Category: Statistics

BMC Health Serv Res. 2025 Nov 22. doi: 10.1186/s12913-025-13694-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chinese government has been adjusting its strategies in response to rapid domestic and international changes to devise effective health policies and enhance public health. However, with the rapid socio-economic development and the COVID-19 outbreak, many researchers have identified issues of inefficiency and uneven distribution in health resource allocation within China. Therefore, how to scientifically allocate and efficiently use Chinese health resources has become an urgent issue.

METHODS: The super-efficiency SBM model and global Malmquist model were used to measure and dynamically monitor the health resource allocation efficiency of 31 provinces in China from 2008 to 2020. Moran’s I was applied to test the spatial autocorrelation of the efficiency, and the spatial Dubin model was constructed to analyze influencing factors. All data were collected from the China Health Statistical Yearbook and China Statistical Yearbook from 2008 to 2020.

RESULTS: The super-efficiency SBM model revealed an average health resource allocation efficiency score of 0.632. The average Malmquist productivity index for the same period was 1.090, indicating a generally positive growth. Moran’s I test showed a notable spatial autocorrelation in efficiency distribution. And the regression results of the spatial Dubin model showed that the efficiency was affected by the dependency ratio, illiteracy rate, per capita disposable income, per capita public health budget expenditure, number of medical insurance participants, and the balance of medical insurance fund revenue and expenditure.

DISCUSSIONS: The results revealed that China’s health resource allocation exhibited low efficiency and regional disparities, primarily driven by uneven regional development. From 2008 to 2020, overall productivity increased by 9%, which were predominantly attributable to technological advancements. Under conditions of strong spatial autocorrelation, the efficiency of health resource allocation was shaped by multiple factors operating through distinct spatial channels.

CONCLUSION: Given the challenges of health resource allocation efficiency in China, it is vital to implement targeted strategies. These include strengthening policy support for inefficiency regions, relying on technological progress and scientific management, fostering cross-regional collaboration to leverage spatial effects, and considering multiple factors for rational health resource allocation to ensure the sustainability of the health services.

PMID:41275267 | DOI:10.1186/s12913-025-13694-6

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07338-8. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the temperature values including initial, maximum, and rising caused by light-cured materials used for direct capping during polymerisation.

METHODS: A 3 mm deep, wide, and length class-I cavity was prepared to a premolar tooth, leaving hard tissue at the pulpal floor of 1 mm thickness with a 1 mm diameter of exposure. The sample was placed in a customised mimicry setup in which the temperature was standardised (37 °C) by a double-verified system. Light-curing capping materials (Theracal LC, Theracal PT, Harvard BioCal, and Ultrablend Plus) were placed, polymerised, and temperature values were recorded. Kruskal-Wallis test was used to compare parameters among groups, and Dunn’s test was used to define the group that caused the difference (p < 0.05).

RESULTS: There were statistically significant differences between the materials in terms of initial, maximum, and temperature rising values (p_in=0.014, p_max=0.034, p_tr= 0.016). The values of Theracal PT were measured highest in terms of temperature increase, while no statistically significant difference was observed between other materials during polymerisation.

CONCLUSIONS: Theracal PT caused higher temperature rise, however, it did not exceed 5.6 °C, which is the critical value for the pulp. Theracal PT should be used with caution as its use during direct capping causes high temperature increases, and there is a need for a light-curing regime to be designed for its use.

PMID:41275265 | DOI:10.1186/s12903-025-07338-8

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07310-6. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary aim of this study was to evaluate the impact of cyclooxygenase-2 (COX-2) expression on overall survival (OS), local recurrence-free survival (LRFS), and regional recurrence-free survival (RRFS) in patients diagnosed with advanced oral squamous cell carcinoma (AOSCC).

MATERIALS AND METHODS: COX-2 expression levels were assessed in 191 cases of AOSCC and 50 cases of normal mucosa using immunohistochemistry (IHC). Comparisons were made between COX-2 expression in AOSCC and normal mucosal tissues, as well as its influence on OS, LRFS, and RRFS. The Cancer Genome Atlas (TCGA)- Head and Neck Squamous Cell Carcinoma (HNSC) database was utilized for validation.

RESULTS: In this cohort of 191 patients with AOSCC followed for 1-145 months (median: 68.3 months), AOSCC Patients exhibited significantly higher COX-2 expression compared to normal oral mucosa tissues. Consistent result was obtained from analysis of the AOSCC subgroup from TCGA HNSC cohort. In the subset of AOSCC patients filtered from the TCGA-HNSC database, COX-2 mRNA expression showed no statistically significant association with survival. However, In our cohort of AOSCC patients from IHC analysis, COX-2 expression emerged as an independent prognostic factor for OS, LRFS, and RRFS. Positive COX-2 expression was associated with a markedly increased risk of recurrence and diminished survival outcomes.

CONCLUSIONS: COX-2 is overexpressed in AOSCC and appears to be a potential adverse prognostic factor in our cohort. As a biomarker, COX-2 may offer valuable prognostic insights for AOSCC.

PMID:41275260 | DOI:10.1186/s12903-025-07310-6

Int J Equity Health. 2025 Nov 22. doi: 10.1186/s12939-025-02701-1. Online ahead of print.

NO ABSTRACT

PMID:41275258 | DOI:10.1186/s12939-025-02701-1

BMC Public Health. 2025 Nov 22. doi: 10.1186/s12889-025-25718-1. Online ahead of print.

ABSTRACT

BACKGROUND: Due to their fragile physiologic functions, Over 65% of deaths from complicated severe acute malnutrition occur in the first week of treatment, primarily due to medical complications. To reduce this, early stabilization is crucial, and there is limited evidence regarding stabilization time in Ethiopia.

OBJECTIVE: To assess predictors of time to stabilization among under-five children admitted with severe acute malnutrition to stabilization centers in Ethiopia.

METHOD: A retrospective follow up study was conducted from January 20 to February 29, 2025 on 543 sampled children selected by a simple random sampling from severely malnourished children admitted to selected hospitals in Western Oromia between January 2020 and December 2024. After collecting data using kobotoolbox, it was exported to STATA version 17 for analysis. Kaplan Meier curve and log-rank test were used to estimate the stabilization rate and presence of statistically significant difference in survival and hazard rate between categories of explanatory variables. Proportional hazard assumption was checked using schoenfeld residual test and log-log survival curve. After performing model comparison, the Weibull model was selected and variables with p < 0.25 on bi-variable regression was selected for multivariable weibull regression. Estimating adjusted hazard ratio with their respective 95% confidence interval, P-value of less than 0.05 was used to declare statistically significant association with stabilizing time.

RESULT: Over 5600 child-days of observation, the median time to stabilize from severe acute malnutrition was 11 days, with 86.39% rate of stabilization and 86.6/1000 incidence of stabilization (95% CI: (74.45-89.44)). Immunization status (AHR: 0.66, 95% CI (0.54-0.8)), pneumonia (AHR: 2.17, 95% CI (1.74-2.70)), hospital acquired infections (AHR: 1.34 95% CI (1.09-1.65)) and vitamin A supplementation (AHR: 0.61, 95%CI (0.49-0.77)) were predictors of stabilization time.

CONCLUSION: This study found prolonged time to stabilization of 11 days compared to the recommendation of Ethiopian national management protocol of severe acute malnutrition. To achieve quicker stabilization, health professionals, hospital managers, and all stakeholders must collaboratively address and reduce the burdens stemming from identified predictors.

PMID:41275240 | DOI:10.1186/s12889-025-25718-1

Int J Health Geogr. 2025 Nov 22;24(1):36. doi: 10.1186/s12942-025-00422-w.

ABSTRACT

BACKGROUND: Geospatial studies that consider the relationships between the built environment and health typically rely on researcher-led ‘objective’ measurement of geospatial attributes of the built environment. Some studies can fail to find expected associations between environments and health outcomes where the geospatial measures do not reflect the experiences or perceptions of people themselves. We took a participatory approach to work with older adults with a concern for falling to assess the built environment in order that we could understand how their assessments relate to researcher assessments. We also wanted to assess whether specific demographic characteristics explained differences in assessments of the built environment between participants. Age-friendly environments can contribute to healthy active ageing. Falling and a fear of falling can lead to restricted outdoor activity. Therefore, understanding how the built environment contributes to fear of falling is important for age-friendly environments.

METHODS: The study is a cross-sectional retrospective observational study of the built environment. We worked with older adults in workshop settings to undertake community audits of the built environment in Google Street View. They assessed locations where a fall had occurred. Researchers separately audited the same locations. We used descriptive statistics and ordinal regression cumulative link mixed models to estimate the odds that community members would rank a location one level higher than the researchers.

RESULTS: There are significant differences in researcher and community auditor assessments of locations of attractiveness. Site related and individual attributes explain variation in how difficult locations were rated for walking, and for concern about falling. Only individual attributes explained variation in site attractiveness. Locations with more trip hazards and steeper slopes were rated as being more difficult to walk and were associated with greater concern for falling.

CONCLUSIONS: Attributes of the built environment influence perceptions of difficulty walking and concern or falling at specific locations. Furthermore, there are some differences in how researchers and community auditors assess the same locations, meaning that geospatial studies which rely only on researcher assessments may be prone to bias. Involving older people in geospatial studies that measure age-friendly environments can make measurement more reflective of their experiences.

PMID:41275235 | DOI:10.1186/s12942-025-00422-w

BMC Oral Health. 2025 Nov 22;25(1):1822. doi: 10.1186/s12903-025-07145-1.

ABSTRACT

BACKGROUND: In periodontitis, the classical inflammatory NF-κB signaling pathway is activated, which promotes alveolar bone resorption and inhibits osteogenic differentiation of periodontal ligament stem cells. Low-energy laser therapy can reduce inflammation and promote healing. This in vitro study aimed to investigate the effects of different low-energy lasers on inflammation and osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) under inflammatory conditions, and to determine whether these effects are associated with the NF-κB signaling pathway at both the protein and gene levels.

METHODS: Healthy premolars or third molars were collected during oral and maxillofacial surgery, and periodontal ligament tissues were obtained. hPDLSCs were cultured using the tissue block method and identified by osteogenic differentiation potential and flow cytometry. Based on treatment conditions, the cells were divided into five groups (using abbreviations from key elements of the grouping): control group (C, control), lipopolysaccharide group (L, LPS), LPS + Nd:YAG laser group (N, Nd:YAG), LPS + Er:YAG laser group (E, Er:YAG), and LPS + semiconductor laser group (D, semiconductor). Enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR), alizarin red staining, and immunofluorescence (IF) were performed to detect inflammatory factors, osteogenic ability, and NF-κB signaling pathway activity. Fluorescence intensity of P65 was quantified using ImageJ software. Statistical analysis was conducted using SPSS 21.0.

RESULTS: The cultured cells were confirmed as periodontal stem cells. Statistical significance was set at P < 0.05. The CCK-8 assay showed that on day 7, the optical density (OD) values of all three laser groups were higher than those of group L (P < 0.05). Compared with group C, IL-6 and TNF-α levels in the supernatant were increased in group L (P < 0.05). After laser treatment, IL-6 and TNF-α levels in groups N, E, and D were lower than in group L (P < 0.05), with the lowest levels observed in group N. Expression of Runx-2 and OSX mRNA was higher in groups N, E, and D than in group L, with group N showing the highest expression of osteogenic genes. The fluorescence intensity of P65 in group L was significantly higher than in group C (P < 0.05), indicating increased nuclear translocation of P65. Among the laser-treated groups, group N showed the lowest nuclear P65 fluorescence intensity (P < 0.05).

CONCLUSIONS: Low-energy lasers promote anti-inflammatory activity and osteogenic differentiation of hPDLSCs in LPS-induced inflammatory environments by regulating the NF-κB signaling pathway, with Nd:YAG lasers showing the strongest effect.

PMID:41275224 | DOI:10.1186/s12903-025-07145-1

BMC Public Health. 2025 Nov 22. doi: 10.1186/s12889-025-25557-0. Online ahead of print.

ABSTRACT

BACKGROUND: The use of electronic cigarettes (e-cigarettes) among young people is rising globally, including in the Middle East. This increase is largely due to widespread misconceptions that e-cigarettes are harmless alternatives to traditional smoking, despite the known health risks associated with their use. However, there is limited data on e-cigarette consumption among young adults in Iran. To address this gap, we conducted a nationwide survey to assess the prevalence of e-cigarette use, as well as the knowledge, attitudes, and factors influencing the use of these products among young adults.

METHODS: Study of Measurement of Knowledge and Examination of Support for tobacco control policies (SMOKES) is a nationwide multi-center cross-sectional survey, which was conducted from 2024 to 2025. A total of 2,246 university students aged 18-40 years from 15 provinces, encompassing a wide range of disciplines and ethnicities, participated in an online survey that collected data on sociodemographics, tobacco use, knowledge of e-cigarettes, attitudes toward them, and support for related policies. Descriptive statistics were utilized to summarize patterns of e-cigarette use and related misconceptions. Candidate explanatory variables were selected through a comprehensive literature review, including sociodemographic (age, sex, parental education), behavioral (concurrent tobacco use), and social (peer influence) factors. All variables showing association at p < .20 in bivariate analysis were entered into the multivariable logistic regression model examining current e-cigarette use as the dependent variable, with final models retaining significant predictors (p < .05).

RESULTS: Ever-use of e-cigarettes was reported by 28.2% of participants, while past-month use prevalence was 5.6%. Knowledge of e-cigarette health risks was poor and misconceptions were common (34.4% believing the vapor is “just water”; 24.7% considering that e-cigarettes are less harmful than cigarettes;<40% recognizing cardiovascular or reproductive risks); on the other hand, the attitudes towards vaping was widely seen as socially acceptable (36.2% expressed e-cigarettes are more socially acceptable; 34.6% perceived that vaping is enjoyable). The ever-use of e-cigarette was significantly associated with several factors, including male sex (OR = 1.36), having divorced parents (OR = 2.37), part-time employment (OR = 1.42), concurrent use of cigarettes (OR = 6.76) or hookah (OR = 4.95), and the presence of peers or siblings who use tobacco products (OR = 1.93) (p < .05 for all). Students also reported weak enforcement of campus anti-e-cigarette policies and low access to cessation resources.

CONCLUSION: The high prevalence of e-cigarette use among Iranian university students is compounded by significant knowledge gaps and permissive attitudes. This underscores an urgent need for multi-level interventions, including targeted educational campaigns, comprehensive smoke-free campus policies, and national regulations to curb access and marketing, to effectively counter this public health threat.

PMID:41275223 | DOI:10.1186/s12889-025-25557-0

BMC Musculoskelet Disord. 2025 Nov 22;26(1):1065. doi: 10.1186/s12891-025-09320-5.

ABSTRACT

OBJECTIVE: To assess patients’ compliance with post-operative rehabilitation protocols following orthopaedic lower limb surgeries, and to identify clinical, demographic, and socioeconomic factors leading to variability in compliance within and across different types of surgeries performed.

METHODS: This was a prospective study conducted in a tertiary healthcare hospital in South India. 240 patients who underwent orthopaedic lower limb surgery under the same unit, aged above 18 years, with cognitive capability to comprehend rehabilitation protocols, were included in the study. Patient compliance was assessed according to five parameters: adherence to appointments, weight-bearing activities, exercises, use of walking aids, and intake of medications. Patients’ compliance is scored dichotomously for a total score of five, followed by statistical evaluation (binary and multivariate regression analysis) to identify factors leading to variability in compliance.

RESULTS: 53.7% patients were compliant (5/5). The highest compliance was with the intake of medications (91.7%), and the lowest was weight-bearing advice (75.4%). Statistical significance observed for compliance with the appointment date and exercises advised. Males (58.2%) and married individuals (58.3%) with (p value = 0.041 and 0.022, respectively) demonstrated higher compliance. 70.5% of patients in the government scheme in arthroscopy surgeries demonstrated non-compliance. 76.2% married individuals were compliant in the subgroup of other surgeries. 70% females who underwent arthroplasty demonstrated non-compliance. However, no independent predictor was statistically significant in the regression analysis.

CONCLUSION: Understanding the factors leading to variation in compliance and tailoring the rehabilitation plan is essential to balance the intervention demands and the patient’s needs.

PMID:41275219 | DOI:10.1186/s12891-025-09320-5

BMC Health Serv Res. 2025 Nov 22. doi: 10.1186/s12913-025-13808-0. Online ahead of print.

ABSTRACT

BACKGROUND: National data on the characteristics of ambulatory visits with non-specific shoulder pain (NSSP) labels are lacking. The aim of this study was to identify the differences in the utilization of physical therapy (PT) for visits with NSSP labels and visits with specific shoulder pain (SSP) labels by using National Ambulatory Medical Care Survey (NAMCS) database.

METHODS: The NAMCS was queried from 2007 to 2016 to identify the ambulatory visits for shoulder pain. The study population was stratified according to the top 3 diagnoses, including NSSP group and SSP group. Data on patient, practice and visit characteristics were included, as variables in both descriptive and adjusted analyses. Differences in these characteristics and clinical management for the two groups were tested. Multivariable logistic regression analyses were employed to identify the association between the diagnosis type and utilization of PT.

RESULTS: An estimated total of 86.49 million adult ambulatory visits for shoulder pain were identified in this study. Of these, 24.31 million visits (28.1%) were assigned to NSSP labels. Combining all years, PT was prescribed in approximately 10.8% of visits with NSSP labels, which was significantly lower than visits with SSP labels (22.2%). After adjustment for covariates including age, sex, race, expected source of payment, metropolitan statistical area (MSA), major reason for this visit, injury related, referred for this visit, continuity of care, number of medical comorbidities, and physician specialty, visits assigned to NSSP labels had significantly lower odds of prescribing PT compared to visits assigned to SSP labels (adjusted OR = 0.62, 95% CI: 0.41-0.94).

CONCLUSIONS: The results of this retrospective cross-sectional study identified the significant differences in the utilization of PT for ambulatory visits with NSSP labels and SSP labels by using NAMCS database. These findings may help diminish management disparities and improve appropriate use of PT in the ambulatory management of shoulder pain.

PMID:41275205 | DOI:10.1186/s12913-025-13808-0