Category: Statistics

Am J Mens Health. 2026 May-Jun;20(3):15579883261453962. doi: 10.1177/15579883261453962. Epub 2026 May 30.

ABSTRACT

Cigarette smoking is a recognized risk factor for multiple sclerosis (MS) development and progression; however, the association between smoking and features of MS in male patients remains insufficiently explored. A cross-sectional exploratory study was conducted involving 31 male patients with approved relapsing-remitting MS (RRMS), divided into smokers (n = 9) and non-smokers (n = 22). The Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) were used to assess cognitive performance. Hand dexterity was evaluated using the 9-Hole Peg Test (9HPT). Depressive symptoms and disability were assessed via the Beck Depression Inventory (BDI) and the Expanded Disability Status Scale (EDSS), respectively. Fatigue and related factors were assessed using the Comprehensive Fatigue Assessment Battery for Multiple Sclerosis (CFAB-MS). Serum markers of oxidative stress and antioxidant status, including superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), total antioxidant capacity (TAC), malondialdehyde (MDA), and glutathione (GSH), were also measured. Smokers demonstrated significantly lower SDMT scores compared with non-smokers (36.86 ± 11.16 vs. 52.47 ± 18.54; p = .04), which was no longer significant after adjusting for EDSS and age. No significant differences were observed between groups in PASAT, 9HPT, EDSS, or BDI. Smokers reported higher anxiety and worry scores on the CFAB-MS (p < .05), while other fatigue-related domains were comparable between groups. Regarding the oxidative stress markers, a statistically significant difference was only detected in SOD activity. Regular cigarette smoking may be associated with decreased cognitive processing speed and increased anxiety in male patients with RRMS, which warrants further investigation.

PMID:42218574 | DOI:10.1177/15579883261453962

J Clin Nurs. 2026 May 30. doi: 10.1111/jocn.70383. Online ahead of print.

ABSTRACT

AIMS: To evaluate the health-related quality of life (HRQOL) of adults with Long COVID 2 years and beyond after COVID-19 illness.

DESIGN: Cross-sectional study.

METHODS: Health status was assessed using the EQ-5D-5L instrument among 226 adults diagnosed in primary care with mild-to-moderate COVID-19 during the 2021 pandemic. Data were collected through a cross-sectional survey using a standardized questionnaire with a set of validated clinical outcomes for Long COVID. The sample consisted of adults aged ≥ 18 years who attended the specified ambulatory settings, tested positive for SARS-CoV-2, and agreed to be interviewed; the response rate was 70%. Health utility scores were compared between adults with and without Long COVID. Multivariate logistic regressions were applied to investigate the relationship between Long COVID and health-related quality of life outcomes.

DATA SOURCES: Primary data were collected from six public Family Health Care Units in João Pessoa, Brazil, between May 2023 and July 2024.

RESULTS: Adults with Long COVID had statistically significantly lower median utility scores (0.784, IQR: 0.633-0.902) than those without persistent symptoms (1.0, IQR: 0.877-1.0). Poorer HRQOL was more evident among women, older adults, non-White individuals, participants with pre-existing chronic diseases, and those with lower educational attainment. Long COVID was associated with impairments in anxiety/depression, pain/discomfort and usual activities.

CONCLUSION: Adults with Long COVID experienced poorer HRQOL 2 years or longer after mild-to-moderate infection compared with those without persistent symptoms, regardless of sex, age, ethnicity, education level or comorbidities. These findings support the implementation of targeted interventions and rehabilitation services in primary care for individuals experiencing long-term health problems following COVID-19 illness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying adults at greater risk of persistent health impairments following COVID-19 may help health professionals, caregivers and policymakers better address the aspects of patients’ lives that lack quality and develop a multidisciplinary approach in primary care to managing this condition.

IMPACT: What problem did the study address? ○ This study examined the association between persistent symptoms 2 years or longer after non-severe COVID-19 illness and health-related quality of life. What were the main findings? ○ Long COVID was associated with poorer health-related quality of life, particularly in the domains of anxiety/depression, pain/discomfort and usual activities. Where and on whom will the research have an impact? ○ The findings highlight the need for multidisciplinary management of long-term health problems among adult COVID-19 survivors in primary care.

REPORTING METHODS: The STROBE checklist was followed.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:42218573 | DOI:10.1111/jocn.70383

J Clin Nurs. 2026 May 30. doi: 10.1111/jocn.70377. Online ahead of print.

ABSTRACT

AIM: This study aimed to (1) implement a Safety Protocol of Thirst Management (SPTM) as an evidence-based practice for quenching postoperative thirst and (2) evaluate its effectiveness using a comparative pre-and-post induction design.

DESIGN: A quasi-experimental study using propensity scored matching.

METHOD: Guided by the Iowa Model, the SPTM was implemented at a tertiary medical centre in Taiwan in 2023. Outcomes were compared between adult surgical patients admitted in 2023 (post-induction) and those admitted prior (pre-induction). Data on thirst and pain intensity, body temperature, and PACU length of stay (LOS) were analyzed for 15,168 patients.

RESULTS: A standardized SPTM flow diagram was established. Following SPTM induction, mean thirst scores significantly decreased from 5.76 to 1.30 (p < 0.001). Although pain intensity and PACU LOS (63.63 vs. 62.23 min) showed statistically significant increases, these changes were clinically marginal. Body temperature remained stable with no incidence of perioperative hypothermia.

CONCLUSIONS: The Iowa Model effectively guides nursing organizations in translating evidence into practice. The SPTM provides a safe, consistent framework for nurses to alleviate postoperative thirst, significantly enhancing the quality of surgical care.

IMPACT: This study addresses the lack of standardized thirst management. Results demonstrate that an evidence-based SPTM protocol effectively quenches thirst without increasing adverse clinical risks.

PATIENT AND PUBLIC CONTRIBUTION: The SPTM was triggered by patient reports of thirst-related distress. During the design phase, patient feedback on the acceptability of cold oral stimuli was used to refine the protocol. While patients did not participate in the data analysis, the primary outcome (thirst intensity) was selected based on its significance to patient-cantered care.

REPORTING METHOD: This study was reported according to TIDieR guideline.

PMID:42218571 | DOI:10.1111/jocn.70377

BMC Psychol. 2026 May 30. doi: 10.1186/s40359-026-04673-5. Online ahead of print.

ABSTRACT

BACKGROUND: The growing popularity of cosmetic surgery over the past two decades reflects increasing concern with physical appearance. However, many individuals do not experience the expected psychological benefits following cosmetic procedures. body image victimization experiences, particularly those involving peers or caregivers, may play a critical role in shaping body-related shame and appearance anxiety later in life.

OBJECTIVES: This study aimed to investigate the relationship between body image victimization experiences and appearance anxiety among individuals seeking cosmetic surgery, with a focus on the serial mediating roles of body image shame and body compassion.

METHODS: A total of 409 patients attending cosmetic surgery clinics in Tehran were recruited through convenience sampling. Participants completed standardized self-report measures assessing appearance anxiety, body image victimization experiences, body image shame, and body compassion. Data were analyzed using IBM SPSS Statistics version 24. Simple and serial mediation models were tested using bootstrapping procedures, with age and gender entered simultaneously as covariates in all analyses.

RESULTS: Body image victimization experiences were positively associated with appearance anxiety. Body image shame was positively associated with appearance anxiety, whereas body compassion was negatively associated with appearance anxiety. Mediation analyses indicated that body image shame and body compassion were statistically associated with the relationship between body image victimization experiences and appearance anxiety within the tested models. These associations remained significant after controlling for age and gender.

CONCLUSIONS: The findings are consistent with theoretical models suggesting that body image shame and body compassion may be relevant psychological correlates of appearance anxiety among individuals seeking cosmetic procedures. However, given the cross-sectional design, causal inferences cannot be drawn. Longitudinal and experimental studies are needed to clarify the temporal ordering of these variables and to determine their potential relevance for future interventions.

PMID:42218568 | DOI:10.1186/s40359-026-04673-5

Chin Med J (Engl). 2026 May 29. doi: 10.1097/CM9.0000000000004140. Online ahead of print.

ABSTRACT

BACKGROUND: The association of Life’s Essential 8 (LE8) with the development of first chronic lung disease (FCLD), progression to chronic lung multimorbidity (CLM), and subsequent mortality remains inconclusive. In addition, the relative importance of individual LE8 components is unclear.

METHODS: We used data from the UK Biobank, including 391,384 participants free of chronic lung diseases (CLDs) at baseline. CLM was defined as the coexistence of two or more CLDs, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. A multistate model was used to estimate the impact of LE8 score on the dynamic progression of CLDs. Component-specific contributions were assessed using Heller’s explained risk.

RESULTS: During a median follow-up of 13.6 years, 27,934 participants developed FCLD, 4174 subsequently developed CLM, and 31,881 died. Higher LE8 scores were consistently associated with lower risks across all transition stages, with hazard ratios (95% confidence intervals) per 10-point increase of 0.75 (0.74-0.76) for transition from baseline to FCLD, 0.85 (0.83-0.87) from FCLD to CLM, 0.85 (0.84-0.86) from baseline to death, 0.92 (0.90-0.94) from FCLD to death, and 0.89 (0.85-0.92) from CLM to death. For CLD subtypes, LE8 scores showed heterogeneous associations with disease-specific transitions, even within the same transition stage. LE8 showed the strongest protective association with COPD incidence (a 36% risk reduction per 10-point increase), whereas its strongest protective association with disease progression was observed for asthma to CLM (a 27% risk reduction per 10-point increase). Among the component of LE8, smoking ranked highest in relative importance across nearly all transitions, while diet emerged as a comparably influential factor for the transition from CLM to death.

CONCLUSIONS: Higher LE8 scores are associated with significant risk reductions for CLDs at all progression stages. Early LE8 optimization, particularly smoking avoidance, offers the greatest potential for CLDs prevention, while post-diagnosis benefits support lifelong adherence.

PMID:42218565 | DOI:10.1097/CM9.0000000000004140

Gut Pathog. 2026 May 30. doi: 10.1186/s13099-026-00838-0. Online ahead of print.

ABSTRACT

BACKGROUND: Gut microbial dysbiosis has been implicated in sepsis-related organ dysfunction. However, the longitudinal dynamics of the gut microbiota and mycobiota-and particularly their cross-kingdom ecological organization-in pneumonia-derived sepsis remain incompletely understood.

METHODS: Patients with pneumonia-derived sepsis were prospectively enrolled. Fecal samples and clinical data (SOFA scores and inflammatory markers) were collected on Day 1 and Day 7. Gut bacterial and fungal communities were profiled using 16 S rRNA and ITS1 sequencing. Longitudinal and outcome-stratified analyses were performed. Trans-kingdom co-occurrence networks and module-based topological analyses were constructed, and associations with clinical parameters were explored.

RESULTS: Global analyses indicated relative compositional stability in the gut microbiota and mycobiota between Day 1 and Day 7, with no significant differences in alpha or beta diversity. The dominant bacteria were Bacillota, Bacteroidota, and Pseudomonadota at the phylum level, and Enterococcus, Bacteroides, and Escherichia-Shigella at the genus level; Escherichia-Shigella showed a decreasing trend and Bacteroides an increasing trend, though neither reached statistical significance (Padj > 0.05). Ascomycota dominated the fungal community, with Candida, Fusarium, and Oligophagozyma as the core genera, with no obvious temporal shifts. However, outcome-based stratification revealed that fungal Chao1 richness increased significantly post-treatment, specifically in the bad-outcome group (P < 0.05). The most notable findings emerged from the trans-kingdom interactome. In the favorable-outcome group, a specific modular configuration (ModM1) was identified post-treatment, containing four microbiota hubs (Parabacteroides, Mediterraneibacter, Serratia, and Enterococcus). While the aggregate abundance of ModM1 lacked clinical correlation, its hub genus, Mediterraneibacter-a prevalent anaerobe-showed a negative association with PCT and TNF-α. Additionally, the fungal-integrated ModM8 showed a potential positive association with IL-8. Conversely, the bad-outcome group showed a lack of such hub-anchored coordination.

CONCLUSIONS: In this small exploratory cohort, early pneumonia-derived sepsis appeared to exhibit relative taxonomic stability but subtle reorganization of cross-kingdom ecological connectivity. Microbial shifts appeared to manifest primarily as changes in network embedding rather than abundance. These observations provide exploratory insights that require further validation regarding topological integration, especially fungal involvement in inflammatory modules, for understanding host-microbiome interactions in critical illness. Larger longitudinal studies are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04525677, registered on 14 July 2020.

PMID:42218556 | DOI:10.1186/s13099-026-00838-0

J Orthop Surg Res. 2026 May 30. doi: 10.1186/s13018-026-07002-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Ingrown toenail surgery is a standard procedure that can significantly affect a patient’s quality of life. While preoperative photo demonstration has been proven to enhance patient satisfaction in other surgical fields, its potential in ingrown toenail surgery remains unexplored. The primary objective of this study is to investigate whether exposure to preoperative photographs influences the perception of postoperative outcomes in patients undergoing ingrown toenail surgery using the Winograd technique.

METHODS: This retrospective study included 126 patients who underwent ingrown toenail surgery using the Winograd technique between January 2022 and August 2024. Patients were divided into two groups based on whether standardized preoperative clinical photographs were shown: Group 1 (photographs shown) and Group 2 (photographs not shown). All patients were followed up for 12 months. Clinical and functional outcomes were assessed using the Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), Manchester-Oxford Foot Questionnaire (MOXFQ), and the Patient Satisfaction Scale (PSS). Both groups were compared using these scores and recurrence rates.

RESULTS: Significant postoperative improvements were observed in both Group 1 (n = 57) and Group 2 (n = 69) in VAS, DLQI, MOXFQ, and PSS scores (p < 0.001). The postoperative VAS score was significantly lower in Group 1 (2.15 ± 2.07) compared to Group 2 (3.01 ± 2.20) (p = 0.015). The postoperative PSS score was significantly higher in Group 1 (7.95 ± 2.64) than in Group 2 (6.19 ± 2.95) (p < 0.001). No statistically significant difference was found between the groups regarding recurrence rates (p > 0.05).

CONCLUSIONS: Preoperative photograph presentation may modify patients’ perception of postoperative outcomes, rather than directly improving clinical results. This approach may be considered a potential adjunct to the patient education process, offering a promising avenue for improving patient outcomes.

PMID:42218540 | DOI:10.1186/s13018-026-07002-z

Infect Agent Cancer. 2026 May 30. doi: 10.1186/s13027-026-00769-0. Online ahead of print.

ABSTRACT

BACKGROUND: Worldwide, it is believed that high-risk human papillomavirus (hr-HPV) strains are the root cause of many types of cancers, including cervical cancer, anorectal cancers, vaginal cancers, and penile cancers, with an estimated 922, 728 females diagnosed with HPV-related cancer in 2022. Particularly, in sub-Saharan Africa, the majority of women (55.13%) were affected by hr-HPV, and human immunodeficiency virus (HIV)-positive women have had double-fold higher risk of hr-HPV infection. Evidence is scarce in the study area; therefore, the current study aimed to assess the prevalence of hr-HPV and associated factors among HIV-positive women in public health facilities of Mekelle, Tigray, northern Ethiopia.

METHODS: A health facility-based cross-sectional study was conducted in five conveniently selected public health facilities of Mekelle, northern Ethiopia, from December 10, 2024, to July 10, 2025. The study included 390 consecutively recruited HIV-positive women, from whom questionnaire-based interviews were made, and provider-collected cervical brush specimens were processed using the Abbot cervi-collect kit in accordance with standard procedures. Following automated deoxyribonucleic acid (DNA) extraction using the Abbot m2000sp, the presence of 14 hr-HPV genotypes was detected using the m2000rt real-time polymerase chain reaction (RT-PCR) assay. Bivariate and multivariate logistic regression analyses were performed to assess the statistical association between the potential factors and hr-HPV status. Finally, statistical significance was declared at p < 0.05, along with the corresponding 95% confidence interval.

RESULT: The mean ± SD age of the respondents was 42 years (42.82 ± 9.55). The majority, 231/390 (59.2%) of the respondents, were of a normal weight, and with an overall mean Body Mass Index (BMI) of 21.77 ± 3.86 kg/m². According to the RT-PCR, the overall prevalence of hr-HPV DNA positivity was 39.7% (155/390); [95% CI: 34.9-44.9%]. Specifically, the prevalence of HPV-16, HPV-18, and collectively the other hr-HPV types was 10.8% [95% CI: 7.7-13.8%], 3.6% [95% CI: 1.8-5.6%], and 32.7% [95% CI: 27.9-37.2%], respectively. In multivariable logistic regression analysis, condom use was assocatied with lower odds of hr-HPV infection [AOR = 0.23; 95%CI: 0.06-0.89; p = 0.034], whereas oral contraceptive use [AOR = 4.47; 95%CI: 1.39-14.28; p = 0.012], history of vaginal discharge [AOR = 2.61; 95%CI: 1.01-6.70; p = 0.046], genital ulcer disease [AOR = 4.09; 95%CI: 1.12-14.59; p = 0.030], history of unprotected sex before marriage [AOR = 2.20; 95%CI: 1.14-4.24; p = 0.017], lack of awareness about HPV-linked cervical cancer [AOR = 2.23; 95%CI: 1.18-4.24; p = 0.013], duration ( less than or equal to11 years) since ART initiation [AOR = 2.05; 95%CI: 1.13-3.74; p = 0.018], a history of 3 or more documented ART interruption events [AOR = 4.37; 95CI: 1.06-17.99; p = 0.041], and having detectable recent HIV viral load (40 copies/mL or greater) [AOR = 6.89; 95%CI: 2.75-17.28; p < 0.001] were independently associated with higher odds of hr-HPV infection.

CONCLUSION: The findings of the current study indicate a high burden (39.7%) of oncogenic HPV strains among HIV-positive women, though lower than the pooled estimates in sub-Saharan Africa. Notably, HPV-16 and the non-HPV-16/18 high-risk genotypes collectively accounted for the majority of infections. Factors that influenced the presence of high-risk HPV included a history of unprotected sex before marriage, oral contraceptive use, vaginal discharge, genital ulcer disease, lack of awareness regarding HPV and cervical cancer, a shorter duration since ART initiation, frequent ART interruptions, and detectable recent HIV viral loads.

PMID:42218531 | DOI:10.1186/s13027-026-00769-0

BMC Res Notes. 2026 May 30. doi: 10.1186/s13104-026-07877-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Anopheles gambiae s.l. is the major malaria vector in sub-Saharan Africa, and increasing pyrethroid resistance threatens vector control. This study investigated the prevalence of knockdown resistance (kdr) mutations and pyrethroid susceptibility in An. gambiae s.l. populations from Kwara State, North-Central Nigeria.

RESULTS: A total of 250 An. gambiae s.l. mosquitoes were collected from three Local Government Areas. Molecular analysis identified An. coluzzii (31.2%, 95% CI: 25.7-37.3%), An. gambiae s.s. (16.8%, 95% CI: 12.6-22.0%), and An. arabiensis (13.6%, 95% CI: 9.9-18.4%), while 38.4% failed amplification. All populations were resistant to permethrin, deltamethrin, and alphacypermethrin (mortality < 90%), with mortality ranging from 23% to 64% across locations. Knockdown times were fastest with deltamethrin (KDT₅₀: 32.75-52.80 min) and slowest with permethrin (KDT₅₀: 39.41-93.34 min). Kdr genotyping showed 41.6% homozygous resistant (RR) and 58.4% homozygous susceptible (rr) mosquitoes; no heterozygotes were detected. These findings indicate widespread pyrethroid resistance partially mediated by kdr mutations, with significant variation among locations and sibling species. The absence of heterozygotes suggests strong selection pressure, emphasizing the need for resistance monitoring and strategic vector control interventions.

PMID:42218529 | DOI:10.1186/s13104-026-07877-5

BMC Sports Sci Med Rehabil. 2026 May 30. doi: 10.1186/s13102-026-01770-1. Online ahead of print.

ABSTRACT

BACKGROUND: Injury is an inevitable component of competitive football and has a significant influence on the psychological and physical well-being of the athletes. Psychological readiness to return to sport following injury is a multidimensional construct encompassing emotional, cognitive and contextual factors that influence an athlete’s transition back to training and competition.

OBJECTIVE: This study aims to evaluate the level and multidimensional structure of psychological readiness to return to sport in elite female football players using the Psychological Readiness of Injured Athletes to Return to Sport (PRIA-RS) questionnaire.

METHODS: A cross-sectional questionnaire-based study was conducted, which included 84 elite and semi-professional female football players who were undergoing the final stages of rehabilitation or preparing to return to full training post a sports-related injury. The psychological readiness of these athletes was assessed using the PRIA-RS instrument. Descriptive statistics and exploratory factor analysis (EFA) were performed to identify the underlying psychological dimensions associated with the return-to-sport readiness.

RESULTS: Most athletes reported positive perceptions of rehabilitation progress, mood, functional recovery, and overall readiness to return to training. Approximately 64.3% of the respondents rated rehabilitation progression as “very good,” while 70.2% reported having a very positive attitude at the end of rehabilitation. However, a substantial proportion reported anxiety (29.8%) and uncertainty risk towards a reinjury (23.8%) related to returning to sport. Exploratory factor analysis identified four components explaining 61.2% of total variance, representing emotional confidence, fear and anxiety, perceived functional safety, and external pressure.

CONCLUSION: Elite female football players generally report a high level of psychological readiness to return to sport following an injury, although anxiety and fear of reinjury remain prevalent in a meaningful portion of the athletes. Inclusion of psychological tools such as PRIA-RS into return-to-sport decision-making alongside physical rehabilitation provides the necessary psychological support to the athletes before them to return to full training and competition. The findings support the importance of evaluating psychological readiness as a multidimensional construct alongside physical recovery when making return to sport decisions.

PMID:42218527 | DOI:10.1186/s13102-026-01770-1