Category: Statistics

BMC Oral Health. 2026 Jul 15;26(1):1271. doi: 10.1186/s12903-026-09231-4.

ABSTRACT

OBJECTIVE: To investigate, using micro-computed tomography (micro-CT), the apical anatomy of mandibular second primary molar roots in Egyptian children, with emphasis on the spatial relationship between the apical foramen and the anatomic apex, and the morphology and dimensions of the root canal at the apical foramen level.

MATERIALS AND METHODS: Fifty extracted human mandibular second primary molars (150 canals: 50 distal, 50 mesiobuccal, 50 mesiolingual) with complete root length and minimal resorption were scanned using high-resolution micro-CT (15.24 μm voxel size). The distance between the apical foramen and the apex, canal major diameter, and roundness at the foramen level were measured using CTAn software. Descriptive statistics were calculated, and exploratory canal-type comparisons were performed using one-way ANOVA followed by Tukey post-hoc tests. (α = 0.05).

RESULTS: The apical foramen did not coincide with the anatomic apex in any canal. The mean apex-to-foramen distance was 0.57 ± 0.44 mm. Mean apical canal diameter was 0.63 ± 0.24 mm and mean roundness was 0.48 ± 0.17, indicating predominantly oval canal shapes. The overall comparison suggested variation in apex-to-foramen distance among canal types (p = 0.040), but post-hoc comparisons did not confirm statistically significant pairwise differences between individual canal types. Distal canals exhibited significantly larger diameters than both mesial canals (p < 0.05), whereas the difference between mesiobuccal and mesiolingual canals was not significant. Roundness did not differ significantly among canal types (p = 0.079).

CONCLUSIONS: In Egyptian children, the apical foramen of mandibular second primary molar is consistently offset from the anatomic apex. The distal canals demonstrated the largest major canal diameter at the apical foramen level.

CLINICAL RELEVANCE: Because the apical foramen rarely coincides with the apex and complete mechanical enlargement to the true apical diameter is often clinically unrealistic, pediatric endodontic treatment should prioritize accurate working-length determination (e.g., electronic apex locators) and combine conservative shaping with effective chemical disinfection to optimize apical cleaning while preserving root integrity.

PMID:42458474 | DOI:10.1186/s12903-026-09231-4

BMC Nurs. 2026 Jul 15. doi: 10.1186/s12912-026-05046-4. Online ahead of print.

ABSTRACT

BACKGROUND: Major Depressive Disorder (MDD) is a debilitating psychiatric condition that severely impairs patients’ self-care capabilities, self-esteem, and resilience. Dorothea Orem’s Self-Care Deficit Theory offers a systematic nursing framework to transition patients from passive care recipients to active self-managers. This study aimed to evaluate the effects of a nursing intervention based on Orem’s self-care model on self-esteem and resilience among hospitalized patients with MDD.

METHODS: This randomized controlled trial was conducted from February to May 2026 among 60 patients diagnosed with MDD who were hospitalized in the psychiatric ward of Shahid Madani Hospital in Khoy, Iran. Patients were selected via convenience sampling and randomly assigned to either the intervention group (n = 30) or the control group (n = 30) using block randomization. The intervention group received 5 sessions of a tailored self-care program based on Orem’s supportive-educative system, alongside routine clinical care. The control group received only standard hospital care. Data were collected at baseline (pre-test), immediately post-intervention (post-test), and at a one-month follow-up using the Rosenberg Self-Esteem Scale (RSES) and the Connor-Davidson Resilience Scale (CD-RISC). Data were analyzed using SPSS software via descriptive statistics and Repeated Measures ANOVA.

RESULTS: Baseline demographic and clinical characteristics were homogeneous between the two groups (P > 0.05). Mauchly’s test confirmed sphericity for both self-esteem (W = 0.992, P = 0.788) and resilience (W = 0.953, P = 0.252) variables. The Repeated Measures ANOVA demonstrated a significant time-group interaction effect for both self-esteem (F = 10.11, P < 0.001, Partial Eta Squared = 0.15) and resilience (F = 6.59, P = 0.002, Partial Eta Squared = 0.10). At post-test, the intervention group exhibited significantly higher self-esteem (Mean = 18.33, 95% CI: [17.08, 19.58]) and resilience (Mean = 55.70, 95% CI: [52.00, 59.40]) compared to the control group (Self-esteem Mean = 12.03, 95% CI: [10.78, 13.28]; Resilience Mean = 42.07, 95% CI: [38.37, 45.77]) (P < 0.001), which remained stable at the one-month follow-up.

CONCLUSION: Psychiatric nurses can integrate this structured, low-cost, and empowering model into routine clinical practice to foster autonomy and reinforce essential psychological capacities-specifically self-esteem and resilience-in hospitalized psychiatric patients.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20250723066609N3. Registered on February 6, 2026.

PMID:42458470 | DOI:10.1186/s12912-026-05046-4

J Transl Med. 2026 Jul 15. doi: 10.1186/s12967-026-08576-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine whether patients with autoimmune diseases receive differential cardiometabolic and inflammatory laboratory monitoring compared to matched controls in primary care, and to identify predictors of monitoring patterns.

METHODS: We conducted a matched case-control study using electronic health records from the Primary Health Care Corporation (PHCC), Qatar (January 2015 to December 2024). Adults with Hashimoto’s thyroiditis, rheumatoid arthritis (RA), or systemic lupus erythematosus (SLE) were matched 1:2 to controls without autoimmune disease on age and sex. Primary outcomes were receipt of cardiometabolic tests (haemoglobin A1c [HbA1c], complete lipid panel) and inflammatory markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]). We used conditional logistic regression adjusting for comorbidities, medications, and healthcare utilisation.

RESULTS: Among 27,911 participants (9,356 cases, 18,555 controls; mean age 46.7 years; 74.4% female) in 9,356 matched sets, we observed divergent monitoring patterns. Compared to controls, patients with RA had significantly lower odds of HbA1c monitoring (OR 0.77, 95% CI 0.69-0.85) and complete lipid panels (OR 0.74, 95% CI 0.67-0.82). Similar patterns were observed for SLE (HbA1c: OR 0.67, 95% CI 0.57-0.80; lipid: OR 0.60, 95% CI 0.51-0.70). Conversely, RA patients had 4.2-fold higher odds of CRP testing and 4.4-fold higher odds of ESR testing; SLE patients showed similar elevations (3.7-fold and 4.2-fold, respectively). Hashimoto’s patients showed modestly increased monitoring across all test types (HbA1c: OR 1.45, 95% CI 1.23-1.70).

CONCLUSIONS: Despite elevated cardiovascular risk, patients with systemic autoimmune diseases (RA, SLE) receive less cardiometabolic laboratory monitoring than matched controls while receiving substantially more inflammatory marker testing. This differential monitoring pattern – which we describe as a “monitoring gap paradox” and which persisted across sensitivity analyses – is consistent with care coordination challenges at the primary care-specialty interface. The observational design precludes inferences about the underlying causes, but the findings identify a potential quality improvement opportunity warranting further investigation.

PMID:42458465 | DOI:10.1186/s12967-026-08576-2

J Transl Med. 2026 Jul 15. doi: 10.1186/s12967-026-08562-8. Online ahead of print.

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative syndrome diagnosed clinically using standardized criteria, with neuropathological confirmation of motor neuron loss and TDP-43 aggregates in postmortem brain tissue. Extracellular vesicles (EVs) have emerged as potential minimally invasive biomarkers for ALS, but studies vary widely in methodology and reproducibility. We conducted a systematic review and meta-analysis to evaluate the diagnostic potential of EV-associated proteins and RNAs in ALS. Following PRISMA guidelines, we searched PubMed and EMBASE from inception to May 21st, 2026. Forty-one studies met inclusion criteria. Where published summary statistics were available, these were used directly; where they were not, data were reconstructed from figures or obtained from authors and re-analyzed to derive standardized effect sizes and exploratory diagnostic accuracy estimates. Random-effects models were used for continuous outcomes, and diagnostic accuracy was assessed using hierarchical summary ROC and bivariate random-effects models. Publication bias was evaluated using Begg, Egger, and funnel plots. EV-associated TDP-43 was the most frequently studied protein. Meta-analysis of five studies showed a moderate but non-significant increase in EVs from ALS vs. controls (SMD = 1.30) with high heterogeneity (I = 97.8%). Sixteen studies assessing EV-RNA biomarkers showed minimal overlap and limited independent replication. Diagnostic accuracy meta-analysis across 11 studies yielded moderate performance (AUC = 0.839). No publication bias was found across both meta-analyses. EV biomarkers for ALS show biological promise but are limited by methodological variability and insufficient replication. This work highlights the need for standardized protocols, transparent data sharing, and independent validation.

PMID:42458453 | DOI:10.1186/s12967-026-08562-8

BMC Oral Health. 2026 Jul 15. doi: 10.1186/s12903-026-09161-1. Online ahead of print.

ABSTRACT

BACKGROUND: This in vitro study investigated the remineralization of artificial caries-like lesions in primary teeth using a multimodal microscopy approach. Micro- and nano-sized 45S5 bioactive glass (BAG) gels were compared with fluoride varnish in terms of surface morphology and volumetric mineral density changes.

METHODS: Enamel-dentin blocks prepared from extracted human primary molars and incisors were demineralized and randomly assigned to three treatment groups (n = 10): fluoride varnish, micro-sized BAG gel, and nano-sized BAG gel. Following treatment, all specimens were subjected to a 6-day pH-cycling protocol. Surface characteristics and elemental composition were analyzed using scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM/EDS), while three-dimensional mineral density (MD) distributions were quantified using micro-computed tomography (µCT). MD differences within and between groups were analyzed using two-way analysis of variance (ANOVA) with Tukey’s post-hoc test, with statistical significance set at p < 0.05.

RESULTS: SEM/EDS analysis demonstrated that both BAG gels produced relatively uniform superficial reaction products compared to fluoride varnish. However, µCT measurements revealed significantly higher mineral density in the fluoride-treated specimens (1.39 ± 0.10 g/cm³) than in the MicroBAG (1.09 ± 0.21 g/cm³) and NanoBAG groups (0.98 ± 0.16 g/cm³) (p < 0.05).

CONCLUSIONS: The combined findings highlight a discrepancy between surface-level observations and subsurface mineral recovery, emphasizing the importance of volumetric µCT analysis when assessing remineralization efficacy. Fluoride achieved higher volumetric mineral density than BAG gels. This study demonstrates the value of integrating surface and volumetric microscopy techniques for the accurate evaluation of mineralized dental tissues.

PMID:42458445 | DOI:10.1186/s12903-026-09161-1

BMC Nurs. 2026 Jul 15. doi: 10.1186/s12912-026-05018-8. Online ahead of print.

ABSTRACT

BACKGROUND: Competency training is essential for cultivating qualified anaesthesia Master of Nursing Specialist (MNS) graduates. Although a previous study has established relevant competency dimensions for anaesthesia nursing, no refined framework with operationalized indicators is currently available for Chinese MNS anaesthesia students.

OBJECTIVE: To construct an index system for the core clinical competencies of MNS anaesthesia students.

METHODS: Following literature screening, 26 eligible publications were selected to draft preliminary indicators. Semi-structured interviews with 15 participants were performed, and interview data were analysed via thematic coding.21 experts from 11 regions across China completed two rounds of Delphi surveys. Indicators were rated on a 5-point Likert scale, with expert consensus determined by predefined statistical cut-offs (mean importance score ≥ 3.5, coefficient of variation (CV) ≤ 0.25, ≥ 75% ratings ≥ 4) combined with comprehensive expert revision opinions.

RESULTS: The response rates of the two Delphi rounds were 100% and 95.24%, respectively. The expert authority coefficients (Cr) were 0.95 and 0.96, indicating high reliability of the consultation results. In the second round, Kendall’s concordance coefficients (W) for the first, second, and third-level indicators were 0.552 (strong consensus), 0.324 (moderate consensus), and 0.254 (weak-moderate consensus) respectively (P < 0.01), which indicated that the consistency of expert opinions was statistically significant and the consultation results were valid. The range of coefficient of variation was from 0.05 to 0.25. The final indicator system included 8 first-level indicators, 39 s-level indicators, and 109 third-level indicators.

CONCLUSION: Core clinical competency indicators for MNS anaesthesia students, established in this study, achieved expert consensus validity. These competency indicators can serve as a theoretical reference for the future training and assessment of MNS postgraduates in this field.

PMID:42458437 | DOI:10.1186/s12912-026-05018-8

Malar J. 2026 Jul 15. doi: 10.1186/s12936-026-06036-2. Online ahead of print.

ABSTRACT

Malaria remains a leading cause of morbidity and mortality among children in Malawi with transmission exhibiting marked geographic disparities. While standard regression models estimate the association between childhood malaria and risk factors across the entire study area, they assume spatial stationarity, thereby masking local-area variations in estimated effects. We applied Geographically Weighted Regression, a spatial non-stationarity modeling approach to data from the recent 2024 Malawi Demographic and Health Survey to estimate district-specific associations between childhood malaria and selected risk factors, namely mosquito net use, place of residence, household wealth, maternal age, and maternal education. The overall malaria prevalence among children aged five or under was 36.3%. By applying Geographically Weighted Regression, the study demonstrated substantial spatial heterogeneity in the associations between childhood malaria and the selected predictors across Malawi, revealing locally varying effects that would have been obscured under conventional global modelling approaches. These findings highlight the value of locally estimated relationships for understanding contextual differences in the predictors of childhood malaria and provide district-specific evidence to support geographically targeted intervention strategies and more efficient allocation of prevention and treatment resources within Malawi’s National Malaria Control Programme.

PMID:42458435 | DOI:10.1186/s12936-026-06036-2

BMC Health Serv Res. 2026 Jul 15. doi: 10.1186/s12913-026-15111-y. Online ahead of print.

ABSTRACT

BACKGROUND: China introduced the Supplementary High-Cost Illness Insurance (SHCII) to strengthen financial protection against medical impoverishment. This study assesses its effectiveness and, critically, examines the distribution of its benefits across population subgroups to identify who benefits more.

METHODS: We used 2013 and 2018 survey data from Shandong Province and a difference‑in‑differences design, restricting the sample to hospitalized patients (n = 3,136). The treatment group comprised patients whose out‑of‑pocket expenses exceeded city‑specific 2018 SHCII thresholds; the control group comprised those below the thresholds. The outcome was Vulnerability to Expected Poverty (VEP). Subgroup analyses were performed by income, urban‑rural residence, healthcare access, and age.

RESULTS: Patients who benefit from SHCII experienced a significant reduction in VEP relative to those below the threshold (OR = 0.624; average marginal effect = -0.064). The protective effect was statistically significant for low‑income individuals, rural residents, those with healthcare access within 15 min, and adults aged 45 years and above. No significant effect was found for urban residents or for those with poorer geographical access to care.

CONCLUSION: Patients who benefit from SHCII experienced a greater reduction in poverty vulnerability relative to those below the threshold, with effects concentrated among low‑income, rural, older, and well‑accessed populations. No significant association was observed for urban residents. The findings from Shandong, where policy parameters are broadly consistent with national guidelines, are likely generalizable to other provinces with similar policy designs and rural healthcare infrastructure. Future research is needed to test how different policy parameters affect the results.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42458432 | DOI:10.1186/s12913-026-15111-y

BMC Med Educ. 2026 Jul 15. doi: 10.1186/s12909-026-09901-5. Online ahead of print.

ABSTRACT

BACKGROUND: Digital technologies – including computer-aided design and manufacturing systems, three-dimensional printing, digital radiography, intraoral scanners, and artificial intelligence – are increasingly central to clinical dentistry, yet their integration into undergraduate curricula remains uneven. Clinical-year students, approaching graduation and patient-facing practice, are a critical group in whom to assess this transition, but evidence on how they perceive these technologies and relate them to curriculum expectations is limited. This study evaluated the awareness, attitudes, and curriculum expectations of clinical-year dental students regarding digital dentistry.

METHODS: A descriptive cross-sectional survey was conducted among fourth- and fifth-year students at a single dental faculty using a census-based approach. An 11-item online questionnaire assessed familiarity with five digital technologies, attitudes, and future professional perspectives, with an attention-check item and electronic informed consent. The questionnaire underwent multi-step validation, including expert-panel content validity, exploratory factor analysis, and internal-consistency reliability. Group comparisons by sex and year of study were examined with chi-square tests and Cramér’s V, applying the Benjamini-Hochberg procedure to control the false discovery rate.

RESULTS: Of 187 included students (85.0% response rate), the questionnaire showed strong content validity (scale-level content validity index = 0.94) and acceptable reliability (Cronbach’s alpha = 0.83 for familiarity and 0.92 for the positive-attitude scale). Familiarity was highest for digital radiography and lowest for artificial intelligence. Attitudes were strongly positive: most students reported high interest in digital dentistry and a clear desire for greater curricular coverage, and 74.3% considered digital dentistry teaching at their faculty insufficient. Apparent differences by sex and year of study did not remain statistically significant after correction for multiple comparisons.

CONCLUSIONS: Clinical-year dental students held favourable attitudes toward digital dentistry and expressed strong demand for expanded training, yet their self-reported familiarity remained modest and was lowest for artificial intelligence. This gap between motivation and perceived provision highlights a concrete target for curriculum development, suggesting that undergraduate dental education should strengthen structured, hands-on exposure to digital technologies – particularly artificial intelligence – to better prepare graduates for contemporary clinical practice.

PMID:42458426 | DOI:10.1186/s12909-026-09901-5

BMC Med Educ. 2026 Jul 15. doi: 10.1186/s12909-026-09927-9. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to evaluate the role of social media in the career choices of first-year dental students in Turkey and to examine the relationship between this effect and demographic characteristics and social media usage habits.

METHODS: This descriptive cross-sectional study included first-year dental students enrolled in different dental faculties in Turkey during the 2025-2026 academic year. Data were collected through a two-part online questionnaire developed in line with the literature, with internal consistency assessed as a preliminary step (α = 0.84); formal psychometric validation was not conducted. The questionnaire assessed demographic characteristics, social media usage habits, exposure to dentistry-related content, and factors influencing career choice. Descriptive statistics and Chi-square test were used to analyze the data, and the significance level was set at p < 0.05.

RESULTS: 64.9% of the study sample reported being influenced by social media content during the career decision-making process; this figure reflects the study sample only and should not be interpreted as a population prevalence estimate. No statistically significant associations were found between social media influence and gender, type of high school graduated from, or year of university admission (p > 0.05). Among students influenced by social media, 47.9% reported using social media for 3 h or more per day, and TikTok was the most frequently used platform (20.3%). Animations were the most attention-grabbing content type (22.9%), while social prestige (22.9%) was the most common expectation associated with social media. Across all participants, the most frequently reported reasons for choosing dentistry were guidance counselor recommendations (15.5%) and the prestige of the profession (14.2%).

CONCLUSIONS: The findings indicate that a considerable proportion of first-year dental students in the study sample reported being influenced by social media during their career decision-making, and this reported influence was not significantly associated with demographic variables. Idealized professional representations on social media, particularly those emphasizing prestige and lifestyle expectations, may shape students’ perceptions of the profession. These findings highlight the need for dental faculties to develop realistic and balanced digital content strategies, and for guidance services to incorporate media literacy training, so that prospective students can critically evaluate social media content during the career choice period.

PMID:42458420 | DOI:10.1186/s12909-026-09927-9