Category: Statistics

BMC Public Health. 2026 Jun 4. doi: 10.1186/s12889-026-27726-1. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the effect of menstrual knowledge, and of menstrual education interventions, on broader dimensions of menstrual health. We assessed factors associated with menstrual knowledge and attitudes, and the association of menstrual knowledge with menstrual health related outcomes among female Ugandan adolescents enrolled in the control arm of a menstrual health intervention trial.

METHODS: We conducted a secondary data analysis of longitudinal data from control arm participants in a cluster-randomised trial conducted in Ugandan secondary schools. Endline data were collected one year after baseline. We identified baseline factors associated with the menstrual knowledge and attitudes at endline, and estimated associations of menstrual knowledge items with menstrual practice needs and menstrual confidence at endline, using random-effects Poisson and linear regression analyses to estimate adjusted incidence rate ratios (aIRR) and mean differences (aMD) respectively.

RESULTS: Among 1453 female and 317 male participants in 30 control arm schools who completed both baseline and endline surveys, there was evidence of small associations between better menstrual knowledge at endline with better baseline knowledge (both male and female participants), and in females only, being in a private school (aIRR = 1.05, 95%CI 1.00-1.11), and knowledge about menstruation prior to menarche (aIRR = 1.08, 95%CI 1.03-1.14). Positive attitudes towards menstruation at endline were associated with baseline positive attitudes (male and female participants), and with knowledge prior to menarche (aIRR = 1.10, 95%CI 1.01-1.21). Participants with better knowledge scores had better menstrual experiences (Menstrual Practice Needs Scale: aMD = 0.19, 95%CI 0.08-0.30, p < 0.001 for high versus low knowledge scores).

CONCLUSIONS: Female adolescents who know about menstruation before menarche have slightly greater menstrual knowledge and positive attitudes towards menstruation. In turn, menstrual knowledge is associated with fewer unmet menstrual practice needs. Future interventions should consider tailoring educational content to address specific knowledge gaps and cultural attitudes and include boys.

TRIAL REGISTRATION NUMBER: ISRCTN45461276 Registration date: 16/09/2021.

PMID:42243798 | DOI:10.1186/s12889-026-27726-1

BMC Pulm Med. 2026 Jun 4. doi: 10.1186/s12890-026-04386-w. Online ahead of print.

ABSTRACT

BACKGROUND: Prompt detection and isolation of active Pulmonary Tuberculosis(PTB) are critical to prevent hospital transmission. In Ethiopia, evidence on PTB isolation practices in high-risk settings is limited. This study assessed the median time to isolation and factors associated with delays in a teaching hospital emergency department.

METHODS: All adult GenXpert-confirmed active PTB patients diagnosed in the emergency outpatient (acute care) department of a Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia, between November 2021 and March 2024, were included. Data were extracted from the electronic medical records database. Delay in isolation was defined as failure to isolate a patient suspected or confirmed to have infectious tuberculosis (TB) at the first point of contact in the study hospital (triage). The Multivariable analysis using the Cox proportional hazards model was used to determine the statistically significant predictors of delayed isolation of active PTB with P-values < 0.05.

RESULTS: Seventy-five patients with a mean age of 32 years were included. The median time to isolation for active PTB was two days (interquartile range: 1-4 days). More than half (58.7%) of patients were isolated within two days. In the Multivariable Cox regression analysis, several factors were associated with a longer time to isolation: acute cough (Hazard Ratio, HR: 0.43; 95% CI: 0.23-0.80), requirement for supplemental oxygen (HR: 0.46; 95% CI: 0.23-0.89), non-cavitary lesion on chest radiograph (HR: 0.46; 95% CI: 0.25-0.85), intravenous antibiotic use (HR: 0.46; 95% CI: 0.33-0.97), abnormal white blood cell count (HR: 0.27; 95% CI: 0.13-0.56), and weekend emergency department visits (HR: 0.46; 95% CI: 0.25-0.84).

CONCLUSIONS: This study found that clinical and laboratory factors, as well as the timing of hospital visits, were associated with delayed isolation of active PTB patients in the emergency department. These findings highlight key areas for improving timely isolation in the acute care setting.

CLINICAL TRIAL REGISTRATION NUMBER: The study is purely observational. Thus, the clinical trial registration number is not applicable.

PMID:42243793 | DOI:10.1186/s12890-026-04386-w

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08759-9. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate and accessible screening tools for periodontitis are essential for early detection and disease prevention. This study evaluated a non-invasive diagnostic approach integrating sociodemographic data, self-reported oral health (SROH) questionnaires, and salivary biomarkers, using both conventional statistical and machine learning (ML) predictive models.

METHODS: Seventy-seven adults completed a validated SROH questionnaire and provided saliva samples for quantification of six biomarkers: interleukins (IL-1β, IL-6), tumour necrosis factor (TNF-α), matrix metalloproteinases (MMP-8, MMP-9), and metallothionein (MT). Participants were clinically classified as having (i) periodontal health, (ii) gingivitis, or (iii) periodontitis. Predictive models were developed using Logistic Regression (LR), Random Forest (RF), and Naive Bayes (NB) across three feature sets: (i) SROH, salivary biomarkers and sociodemographic, (ii) SROH and salivary biomarkers, (iii) SROH and sociodemographic and (v) SROH alone. Model performance was assessed using 10-fold cross-validation and standard evaluation metrics.

RESULTS: The RF model trained on SROH, and salivary biomarkers achieved the highest accuracy with area under the receiver operating characteristic curve (AUC = 0.856), with superior precision (70.13%), sensitivity (0.701) and lower error rates (RMSE = 0.371) compared with NB (AUC = 0.795) and LR (AUC = 0.724) models in detecting periodontitis.

CONCLUSIONS: This non-invasive, SROH and biomarker-integrated approach shows potential as a first-line screening and referral tool in primary care and population-based settings where comprehensive periodontal examination is not routinely available. Further validation in larger, more diverse populations is warranted to support clinical translation.

PMID:42243783 | DOI:10.1186/s12903-026-08759-9

BMC Psychiatry. 2026 Jun 4. doi: 10.1186/s12888-026-08238-z. Online ahead of print.

ABSTRACT

BACKGROUND: Toxoplasma gondii (T. gondii) is a globally prevalent intracellular parasite capable of causing latent infections in humans. T. gondii, a widely prevalent protozoan parasite, has been increasingly linked to mental, psychiatric, and neurological disorders. Understanding its seroprevalence is critical to assess its potential public health impact and guide preventive strategies. Despite the extensive research conducted in Türkiye on this association, the outcomes have shown variability. A comprehensive synthesis is required to elucidate the seroprevalence of T. gondii among affected patient groups and to enhance our understanding of the potential public health implications. This study posits that the prevalence of T. gondii among patients with psychiatric and neurological disorders in Türkiye is substantial, with notable socioeconomic and geographical variations. It aims to estimate the seroprevalence of T. gondii infection among these patients in Turkey, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS: A systematic review and meta-analysis were performed following the guidelines of the PRISMA. In November 2024, comprehensive searches were conducted across PubMed, Web of Science, Scopus, and the TR index using a set of predetermined keywords without imposing any temporal limitations. The methodological quality of the studies included in the review was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist, which is applicable to both randomized controlled trials and cross-sectional studies. Data were synthesized using a meta-analytic technique.

RESULTS: Prevalence was calculated using a random-effects model with a 95% confidence interval (CI). Cochran’s Q and I² statistics were performed to assess heterogeneity among the included studies, while funnel plots and Egger’s tests were used to evaluate publication bias. The prevalence of toxoplasmosis was 34% (95% CI: 28%-39%). When the patient groups of the studies included in the research were classified, the subgroup analysis performed with the obtained data was found to be 34% (95% CI: 28%-39%) in patients with both neurological and psychiatric disorders.

CONCLUSION: This meta-analysis identified a significant seroprevalence of T. gondii infection among individuals with psychiatric and neurological disorders in Türkiye. These findings indicate a potential association between T. gondii exposure and neuropsychiatric conditions, highlighting the need for further research and increased clinical awareness in at-risk populations.

PMID:42243782 | DOI:10.1186/s12888-026-08238-z

BMC Public Health. 2026 Jun 4. doi: 10.1186/s12889-026-28028-2. Online ahead of print.

ABSTRACT

BACKGROUND: Inherited hemoglobinopathies, particularly sickle cell disease (SCD) and thalassemia, represent a major public health burden in Saudi Arabia. However, comprehensive nationwide real-world data have historically been fragmented across healthcare facilities. This study describes the development, governance framework, and epidemiological characterization of the Saudi National Inherited Hemoglobin and Blood Disorders (IHBD) Registry and reports population-level patterns derived from unified Ministry of Health (MOH) data integration.

METHODS: A nationwide registry infrastructure was established under the MOH using phased implementation: retrospective manual digitization of historical records (2016-2018), followed by phased automated electronic medical record (EMR) integration implemented between 2019 and 2025. Between 2019 and 2025, 166,727 IHBD-related diagnostic entries were extracted from 31 MOH-affiliated hospitals. Two different data sources were leveraged. For all records, 3-year retrospective data were entered, and prospective data were utilized moving forward in the IHBD registry. Records were consolidated using national identification numbers to generate a de-duplicated patient-level dataset. Descriptive statistics summarized demographic and geographic distributions. IHBD Registry coverage per 100,000 population was calculated using the 2024 Saudi census estimate. Associations between disease groups and geographic regions were evaluated using chi-square testing.

RESULTS: After deduplication, 105,008 unique patients with inherited blood disorders were identified, corresponding to approximately 298 patients per 100,000 population in the IHBD Registry. The registry captured 105,008 unique diagnosed patients (surveillance coverage), of whom 65,679 (62.6%) had fully structured, longitudinally validated records within the registry module. SCD represented the predominant subgroup. Geographic clustering was observed, with the Eastern (32.0%), Makkah (28.1%), and Riyadh (19.1%) regions accounting for the majority of registered cases. Approximately 32.6% of patients had multiple IHBD-related diagnoses, reflecting overlapping hemoglobinopathy and bleeding disorder classifications within the healthcare system.

CONCLUSIONS: The IHBD Registry provides the first unified, nationwide MOH-based dataset for inherited hemoglobinopathies, enabling population-level surveillance and regional burden assessment. By integrating phased data consolidation and EMR interoperability, the registry establishes a scalable national infrastructure for rare hematologic disease monitoring. These findings support evidence-based resource allocation, regional health planning, and future expansion toward integrated screening, longitudinal outcome tracking, and advanced analytic applications.

PMID:42243779 | DOI:10.1186/s12889-026-28028-2

BMC Public Health. 2026 Jun 4. doi: 10.1186/s12889-026-27958-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate oral health parameters and health-related quality of life (HRQoL) in children and adolescents with chronic kidney disease (CKD), and compare them with non-CKD peers. Additionally, the impact of various sociodemographic, health-related, and oral health parameters on HRQoL was examined within the CKD group.

METHODS: In this cross-sectional observational study, 82 children with CKD were compared to 85 non-CKD controls within the same age range. Participants were evaluated through a comprehensive clinical assessment that included sociodemographic and health-related characteristics, oral hygiene habits, and oral health parameters including dental caries, oral hygiene status, gingival health, and developmental enamel defects. Both child self-report and parent proxy-report versions of the KINDL questionnaire were used to assess HRQoL. Statistical analyses were conducted to evaluate group differences and associations between variables.

RESULTS: Children with CKD had significantly lower HRQoL scores across all domains (p < 0.05). They also exhibited higher rates of enamel defects, gingival inflammation, and poorer oral hygiene. Although DMFT/dft scores were lower in the CKD group, ICDAS II showed a higher prevalence of early carious lesions. Multiple regression analysis revealed that HRQoL was significantly associated with CKD status, number of siblings, oral hygiene, and gingival health (p < 0.001).

CONCLUSIONS: Oral health is strongly associated with HRQoL in children with CKD. Public health strategies should prioritize regular HRQoL monitoring and early preventive dental care to improve overall well-being in this vulnerable population.

PMID:42243776 | DOI:10.1186/s12889-026-27958-1

BMC Cancer. 2026 Jun 4. doi: 10.1186/s12885-026-16296-5. Online ahead of print.

ABSTRACT

BACKGROUND: Acute lymphoblastic leukemia (ALL) remains a significant challenge in pediatric malignancies, particularly in cases of relapse and treatment resistance. This study aimed to investigate the expression patterns of ferroptosis-related genes, GPX4 and LINC00618, across different disease phases in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL).

METHODS: This case-control study analyzed 82 samples from pediatric BCP-ALL patients comprising 14 new cases, 29 in remission, and 17 relapsed cases alongside 22 healthy controls. Expression levels of GPX4 and LINC00618 were evaluated using quantitative real-time PCR. The relationship between gene expression and clinical parameters was assessed. Statistical analyses were performed employing parametric or nonparametric tests.

RESULTS: GPX4 expression was significantly elevated in ALL patients compared to controls (p < 0.01), with notably higher levels in new cases (p < 0.01) and relapsed patients (p < 0.05). Similarly, LINC00618 exhibited significant upregulation in ALL patients (p < 0.05), particularly in new cases (p < 0.01) and relapsed patients (p < 0.05). Both genes demonstrated reduced expression during the remission. External validation using the GSE13159 dataset demonstrated a consistent direction of increased GPX4 expression in ALL samples compared to controls.

CONCLUSIONS: Our findings suggest phase-associated expression patterns of GPX4 and LINC00618 in pediatric BCP-ALL. The consistent direction of GPX4 expression observed in external validation supports its potential relevance in leukemic biology. These results provide a basis for further studies to clarify the role of ferroptosis-related pathways in disease progression and therapeutic response.

PMID:42243765 | DOI:10.1186/s12885-026-16296-5

BMC Nephrol. 2026 Jun 4. doi: 10.1186/s12882-026-05078-7. Online ahead of print.

ABSTRACT

BACKGROUND: Patients receiving maintenance hemodialysis (MHD) experience multiple concurrent symptoms with substantial heterogeneity in symptom burden. However, a reproducible evidence framework to translate symptom interdependencies into intervention priorities is lacking. To address this gap, we use model-based in silico perturbation simulations to quantitatively rank modifiable symptom targets, providing non-causal decision support for symptom-focused management in resource-constrained settings.

METHODS: We used convenience sampling to recruit adults receiving MHD from 13 hemodialysis centers in Southwest China between February and June 2025. Symptoms were assessed using the modified Dialysis Symptom Index. We identified symptom clusters using exploratory factor analysis and estimated symptom networks to characterize interconnections and centrality. Latent profile analysis defined symptom-burden subgroups. To explore interventions, we performed in silico perturbation analyses with NodeIdentifyR, simulating both alleviating and aggravating interventions. Changes in the total number of active symptoms served as the primary outcome for comparing effects on symptom network structure.

RESULTS: A total of 962 participants were included. Seven symptom clusters were identified: emotional, sexual and cardiopulmonary dysfunction; gastrointestinal; musculoskeletal; sleep disturbance; neurologic; and skin discomfort. Two symptom-burden profiles were identified by latent profile analysis, representing Profile 1 (lower-burden groups) and Profile 2 (high-burden group), with clear clinical interpretability. Feeling nervous showed the highest centrality, and fatigue demonstrated the strongest bridging role across clusters. Model-based perturbation analyses ranked candidate priorities. Simulated alleviation of feeling anxious, worrying, and feeling nervous was associated with estimated reductions in overall burden of 17.3%, 16.0%, and 14.4%, respectively. Simulated exacerbations of feeling irritable, nervous, and sad were associated with estimated increases in overall burden of 21.2%, 19.4%, and 18.5%, respectively.

CONCLUSIONS: Our findings suggest emotional symptoms are priority candidates for intervention in patients receiving MHD. They may provide non-causal decision support for symptom management and resource allocation. Future longitudinal studies and intervention trials are needed to further evaluate both their effectiveness and generalizability.

PMID:42243764 | DOI:10.1186/s12882-026-05078-7

BMC Oral Health. 2026 Jun 4. doi: 10.1186/s12903-026-08698-5. Online ahead of print.

ABSTRACT

BACKGROUND: Dental pulp calcifications, including pulp stones and diffuse calcific changes, can complicate endodontic access, canal negotiation, and treatment planning. Artificial intelligence may support radiographic detection of these findings, but the available evidence remains limited and methodologically heterogeneous. This scoping review mapped peer-reviewed studies that applied artificial intelligence to detect, classify, or segment dental pulp calcifications on two-dimensional radiographs and cone-beam computed tomography.

METHODS: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar were searched for English-language studies published from 1 January 2015 to 29 September 2025. After duplicate and ineligible records were removed, 450 records underwent title and abstract screening, 32 full-text reports were assessed, and seven peer-reviewed studies were included. Data were charted descriptively according to imaging modality, artificial intelligence architecture, task type, validation design, annotation approach, and reported performance. Owing to heterogeneity in tasks, datasets, and outcome metrics, no meta-analysis or inferential statistical testing was performed.

RESULTS: The included studies were retrospective, single-centre investigations published between 2023 and 2025. Two-dimensional radiographic studies using detection or classification pipelines reported high internal performance, with accuracy ranging from 95.4% to 96.5% and F1 scores ranging from 78.9% to 96.6%. One panoramic segmentation study reported Dice scores of 0.84 for pulp and 0.759 for pulp stones. In cone-beam computed tomography, one three-dimensional U-Net study reported accuracy of 72.8% and an area under the curve of 0.74, with reduced sensitivity for micro or diffuse calcifications. No study used external validation, and public code or datasets were generally unavailable.

CONCLUSIONS: Artificial intelligence methods show technical potential for detecting dental pulp calcifications, particularly in internally validated two-dimensional radiographic studies. However, the evidence is still preliminary. Clinical translation is limited by single-centre designs, small and heterogeneous datasets, lack of external validation, inconsistent reporting, and limited reproducibility. Future research should prioritize multicentre datasets, lesion-size stratification, standardized reporting, open benchmarking, calibration assessment, and prospective workflow-based evaluation.

TRIAL REGISTRATION: Not applicable. This study was a scoping review and did not involve a clinical trial.

PMID:42243743 | DOI:10.1186/s12903-026-08698-5

BMC Gastroenterol. 2026 Jun 4. doi: 10.1186/s12876-026-04987-z. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health burden. Identifying robust prognostic biomarkers is crucial for early risk stratification. The red blood cell distribution width to albumin ratio (RAR) has emerged as a potential biomarker reflecting inflammation and nutritional status. This study aimed to evaluate the association between RAR and both all-cause and cardiovascular mortality among adults with MASLD.

METHODS: Data from the National Health and Nutrition Examination Survey 1999-2018 were analyzed. MASLD was defined using the United States Fatty Liver Index (USFLI ≥ 30), combined with cardiometabolic criteria. Participants were categorized into RAR quartiles. Weighted Cox proportional hazards models, Fine-Gray competing risk models, and restricted cubic splines were employed to the association between RAR and mortality. Stratified and sensitivity analyses were conducted to test robustness.

RESULTS: Among 6,287 MASLD patients (mean age 51.39 years, 42.69% female), there were 1,161 all-cause deaths and 324 cardiovascular deaths over a median follow-up of 9.2 years. In the fully adjusted Model 3, individuals in the highest RAR quartile had a higher risk of all-cause mortality (hazard ratio [HR] = 2.41, 95% confidence interval [CI] = 1.87-3.10, P < 0.001) and cardiovascular mortality (HR = 3.39, 95% CI = 2.17-5.31, P < 0.001) compared to those in the lowest quartile. Each unit increase in RAR was associated with a 93% increase in all-cause mortality (HR = 1.93, 95% CI = 1.62-2.30, P < 0.001) and a 130% increase in cardiovascular mortality (HR = 2.30, 95% CI = 1.83-2.90, P < 0.001). No significant nonlinear associations were found. A significant age interaction was observed in all-cause mortality (P for interaction < 0.05), with stronger associations seen among younger individuals. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS: Higher RAR levels were significantly associated with increased all-cause and cardiovascular mortality in adults with MASLD. RAR holds potential as a risk stratification tool for MASLD adults in clinical practice.

PMID:42243742 | DOI:10.1186/s12876-026-04987-z