Category: Statistics

Int J Dent Hyg. 2026 Apr 26. doi: 10.1111/idh.70071. Online ahead of print.

ABSTRACT

BACKGROUND: Nowadays, there is a trend to promote the use of natural materials in dentistry. One of these compounds that has lately grown significantly in relevance in clinical research is Pelargonium Graveolens.

OBJECTIVES: This study was conducted to evaluate the antimicrobial efficacy of gold nanoparticles (AuNPs) of Pelargonium Graveolens leaves extract for children in comparison with the commonly used chlorhexidine. There are no previously available studies concerning the anti-microbial activity of Pelargonium Graveolens leaves.

MATERIALS AND METHOD: Sixty participants with mild to moderate gingivitis were randomly allocated in a ratio of 1:1 to receive twice-daily mouthwash for 3 weeks (30 with a novel herbal mouthwash containing Pelargonium Graveolens AuNPs as a study group and 30 children with chlorhexidine as a control group). Clinical parameters (plaque index and gingival index) were assessed at the baseline (before the use of mouthwash), and then they were assessed 3 times at one-week intervals after the first assessment through the period of the study. On the other hand, microbiological examination was done using supragingival plaque sampling with a curette for those participants at the baseline and three weeks after the use of the mouthwash.

RESULTS: After completing the intervention, although the study group had lower plaque scores compared to the control group, the difference was statistically significant. On the other hand, the study group had a significant reduction in the gingival index scores compared to the control group (p = 0.000). The microbiological analysis revealed that the treatment mouthwash significantly depleted the count of S. mutans in the last visit.

CONCLUSION: The novel Pelargonium Graveolens AuNPs mouthwash was effective in improving (PI) and (GI), which mean improve oral health status. Rinsing with Pelargonium Graveolens AuNPs mouthwash reduced the count of oral Streptococcus mutans significantly in children.

CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov on April 15, 2023, with ClinicalTrials.gov ID: NCT05816512.

PMID:42036760 | DOI:10.1111/idh.70071

Int J Dent Hyg. 2026 Apr 26. doi: 10.1111/idh.70066. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective was to compare the effectiveness of hands-on toothbrushing training alone or in conjunction with conventional oral health education (OHE) or with the use of the 21-Day FunDee chatbot on the caregiver’s oral hygiene care and plaque control for young children.

METHODS: A quasi-experimental, parallel, three-group pretest-posttest designed study was applied. The participants included 213 pairs of caregivers and children aged 6-30 months. Each group consisted of 71 pairs of caregivers and children. Participants were divided into three groups: Gr. I was the Hands-On (HO) in-person tooth brushing practice group, Gr. II was the Hands-On and Poster (HO + PO) group with in-person tooth brushing practice and OHE via posters and Gr. III was the Hands-On and Chatbot group (HO + CB) with in-person tooth brushing practice and 21-Day FunDee chatbot media. Oral examinations and a structured questionnaire compared oral hygiene behaviours, oral health perceptions, knowledge and plaque levels among the three groups at baseline and 35-45 days subsequently. Multiple linear regression was used to determine the difference between the three groups on plaque reduction.

RESULTS: The majority of caregivers were Muslim mothers. The plaque score reduction was 0.34 ± 0.30, 0.50 ± 0.23 and 0.52 ± 0.25 for Gr. I, II and III, respectively. Compared with the Hands-On group, there was a statistically significant difference in plaque reduction for the Hands-On and Poster group (p-value = 0.039) and the Hands-On and Chatbot group (p-value = 0.047). The baseline frequency of tooth brushing was an important determinant for plaque reduction (p-value = 0.007). However, there was no significant association between baseline knowledge, protection-motivation theory perceptions or educational levels regarding plaque reduction. Both conventional OHE and 21-Day FunDee chatbot media received high user satisfaction ratings.

CONCLUSION: Caregiver-assisted toothbrushing, combined with either conventional oral health education or chatbot support, significantly improved oral hygiene care and plaque control in young children compared with hands-on toothbrushing training alone.

PMID:42036756 | DOI:10.1111/idh.70066

Zoonoses Public Health. 2026 Apr 26. doi: 10.1111/zph.70061. Online ahead of print.

ABSTRACT

INTRODUCTION: Human brucellosis remains a persistent zoonotic and occupational health challenge in endemic regions of the Middle East. Despite long-standing national control efforts, limited region-specific evidence is available from southeastern Iran. This study described the demographic characteristics, exposure patterns, temporal and seasonal trends and spatial distribution of laboratory-confirmed human brucellosis in districts covered by the Iranshahr University of Medical Sciences between 2019 and 2023.

METHODS: A retrospective descriptive study was conducted using routine surveillance records of all confirmed brucellosis cases. Demographic, occupational and exposure variables were summaried using descriptive statistics, and associations were assessed using Pearson’s χ² test. Multivariable logistic regression was applied to identify factors associated with reported livestock contact. Annual and cumulative incidence rates per 100,000 population were calculated using official district census data, and spatial patterns were examined using GIS-based mapping.

RESULTS: A total of 758 confirmed cases were recorded, with a mean age of 34.7 years. Females (61.3%) and rural residents (86.4%) predominated. Housewives (43.4%) and livestock farmers (33.2%) represented the main occupational groups. Reported exposures included consumption of unpasteuried dairy products (87.2%) and direct animal contact (81.9%). Livestock farming (OR 3.01; 95% CI: 1.74-5.21) and unpasteuried dairy consumption (OR 1.86; 95% CI: 1.13-3.06) were independently associated with livestock contact. Incidence peaked during spring and summer, with an overall declining trend over the study period. Higher cumulative incidence was observed in Sarbaz, Iranshahr and Dalgan districts.

CONCLUSION: Human brucellosis remains endemic in southeastern Iran, disproportionately affecting rural populations engaged in traditional livestock practices. Strengthened One Health interventions including expanded livestock vaccination, community-based food safety education and integrated cross-sectoral surveillance are required to reduce transmission and disease burden.

PMID:42036729 | DOI:10.1111/zph.70061

J Eat Disord. 2026 Apr 26. doi: 10.1186/s40337-026-01619-5. Online ahead of print.

ABSTRACT

BACKGROUND: Our previous research indicated that patients with self-reported onset of eating disorders (EDs) during Japan’s first state of emergency (declared April 7, 2020) for COVID-19 were significantly Eyounger at presentation and had a shorter illness duration, which potentially facilitated earlier clinical intervention. Since early consultation is often associated with better prognosis in anorexia nervosa (AN), we hypothesized that patients with AN development during the first state of emergency would exhibit more favorable outcomes.

METHODS: This age-adjusted comparative study included 36 female adolescent and young adult patients (aged 12-24 years) with restricting-type AN (AN-R) diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. Both inpatients and outpatients were included and categorized into three groups: those who visited the hospital before (Before group, n = 12) and after (After group, n = 12) the emergency declaration and those with self-reported symptom onset during the first state of emergency (During group, n = 12). Patients were evaluated at their initial visit (T0) and 3 (T1), 6 (T2), and 12 months (T3) thereafter using the Global Clinical Score (GCS) and percent standard weight as outcome measures. Psychological characteristics at T0 were assessed using the Parental Bonding Instrument (PBI) and Eating Disorder Inventory (EDI).

RESULTS: The During group demonstrated significantly earlier improvement compared to the other two groups. Specifically, GCS scores at T1 were significantly lower in the During group (Before vs. During: 11 vs. 9, p = 0.006; After vs. During: 11 vs. 9, p = 0.0030), indicating a large effect. Percent standard body weight at T2 was significantly higher in the During group than in the After group (After vs. During: 73 vs. 83.5, p = 0.01), exhibiting a large effect. EDI and PBI scores were comparable among groups.

CONCLUSION: Patients whose patient-reported AN-R symptom onset occurred during the first state of emergency showed a faster recovery trajectory than did those who presented before or after the emergency, consistent with our hypothesis. Increased time spent at home with family during the “stay-at-home” period may have contributed to earlier medical consultation and subsequent recovery, although this interpretation remains speculative. These findings highlight the importance of early intervention in AN treatment.

PMID:42036723 | DOI:10.1186/s40337-026-01619-5

Diabetol Metab Syndr. 2026 Apr 27. doi: 10.1186/s13098-026-02162-8. Online ahead of print.

ABSTRACT

BACKGROUND: With the acceleration of global urbanization and lifestyle changes, overweight/obese patients with type 2 diabetes mellitus have become major public health challenges, and these two conditions often coexist. Exercise is recognized as a key non-pharmacological intervention in the comprehensive management of the two diseases. However, whether different exercise interventions have their respective advantages in improving blood glucose, blood lipids, body composition and cardiopulmonary function remains to be fully elucidated.

METHODS: A systematic search was conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify randomized controlled trials involving overweight/obese patients with type 2 diabetes mellitus. After screening the literature, extracting data, and assessing the risk of bias of the included studies, a network meta-analysis was performed using Stata 16.0 software. The certainty of evidence was evaluated using the CINeMA framework.

RESULTS: A total of 16 randomized controlled trials (RCTs) were included: aerobic exercise (AE), resistance training (RT), combined training (CT), and high-intensity interval exercise (HIIE). Nine studies reported glycated hemoglobin A1c (HbA1c), twelve studies assessed body mass index (BMI), and six studies measured the percentage body fat (PBF). The network meta‑analysis results showed that aerobic exercise (AE) (MD, – 0.91; 95% CI, – 1.32 to – 0.50), resistance training (RT) (MD, – 0.97; 95% CI, – 1.51 to – 0.43), combined training (CT) (MD, – 0.76; 95% CI, – 1.19 to – 0.33), and high‑intensity interval exercise (HIIE) (MD, – 1.24; 95% CI, – 1.72 to – 0.76) all demonstrated significantly lower HbA1c levels compared with the control group (CON). According to the surface under the cumulative ranking curve (SUCRA), high-intensity interval exercise ranked relatively high in reducing HbA1c in overweight/obese patients with type 2 diabetes mellitus (SUCRA = 90.2%). AE reduced BMI (MD, – 0.61; 95% CI, – 0.94 to – 0.28) and PBF (MD, – 0.66; 95% CI, – 1.29 to – 0.02) compared with CON, while no statistically significant differences were observed in the other comparisons. AE ranked relatively better for reducing both BMI (SUCRA = 92.0%) and PBF (SUCRA = 81.5%) in overweight/obese patients with type 2 diabetes mellitus. According to SUCRA values, different exercise interventions had their respective advantages across different outcome indicators.

CONCLUSIONS: Different exercise modalities demonstrate distinct advantages in improving metabolic parameters. HIIE shows positive effects in improving HbA1c, FBG, lipid profiles (TC, TG, and HDL), and in reducing WC and systolic blood pressure (SBP). AE can improve body composition indicators (BMI, PBF, and BW) and enhance VO₂max. RT improves HbA1c, FBG, TC, and TG. CT improves HbA1c and FBG. In clinical practice, individualized exercise prescriptions should be formulated based on patients’ specific metabolic needs.

PMID:42036715 | DOI:10.1186/s13098-026-02162-8

J Orthop Surg Res. 2026 Apr 26. doi: 10.1186/s13018-026-06865-6. Online ahead of print.

ABSTRACT

Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ligament reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and associated fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. Our VR content incorporated several novel elements, including embodiment in a virtual body, first-person perspective, and the performance of virtual exercises guided by a virtual physiotherapist. Another innovative feature was that patients conducted the daily VR training independently at home using a standalone head-mounted display. The VR group performed a 20-min daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (International Knee Documentation Committee score, IKDC), quadriceps strength limb symmetry, active knee extension range of motion (ROM) limb symmetry, and kinesiophobia (Tampa Scale of Kinesiophobia-short form, TSK-11) were measured at baseline, 4, 12, and 36 weeks. Forty-seven participants were randomized, with 44 completing treatment. IKDC scores were not statistically significantly different between groups, despite moderate effect sizes at 4 and 36 weeks (Cohen’s d = 0.559, and d = 0.722, respectively). The VR intervention group showed significantly lower kinesiophobia at 4 weeks post-surgery compared to controls (27.00 ± 6.58 vs. 33.35 ± 5.07, Cohen’s d = – 0.971, p = 0.045). Both groups demonstrated significant improvements in all outcomes over time (p < 0.001). No significant differences were found for range of motion or quadriceps strength limb symmetry. No adverse events were reported related to the intervention. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. To our knowledge, this is the first clinical study to investigate the independent use of therapeutic VR at home during post-orthopedic surgery rehabilitation. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery. The study was pre-registered with the National Library of Medicine (NCT05080894; first registered 09/20/2021).

PMID:42036710 | DOI:10.1186/s13018-026-06865-6

Syst Rev. 2026 Apr 27. doi: 10.1186/s13643-026-03181-2. Online ahead of print.

ABSTRACT

BACKGROUND: There are no established evidence-based guidelines for the administration of intraoperative local anesthesia (LA) during dental rehabilitation under general anesthesia (GA). This systematic review aims to evaluate the effects of intraoperative LA on physiological parameters and pain control in children undergoing GA for comprehensive dental treatment.

METHODS: Comprehensive search was conducted across four electronic databases: PubMed, Cochrane Central Register of Controlled Trials, EBSCO, and Scopus. Search strategy was structured, yielding 14 articles that follow the study inclusion criteria. Risk of bias was performed using Cochrane Collaboration’s tool for randomized trials and confidence of recommendation according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Whenever there were sufficient studies with comparable data, meta-analysis was performed.

RESULTS: Pain levels were significantly lower in the LA group compared to controls (OR = 0.32, 95% CI 0.14-0.70, P = 0.005). Lip and/or cheek biting occurred more frequently in the LA group, though this difference was not statistically significant. Although reductions were observed in physiological parameters, only the decrease in end-tidal CO₂ volume reached statistical significance (P = 0.02). The included studies were rated as having low confidence and quality based on the GRADE assessment.

CONCLUSION: While the intraoperative use of LA under GA reduced postoperative pain and end-tidal CO₂ volume, other effects were negligible, making its routine use optional. Evidence suggests targeting LA for high-pain procedures, such as multiple extractions, while exercising caution or withholding it during deep sedation to mitigate potential drops in tidal volume.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022340846.

PMID:42036699 | DOI:10.1186/s13643-026-03181-2

J Eat Disord. 2026 Apr 26. doi: 10.1186/s40337-026-01621-x. Online ahead of print.

ABSTRACT

BACKGROUND: Eating disorders can result in inpatient admissions. The transition of care between this tier of service and outpatient support can be challenging, particularly without intensive outpatient options. The potential benefits of providing intensive outpatient options during this transition period are significant, however there is limited research in this area. This study aimed to understand the experiences and needs of persons with lived experience, carers and health professionals before and after this transition in care for adults in Australia.

METHODS: Using mixed quantitative and qualitative methodology, and experience based co-design principles and processes, we gathered individual experience (stage 1) and developed an understanding of the care transition (stage 2). In stage 1, persons with lived experience and carers were interviewed. Health professionals were surveyed using an online questionnaire. In stage 2, preferences for support were explored in workshops. Findings were analysed using descriptive statistics (quantitative data) and inductive content analysis (qualitative data).

RESULTS: Stage 1: Five persons with lived experience and six carers were interviewed. Seventy-three health professionals completed the questionnaire. Stage 2: Two persons with lived experience, two carers and three health professionals participated in workshops. Given the small sample sizes, findings should be interpreted as exploratory. We identified three themes in stage 1: (1) Eating disorder care has the potential to be disempowering, traumatic and isolating but can also be motivating and hopeful, (2) Inpatient care does not always prepare patients for success prior to discharging, (3) Transitioning into outpatient care has the potential to be inequitable, expensive or non-existent. Preferred priority areas for improvement (stage 2) included individualised holistic and empathetic care, practical and timely post-discharge support, additional supportive networks, cultural change in healthcare, workforce training and development, and consistency in service offerings and equity of access.

CONCLUSIONS: The return home from inpatient care can be difficult to navigate, marked by a lack of continuity of care and insufficient resources. This research highlights areas to target in co-designing a support system for adult patients with eating disorders after discharge from inpatient care.

PMID:42036689 | DOI:10.1186/s40337-026-01621-x

BMC Med Educ. 2026 Apr 27. doi: 10.1186/s12909-026-09045-6. Online ahead of print.

ABSTRACT

BACKGROUND: In dentistry, moral judgment skills are a fundamental competency that helps dentists make the best decisions when faced with challenging clinical problems and ethical dilemmas. The aim was toexamine the moral sensitivity levels of fourth- and fifth-grade dentistry students and orthodontic clinicians.

METHODS: The study included fourth-grade (n = 116) and fifth-grade dentistry students (n = 106) as well as orthodontic clinicians, including residents and specialists (n = 117). Data were collected using a sociodemographic form and the self-administered Moral Sensitivity Questionnaire (MSQ) including six sub-dimensions: autonomy, holistic approach, conflict, orientation, providing benefit, and application. Participants were asked to rate the questionnaire on a 7-point Likert-type scale. Cronbach’s alpha coefficient was used in reliability analysis. Continuous variables were presented as mean and standard deviation, and categorical variables were summarized as frequency and percentage. Intergroup differences were assessed by one-way ANOVA. Pairwise comparisons were further identified with Tukey’s post-hoc test. Two-way ANOVA was performed to assess the combined effects of group and demographic variables on the total scale score.

RESULTS: The overall reliability of the MSQ scale was 0.84. The total moral sensitivity scores for fourth-grade, fifth-grade students, and orthodontic clinicians were 92.7 ± 15.7, 92.4 ± 17.8, and 93.8 ± 14.4, respectively, revealing no statistically significant difference. Fifth-grade students scored significantly lower than orthodontic clinicians on the Holistic Approach and Conflict sub-dimensions but scored significantly higher on the Orientation sub-dimension compared to orthodontic clinicians.

CONCLUSIONS: Undergraduate dentistry students and orthodontic clinicians exhibited moderate levels of moral sensitivity. Fifth-grade students were found to have higher moral sensitivity thanorthodontic clinicians on the holistic approach and conflict sub-dimensions, while orthodontic clinicians were found to be more sensitive on the orientation sub-dimension. These differences suggest that integrating case-based ethics training into the dental curriculum, regardless of academic year, can help students better identify ethical issues and develop strategies to address them effectively.

PMID:42036666 | DOI:10.1186/s12909-026-09045-6

BMC Gastroenterol. 2026 Apr 27. doi: 10.1186/s12876-026-04831-4. Online ahead of print.

ABSTRACT

Liver transplantation remains the definitive therapy for end-stage liver disease, yet Early Allograft Dysfunction (EAD) continues to challenge post-transplant outcomes. Several models have been developed to predict graft dysfunction and survival, including Olthoff’s static definition, and three kinetic prediction scores: the Model for Early Allograft Function (MEAF), the Liver Graft Assessment Following Transplantation score (L-GrAFT), and the more recent Early Allograft Failure Simplified Estimation (EASE). While these scores have been validated in Western populations, data from Eastern Europe are limited. This retrospective study aimed to externally validate and compare these recipient-centred prediction models for EAD, Early Allograft Failure (EAF), and patient/graft survival in the Romanian national transplant program.Between January 2019 and May 2025, 281 adult recipients of donation-after-brain-death grafts at Fundeni Clinical Institute met inclusion criteria. EAD (Olthoff’s definition) occurred in 79 patients (28.1%), while EAF (re-transplantation or death by POD 90) occurred in 27 patients (9.6%). The median recipient age was 52 years, with viral hepatitis representing the predominant aetiology. At 12 months, overall survival reached 86%. By Olthoff’s criteria, survival was lower in EAD vs. non-EAD, though differences were not statistically significant. Risk stratification using L-GrAFT10 and EASE identified significant survival differences across patient groups, whereas MEAF stratification failed to reach significance. Among the models, EASE demonstrated the strongest predictive accuracy for both patient and graft survival at 3 and 6 months, outperforming Olthoff’s classification. L-GrAFT10 showed the strongest association with mortality across strata, while MEAF provided robust prediction of EAD comparable to L-GrAFT10, with the advantage of relative computational simplicity.Findings confirm that established scores perform reliably within this Eastern European cohort, suggesting that regional differences in disease epidemiology do not diminish their predictive value. MEAF offered practical utility for early postoperative assessment of EAD, while EASE appeared to be the most accurate model for survival stratification. Broader multicentre studies – such as the ongoing global IMPROVEMENT study – remain necessary to optimize kinetic prediction models and guide clinical decision-making in liver transplantation.

PMID:42036635 | DOI:10.1186/s12876-026-04831-4