Category: Statistics

Glob Health Action. 2026 Dec 31;19(1):2641401. doi: 10.1080/16549716.2026.2641401. Epub 2026 Mar 10.

ABSTRACT

BACKGROUND: Rwanda’s community-based health insurance (CBHI) has achieved near-universal enrollment, yet inequities in healthcare use remain. Understanding whether coverage translates into equitable utilization is critical for advancing universal health coverage (UHC). This study aims to examine how social protection complements health insurance in promoting equitable healthcare access.

OBJECTIVE: To examine the relationship between insurance coverage and healthcare utilization in sectors targeted by the Vision Umurenge Programme (VUP), assess socioeconomic inequities, and evaluate the complementary role of social protection.

METHODS: This study analyzed cross-sectional data from 15,039 households in VUP sectors using the 2023-2024 Seventh Integrated Household Living Conditions Survey. Socioeconomic inequality was measured using Erreygers-corrected concentration indices and need-standardized horizontal inequity analysis. Insurance effects were estimated using survey weighted logistic regression, propensity score matching, and doubly robust inverse-probability-weighted regression adjustment.

RESULTS: Insurance coverage was 85.8%, yet only 25.5% reported any formal healthcare utilization in the 12 months preceding the survey, including outpatient visits, inpatient admissions and preventive services. Utilization showed stronger pro-rich concentration (E = +0.066) than coverage (E = +0.026) and need-standardized analysis confirmed residual inequity. Insurance increased utilization by +14.6% points in regression models and ~+12% points in causal estimators. Participation in VUP components, particularly direct support, was consistently associated with higher service use.

CONCLUSIONS: In a high coverage setting, persistent pro-rich inequities highlight the role of non-financial barriers such as indirect costs and service readiness. Layering social protection with insurance and strengthening primary care delivery is critical to convert nominal coverage into equitable healthcare access.

PMID:41804591 | DOI:10.1080/16549716.2026.2641401

Nurs Open. 2026 Mar;13(3):e70427. doi: 10.1002/nop2.70427.

ABSTRACT

AIM: To address participants’ requests for an educational guide for midwifery students learning newborn resuscitation.

DESIGN: An explorative design and qualitative method were undertaken.

METHODS: From May 2018 to October 2020, midwives and midwifery students across Norway were interviewed individually (n = 16) and participated (n = 20) in four digital workshops. Participants collaborated to design a tailored newborn resuscitation course and subsequently developed an educational guide to simplify the learning process for midwifery students. A secondary analysis of previously collected qualitative data was conducted.

RESULTS: Simplified guidance on newborn resuscitation was developed using the ADDIE model, emphasising midwives’ roles in quickly managing complex tasks. A three-step pocket guide was created to help midwifery students prepare effectively.

PATIENT OR PUBLIC CONTRIBUTION: Midwives and midwifery students willingly shared their experiences and suggestions in interviews and workshops, where they collaborated to develop a tailored course in newborn resuscitation and an educational guide to support midwifery students’ learning in newborn resuscitation.

CONCLUSION: Stimulate, ventilate and collaborate are key elements in newborn resuscitation. Midwifery students and midwives requested simplified guidance for learning, training and performing newborn resuscitation. Given the close association, further research is recommended to evaluate the ‘Stimulate, Ventilate, Collaborate’ educational guide by implementing and evaluating its effectiveness across diverse international midwifery educational and clinical settings. This study underpins the importance of addressing participants’ request for an educational guide for midwifery students learning newborn resuscitation. The educational guide offers this requested guide to newborn resuscitation, addressing the need for simplified guidance identified by midwifery students and midwives. By providing clear, memorable steps for learning, training and clinical application, this educational guide has the potential to enhance confidence and competence in performing newborn resuscitation. Implementing and evaluating this guide across diverse international settings can improve midwifery education and midwives’ clinical practice. However, implementation and evaluation are still pending.

PMID:41804581 | DOI:10.1002/nop2.70427

Sports Biomech. 2026 Mar 10:1-14. doi: 10.1080/14763141.2026.2638941. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate how floating toes affect baseball pitching motion. Fifteen young male baseball players pitched from a pitching mound after physical examination, including floating toes, determining if any toes are not in contact with the ground. At least 20 pitches were thrown and the 10-best pitches were selected for the analysis. Images of the ball release point for sagittal and coronal views were captured from the videos recording the pitching motion. The positions of the ball, wrist, and leading foot were measured and the variability of each position over the 10 pitches was expressed as a standard deviation (SD). Each SD between the players with and without floating toes was statistically compared. The prevalence of floating toes on the pivot and plant foot was 47% and 33%, respectively. Those with floating toes on the pivot foot showed significantly greater SD in the antero-posterior position on the ball, wrist, and leading foot at ball release (p = 0.04, 0.02, and 0.01, respectively). Those with floating toes on the plant foot showed a significantly greater SD in the antero-posterior position of the plant foot (p = 0.02). Pitching with floating toes may lead to inconsistent pitching motion.

PMID:41804542 | DOI:10.1080/14763141.2026.2638941

Work. 2026 Mar 10:10519815261427709. doi: 10.1177/10519815261427709. Online ahead of print.

ABSTRACT

BackgroundWork-life balance (WLB) is crucial for occupational health, especially for bus conductors, who face high levels of stress and irregular schedules. Despite the extensive exploration of WLB across occupations globally, a pronounced research gap exists for bus conductors, notably in the Sri Lankan context.ObjectiveThe objective of this study was to develop and validate a context-specific WLB tool for Sri Lanka Transport Board (SLTB) bus conductors.MethodsThe tool was developed via qualitative methods (in-depth interviews, focus group discussions, and key informant interviews) and a review of existing tools, followed by pilot testing. Statistical analyses were conducted for exploratory factor analysis (EFA), whereas confirmatory factor analysis (CFA) was performed using the lavaan package in R. The sample sizes for the factor analyses adhered to the established subject-to-item ratio guidelines, ensuring the statistical robustness of the psychometric validation.ResultsThe tool showed high reliability (Cronbach’s α = 0.784) and strong construct validity, as supported by EFA with 147 bus conductors and CFA with a separate sample of 100. It comprises 10 items with three dimensions, namely, work-family integration, institutional support and work satisfaction, and health and work interference, collectively explaining 75.7% of WLB variance.ConclusionThis study provides a validated, context-specific instrument to measure the WLB of bus conductors, which can be used by relevant stakeholders to assess, compare, and improve WLB following targeted interventions, thereby enhancing the efficiency of public transportation bus services.

PMID:41804531 | DOI:10.1177/10519815261427709

Work. 2026 Mar 10:10519815261426994. doi: 10.1177/10519815261426994. Online ahead of print.

ABSTRACT

BackgroundNursing students who are majoring to become nurses are under risk with regards to complications and injuries due to practice lack and insufficient clinical experience.ObjectiveThis research was conducted to determine the knowledge, attitude, and behaviors of nursing faculty students regarding needlestick and sharps injuries.MethodsThis research was planned in a descriptive and correlational study. Attitude 447 students who accepted to take part in the research and suitable to the criterions of inclusion accounted for the sampling of the research. Scale oriented to “Attitude Scale for Safe Use of Sharps by Healthcare Workers” and “Student Information Form” were used in the gathering of data.ResultsIt was seen that 29.5% of the students experienced at least one NSSIs during their education life and the most common injuries were in the 4^th year. Overall score point average of “Attitude Scale for Safe Use of Sharps” was found to be 118.11 ± 7.33 and according to age, gender, wounding case, wounding area and wounding reason, statistically significant differences were determined as regards to total scale and subscale score averages.ConclusionsAs a result, although the scores that the students knowledge, attitude and behaviours were high, it was seen that there were injuries. The sustenance of trainings oriented to preventing injuries can be suggested.

PMID:41804530 | DOI:10.1177/10519815261426994

Int Wound J. 2026 Mar;23(3):e70875. doi: 10.1111/iwj.70875.

ABSTRACT

Peripheral intravenous catheters (PIVCs) are widely used in hospital settings but are associated with high failure rates and patient safety risks. Various dressing and securement methods have been implemented to mitigate these complications. This systematic review aimed to systematically review the effectiveness and safety of different dressing and securement methods for PIVCs in hospitalised adult and paediatric patients. Randomised controlled trials (RCTs) published between 1959 and 2024 were identified through searches of CENTRAL, CINAHL, Ovid EMBASE, and Ovid MEDLINE. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Outcomes included PIVC failure, dislodgement, occlusion, infiltration, extravasation, phlebitis, and catheter-related bloodstream infection (CRBSI), analysed using risk ratios where meta-analysis was feasible. Dwell time was reported descriptively as mean or median values. Fifteen RCTs involving 5542 participants evaluated eight PIVC dressing and securement methods. In adult populations, tissue adhesive significantly reduced PIVC failure compared with transparent polyurethane dressing (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.73-0.95), as well as dislodgement (RR 0.60, 95% CI 0.42-0.84) and occlusion (RR 0.73, 95% CI 0.57-0.94). Transparent polyurethane dressing was associated with lower dislodgement rates compared with gauze in adults. Other comparisons showed no statistically significant differences or were informed by single studies only, limiting the strength of conclusions. Evidence in paediatric populations was sparse and predominantly derived from individual trials. Tissue adhesive appears effective in reducing PIVC failure and mechanical complications in adults. Its effectiveness in pediatric patients remains uncertain, highlighting the need for further adequately powered trials.

PMID:41804526 | DOI:10.1111/iwj.70875

Work. 2026 Mar 10:10519815261428096. doi: 10.1177/10519815261428096. Online ahead of print.

ABSTRACT

BackgroundThe construction industry internationally and in Taiwan experiences high rates of injury, and fatalities. Worker behaviour is frequently associated with construction site accidents. The paper examines evidence on the effectiveness of a safety culture focus in improving safety behaviour on Taiwanese construction sites.ObjectiveTaking a public health approach, the research systematically evaluates safety culture focused initiatives to enhance construction site safety in Taiwan, with a particular focus on SMEs, given their overrepresentation in accident statistics.MethodsInformation from a systematic review of safety culture research in construction published between 2014 and 2024, combined with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) process, was used to assess the evidence supporting safety culture improvements. The combination of methods provides a systematic framework with a novel perspective on safety culture initiatives to improve safety behaviour in construction.ResultsEvidence from 99 articles shows that emphasising safety climate can improve construction workers’ safety behaviour. Nonetheless, key questions around resourcing, acceptability, and feasibility remain, particularly for small and medium enterprises. Benefits may include reduced government compensation costs and better health equity in the industry.ConclusionThis review using EtD offers a new perspective on international safety-climate research and highlights key gaps in construction safety. The findings suggest that EtD supports comprehensive evidence assessment for practical and policy use. Limited data in many areas points to the need for more holistic, public health-focused research to help achieve construction safety policy goals in Taiwan.

PMID:41804525 | DOI:10.1177/10519815261428096

J Neuroendovasc Ther. 2026;20(1):2025-0130. doi: 10.5797/jnet.oa.2025-0130. Epub 2026 Mar 4.

ABSTRACT

OBJECTIVE: Minimizing the time to reperfusion is a critical determinant of the prognosis of acute ischemic stroke (AIS). To reduce the workload of neurosurgeons, improve efficiency, and shorten the time required for AIS management delivered by the neurosurgical department, a nurse practitioner (NP) was introduced in April 2019. However, the effect of NP involvement on post-door-to-needle (D2N) intervals, particularly time to reperfusion, has not been clarified. This study examined whether NP participation was associated with shorter post-D2N time metrics in patients with AIS undergoing mechanical thrombectomy (MT).

METHODS: This study included all consecutive patients with AIS due to intracranial large vessel occlusion who underwent MT between April 2019 and March 2024 at our institution. Patients with NP involvement were assigned to the NP group, and those without NP involvement were assigned to the non-NP group. NP participation was randomly determined according to their duty schedule. The primary outcomes were the median times from angiography suite entry-to-puncture (E2P) and from suite entry-to-recanalization (E2R). Secondary outcomes included onset-to-puncture (O2P), puncture-to-recanalization (P2R), door-to-entry (D2E), door-to-puncture (D2P), and the proportion of patients with a modified Rankin Scale (mRS) score of 0-2 at discharge. Statistical analyses included univariate and multivariate linear regression analysis, with significance set at p <0.05.

RESULTS: In total, 115 patients were included: 44 in the NP group and 71 in the non-NP group. The baseline patient characteristics were comparable. The median E2P was significantly shorter in the NP group (15 vs. 21 min; p <0.05), representing a 6-min reduction (28.6%). The median E2R was 73 vs. 76.5 min, showing a nonsignificant 3.5-min decrease. Among the secondary metrics, D2P was shorter in the NP group, whereas the O2P, P2R, and D2E levels did not differ significantly. In the multivariate linear regression analyses, only E2P remained independently associated with NP involvement. The proportion of patients with favorable outcomes (mRS 0-2) at discharge was higher in the NP group (27.3% vs. 19.7%), although the difference was not significant.

CONCLUSION: NP participation significantly reduced E2P time. These findings suggest that NP involvement contributes to shortening the treatment time in the post-D2N phase and may have a crucial role in promoting efficient team-based care in AIS management.

PMID:41804504 | PMC:PMC12967338 | DOI:10.5797/jnet.oa.2025-0130

Health Sci Rep. 2026 Mar 8;9(3):e71840. doi: 10.1002/hsr2.71840. eCollection 2026 Mar.

ABSTRACT

BACKGROUND AND AIM: With the development of trade between countries, the transportation of goods has increased, and ports struggle to accommodate the demands of unloading and loading operations. Seaport workers may experience work-related musculoskeletal disorders (WMSDs), which in many cases result in disabilities. Few studies have investigated the prevalence of work-related musculoskeletal disorders (WMSDs) and associated psychological factors among dock workers in Iran. Existing findings indicate a high prevalence of WMSDs in these settings, primarily attributed to adverse working conditions such as repetitive movements, awkward postures, heavy lifting, and excessive physical strain. Moreover, there is a scarcity of research examining the impact of psychological factors on musculoskeletal disorders within this occupational group. This study investigated the relationship between work-related psychological factors and job characteristics and WMSDs at the Port of Shahid Rajaee in Bandar Abbas, Iran, from December 2023 to April 2024.

METHODS: In this cross-sectional study, all 351 dock workers were enrolled as research subjects. Dock workers in our study encompassed four distinct occupational roles with different physical and postural demands, including Trans Trainer Operators, Gantry Crane Operators, Tractor Drivers, and warehouse workers. To collect data, the Job Content Questionnaire (JCQ) and the Nordic Musculoskeletal Questionnaire (NMQ) were used. The sampling method used in this study was a census approach, encompassing all eligible workers at Sina port and Marine Service Development Company. Statistical analyses included descriptive statistics, independent t-tests, Pearson’s correlation coefficients, and one-way analysis of variance (ANOVA).

RESULTS: The NMQ scores across the four groups were highest for the neck, shoulder, and upper back regions, with a mean score of 38.02, and lowest for the upper limb region, with a mean score of 10.40. Trans trainer and gantry crane operators and warehouse workers had significantly higher WMSDs in neck, shoulder, and upper back than tractor drivers (p < 0.001). Additionally, NMQ scores for the lower back were significantly correlated with the job type (p < 0.001), with warehouse workers having the highest MSD scores (22.85). Higher psychological job demands and psychosocial and physical stress were associated with more severe WMSDs for the workers. In addition, type of the job, age, work experience, marital status, and high job insecurity were significant factors influencing WMSDs.

CONCLUSION: Work-related psychosocial factors play an important role in the development of work-related musculoskeletal disorders (WMSDs) among port workers. To mitigate these risks, it is essential to address psychological stress and job demands. Additionally, improving communication between port workers and management may contribute to a healthier and more supportive work environment.

PMID:41804502 | PMC:PMC12967559 | DOI:10.1002/hsr2.71840

Health Sci Rep. 2026 Mar 8;9(3):e71961. doi: 10.1002/hsr2.71961. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Upper gastrointestinal endoscopy (UGIE) is a commonly performed procedure for evaluating complaints related to the upper gastrointestinal tract. It serves both diagnostic and therapeutic purposes. Over the last decade, there has been an increasing demand for UGIE, and selecting patients for the procedure according to standard guidelines is essential to enhance the quality of healthcare, reduce costs, and avoid unnecessary workload. This study was conducted to assess the appropriateness of indications for UGIE and the factors associated with abnormal findings in endoscopy among patients at the National Referral Hospital, Bhutan.

METHODS: A cross-sectional study was conducted at the Endoscopy Unit of the Surgical Department, National Referral Hospital, Bhutan. All patients aged > 12 years who underwent UGIE during the study period were included. Data were collected using a standard pro forma developed for the study, and statistical analysis was performed using SPSS software, version 23 (IBM Corp., Armonk, NY, USA).

RESULTS: A total of 200 patients underwent UGIE, of whom 50.5% (101/200) had the procedure performed for inappropriate indications. The majority of UGIE referrals originated from medical officers and residents.Among the appropriate indications, the most common was chronic liver disease with suspected portal hypertension (33.3%), followed by new-onset abdominal symptoms in patients over 50 years of age (25.3%).Abnormal endoscopic findings were detected in approximately two-thirds of cases (65.5%). The most frequently observed abnormality was esophageal varices (30.5%), followed by atrophic gastritis (26.7%) and erosive gastritis (16.0%). Esophageal and gastric growths were identified in 1.5% of cases.Notably, referrals for UGIE by medical specialists were nearly 14 times more likely to yield abnormal findings (adjusted odds ratio [aOR]: 13.5; 95% CI: 3.69-49.57; p < 0.001).

CONCLUSION: Approximately half of the UGIE indications were found to be inappropriate, with more than half of these cases showing normal findings on endoscopy. These results underscore the importance of adhering to standardized guidelines when recommending UGIE, to minimize unnecessary procedures, mitigate patient risks, and ensure the optimal use of healthcare resources.

PMID:41804497 | PMC:PMC12967617 | DOI:10.1002/hsr2.71961