline specification, and covariate integration. Socio-economic, health, and infrastructural indicators appeared in less than one third of studies, typically as effect modifiers in meta-regression analyses, highlighting uneven integration of contextual determinants. No consensus currently exists on what constitutes a minimum model specification necessary to ensure reliable and interpretable effect estimates.

CONCLUSIONS: Current temperature and health modelling remains fragmented, with notable variability in input specification and transparency. Strengthening methodological coherence through clearer guidance on input selection is essential. Greater integration of socio-economic and infrastructural variables would further enhance models’ capacity to capture contextual vulnerability. To ensure reliability and policy relevance, future research should develop shared guidelines for input specification, define minimum modelling standards, and promote transparent reporting of analytical decisions.

PMID:42098811 | DOI:10.1186/s12940-026-01290-y

Malar J. 2026 May 7. doi: 10.1186/s12936-026-05926-9. Online ahead of print.

ABSTRACT

BACKGROUND: Despite decades of control efforts. malaria burden in Tanzania remains high, with marked heterogeneity in transmission intensity across regions. Insecticide-treated bed nets (ITNs) are a core malaria intervention and are distributed through multiple channels in Tanzania to promote equitable access and use, yet disparities in ITNs ownership and use persist. This study evaluated socio-demographic predictors of ITNs ownership and use among rural communities from five regions with varying malaria endemicity.

METHODS: A community-based cross-sectional survey covering individuals aged ≥ 6 months was conducted from July to August 2023 in 15 villages across five districts from five regions of Mainland Tanzania (Kagera, Kigoma, Njombe, Ruvuma, and Tanga). Data on demographics, malaria prevention practices, anthropometrics and socio-economic status (SES) were collected using structured questionnaires installed in tablets, run with Open Data Kit (ODK) software. Socio-demographic predictors of ITNs ownership and use were assessed using logistic regression analysis. The results were reported as crude (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a p-value < 0.05 was considered statistically significant.

RESULTS: Among the 10,228 enrolled participants, 7939 (77.6%) and 7899 (77.2%) reported owning and using ITNs, respectively. ITNs ownership and use varied significantly across districts (p < 0.001), with the highest rates observed in Nyasa (Ruvuma) and the lowest in Kyerwa (Kagera). Females had higher odds of both ITNs ownership and use than males (aOR = 1.27, 95% CI 1.12-1.45, p < 0.001 for both outcomes). Under-fives were more likely to own (aOR = 1.83, 95%CI 1.56-2.15, p < 0.001) and use ITNs (aOR = 2.26, 95%CI 1.62-3.15, p < 0.001) than adults. Participants from Nyasa (Ruvuma), Ludewa (Njombe), Muheza (Tanga) and Buhigwe (Kigoma) districts exhibited higher odds of ITNs ownership and use compared to those from Kyerwa (Kagera) (p < 0.001). Higher education attainment and household SES were independently associated with increased ITNs ownership and use (p < 0.001).

CONCLUSION: Although ITNs ownership and use were relatively higher across the surveyed communities, coverage remained below the national target of 80% (projected for 2023). Higher ITNs ownership and use were reported among females, under-fives, participants with higher education and those from households with high SES. Disparities by sex, age groups, household SES and education status persist and should be explicitly addressed through ITNs distribution strategies to enable equitable access and use of ITNs across all population groups to expedite progress toward malaria elimination in Tanzania.

PMID:42098806 | DOI:10.1186/s12936-026-05926-9

J Cardiothorac Surg. 2026 May 7. doi: 10.1186/s13019-026-04197-4. Online ahead of print.

ABSTRACT

OBJECTIVES: In 2008, the National Institute for Health and Care Excellence (NICE) recommended cessation of antibiotic prophylaxis for at-risk patients undergoing dental procedures (CG64). This study aimed to evaluate the impact of these guidelines on the incidence, microbiological profile, and surgical characteristics of infective endocarditis (IE) requiring operative intervention.

METHODS: A retrospective analysis was performed using a prospectively maintained surgical database to identify all cases of surgically treated IE at a UK cardiothoracic centre from 2004 to 2023. Patients were stratified into pre- and post-2008 cohorts. Temporal trends in surgical IE incidence were evaluated alongside changes in microbiology, valve involvement, urgency of surgery, and proportion of dental-related organisms. Statistical comparisons included Welch’s t-test, Fisher’s Exact Test, chi-squared analysis, and Poisson regression.

RESULTS: A total of 313 surgical IE cases were identified (41 pre-2008, 272 post-2008). Mean annual incidence rose from 10.0 pre-2008 to 18.1 post-2008 cases per year. Poisson regression demonstrated a significantly higher incidence post-2008 (incidence rate ratio [IRR] 1.81, 95% CI 1.30-2.53, p < 0.001). The odds of dental-associated pathogens were unchanged (OR 0.65, 95% CI 0.24-1.74, p = 0.39). Staphylococcus aureus predominated in the later cohort, while the proportion of oral streptococci remained stable. Surgical characteristics, including prosthetic valve involvement (OR 1.61, 95% CI 0.78-3.29, p = 0.20) and urgency (OR 0.89, 95% CI 0.35-2.27, p = 0.81), were similar between groups.

CONCLUSIONS: The 2008 NICE recommendation to discontinue dental antibiotic prophylaxis was associated with a significant rise in surgically managed IE at our centre. However, the microbiological and surgical profiles of IE remained consistent, with no increase in cases attributable to oral streptococci. These findings suggest that factors beyond dental prophylaxis may concomitantly contribute to the observed rise in surgical IE.

PMID:42098802 | DOI:10.1186/s13019-026-04197-4

Syst Rev. 2026 May 8. doi: 10.1186/s13643-026-03156-3. Online ahead of print.

ABSTRACT

BACKGROUND: Indigenous populations in high-income countries (HICs) experience disproportionately high rates of food insecurity, particularly in remote regions where high costs, poor quality, and limited variety limit access to perishable foods. Fragile perishable food supply chains (PFSCs) further compound these vulnerabilities. Although existing reviews have examined nutrition policies, socioeconomic interventions, and retail food environments, they have largely overlooked the operational and logistical challenges associated with perishable food supply chain management (PFSCM). Moreover, no review has systematically mapped the reported practices in the literature to address these challenges across interconnected supply chain levels, including procurement, transportation, distribution, and retail. To address these gaps, this systematic scoping literature review (SSLR) will employ a food access framework to synthesize the challenges and practices of PFSCM in remote Indigenous communities across 17 HICs.

METHODS: This SSLR will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols (PRISMA-P). A three-step JBI search strategy will be used to identify relevant published and unpublished evidence, including grey literature. Databases will include IEEE, MEDLINE (Ovid), ABI/Inform Global (ProQuest), CAB Abstracts, and Web of Science (Core Collection). Grey literature will be sourced from the Grey Source Index, Web of Conferences, government publications, OpenDOAR, OpenAIRE, and SSRN. Sources will be included if published in English between 1996 and 2024 and if they address PFSCM (phenomenon), perishable food access (concept), and remote Indigenous communities in HICs (context). Data will be extracted using a structured framework. Descriptive statistics will summarize study characteristics, and thematic analysis will be conducted to identify patterns in PFSCM challenges and reported practices. NVivo will support data management, and results will be reported in accordance with PRISMA-ScR guidelines.

DISCUSSION: This review will provide the first systematic scoping synthesis of PFSCM challenges and reported practices in remote Indigenous communities across HICs. By integrating a food access framework with a systems-oriented supply chain perspective, the review will extend prior work that has primarily focused on retail or policy interventions and limited geographic settings. The resulting evidence map and conceptual framework will support future research, policy dialogue, and context-sensitive planning to strengthen perishable food systems and food access in remote Indigenous settings.

SYSTEMATIC REVIEW REGISTRATION: Open science framework registration: https://osf.io/kqpvn.

PMID:42098800 | DOI:10.1186/s13643-026-03156-3

BMC Oral Health. 2026 May 7. doi: 10.1186/s12903-026-08525-x. Online ahead of print.

ABSTRACT

BACKGROUND: This randomized clinical trial aimed to compare postoperative pain (PP) and analgesic consumption following single-visit root canal treatment using two calcium silicate-based sealers (BioMTA + and Well-Root PT) and one epoxy resin-based sealer (Endoplus) in mature permanent mandibular molars diagnosed with asymptomatic irreversible pulpitis.

METHODS: Fifty-four patients were randomly allocated into three groups (n = 18) according to the obturation material used: Endoplus, BioMTA+, or Well-Root PT. All treatments were performed in a single visit under standardized clinical conditions. Root canals were prepared using FKG Race Evo rotary files and irrigated with NaOCl and EDTA, followed by passive ultrasonic activation. Postoperative pain was assessed using a visual analog scale (VAS) at 6, 12, 24, 48, and 72 h and at 1 week postoperatively. Analgesic intake was recorded. Data were analyzed using repeated measures ANOVA and chi-square tests, with the significance level set at p < 0.05.

RESULT: All groups exhibited a statistically significant reduction in postoperative pain over time (p < 0.001 for Endoplus and BioMTA+; p = 0.004 for Well-Root MTA). However, intergroup comparisons revealed no statistically significant differences in pain scores at any evaluation time point (p > 0.05). The highest pain levels were observed within the first 24 h, followed by a rapid decline thereafter. None of the patients required analgesic intake during the postoperative period. Demographic variables were comparable among the groups.

CONCLUSION: Within the limitations of this randomized clinical trial, no statistically significant differences were detected among BioMTA+, Well-Root PT, and Endoplus regarding early postoperative pain following single-visit root canal treatment in mandibular molars with asymptomatic irreversible pulpitis. The type of root canal sealer did not significantly influence postoperative pain outcomes.

TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (ID: NCT06795282, Record Dates: 22/12/2024).

PMID:42098797 | DOI:10.1186/s12903-026-08525-x

Implement Sci. 2026 May 7. doi: 10.1186/s13012-026-01500-8. Online ahead of print.

ABSTRACT

BACKGROUND: “Nudges” embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges.

RESULTS: The primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation.

CONCLUSIONS: EHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU.

TRIAL REGISTRATION: Clinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.

PMID:42098760 | DOI:10.1186/s13012-026-01500-8

BMC Med Educ. 2026 May 7. doi: 10.1186/s12909-026-09365-7. Online ahead of print.

ABSTRACT

BACKGROUND: Periodontal diseases are closely related to various systemic conditions including diabetes mellitus (DM), cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis (RA). Internal medicine physicians frequently encounter patients with these systemic conditions and are in a strategic position to facilitate early diagnosis and referral for periodontal problems. Despite international evidence suggesting significant knowledge gaps among medical practitioners regarding periodontal health, limited data are available from Turkey. The aim of this study was to evaluate the knowledge levels and attitudes of internal medicine specialists and residents regarding periodontal health and periodontal disease, and their relationship with systemic conditions, in comparison with dentists.

METHODS: This cross-sectional descriptive survey study was conducted between April 2021 and December 2021 in Turkey. A content-validated, self-administered online questionnaire consisting of 7 sociodemographic questions and 29 questions related to periodontal health and periodontal disease knowledge and attitudes was distributed to internal medicine specialists/residents (IMS group, n = 107) and dentists (control group, n = 133) via social media platforms. Internal consistency was assessed using Cronbach’s alpha (α = 0.829). Normality of continuous variables was assessed using the Shapiro-Wilk test. Data were analyzed using chi-square tests, Kruskal-Wallis tests, and Mann-Whitney U tests, with statistical significance set at p < 0.05. Bonferroni correction was applied for multiple comparisons. Multiple linear and logistic regression models were used to adjust for potential confounders.

RESULTS: A total of 240 participants met the inclusion criteria. Internal medicine specialists/residents demonstrated significantly lower knowledge levels compared to dentists across most periodontal knowledge domains (p < 0.05). Only 65.4% of the IMS group correctly defined periodontitis compared to 98.5% of dentists (p < 0.001). Knowledge gaps were particularly prominent regarding the relationship between periodontal disease and pregnancy complications (46.7% vs. 91%, p < 0.001), the effect of smoking on periodontal tissues (59.8% vs. 97.7%, p < 0.001), and the role of radiographic examination in periodontal diagnosis (37.4% vs. 88.8%, p < 0.001). After Bonferroni correction, 14 of 22 comparisons remained statistically significant. Notably, both groups showed high and comparable knowledge regarding the recognition of diabetes as a risk factor for periodontitis (IMS: 93.5% vs. dentists: 92.5%). Subgroup analysis revealed that specialists scored significantly higher than residents across all knowledge domains (total score: 16.94 ± 2.90 vs. 14.38 ± 3.73, p < 0.001). Multivariate analysis confirmed that group differences remained significant after adjusting for age, sex, marital status, and years since graduation (adjusted B = 4.65, p < 0.001). Self-assessment scores for periodontal knowledge significantly increased after completing the survey in the IMS group (4.02 to 5.34, p < 0.001).

CONCLUSIONS: The findings of this study suggest that internal medicine specialists and residents in Turkey may have lower knowledge levels regarding periodontal health and periodontal disease, and the periodontal-systemic health relationship compared to dentists. Specialists demonstrated significantly higher knowledge than residents across all domains. While these results should be interpreted within the context of the study’s methodological limitations, they point to a potential need for integration of oral health education into medical curricula and enhanced interprofessional collaboration between medicine and dentistry. Further research using representative sampling strategies and longitudinal designs is warranted to confirm these findings.

PMID:42098754 | DOI:10.1186/s12909-026-09365-7

BMC Public Health. 2026 May 7. doi: 10.1186/s12889-026-27664-y. Online ahead of print.

ABSTRACT

BACKGROUND: It is still unclear how the risk of cardiovascular disease (CVD) changes across life course and the specific influence of body mass index (BMI) on risk trajectory.

METHODS: We included 106,962 participants aged 35-74 from a Chinese longitudinal cohort during 1992 to 2021 with 4 repeated measurements. China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equation was applied to calculate 10-year CVD risk. General additional mixed model and Joinpoint model were used to elaborate CVD risk trajectory and the potential benefits of normal BMI.

RESULTS: The 10-year CVD risk for Chinese adults increased from 1.11% [95% confidence interval (CI): 1.00%, 1.22%] to 14.87% (95%CI: 14.76%, 14.99%) dramatically between ages 35-74, with average CVD risk reaching moderate- and high-risk level at 53 and 65 years, respectively. Compared to overweight/obesity (BMI ≥ 25 kg/m²), normal BMI (< 25 kg/m²) could effectively slow the increase of CVD risk during lifespan (average slope: 0.42% vs. 0.33%), and postpone the moderate- and high-risk age window by 4 years and 5 years, respectively. Risk difference between overweight/obesity and normal BMI groups gradually climbed from -0.10% (95%CI: -0.47%, 0.28%) to 3.02% (95%CI: 2.69%, 3.35%) between ages 35-74. Women displayed a similar uptrend, while men experienced peak benefits at 53 years (2.09%, 95%CI: 1.86%, 2.31%) followed by a slight decrease.

CONCLUSIONS: This study delineated cardiovascular risk trajectory, identifying critical intervention windows and demonstrating potential cardiovascular benefits of normal BMI, particularly in women.

PMID:42098752 | DOI:10.1186/s12889-026-27664-y

BMC Womens Health. 2026 May 7. doi: 10.1186/s12905-026-04520-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine temporal trends in routine leucorrhea test results and associated pathogen findings among women participating in sustained cervical and breast cancer screening programs in a county-level city of western China.

METHODS: In this repeated cross-sectional screening study, routine leucorrhea test data were collected from women aged 35-64 years who participated in cervical and breast cancer screenings in Jianyang City, Sichuan Province, between January 2022 and December 2024 (12,156 cases in 2022, 13,824 cases in 2023, and 11,382 cases in 2024). Participants were stratified by age and region. Vaginal cleanliness and pathogens were assessed using the normal saline wet mount method. Statistical analyses were performed using SPSS 26.0, including trend analysis, linear regression, and stratified analyses to examine age-region interaction effects.

RESULTS: Over the three-year period, the abnormal rate of routine leucorrhea tests (Grade III-IV) decreased from 34.21% to 30.00%, corresponding to an annual reduction of 6.5% (P < 0.001). Infection rates of Candida albicans, Trichomonas vaginalis, and clue cell positivity declined concurrently. The 51-55 age group had the highest baseline abnormal rate but showed the most pronounced decrease (5.40% points). Stratified analysis indicated that township perimenopausal women (51-55 years) experienced the steepest improvement (7.2% points) compared with urban counterparts (3.8% points, P < 0.01). The urban-rural gap narrowed by 3.90% points (P < 0.001). Following the 2023 township healthcare initiative, township abnormal rates declined more steeply than the pre-intervention trend would have predicted (difference of 3.10% points); given the cross-sectional design, this difference should be interpreted as a temporal association rather than causal attribution.

CONCLUSION: Participation in a sustained, population-based screening program was temporally associated with a declining trend in abnormal leucorrhea findings among women aged 35-64 years in this county-level city of western China. Based on a preliminary linear trend estimate derived from three annual data points, the abnormal rate may decrease to approximately 26% by 2026 if current intervention intensity is maintained; this projection should be interpreted with caution given the limited time series. Because this is a repeated cross-sectional analysis, causal inference is not warranted. Targeted interventions for perimenopausal women and residents of township areas should be reinforced to optimize gynecological health services in western China.

PMID:42098750 | DOI:10.1186/s12905-026-04520-0