Category: Statistics

BMC Nurs. 2025 Nov 13;24(1):1394. doi: 10.1186/s12912-025-04058-w.

ABSTRACT

OBJECTIVES: Childhood obesity prevention is a public health priority to reduce the burden of chronic diseases. This study assessed the impact of a capacity-building program designed to enhance school nurses’ competencies in adolescent obesity prevention in the Sousse region of Tunisia.

TRIAL DESIGN: A randomized controlled trial was conducted among all school nurses in the region for nine months, from January to September 2024, in the Sousse region health district. Eligible participants were stratified by the school district and randomly assigned to either the intervention (IG) or control group (CG) using a random number generator.

METHODS: The target population was school nurses actively engaged in school health services, including health promotion and obesity prevention, with a minimum of six months of professional experience. Ninety-five participants were allocated to the intervention. The intervention was multidisciplinary, including expert-led trainers on nutrition, communication, physical activity, and obesity. The primary outcome was perceived skills, and the secondary outcomes were professional attitudes and challenges regarding childhood obesity prevention. Blinding was not used in this study.

RESULTS: A total of 116 nurses participated, predominantly female, with one-third aged 40-49 years. Forty-nine participants were randomised to the IG and 46 to the CG (n = 46). At baseline, the intervention group reported significantly lower self-perceived competency in obesity management than the control group (p = 10^-3). After six months, there is a significant difference between the intervention and the control group in terms of perceived skills, including significant improvements in educating adolescents about physical activity, promoting healthy eating habits, and addressing obesity-related concerns with confidence (p = 10^-3). Regarding perceived challenges, the IG expressed an increased need for further training, particularly in counseling and motivational interviewing (p = 10^-3), higher than the CG.

CONCLUSION: This capacity-building program significantly improved school nurses’ skills, confidence, and motivation in adolescent obesity prevention. Nevertheless, skills related to family dynamics and behavioral management require more targeted interventions. Sustained professional training is crucial for addressing structural barriers and ensuring the long-term effectiveness of the program.

TRIAL REGISTRATION: This clinical trial was registered with the Pan African Clinical Trial Registry on April 7, 2025, under reference number PACTR202504907833519.

PMID:41233857 | DOI:10.1186/s12912-025-04058-w

BMC Med Educ. 2025 Nov 13;25(1):1595. doi: 10.1186/s12909-025-08143-1.

ABSTRACT

BACKGROUND: The admission of graduate students (GS) into medical courses is seen as a mechanism that allows students to have better academic performance during the medical course and to become more competent professionals. For these reasons, specific programs for this purpose agree that GS may have better academic performance in medical courses than nongraduate students (NGS). This study aimed to assess whether graduate-entry students (GS) outperformed admission test (AT) and transfer (Tr) students in both the pre-clinical and clinical phases of an undergraduate medical program that adopts a hybrid Problem-Based Learning (PBL) methodology.

METHODS: A retrospective longitudinal cohort study was carried out, collecting and analysing non-academic data upon entry into the course, as well as academic and non-academic data during the course, from medical students enrolled at the time of the study (2016-2023). We analysed the data relating to the students who, at the beginning of the course, were previously graduates (GS) or nongraduates (NGS), which were composed of students submitted to the admission test (AT) and transferred (Tr). Continuous variables were presented as the median, the interquartile ranges (IR) was used to calculate the measure of dispersion of the data and Cohen’s d was used to estimate effect size. Differences were evaluated using the Kruskal‒Wallis test and post hoc multiple comparisons were carried out with Dunn’s test. The Bonferroni correction was used to control for Type I error across the three pairwise comparisons, in most of the data presented, setting a revised significance threshold of α = 0.0167 for each test (0.05 / 3). Thus, only p-values below 0.0167 were deemed statistically significant.

RESULTS: GS students performed better than AT and Tr students in terms of overall grades, in the Tutorial sessions, in special in attitudinal performance, and on areas of Clinical skills, Primary care and Clerkship, better than Tr. In Clinical skills and Clerkship, AT performed better than Tr. In the progress test (PT), GS performed better than all the other groups and AT performed better than Tr also in the OSCE. In the GS group, male and female students performed similarly, and both groups performed better than male and female students in all the other groups (except for the both gender of the GS group that performed similarly to both gender of the AT group). GS students had a greater median age than did all the other students. On the other hand, Tr students presented the lowest scores for all analysed parameters and presented, except for the AT in the Primary care and Attitudinal, for GS in the OSCE. Tr presented a greater median age than did the AT group.

CONCLUSION: This study suggests that there are advantages of adapting programs to integrate GS students into medical courses that adopt the hybrid PBL model before the clerkship.

PMID:41233855 | DOI:10.1186/s12909-025-08143-1

Thromb J. 2025 Nov 13;23(1):109. doi: 10.1186/s12959-025-00766-0.

ABSTRACT

BACKGROUND: Plasma coagulation factor XIII (OMIM#134570 (F13A1) and 134580(F13B), synthesized in haematopoietic cells (FXIII-A) and hepatocytes (FXIII-B); stabilizes and protects fibrin clots against fibrinolytic breakdown, ensuring haemostasis. Inherited FXIII deficiency is a rare inherited autosomal recessive bleeding disorder affecting 1-3 million people globally and demonstrating strong consanguinity contributing to high incidence of cases in Pakistan. Patients manifesting severe illness are homozygotes or compound heterozygotes.

AIMS: This study aims to estimate phenotypic traits, genetic alterations, and carrier rates in families with known genetic abnormalities in individuals with Factor XIII deficiency.

METHODS: This cross-sectional study was approved by Advanced Studies Research Board and Ethical Review Committee of LUMHS, Jamshoro and conducted in concordance with Declaration of Helsinki 2000 in collaboration at the Biochemistry Department of LUMHS and Haematology Department, Baqai medical university, Karachi. Written informed consent obtained from all participants included in the study. Pedigree was constructed. Direct DNA sequencing performed via big dye terminator by using selective exon as per previously identified mutations in the patients of their families. FXIII confirmed with clot solubility testing and Elisa performed for Assay antigen detection for FXIII. Pathogenicity scoring done by using different software.

RESULTS: All the families had a history of consanguineous marriages and history of bleeding. From the six families, four families show same mutation in patient i.e. IVS11 (+ 1) G > A while two families showed c.2045G > A mutation in their homozygous patient.

CONCLUSION: The results of this study highlight how crucial it is to combine biochemical, clinical, and statistical approaches to increase the precision of diagnoses, improve patient treatment, and make genetic counselling easier for families who are at risk.

PMID:41233847 | DOI:10.1186/s12959-025-00766-0

BMC Ophthalmol. 2025 Nov 13;25(1):640. doi: 10.1186/s12886-025-04505-x.

ABSTRACT

BACKGROUND: Diabetes mellitus is a chronic condition that affects various organs, including the eyes. Corneal endothelial dysfunction, a key factor in ocular health, can be influenced by long-term diabetes. Early detection of corneal changes, such as central corneal thickness (CCT), endothelial cell density (CD), coefficient of variation (CV), and hexagonality (HEX), may provide insights into diabetic ocular complications. This study evaluates the differences in corneal endothelial parameters between diabetic and non-diabetic individuals.

AIM: To compare the corneal endothelial parameters, including CCT, CD, CV, and HEX, in diabetic patients and non-diabetic controls, and assess the correlation between these parameters and the duration of diabetes.

METHODOLOGY: This cross-sectional comparative study was conducted at a tertiary eye care hospital with 100 eyes from 50 diabetic patients and 100 eyes from 50 age-matched non-diabetic controls. All participants underwent a comprehensive ophthalmological evaluation, including intraocular pressure measurement, refraction, best corrected visual acuity, and slit-lamp biomicroscopy. Corneal endothelial imaging was performed using non-contact specular microscopy to assess CCT, CD, CV, and HEX. Statistical analysis was performed using SPSS, with a p-value of < 0.05 considered statistically significant.

RESULTS: In our study, diabetic patients had significantly higher central corneal thickness (CCT) in both eyes (OD: 593.9 ± 60.2 μm; OS: 610.5 ± 60.7 μm) compared to non-diabetics (OD: 550.9 ± 66.1 μm; OS: 593.9 ± 60.2 μm). Hexagonality (HEX) was lower in diabetics (OD: 43.2 ± 12.5%; OS: 42.3 ± 15.8%) vs. non-diabetics (OD: 52.1 ± 10.5%; OS: 41.7 ± 11.9%). HbA1C was significantly higher in diabetics (7.31 ± 1.13%) than non-diabetics (5.48 ± 0.67%; p = 0.012). Cell density (CD) and coefficient of variation (CV) showed no significant differences.

CONCLUSION: Diabetic patients exhibit significant changes in corneal endothelial parameters, which may indicate early endothelial dysfunction. Regular monitoring of these parameters could provide valuable insights into the ocular health of diabetic individuals.

PMID:41233814 | DOI:10.1186/s12886-025-04505-x

BMC Public Health. 2025 Nov 13;25(1):3935. doi: 10.1186/s12889-025-25103-y.

ABSTRACT

BACKGROUND: Opioid-related harms and deaths remain a persistent public health crisis across Ontario, Canada, with non-urban regions facing a disproportionate burden. However, discussions of opioid-related harms across Ontario’s geographic regions have provided an oversimplified assessment, contrasting rural and urban regions which mask the unique challenges and true disparities faced by sparsely populated communities, which are commonly located in the Northern regions. Our study aims to provide a more in depth understanding of the opioid crisis in Ontario across different geographic classifications in accordance to population size, such as rural, urban, and sparsely populated regions, presenting data in both absolute numbers and crude rates with contextual grounding of regional characteristics. A number of different opioid-related indicators such as hospitalizations, overdose rates, opioid service provision and harm reduction supply distribution were analyzed across all 34 of Ontario’s public health units (PHUs) to understand the differences in these indicators based on region across the province. The findings can inform the development of targeted interventions and improve service accessibility for those most affected by the overdose crisis in Ontario.

METHODS: Publicly-available secondary data for each PHU was collected from several provincial and national data sources and analyzed between November 2024 and January 2025. Annual data from 2022 to 2023 on opioid-related harms, opioid agonist treatment (OAT) prescribers and engagement, and the distribution of harm reduction supplies, as well as annual data from 2024 on opioid-inclusive service provision, were collected. Using Statistics Canada’s 2023 Health Region Peer Group Classification, the PHUS were grouped into four geographic classifications: sparsely populated, rural, urban/rural mix, and urban. Crude average rates were calculated for all indicators. Statistical analysis was performed to assess significance of indicators between regions.

RESULTS: Sparsely populated PHUs were primarily located in Northern Ontario, while rural, urban/rural mix, and urban PHUs were mainly concentrated in Southern Ontario. Urban PHUs have the highest number and lowest rate of opioid-related harms (e.g. 947 opioid-related deaths, representing a rate of 12.5 per 100,000 population), while sparsely populated PHUs reflect the opposite trend (e.g. 158 opioid-related deaths, representing a rate of 44.2 per 100,000 population). A similar pattern emerges for harm reduction services and naloxone distribution. The number of treatment services is highest in rural PHUs (n = 237) and lowest in sparsely populated PHUs (n = 83), despite having the highest rate. OAT prescribers, OAT engagement, and needle distribution follow a similar trend. Statistical significance was found between geographic regions for most indicators, except opioid-inclusive support services, harm reduction services, and naloxone distribution.

CONCLUSION: Sparsely populated and rural PHUs experience the highest burden of opioid-related harms, coupled with limitations in service accessibility, demonstrating a clear need for additional harm reduction services. Decision-makers may be misled into underestimating the crisis in non-urban areas as a result of oversimplified reporting, resulting in inadequate support for these regions. Addressing these disparities is key to reducing opioid-related mortality and ensuring equitable access to life-saving services across Ontario.

PMID:41233802 | DOI:10.1186/s12889-025-25103-y

BMC Nurs. 2025 Nov 13;24(1):1397. doi: 10.1186/s12912-025-03979-w.

ABSTRACT

BACKGROUND: Near-miss incidents represent critical learning opportunities in healthcare, yet they are frequently underreported due to fear of blame and lack of organizational support. A Just Culture framework promotes fairness, trust, and learning from errors, which may encourage voluntary reporting, especially among nurse interns in high-stakes clinical environments.

AIM: To assess the perception of Just Culture among nurse interns and examine its influence on their willingness to report near-miss events in governmental university hospitals in Egypt.

METHODS: A cross-sectional analytical study was conducted among 163 nurse interns (sampling frame N = 264) using systematic random sampling across five university hospitals in Cairo, Egypt. Data were collected between March and April 2025 using a self-administered questionnaire comprising the Just Culture Assessment Tool (JCAT) and a researcher-developed Willingness to Report Near-Miss Scale. Data analysis included descriptive statistics, correlation analysis, and multiple linear regression.

RESULTS: The mean Just Culture score was 3.6 (SD = 0.5), while the mean willingness to report near-miss events was 3.6 (SD = 0.5). Significant positive correlations were observed between Just Culture dimensions (trust, feedback, openness, balance, and continuous improvement) and willingness subdomains (awareness, skills, attitude, behavior) (p < 0.001). Regression analysis indicated that Just Culture score (B = 0.70, β = 0.67, p < 0.001) was the strongest predictor of willingness to report, explaining 55% of the variance.

CONCLUSION: A supportive Just Culture significantly enhances nurse interns’ willingness to report near-miss events. Strengthening institutional safety culture through leadership, training, and non-punitive policies is essential to fostering early-career nurses’ engagement in safety reporting.

PMID:41233794 | DOI:10.1186/s12912-025-03979-w

BMC Ophthalmol. 2025 Nov 13;25(1):643. doi: 10.1186/s12886-025-04496-9.

ABSTRACT

PURPOSE: To evaluate the long-term benefit of early targeted panretinal photocoagulation (PRP) combined with anti-VEGF therapy (IVL group) versus anti-VEGF monotherapy (IV group) in treatment-naïve eyes with macular edema (ME) secondary to ischemic RVO.

METHODS: A retrospective analysis of 143 patients (85 IVL, 58 IV) with ischemic RVO. Baseline ischemic index (IsI), central retinal thickness (CRT), best-corrected visual acuity (BCVA), and age were adjusted.

RESULTS: Over 48 months, the IVL group showed a reduction in mean CRT from 475.6 ± 117.3 μm to 282.0 ± 69.5 μm and improved BCVA from 0.61 ± 0.34 LogMAR to 0.44 ± 0.34 LogMAR. The IV group demonstrated CRT reduction from 479.4 ± 135.5 μm to 340.9 ± 127.3 μm and BCVA improvement from 0.58 ± 0.32 LogMAR to 0.50 ± 0.43 LogMAR. The IVL group received 26.0 ± 8.6 intravitreal anti-VEGF treatments (IVT), compared to 25.5 ± 6.2 IVT in the IV group.

CONCLUSIONS: The IVL group exhibited a trend toward better treatment response, particularly in patients with severe retinal ischemia, though findings were not statistically significant. Baseline IsI quantification is recommended for optimal RVO management.

PMID:41233793 | DOI:10.1186/s12886-025-04496-9

Int J Equity Health. 2025 Nov 13;24(1):311. doi: 10.1186/s12939-025-02696-9.

ABSTRACT

BACKGROUND: The imbalance between supply and demand in China’s healthcare sector has become increasingly pronounced. This study aims to quantitatively assess the coupling and coordination status of health resource supply and demand in China, reveal its determinants, with the goal of narrowing regional disparities and improving the overall coordination level. By analyzing the spatiotemporal evolution of health resource allocation from 2002 to 2021, we seek to provide evidence-based policy recommendations for addressing the imbalance in China’s healthcare sector.

METHODS: Using provincial panel data from 2002 to 2021, we constructed a comprehensive evaluation index system for the health resource supply-demand system. The entropy weight method and the Technique for Order Preference by Similarity to Ideal Solution were employed to quantify the comprehensive levels of supply and demand. The coupling coordination degree (CCD) and its types were assessed using a coupling coordination model. Finally, the geographically and temporally weighted regression (GTWR) model and Geodetector model was used to analyze the spatiotemporal evolution and determinants of CCD in 31 provinces of China from 2002 to 2021.

RESULTS: From 2002 to 2021, the CCD of health resource supply-demand in China improved significantly, increasing from 0.400 to 0.804, reaching a good coupling coordination level. Although the regional coefficient of variation (CV) of CCD decreased from 0.225 to 0.206, regional heterogeneity persisted, with the eastern region exhibiting the highest coordination, followed by the central, western, and northeastern regions. Analysis using Geodetector and GTWR models identified key spatiotemporal determinants. Notably, education level emerged as the core factor explaining the spatial heterogeneity (q = 0.608), and its interaction with urbanization (q = 0.885) significantly amplified these spatial differences. Population density, government support, and transportation accessibility were also identified as important influencing factors.

CONCLUSIONS: The current healthcare supply-demand conflict in China is characterized by insufficient supply, low quality, and an irrational structure and layout. Although coupling coordination has improved under recent reforms and policies, challenges such as poor coordination degrees and significant regional disparities persist. The Chinese government should strengthen supply-side healthcare reforms to address regional disparities and enhance the coupling coordination of health resource supply and demand.

PMID:41233779 | DOI:10.1186/s12939-025-02696-9

J Headache Pain. 2025 Nov 13;26(1):259. doi: 10.1186/s10194-025-02190-1.

ABSTRACT

BACKGROUND: Migraine is prevalent among women of childbearing age and is associated with increased long-term cardiovascular and cerebrovascular risk. Pregnancy, a hypercoagulable state, may potentiate these risks. This study aimed to quantify the association between migraine or pregnancy-related headaches and cerebrovascular and cardiovascular events during pregnancy and the postpartum period.

METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis of observational studies comparing pregnant women with and without migraine or pregnancy-related headaches. PubMed, Scopus, and Web of Science were searched through May 8, 2025. Adjusted odds ratios (ORs) were pooled using random-effects models.

RESULTS: Twelve studies encompassing 94,195,776 pregnancies met the inclusion criteria. Migraine was associated with markedly increased odds of all strokes and transient ischemic attacks (OR 10.45; 95% CI 4.27-25.57) and ischemic stroke (OR 7.14; 95% CI 2.51-20.31). Hemorrhagic stroke risk was elevated but not statistically significant overall (OR 2.25; 95% CI 0.99-5.18), while subarachnoid hemorrhage showed a 69% increased odds. Regarding cardiovascular events: myocardial infarction risk increased by 96%, peripartum cardiomyopathy odds were 2.68-fold (95% CI 1.73-4.14), and spontaneous coronary artery dissection odds were 9.21-fold higher (95% CI 3.72-22.82). All included studies were rated as “good” quality by the Newcastle-Ottawa Scale.

CONCLUSIONS: Migraine and pregnancy-related headaches are independent risk factors for a broad spectrum of cerebrovascular and cardiovascular events during pregnancy and the puerperium. These findings highlight the need for heightened clinical surveillance, targeted cardiovascular risk counselling, and multidisciplinary management strategies for this population.

PMID:41233752 | DOI:10.1186/s10194-025-02190-1

BMC Public Health. 2025 Nov 13;25(1):3932. doi: 10.1186/s12889-025-24820-8.

ABSTRACT

BACKGROUND: Depression and physical activity (PA) are interrelated elements crucial to human health. However, the evidence regarding the relationship between depression, PA, and mortality remains limited.

OBJECTIVE: To estimate the single and joint associations PA and depression on mortality risk, and further examine whether PA moderates the association between depression and mortality.

METHODS: Data were from the National Health and Nutrition and Examination Survey (NHANES) conducted between 2007 and 2018 and linked to the National Death Index death certificate records. Depression status was determined by the 9-item Patient Health Questionnaire (PHQ-9) and PA levels were measured by self-reporting activity (type, metabolic equivalent (MET) and time per week). Kaplan-Meier method and Cox proportional hazards models were applied to explore the single and joint associations between depression and PA with all-cause mortality.

RESULTS: A total of 26,150 participants were enrolled, of whom 9.2% (n = 2412) died during follow-up (median 81 months), 29.9% (n = 7810) met the PA recommendation and 9.2% (n = 2416) suffered from depression (scored ≥ 10 on the PHQ-9). For the single association, depression (HR 1.40, 95% CI 1.16-1.69, serious depression vs. no) was positively associated with mortality, but the association of PA (HR 0.66, 95% CI 0.58-0.76, regular PA vs. physically inactive) was inverse. Joint association analyses showed that the association between depression and mortality was influenced by PA, whereas more frequent PA was associated with lower mortality risk irrespective of the level of depression symptoms: compared to participants who were depressed and did not participate in PA, those who did participate in PA, whether depressed or not, had a lower risk of death. Especially, for participants who were moderately depressed and did not PA, both insufficient PA (HR, 0.43; 95% CI, 031-0.61) and regular PA (HR, 0.37; 95% CI, 0.24-0.58) significantly reduced the risk of all-cause mortality.

CONCLUSIONS: Our study found that depression was positively associated with increased mortality risk, while PA was negatively associated with it; moreover, the mortality risk associated with depression worsened with low levels of physical activity. These findings underscore the critical importance of promoting physical activity, especially among individuals with depression, as a potential strategy to mitigate mortality risk. This highlights the need for integrated public health interventions that address both mental health and physical activity to improve overall population health outcomes.

PMID:41233750 | DOI:10.1186/s12889-025-24820-8