Category: Statistics

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09079-8. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the relationship between hyoid bone morphology and stylohyoid complex morphometry using cone-beam computed tomography and to investigate the influence of age and sex on these characteristics.

METHODS: A retrospective cone-beam computed tomography analysis of 338 individuals was performed to evaluate hyoid bone morphology, styloid process length, angulation, elongation type, and calcification patterns. The lesser horn-body angle was measured as a novel angular parameter to assess its relationship with the stylohyoid complex anatomy.

RESULTS: The study included 338 individuals (226 females, 66.9%; 112 males, 33.1%) with a median age of 43 years. No significant associations were found between hyoid bone morphology and styloid process length, angulation, elongation type, or calcification pattern (p > 0.05). Type U was the most common hyoid bone morphology overall and in males, whereas Type B predominated in females; however, the association between hyoid bone morphology and sex was not statistically significant. Although the highest lesser horn-body angle difference was observed in Type H and the lowest in Type B, these differences did not reach statistical significance (p = 0.076). Styloid process length, medio-lateral angulation, and antero-posterior angulation were significantly greater in males than females bilaterally (p < 0.05). Type I (elongated) and Type II (partial calcification) were the predominant stylohyoid complex elongation and calcification patterns, respectively, both showing bilateral symmetry. Age-related differences were identified among styloid process elongation types on both sides, with Type III (segmented) occurring at younger ages on the right side (p = 0.006) and Type I (elongated) being associated with older age on the left side (p < 0.001). No significant associations were found between hyoid bone morphology and styloid process length, angulation, elongation type, or calcification pattern (p > 0.05).

CONCLUSIONS: CBCT demonstrated bilateral symmetry in stylohyoid complex morphology and angulation. Significant sex and age-related differences were observed in selected stylohyoid complex characteristics, whereas no association was found between hyoid bone morphology and stylohyoid complex morphometry. The lesser horn-body angle exhibited high reproducibility and bilateral consistency, although its significance remains unclear.

PMID:42366385 | DOI:10.1186/s12903-026-09079-8

Arch Public Health. 2026 Jun 29. doi: 10.1186/s13690-026-01999-9. Online ahead of print.

ABSTRACT

BACKGROUND: Sub-Saharan Africa has the highest maternal death rate worldwide. Access to quality healthcare for pregnant women can significantly reduce the number of maternal deaths. There is limited evidence on barriers to healthcare access, particularly among pregnant women in countries with a high burden of maternal mortality. Therefore, this study intended to examine the magnitude of barriers to healthcare access among pregnant women in high and very high maternal mortality countries in sub-Saharan Africa.

METHODS: This study employed a population-based cross-sectional study design. Data was gathered from the latest Demographic and Health Surveys data of the top 15 high and very high maternal mortality sub-Saharan African countries. A total weighted sample of 21,079 pregnant women were participated. A multilevel modified poison regression analysis model was fitted. Adjusted Prevalence Ratio (APR) with a 95% confidence interval and a P-value of less than 0.05 was used to declare statistical significance.

RESULTS: This study revealed that 65.08% (95% CI: 64.43-65.72) of pregnant women in high and very high maternal mortality sub-Saharan African countries have barriers to healthcare access. In this study, age 15-24 (adjusted prevalence ratio [APR] = 1.12, 95%CI: 1.06-1.18), no education (APR = 1.53, 95%CI: 1.37-1.73), primary education (APR = 1.35, 95%CI: 1.49-1.82), secondary educational (APR = 1.48, 95%CI: 1.36-1.62), poor wealth quantile (APR = 1.76, 95%CI: 1.65-1.88), middle wealth quantile (APR = 1.30, 95%CI: 1.23-1.41), partner’s no education (APR = 1.18, 95%CI: 1.06-1.30), partner’s primary education (APR = 1.16, 95%CI: 1.04-1.34), unmarried (APR = 1.13, 95%CI: 1.08-1.21), no health insurance (APR = 1.59, 95%CI: 1.24-1.94), not autonomous in household decision making (APR = 2.12, 95%CI: 1.32-2.88), unwanted pregnancy (APR = 1.20, 95%CI: 1.06-1.40), rural resident (APR = 1.25, 95%CI: 1.17-1.33), community level of women’s education (APR = 1.31, 95%CI: 1.16-1.51), low poverty status (APR = 1.86, 95%CI:1.20-2.52) were significantly associated with barriers to healthcare access.

CONCLUSIONS: Our findings concluded that two-thirds of women in high and very high maternal mortality sub-Saharan African countries have barriers to healthcare access. Women’s barrier to healthcare access was affected by individual and community-level factors. Our findings recommend that empowering women by enhancing their education and reducing poverty can help mitigate women’s barriers to healthcare access. Moreover, healthcare policymakers and stakeholders should improve healthcare infrastructure and the availability of healthcare services in rural areas.

PMID:42366381 | DOI:10.1186/s13690-026-01999-9

BMC Med Educ. 2026 Jun 29. doi: 10.1186/s12909-026-09809-0. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric nursing requires exceptional humanistic care. However, humanistic education is often delivered separately from professional nursing courses, creating a gap between caring principles and clinical practice.

AIM: This mixed-methods study evaluated the effectiveness of the “Humanities in Course” model in enhancing nursing students’ humanistic caring abilities and improving the caring climate in pediatric nursing education.

METHODS: A concurrent mixed-methods approach was adopted. Using a non-probability whole-population sampling method, all third-year undergraduate nursing students enrolled in the Pediatric Nursing course during the 2023 academic year were invited to participate. Seventy-five students who completed the course and provided both pre- and post-course data were included in the final analysis. Quantitative data were collected before and after the course using the Caring Ability Inventory, Peer Group Caring Interaction Scale, and Organizational Climate for Caring Questionnaire, and were analyzed using descriptive statistics and paired-sample t-tests. Students’ perceptions of the course were evaluated after the intervention using a self-developed Teaching Effectiveness Evaluation Questionnaire. Qualitative data were collected from students’ narrative diaries written after the RealCare Baby^® 3 experiential learning activity and analyzed using Colaizzi’s seven-step method with NVivo 12.

RESULTS: Students’ total caring ability scores increased significantly from 188.11 ± 18.69 before the course to 203.57 ± 16.26 after the course (p < 0.001). Significant improvements were also observed in the total scores of the Peer Group Caring Interaction Scale and the Organizational Climate for Caring Questionnaire after the intervention. The teaching effectiveness evaluation showed that most students perceived the course positively, with 94.7% reporting curricular attractiveness, 96.0% reporting improved analytical problem-solving ability, and 98.7% reporting enhanced patience when interacting with patients. Qualitative analysis of narrative diaries identified five themes: gratitude to parents, professional quality development, bioethics, operational learning, and course experience.

CONCLUSION: The “Humanities in Course” model may be a feasible approach for embedding humanistic education into pediatric nursing education. It was associated with improvements in students’ overall humanistic caring ability, peer caring interaction, and perceived caring climate, while qualitative findings indicated perceived development in professional quality, bioethical awareness, operational learning, and reflective understanding of pediatric caring. Future controlled, multi-center, and longitudinal studies with objective and multi-source outcome measures are needed to confirm the effectiveness, sustainability, and transferability of this model.

PMID:42366376 | DOI:10.1186/s12909-026-09809-0

BMC Ophthalmol. 2026 Jun 29. doi: 10.1186/s12886-026-04988-2. Online ahead of print.

ABSTRACT

BACKGROUND: Ranibizumab and Aflibercept are widely used anti-VEGF agents for treating neovascular age-related macular degeneration (nAMD). This meta-analysis compares their efficacy, anatomical outcomes, treatment burden, and safety profiles.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar yielded 1,734 unique records. After screening and applying eligibility criteria, 11 studies were included. Primary outcomes were changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), proportion of dry retina, and injection frequency. Subgroup analyses and funnel plots assessed heterogeneity and publication bias.

RESULTS: Aflibercept showed a trend toward greater BCVA improvement compared with Ranibizumab, although the difference did not reach statistical significance (MD: 3.87 letters; 95% CI: -0.47 to 8.21; p = 0.07; I² = 97%). Similarly, CRT reduction tended to favor Aflibercept (MD: -85.35 µm; 95% CI: -178.45 to 7.75; p = 0.09), but with substantial heterogeneity. The proportion of dry retina was significantly higher with Aflibercept (MD: 18.74%; 95% CI: 15.20 to 22.28; p < 0.001), with no heterogeneity (I² = 0%). Although Aflibercept was associated with fewer injections (MD: -0.91; 95% CI: -1.67 to -0.15; p = 0.02), this finding was accompanied by substantial heterogeneity (I² = 93%) and should be interpreted cautiously given the variability in study design, patient populations, and treatment regimens across included studies. Moreover, although the reduction in injection frequency was statistically significant, its magnitude was modest and its clinical importance remains uncertain given the high heterogeneity and very low certainty of evidence.

CONCLUSIONS: Both agents demonstrated comparable visual efficacy for nAMD. No statistically significant differences were observed for BCVA improvement or CRT reduction, and the available evidence does not establish clear superiority of either treatment. Although differences in dry retina outcomes and injection frequency were observed, these findings should be interpreted cautiously because of substantial heterogeneity, mixed study designs, and predominantly low-certainty evidence. Further standardized head-to-head studies are required to clarify the clinical relevance of these observations.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42366374 | DOI:10.1186/s12886-026-04988-2

BMC Psychiatry. 2026 Jun 28. doi: 10.1186/s12888-026-08340-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the mediating effects of hope traits and psychological distress in the relationship between childhood abuse and suicidal ideation in college students.

METHODS: A total of 1908 college students were surveyed using the Childhood Abuse Questionnaire-Short Form (CTQ-SF), the Adult Dispositional Hope Scale, the SCL-90, and the Suicidal Ideation Self-Rating Scale. The data were screened, SPSS and R software were used to calculate descriptive statistics, and a structural equation model was constructed.

RESULTS: Childhood abuse was significantly associated with higher levels of suicidal ideation. Childhood abuse indirectly affected suicidal ideation through hope traits and psychological distress, both individually and via chain mediation, with all indirect effects remaining significant after controlling for direct effects.

CONCLUSION: Childhood abuse can directly positively impact college students’ suicidal ideation, and also indirectly affect it through the mediating effects of hope traits and psychological distress either individually or as a chain.

PMID:42366372 | DOI:10.1186/s12888-026-08340-2

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09065-0. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the effects of commonly used intracanal medicaments on the dentinal tubule penetration and push-out bond strength of two bioceramic sealers.

METHODS: Eighty extracted single-rooted mandibular premolars were instrumented using sodium hypochlorite and ethylenediaminetetraacetic acid. The specimens were randomly assigned to four groups (n = 20): no medicament, double antibiotic paste, 2% chlorhexidine gel, and calcium hydroxide. After 14 days, medicaments were removed and samples were subdivided according to the sealer used (NeoSealer Flo or BioRoot RCS) labeled with Rhodamine B (n = 10). Sections from the coronal, middle, and apical thirds were analyzed using confocal laser scanning microscopy to evaluate penetration parameters. Push-out bond strength was also measured. Statistical analysis was performed using appropriate tests with a significance level set at p < 0.05.

RESULTS: Compared with the other medicaments, 2% chlorhexidine gel produced significantly lower penetration values (p < 0.001). NeoSealer Flo demonstrated greater dentinal tubule penetration and bond strength than BioRoot RCS (p = 0.012 and p < 0.001). Penetration was highest in the coronal third, whereas bond strength was greatest in the apical third. The control group presented the highest bond strength, whereas calcium hydroxide significantly reduced the dislodgement resistance (p = 0.008). Greater dentinal tubule penetration did not consistently correspond to higher push-out bond strength.

CONCLUSIONS: Intracanal medicaments significantly influence the dentinal tubule penetration and bond strength of bioceramic sealers. However, greater tubular penetration does not necessarily correspond to improved dislodgement resistance. These findings suggest that sealer-dentin interaction may depend more on interfacial adaptation and chemical interaction than on penetration depth alone, with potential implications for material selection in endodontic treatment.

PMID:42366364 | DOI:10.1186/s12903-026-09065-0

Int J Ment Health Syst. 2026 Jun 28. doi: 10.1186/s13033-026-00720-1. Online ahead of print.

ABSTRACT

BACKGROUND: One key question for current psychotherapy research is how limited resources should be used efficiently to optimise treatment pathways. We examined how primary care level (PCL) psychotherapy, a history of mental disorder, and sociodemographic factors are associated with the later probability of receiving long-term rehabilitative psychotherapy.

METHODS: This longitudinal observational cohort study based on a register data from the Gaps in Mental Health-Related Work Disability and Treatment Outcomes (GapMind) project, which combines data from national registers (Statistics Finland and the Social Insurance Institution of Finland) and the largest occupational health service (OHS) provider in Finland. The study population comprised Finnish occupationally active individuals aged 15-65 (N = 1,261,320). Data on the use of PCL psychotherapy in the OHS between 2019 and 2020 were combined with data on age, gender, socioeconomic status, education, history of mental disorders (including psychotropic medication purchases, sickness absences, pensions, and use of OHS due to mental disorders), and somatic disabling comorbidities and four-model logistic regression analyses were conducted. The primary outcome was the use of long-term psychotherapy during 2020-2022.

RESULTS: Participation in PCL psychotherapy (OR 7.05-15.51) and a history of mental disorders (OR 1.67-4.25) were associated with a higher probability of receiving subsequently long-term rehabilitative psychotherapy. Higher age, female gender, and higher socioeconomic status were also associated with an elevated likelihood of engaging in long-term rehabilitative psychotherapy.

CONCLUSIONS: Participation in PCL psychotherapy, and various clinical and sociodemographic factors were associated with an increased probability of receiving later long-term psychotherapy. These findings may support healthcare systems in leveraging this information to better anticipate the need for long-term psychotherapy.

PMID:42366362 | DOI:10.1186/s13033-026-00720-1

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09106-8. Online ahead of print.

ABSTRACT

BACKGROUND: First permanent molars (FPMs) erupt early and remain exposed to the oral environment for prolonged periods, making them particularly susceptible to dental caries, molar-incisor hypomineralization (MIH), restorative failure, and repeated restorative intervention. When long-term prognosis becomes unfavorable, extraction may represent a biologically appropriate treatment option. Favorable spontaneous eruptive adaptation of the second permanent molar (SPM) has been associated with several radiographic and developmental variables. This retrospective radiographic study evaluated demographic and panoramic radiographic parameters associated with favorable eruption potential of SPMs in children with indicated FPM extraction and investigated whether established radiographic conditions were present at the time extraction decisions were made.

METHODS: Following ethical approval, panoramic radiographs of 500 pediatric patients presenting with extraction-indicated FPMs (n = 712) were retrospectively evaluated. Demographic characteristics, dentition stage, number and location of affected FPMs, and extraction indications were recorded. Radiographic assessment included evaluation of SPM developmental stage according to Demirjian classification, SPM angulation, and presence of a third permanent molar (TPM) germ. Statistical analyses were performed using SPSS version 29.0. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were applied, with statistical significance established at p < 0.05.

RESULTS: The mean age of the study population was 128.39 ± 22.11 months; 54.6% were girls and 45.4% boys. Extensive carious destruction (91.4%), repeated treatment interventions, severe structural breakdown, and MIH-related defects represented the principal indications for extraction. Radiographically, 17.6% of SPMs were classified as Demirjian stage E and 27.4% as stage F. Mesial angulation was observed in 55.2% of cases, while a TPM germ was present in 74.2%. However, only 12.8% of cases (62 patients, 91 teeth) fulfilled all predefined radiographic conditions associated with favorable eruption potential following FPM extraction.

CONCLUSION: Radiographic conditions associated with favorable eruption potential of SPMs were present in only a limited proportion of cases at the time FPM extraction decisions were established. These findings highlight the discrepancy between theoretically favorable developmental timing conditions and the clinical realities of pediatric dental practice, where extraction is frequently necessitated by advanced structural disease. Systematic radiographic evaluation of SPM developmental stage, angulation, and TPM germ presence should therefore be incorporated into individualized treatment planning.

PMID:42366359 | DOI:10.1186/s12903-026-09106-8

BMC Med Imaging. 2026 Jun 28. doi: 10.1186/s12880-026-02534-6. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVE: This single-center retrospective study evaluated the associations of AI-quantified coronary plaque parameters and CT-derived fractional flow reserve (CT-FFR) with major adverse cardiovascular events (MACEs) in patients with coronary artery disease, and derived optimal risk cutoff values for plaque burden.

METHODS: A total of 381 patients who underwent CCTA were consecutively enrolled. MACEs were defined as a composite of all-cause death, myocardial infarction (fatal and nonfatal), heart failure death, malignant arrhythmia, coronary revascularization, and rehospitalization for angina exacerbation. Maximum follow-up was 18 months. Risk cutoff values were derived from receiver operating characteristic analysis. Univariate and multivariate Cox regression, Kaplan-Meier analysis, and five predictive models (plaque model, CT-FFR model, combined model, LASSO-Cox, and Cox survival neural network) were constructed.

RESULTS: Among 381 patients, 67 (17.6%) developed MACEs. All six total plaque parameters showed significant associations with MACEs. In multivariate Cox regression, total noncalcified percent atheroma volume (NCPAV) > 4.68% emerged as the strongest predictor (HR 5.073, 95% CI 2.930-8.786, P < 0.001). Analyzed continuously, each 1-SD increase in total-NCPAV conferred an HR of 1.82 (95% CI 1.54-2.14, P < 0.001). The combined model C-index was 0.750 (95% CI 0.696-0.804; optimism-corrected 0.708), comparable to the plaque model alone (0.744, 95% CI 0.686-0.801; corrected 0.705). The LASSO-Cox and Cox survival neural network models achieved C-indices of 0.747 (95% CI 0.674-0.816) and 0.730 (95% CI 0.628-0.833), respectively. In landmark sensitivity analyses excluding early events, the combined model C-index rose to 0.792, with the likelihood ratio test P value narrowing from 0.117 to 0.061, suggesting a trend toward incremental value for CT-FFR after accounting for potential incorporation bias.

CONCLUSIONS: AI-quantified total noncalcified plaque burden was the strongest predictor of MACEs. The addition of CT-FFR to plaque parameters did not provide a clinically meaningful or statistically significant improvement in overall model performance, including discrimination, model fit, reclassification, or discrimination slope. Although landmark analyses suggested a possible trend toward incremental value after exclusion of early revascularization-driven events, this finding should be considered exploratory and requires further validation. Vessel-specific analyses identified RCA plaque burden as having the greatest prognostic weight among the target vessels; however, this exploratory finding also warrants confirmation in independent cohorts.

PMID:42366355 | DOI:10.1186/s12880-026-02534-6

BMC Emerg Med. 2026 Jun 28. doi: 10.1186/s12873-026-01665-x. Online ahead of print.

ABSTRACT

BACKGROUND: Early recognition of non-invasive ventilation failure in patients with acute respiratory failure in the emergency department is essential to prevent delayed intubation and its associated adverse outcomes. The HACOR score is a pragmatic bedside tool developed to predict non-invasive ventilation failure, most prior investigations have been conducted in intensive care settings and have predominantly relied on single time-point measurements or simple change analyses. In this study, we aimed to evaluate predictive value of early change in the HACOR score for non-invasive ventilation failure in emergency department patients with acute respiratory failure and to examine the temporal nature of this association using Generalized Estimating Equations models.

METHODS: This prospective observational cohort study included 106 adult patients. HACOR, National Early Warning Score, National Early Warning Score 2, and Modified Early Warning Score were calculated immediately before and at 1 h after non-invasive ventilation initiation. ΔHACOR was defined as the difference between 1-hour and baseline HACOR scores. The primary outcome was non-invasive ventilation failure. Discriminative performance was assessed using ROC analysis. Logistic regression was used to evaluate the independent association between ΔHACOR and non-invasive ventilation failure. Generalized estimating equations models were constructed to analyze the time-dependent relationship between HACOR and non-invasive ventilation failure.

RESULTS: Non-invasive ventilation failure occurred in 50.9% of patients. Baseline clinical variables and scores did not significantly discriminate between success and failure groups. In contrast, 1-hour HACOR (AUC = 0.760, 95% CI 0.667-0.854) and ΔHACOR (AUC = 0.798, 95% CI 0.711-0.885) demonstrated significant predictive performance. Patients with ΔHACOR ≥ 0 exhibited a substantially higher failure rate (74.4%) compared to those with ΔHACOR < 0 (34.9%). Each one-point increase in ΔHACOR was independently associated with failure (OR 1.63, 95% CI 1.31-2.03; p < 0.001). In Generalized Estimating Equations analysis, the HACOR × time interaction remained statistically significant across adjusted models, supporting the prognostic value of serial HACOR assessment.

CONCLUSIONS: In emergency department patients receiving non-invasive ventilation, early dynamic changes in HACOR provide superior prognostic information compared with baseline measurements alone. Serial HACOR assessment demonstrated through Generalized Estimating Equations modeling supports potential value of response-guided risk stratification and highlights importance of early reassessment in emergency non-invasive ventilation management.

PMID:42366354 | DOI:10.1186/s12873-026-01665-x