Category: Statistics

BMC Med Educ. 2025 Oct 3;25(1):1349. doi: 10.1186/s12909-025-07987-x.

ABSTRACT

BACKGROUND: The landscape of nursing education is rapidly evolving worldwide through the integration of innovative technologies such as mixed reality (MR). While MR-based HoloPatient education shows promise for enhancing nursing education globally, particularly in settings with limited clinical placement opportunities, current research indicates positive effects on nursing students’ learning outcomes. However, no evidence exists that HoloPatient-based education improves students’ learning motivation and attitude. This study aimed to examine nursing students’ learning motivation and attitudes following HoloPatient-based simulation education, and to explore students’ perception of their HoloPatient-based simulation learning experiences.

METHODS: This study used an explanatory sequential mixed methods design with a one group post-test only design followed by focus group interviews. This study was conducted from August to September 2023 at a university in South Korea. Quantitative data were collected from 100 third-year nursing students who participated in HoloPatient-based simulation education. Qualitative data were obtained through semi-structured interviews with two focus groups, conducted one week after HoloPatient-based simulation education. Statistical analyses included descriptive statistics, correlation analysis, and comparative analyses. Qualitative data underwent thematic analysis following established protocols.

RESULTS: This study showed high level of nursing students’ learning motivation (M = 4.42, SD = 0.42) and positive attitude (M = 4.08, SD = 0.50) following HoloPatient-based simulation education. A significant positive correlation was found between learning motivation and attitude (r = .59 or higher, p < .001). Qualitative findings revealed themes of positive experience, influencing factors on HoloPatient-based simulation, and barriers to HoloPatient-based simulation.

CONCLUSION: This exploratory study found high levels of learning motivation and positive attitudes among nursing students following HoloPatient-based simulation education. However, due to the one-group post-test design and small qualitative sample, these findings should be interpreted as preliminary evidence. Further studies are needed to establish its effectiveness with randomized controlled trials or quasi-experimental designs.

PMID:41044594 | DOI:10.1186/s12909-025-07987-x

BMC Vet Res. 2025 Oct 3;21(1):573. doi: 10.1186/s12917-025-05036-9.

ABSTRACT

OBJECTIVE: This randomized, double-blind, placebo-controlled clinical trial investigated the therapeutic efficacy of pulsed electromagnetic field (PEMF) therapy in dogs diagnosed with chronic osteoarthritis (OA).

METHODS: Twenty-one dogs with radiographically confirmed OA in at least one limb were randomized into treatment (n = 10) and placebo (n = 11) groups. PEMF therapy was administered over six weeks. Gait symmetry indices for peak vertical force and vertical impulse were assessed using kinetic analysis at baseline (Day 0), mid-treatment (Day 21), and post-treatment (Day 42). Lameness and pain scores, additional treatments, and dropout rates were recorded. Owners completed the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire at each time point. An Overall Treatment Effectiveness (OTE) score was computed based on objective and subjective outcomes.

RESULTS: PEMF-treated dogs exhibited significant improvements in gait symmetry by Day 42 (p = 0.030). LOAD scores declined steadily in the treatment group, although no statistically significant differences were observed between groups. This trend may suggest a potential reduction in pain and improvement in mobility. No significant between-group differences were found for the OTE score.

CONCLUSION: PEMF therapy appears to be a safe, non-invasive, and potentially effective adjunctive or stand-alone modality for the management of pain and mobility impairment associated with osteoarthritis in dogs. Further research is warranted to confirm long-term efficacy and optimize treatment protocols.

PMID:41044566 | DOI:10.1186/s12917-025-05036-9

BMC Health Serv Res. 2025 Oct 3;25(1):1297. doi: 10.1186/s12913-025-13227-1.

ABSTRACT

BACKGROUND: Unplanned hospital admissions are costly and disproportionately affect people who are socioeconomically disadvantaged and from an ethnic minority group. A national primary care pay-for-performance scheme, the Quality and Outcomes Framework (QOF), was introduced in England in 2004 to financially incentivise general practices to meet a range of performance indicators, but the QOF’s impact on unplanned hospital admissions remains unclear. We examined the association between unplanned hospital admissions for cardiovascular disease (CVD), individual-level characteristics and achievement of key QOF indicators for CVD at the patients’ registered general practice.

METHODS: This study used the Connected Bradford dataset, which links individual-level primary and secondary care data. Our analytical sample included 508,977 patients registered with a Bradford District general practice from 2017 to 2019. Logistic regression was used to estimate associations between achievement of relevant QOF indicators and unplanned admissions for cardiovascular diseases, adjusting for individual-level differences in age, sex, ethnicity, socioeconomic status and pre-existing health conditions.

RESULTS: Significantly reduced odds of unplanned CVD hospital admissions were associated with attending a practice with higher achievement rates for QOF indicators relating to atrial fibrillation management (OR 0.97, p < 0.001), diabetes management (OR 0.98, p = 0.002), and smoking cessation (OR 0.98, p = 0.038). Conversely, increased odds of unplanned admission were associated with higher achievement for QOF indicators relating to antiplatelet or anticoagulation medication (OR 1.06, p < 0.001) and blood pressure control for diabetic patients (OR 1.02, p = 0.03). Individual-level characteristics significantly associated with increased risk of unplanned admission included living in the most deprived fifth of neighbourhoods (OR 2.00, p < 0.001) and having Pakistani ethnicity (OR 1.65, p < 0.001). Primary care diagnoses of hypertension (OR 1.79, p < 0.001), diabetes (OR 1.56, p < 0.001), chronic cardiac disease (OR 2.79, p < 0.001), and stroke (OR 1.6, p < 0.001) were all statistically significant and associated with higher odds of unplanned admissions for CVD.

CONCLUSIONS: We found mixed evidence for an association between practice-level QOF achievement and unplanned hospital admissions for CVD. There were large ethnic and socioeconomic inequalities in unplanned admissions for cardiovascular disease. Supporting general practices to appropriately improve their achievement of key cardiovascular disease related QOF indicators and reducing socioeconomic inequalities might likely reduce the number of unplanned hospital admissions.

PMID:41044559 | DOI:10.1186/s12913-025-13227-1

BMC Med Educ. 2025 Oct 3;25(1):1353. doi: 10.1186/s12909-025-07542-8.

ABSTRACT

BACKGROUND: Medical students face significant psychological distress due to academic, financial, and social pressures. While global studies highlight the mental health challenges of medical students, limited data is available for Moroccan medical students.

OBJECTIVES: This study aims to assess the prevalence of psychological distress, identify associated factors, and explore coping strategies among Moroccan medical students.

METHODS: A cross-sectional study was conducted at the Faculty of Medicine and Pharmacy of Fez, involving 632 clinical-year students. Data were collected using the validated GHQ-12 questionnaire to assess psychological distress and self-reported measures of functional and dysfunctional coping strategies. Statistical analysis included chi-square tests and logistic regression to identify significant associations.

RESULTS: The mean GHQ-12 score was 5.00 (SD: 3.61), with 50.6% of students scoring above the threshold of 4, indicating psychological distress. The most frequently reported stressors were academic challenges (34.1%), emotional problems (12.3%), and financial difficulties (9.6%). Female students experienced significantly higher levels of distress compared to males (P < 0.001). Among the participants, 52.6% reported using coping strategies; of these, 26.5% relied exclusively on functional strategies, such as prayer, relaxation, and seeking social support, while 26.1% used at least one dysfunctional strategy. Dysfunctional coping strategies, such as dietary changes and smoking, were significantly associated with distress (P < 0.001).

CONCLUSION: This study underscores the substantial mental health burden among Moroccan medical students, with significant associations between distress, gender, stressors, and dysfunctional coping strategies. These findings highlight the need for targeted mental health interventions and the development of supportive programs within medical education settings to promote well-being and resilience.

PMID:41044557 | DOI:10.1186/s12909-025-07542-8

BMC Public Health. 2025 Oct 3;25(1):3327. doi: 10.1186/s12889-025-24607-x.

ABSTRACT

BACKGROUND: Given the physiological decline in late life, coupled with an elevated risk of various diseases and anticipated adverse events, frail and vulnerable older persons in nursing homes are a principal group that is vulnerable to health risks, thereby manifesting a triple vulnerability comprising “physical-mental-economic” aspects. However, standardized assessments of health vulnerability in frail and vulnerable older persons within nursing homes in China are currently lacking, and an evaluation index system has not yet been undeveloped. Therefore, the aim of this study was to construct an index system for comprehensively evaluating the health vulnerability of frail and vulnerable older persons in nursing homes, aiming to offer personalized elderly care services as a reference for predicting health vulnerability risks among this demographic population.

METHODS: On the basis of the “sensitivity‒response capacity” vulnerability analysis framework, multidimensional risk indicators for health vulnerability were preliminarily established through policy literature analysis and semistructured interviews. Between April and August 2023, a Delphi study involved 20 expert representatives from four provinces and municipalities, spanning multiple research domains, for participation. Using a five-point Likert scale, they assessed the value of predefined indicators and provided qualitative feedback. Subsequent to each round of expert input, revisions were enacted upon the evaluation index system.

RESULTS: After three rounds of expert consultation, a consensus on the evaluation index system was reached; it contains two primary indicators, individual sensitivity and antifragility capacity, with 12 affiliated secondary indicators and 56 tertiary indicators. The expert authority coefficients ranged from 0.934 to 0.935, and Kendall’s coefficient of concordance ranged from 0.310 to 0.360. These differences were statistically significant (P < 0.05).

CONCLUSION: The evaluation index system for assessing the health vulnerability of frail and vulnerable older persons in nursing homes developed in this study covers a range of health threats and indicators of health coping capacity faced by frail and vulnerable older persons from individual to societal perspectives. This evaluation index system employs the “sensitivity‒responsiveness” vulnerability analysis framework, addressing the limitations of single-dimensional assessment indicators in capturing a comprehensive overview. This study provides a novel research perspective for assessing health vulnerability in frail and vulnerable older persons. This evaluation index system provides a practical tool for nursing home staff to assess health vulnerability, enabling early risk identification and targeted interventions. Policy-makers and administrators can use it to optimize resource allocation and enhance elderly care services. Future research should validate its real-world applicability and integrate it into existing health monitoring and intervention programs to improve older persons’ health outcomes.

PMID:41044556 | DOI:10.1186/s12889-025-24607-x

BMC Surg. 2025 Oct 3;25(1):425. doi: 10.1186/s12893-025-03168-1.

ABSTRACT

BACKGROUND: Monitors that can provide 2-dimensional (2D) or 3-dimensional (3D) images, as well as high-definition (HD) or 4 K-HD image quality, offer various conveniences to surgeons. While studies comparing 2D and 3D screens exist in the literature, studies are needed to investigate the effects of different monitor sizes on surgical success. This study aimed to examine the impact of screen size on surgical parameters in patients who have undergone a hysterectomy using either a 55-inch or a 27-inch monitor.

METHODS: Patients who underwent laparoscopic hysterectomy and salpingectomy/salpingo-oophorectomy between May 2022 and July 2023 were retrospectively screened. Two groups were created. GroupA consisted of patients who underwent surgery using a 55-inch (140 cm) monitor with both 2D and 4 K-HD features. GroupB consisted of patients whose surgery was performed using a 27-inch (69 cm) monitor with both 2D and 4 K-HD features. A total of 72 women (n(GroupA) = 36, n(GroupB) = 36) were included in the study.

RESULTS: No statistically significant difference was observed between groups regarding age, number of cesarean sections, or body mass index (p > 0.05). Additionally, no statistically significant difference was found between groups regarding the total surgery duration (GroupA, GroupB; (126.86 ± 50.42), (128.97 ± 44.29), p = 0.851, respectively). When evaluating the percentage decrease in hemoglobin values before and after surgery, no statistically significant difference was observed between groups (GroupA, GroupB; (-0.11 ± 0.06), (-0.11 ± 0.07), p = 0.746, respectively). There were no statistically significant differences between groups regarding hematocrit changes, frequency of intraoperative complications, postoperative infections, the time to first gas passage, and length of hospital stay (p > 0.05).

CONCLUSIONS: In laparoscopic monitor systems with 4 K-HD resolution, the screen size, whether 27-inches or 55-inches, may not significantly affect surgical parameters.

PMID:41044554 | DOI:10.1186/s12893-025-03168-1

BMC Public Health. 2025 Oct 3;25(1):3334. doi: 10.1186/s12889-025-24685-x.

NO ABSTRACT

PMID:41044545 | DOI:10.1186/s12889-025-24685-x

BMC Surg. 2025 Oct 3;25(1):429. doi: 10.1186/s12893-025-03134-x.

ABSTRACT

BACKGROUND: Laparoscopic inguinal hernia repair is now widely performed worldwide. However, there is no consensus on the most appropriate surgical operation for inguinal hernia in adult males. This study aims to evaluate the clinical efficacy and applicability of laparoscopic free vas deferens separation with transabdominal preperitoneal (LFVD-TAPP) repair for inguinal hernia in adult males, in comparison to the conventional transabdominal preperitoneal prosthesis (TAPP) approach.

METHODS: A retrospective analysis was conducted on 189 adult male patients who underwent laparoscopic inguinal hernia repair at the First Affiliated Hospital of Soochow University between February 2020 and January 2023. Patients were divided into two groups that included the LFVD-TAPP (n = 95) and the conventional TAPP (n = 94). Observation targets included surgical and postoperative recovery, complication rates, recurrence and chronic pain. Data were analyzed using SPSS 27.0, with statistical significance defined as p < 0.05.

RESULTS: No significant differences were found in baseline characteristics between groups. The LFVD-TAPP group showed significantly shorter operative times for both unilateral and bilateral hernias compared to the TAPP group (0.97 ± 0.20 h vs. 1.60 ± 0.21 h; 1.21 ± 0.17 h vs. 2.01 ± 0.30 h; P < 0.001). No significant differences were observed in postoperative blood loss, length of hospital stay, or hospitalization costs (P > 0.05). However, the LFVD-TAPP group exhibited a higher incidence of temporary groin induration (11 vs. 4; P < 0.05),but significantly lower rates of scrotal hematoma (5 vs. 17; P < 0.05), and chronic pain (6 vs. 11; P < 0.05). No differences were observed in other complications or recurrence rates. Follow-up over 12-24 months revealed no cases of ischemic orchitis, testicular atrophy, or ejaculatory dysfunction in the LFVD-TAPP group.

CONCLUSIONS: LFVD-TAPP presents clinical advantages over conventional TAPP, including simplified intraoperative separation, reduced surgical difficulty, and lower rates of postoperative scrotal hematoma and chronic pain, without increasing the risk of recurrence. Therefore, the LFVD-TAPP provides better protection of the vas deferens, suggesting its potential for clinical application and broader promotion.

PMID:41044539 | DOI:10.1186/s12893-025-03134-x

BMC Public Health. 2025 Oct 3;25(1):3319. doi: 10.1186/s12889-025-24687-9.

ABSTRACT

INTRODUCTION: Tetanus is a public health concern in East Africa, impacting pregnant women and infants since vaccination rates are below acceptable levels. Despite several studies examining tetanus toxoid vaccine coverage in East Africa, the total pooled vaccination coverage rate remains unknown, and the results of these studies are related to these variables. The purpose of this meta-analysis is to estimate the pooled tetanus toxoid vaccination coverage rates among pregnant women in East Africa and identify contributing variables.

METHODS: We searched PubMed, Scopus, Embase, and Google Scholar for studies published between March 10, 2015, and March 10, 2025. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. The study quality was assessed using a modified version of the Newcastle-Ottawa quality assessment tool. The data were retrieved separately by two authors using Microsoft Excel and analyzed with Stata version 17. A random effects model was used to calculate the pooled vaccination coverage and related covariates. Publication bias is assessed using funnel plots and Egger’s test, while heterogeneity is evaluated through Cochran’s Q test and the I² statistic, helping to ensure the reliability of meta-analytic findings. The PROSPERO registration number for this evaluation was CRD420251008125.

RESULT: The meta-analysis included 25 articles and 70,592 participants. Pregnant women in East Africa had at least two doses of tetanus toxoid vaccination, with a pooled estimate of 47% (95% CI: 41%-54%). The meta-analysis revealed that maternal education (OR = 0.63), media exposure (OR = 1.14), ANC service follow-up (OR = 1.06), place of delivery (OR = 1.17), wealth index (OR = 1.25), family planning use (OR = 0.55), number of ANC visits (OR = 3.12), place of residence (OR = 0.88), and need for indexed birth status (OR = 1.36) were significant predictors of tetanus toxoid vaccination coverage.

CONCLUSION: The findings indicate that receiving at least two doses of tetanus toxoid immunization coverage among pregnant women in East Africa was low. Furthermore, various factors were significantly associated.

PMID:41044529 | DOI:10.1186/s12889-025-24687-9

BMC Public Health. 2025 Oct 3;25(1):3326. doi: 10.1186/s12889-025-24701-0.

ABSTRACT

BACKGROUND: Masturbation is a common practice across various demographics worldwide. However, its prevalence among the general population in Nigeria remains unknown. This study investigates the prevalence of self- and mutual masturbation and their associated factors among sexually active Nigerians.

METHODS: Data were obtained from the Sexual Behaviour and HPV Infection in Nigerians in Ibadan cross-sectional study, including males and females aged 18-45 years. After obtaining consent, participants were asked during face-to-face interviews whether they had ever touched their genitals or inserted fingers into the vagina or anus for sexual pleasure (self-masturbation) or whether they and their sexual partners had ever touched each other’s genitals by hand for sexual pleasure (mutual masturbation). The prevalence of self- and mutual masturbation was reported using percentages, while their associations with participants’ demographic, lifestyle, and biological characteristics were examined using chi-square tests. Poisson regression with robust variance was performed to identify associated factors. Statistical significance was set at p < 0.05.

RESULTS: Mutual masturbation (83.7%) was more common than self-masturbation (64.9%) among participants. The prevalence of self-masturbation was significantly higher among males than females (69.9% vs. 62.4%, p = 0.022), while mutual masturbation was significantly higher among females than males (86.6% vs. 78.1%, p = 0.001). Occupation, smartphone ownership, and alcohol consumption were significantly associated with self-masturbation, while ethnicity, location, number of penile-vaginal sex partners, and receiving oral sex were associated with mutual masturbation.

CONCLUSION: Self- and mutual masturbation are highly prevalent among sexually active Nigerians, with distinct factors influencing each behaviour.

PMID:41044527 | DOI:10.1186/s12889-025-24701-0