Category: Statistics

BMC Med Educ. 2026 Jan 9. doi: 10.1186/s12909-025-08546-0. Online ahead of print.

ABSTRACT

AIM: The migration of nurses has become a critical concern for Iran’s healthcare system. However, the roots of this challenge may emerge early-during nursing education-when students begin forming attitudes toward working abroad. This study aimed to identify key predictors of Iranian nursing students’ attitudes toward brain drain using a validated multivariate approach.

METHOD: In this cross-sectional study, a total of 296 bachelor’s and master’s nursing students from two nursing schools were recruited through convenience sampling between April and June 2025. Data were collected via an online questionnaire, which included demographic information, educational characteristics, life-related variables, migration-related factors, and the Attitudes toward brain drain scale. Multiple linear regression analysis was performed to examine the predictors of attitudes toward brain drain. Data were analyzed using IBM SPSS Statistics v.26.

RESULTS: The average age of students was 22.7 years. Half of the students reported a moderate level of interest in the profession. Canada was the most frequently chosen destination country (33.5%). The average attitude score toward brain drain was 59.25 ± 11.97. In addition, language proficiency (β = 0.498, p < .001) positively predicted attitudes toward brain drain, whereas life satisfaction (β = -0.192, p < .001) and family connectedness (β = -0.125, p = .014) were negative predictors.

CONCLUSION: These findings highlight the role of both personal and contextual factors in shaping migration attitudes among nursing students. Academic institutions should enhance educational experiences and support students’ psychological well-being to foster more positive professional engagement within the country.

PMID:41514275 | DOI:10.1186/s12909-025-08546-0

BMC Public Health. 2026 Jan 10. doi: 10.1186/s12889-025-26033-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to examine the relationship between empowering motivational climate in physical education and adolescents’ social-emotional competence, and to analyze the chain mediation effect of teacher-student relationship and physical activity level.

METHODS: A questionnaire survey was conducted with 1,145 adolescents from first-tier (Guangzhou), second-tier (Foshan), and third-tier (Qingyuan) cities in Guangdong Province, using scales measuring empowering motivational climate in physical education, teacher-student relationship, physical activity level, and social-emotional competence. Data were statistically analyzed using IBM SPSS 29.0 and IBM AMOS 26.0 software.

RESULTS: (1) empowering motivational climate in physical education was positively correlated with social-emotional competence and had a direct predictive effect on it; (2) empowering motivational climate in physical education could indirectly influence adolescents’ social-emotional competence through the partial mediating effects of teacher-student relationship and physical activity level; (3) empowering motivational climate in physical education may also indirectly affect adolescents’ social-emotional competence through the chain mediation of “teacher-student relationship and physical activity level.”

CONCLUSION: The empowering motivational climate in physical education can not only directly predict social-emotional competence but also exert indirect effects through the mediating roles of teacher-student relationship and physical activity level, thereby providing theoretical support and practical evidence for promoting the development of adolescents’ social-emotional competence.

PMID:41514274 | DOI:10.1186/s12889-025-26033-5

BMC Oral Health. 2026 Jan 10. doi: 10.1186/s12903-025-07442-9. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetes Mellitus (DM) is a chronic metabolic disorder that has been linked to an increased risk of periodontal disease. Among the oral manifestations associated with DM, periodontal disease has been the most extensively studied. Dental calculus, which forms when dental plaque mineralizes over time, is known to trap biological substances and may preserve biochemical markers indicative of systemic health. Therefore, it could provide valuable information about patients’ overall health. In this study, we analyzed the elemental composition of dental calculus in diabetic and non-diabetic (control) patients using scanning electron microscopy (SEM) combined with energy dispersive X-ray spectroscopy (EDX), with a specific focus on potassium (K) content.

PATIENTS AND METHODS: We analyzed 57 dental calculus samples, including 17 from individuals diagnosed with type 2 diabetes and 40 from non-diabetic controls. The elemental composition was assessed using scanning electron microscopy paired with energy-dispersive X-ray spectroscopy (SEM-EDX), targeting standardized 100 × 100 μm regions. Potassium content, along with other elemental data, was reported in both mass and atomic percentages.

RESULTS: The results showed elevated potassium levels in diabetic patients compared to controls, with the difference reaching the treshold of statistical significance (0.484 ± 0.710 wt.% versus 0.186 ± 0.320 wt.%). A similar trend was observed in atomic percentage values (0.249 ± 0.387 versus 0.092 ± 0.174; p = 0.0555). Notably, potassium was present in 100% of the diabetic samples. Carbon and oxygen were the predominant elements in both groups, with the diabetic group exhibiting a slight increase in oxygen and lower levels of calcium and phosphorus.

CONCLUSION: These findings suggest that potassium concentration in dental calculus could serve as a potential biomarker for diabetes. They also highlight the feasibility of incorporating dental calculus analysis after routine dental treatments- which involve the removal of calculus-for early diabetes detection. This approach provides a cost-effective and painless alternative to traditional diagnostic methods. However, we note that while the data are still preliminary, the results indicate a potential biochemical link that warrants further exploration in larger, well-controlled studies.

PMID:41514271 | DOI:10.1186/s12903-025-07442-9

Diabetol Metab Syndr. 2026 Jan 9. doi: 10.1186/s13098-025-02049-0. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic Foot Ulcers (DFUs) represent a global healthcare challenge, imposing substantial socioeconomic burdens due to their increasing incidence and associated mortality. This study evaluates the efficacy and safety of external phytotherapy (utilizing various plant-derived compounds, including Chinese herbal medicines and plant-derived liposomes, administered topically) for the treatment of DFUs.

METHODS: Relevant studies were identified from major electronic databases (PUBMED, EMBASE, WOS, and the Cochrane Library) that were searched up to April 30, 2024. Randomized controlled trials (RCTs) that evaluated the effects of external phytotherapy for DFUs. The treatment group was treated with external phytotherapy plus conventional treatment, while the control group received conventional treatment alone. Two evaluators independently screened and selected literature, extracted data, and assessed the risk of bias. The outcome measures included complete ulcer healing, ulcer improvement, ulcer area reduction, and healing time. Weighted mean difference (WMD), standardized mean difference (SMD), and relative risk (RR) with 95% confidence intervals (CI) were used for data analysis. Heterogeneity was quantified using I² statistics, with appropriate application of fixed-effects or random-effects models. Methodological quality was ensured through Review Manager and Stata software, complemented by GRADE evidence assessment.

RESULTS: Twenty studies with a total of 1,854 participants were identified. Our analysis suggested that compared with conventional treatment, external phytotherapy significantly enhances complete ulcer healing (RR: 1.84; 95% CI: 1.55 to 2.19), promotes ulcer improvement (RR: 1.32; 95% CI: 1.11 to 1.57), reduces ulcer area (WMD: -1.14; 95% CI: -1.45 to -0.83), and accelerates healing time (WMD: -3.93; 95% CI: -7.48 to -0.39). Safety profiles and ulcer depth measurements showed no significant intergroup differences. GRADE assessments indicated high-certainty evidence for most primary outcomes, whereas the evidence for percentage ulcer reduction was of low certainty due to serious inconsistency and imprecision.

CONCLUSION: External phytotherapy demonstrates potential as an adjunctive treatment for diabetic foot ulcers, improving primary outcomes like complete healing with moderate to high certainty of evidence. Nevertheless, regional bias-with most evidence derived from East Asia-warrants caution in generalizing these results. Further rigorous, multi-regional trials are needed to solidify the evidence base and refine clinical application.

PMID:41514269 | DOI:10.1186/s13098-025-02049-0

BMC Complement Med Ther. 2026 Jan 9. doi: 10.1186/s12906-025-05243-9. Online ahead of print.

ABSTRACT

PURPOSE: Continuous positive airway pressure (CPAP) therapy remains the cornerstone of obstructive sleep apnea (OSA) treatment, considerably reducing the risk of cardiovascular complications and improving patient outcomes. However, adherence to CPAP therapy is a major challenge and poor compliance limits its efficacy. This study investigated the potential of aromatherapy, a noninvasive, cost-effective intervention, to improve CPAP adherence and enhance sleep quality in patients with OSA.

METHODS: A prospective observational pilot study was conducted in patients with obstructive sleep apnea who demonstrated poor CPAP adherence (< 70% usage and < 4 h/night). Participants were exposed to lavender or cypress aroma oil during sleep. Pre- and post-intervention subjective sleep measures Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and objective CPAP usage metrics were collected. Normally distributed variables were analyzed using paired t-tests, and non-normally distributed variables were analyzed using the Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. A post hoc power analysis was performed based on observed effect sizes for the primary outcomes.

RESULTS: Eight patients with OSA (mean age 53.5 years; 4 males, 4 females) participated in the study. Following 67 days of treatment, the median PSQI score significantly improved from 9.0 to 6.5 (p = 0.006), and the median ESS score decreased from 9.0 to 6.5 (p = 0.034). Additionally, CPAP for more than 4 h increased from 5.0% to 25.7% (p = 0.028). The median usage duration improved from 149 to 231 min (p = 0.018). No significant change in apnea hypopnea index (AHI) was observed during CPAP use, decreasing from 3.2 events/h to 1.3 events/h (p = 0.226), which is consistent with the understanding that appropriately applied CPAP maintains effective control of respiratory events.

CONCLUSION: Aromatic stimulation with essential oils shows promise in improving both CPAP adherence and sleep quality, offering a novel approach to enhance OSA treatment efficacy.

PMID:41514226 | DOI:10.1186/s12906-025-05243-9

BMC Microbiol. 2026 Jan 9. doi: 10.1186/s12866-025-04623-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigates the impact of transitioning from restricted to 24/7 access to blood culture cabinets on blood culture processing.

METHOD: A post-hoc retrospective study and a prospective laboratory simulation to evaluate the effects of delayed incubation were conducted. Data analysis evaluated clinical data comparing incubation-to-detection (ITD) and Collection-to-detection (CTD) including Collection-to-incubation (CTI) comparing pre- and post-implementing the new protocol (Cut-point). ITD values were obtained using BD Synapsys™ software, with delays factored into CTD. Of 14,673 blood cultures collected from October 2019 to September 2023 at Rigshospitalet, Copenhagen, 3,323 met inclusion criteria. Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pneumoniae were selected as indicator organisms. In the simulation, cultures with 0-, 6-, and 18-hour incubation delays were assessed for growth and detection time.

RESULTS: Median ITD increased significantly post-cut-point: for E. coli from 7.8(IQR: 2.28-13.55) to 11.4(IQR: 9.8-14.7) hours, S. aureus from 9.9(IQR: 4.1-15.6) to 14.3 h(IQR: 11.5-19.5), P. aeruginosa from 14.0(IQR 5.3-19.95) to 16.3 h(IQR 11.75-26.1), and S. pneumoniae from 3.3(IQR: 1.55-9.9) to 11.7 h(IQR: 9-12.6) (all p < 0.01). CTD decreased post-cut-point: by 3h03m for E. coli (p < 0.0001), 3h51m for S. aureus (p = 0.0016), and 4h24m for S. pneumoniae (p < 0.0001). The reduction for P. aeruginosa (1h48m) was not statistically significant. In the simulation-study, delayed incubation increased CTD for all species in aerobic bottles: E. coli (p = 0.0036), S. aureus (p = 0.0036), P. aeruginosa (p = 0.0036), and S. pneumoniae (p = 0.0429); and in anaerobic bottles: E. coli (p = 0.0036), S. aureus (p = 0.0036), and S. pneumoniae (p = 0.0071). No anaerobic growth of P. aeruginosa was observed. An 18-hour delay notably reduced recovery of S. pneumoniae, with growth detected in only one bottle.

CONCLUSION: Minimizing incubation delays significantly reduces CTD and improves detection of fragile bacteria. These findings potentially have significant implications for clinical practice, emphasizing the importance of protocols that limit pre-analytical delays to optimize blood culture diagnostics.

PMID:41514207 | DOI:10.1186/s12866-025-04623-y

Scand J Caring Sci. 2026 Mar;40(1):e70175. doi: 10.1111/scs.70175.

ABSTRACT

INTRODUCTION: Turnover rates among health-care personnel are rising, which could jeopardise patient safety and the quality of care. One contributing factor to the high turnover is the prevalence of mental distress. Stress of conscience among healthcare personnel has been shown to affect them negatively, and feeling that they cannot provide the care their patients need increases their stress levels. Therefore, an increased understanding of stress of conscience, its relation to burnout and its consequences for healthcare can improve hospital care for both patients and staff.

AIM: This study aimed to investigate the correlation between stress of conscience and burnout among health care personnel at an acute care hospital in southern Sweden.

ETHICAL ISSUES AND APPROVAL: This study was approved by the Swedish Ethical Review Authority and followed the guidelines of the Declaration of Helsinki.

METHODS: The study used a descriptive cross-sectional design. A total of 167 healthcare personnel at an acute care hospital in southern Sweden completed a questionnaire based on the Stress of Conscience Instrument and Oldenburg Inventory Burnout Instrument.

RESULTS: There was a positive correlation between the stress of conscience and burnout (p = 0.01, Spearman’s rank correlation coefficient = 0.559). The results showed a statistically significant correlation between ‘living situation’ and stress of conscience, showing higher stress of conscience in groups living alone than in those living with a partner. The analysis also revealed a statistical significance between ‘working schedule’ and burnout, particularly in the groups working daytime and working shifts.

CONCLUSION: Stress of conscience is positively correlated with burnout among healthcare professionals. Shift workers were more likely to experience burnout, and HCP living alone reported higher levels of stress of conscience. These findings highlight the combined impact of personal and organisational factors, underscoring the need for interventions that address both domains to reduce burnout and support workforce wellbeing.

PMID:41514195 | DOI:10.1111/scs.70175

Artif Organs. 2026 Jan 9. doi: 10.1111/aor.70090. Online ahead of print.

ABSTRACT

BACKGROUND: In the last decades, various extracorporeal liver support systems were developed for hepatic failure with hyperbilirubinemia with the aim to clear the blood from protein-bound toxic molecules. Open albumin dialysis (OPAL) is a complex and expensive system that requires addition of human albumin. Plasma adsorption perfusion (PAP) using the anion exchange resin adsorber, BR-350, is an alternative liver support method that does not need additional blood products and is more cost-effective and less time-consuming.

METHODS: At the University Hospital Essen, PAP using BR-350 was performed in a cohort of 9 patients with a mean of 6 sessions per patient. In a retrospective analysis, we compared the detoxification ability of PAP with that of the OPAL system conducted among 24 patients and with standard medical treatment (SMT) including hemodialysis that was performed among 24 patients. In addition, the technical effectiveness of a single session of PAP with BR-350 was compared with OPAL among 12 patients who were treated with both methods in a crossover design.

RESULTS: The first single session (30.7.3 ± 13.5 mg/dL to 25.8 ± 13.4 mg/dL, p = 0.02) and the complete therapy (30.7 ± 13.5 mg/dL to 16.2 ± 6.3 mg/dL, p = 0.004) with PAP using BR-350 resulted in a statistically significant decrease of bilirubin concentrations. The median relative reduction of bilirubin achieved at the end of liver support treatment was comparable between PAP and OPAL (47% vs. 40%, p = 0.29). PAP was associated with a higher bilirubin reduction than the SMT plus dialysis (47% vs. -30%, p = 0.0001). The crossover comparison between the single session of PAP using BR-350 and OPAL revealed similar mean relative reduction rates of bilirubin (11% vs. 10%, p = 0.81). The single session of OPAL was associated with a more pronounced decrease of alkaline phosphatase, gamma-glutamyltransferase, hemoglobin, platelets, and leucocytes compared to PAP.

CONCLUSIONS: Both studied methods had comparable efficacy in reducing bilirubin in our studied patients in contrast to the retrospective control group. Since other substrates may also be relevant in treating liver failure, more studies are required. Patients with concomitant renal failure benefit from OPAL, whereas PAP might be more eligible for patients with a high risk of bleeding.

PMID:41514160 | DOI:10.1111/aor.70090

Oral Maxillofac Surg. 2026 Jan 10;30(1):16. doi: 10.1007/s10006-025-01501-9.

ABSTRACT

BACKGROUND: This study was conducted to investigate the clinical efficacy of Socket-Shield Technique on the adult first premolar bone preservation in Orthodontic Extraction Treatment.

METHODS: 26 patients who were underwent Orthodontic Extraction Treatment in the First Affiliated Hospital of Guangzhou Medical University were enrolled. Extracted teeth were paired and randomly allocated into two groups: test group (Socket-Shield Technique) and control group. Finally, the socket-shield was removed when the adjacent tooth moved proximate to the shield during the process of closing orthodontic gap. Cone beam computerized tomography were utilized to access the buccolingual resorption and vertical resorption at 1 mm, 3 mm and 5 mm from a reference plane of alveolar crest, as well as tooth movement rate.

RESULTS: The first premolar alveolar bone height resorption of test group were significantly lower than those in control group. Resorption of alveolar bone width at 1 mm and 3 mm above the reference plane at T1, T2 and T3 in the test group were significantly lower than those in the control group. There were no significant differences at 5 mm above reference plane. The tooth movement rate between the test group and the control group have no significant difference.

CONCLUSIONS: Socket-Shield Technique has a positive clinical effect on preserving the alveolar bone of the first premolar in adults with thin buccal alveolar bone and does not exert any discernible influence on the rate of orthodontic tooth movement in Orthodontic Extraction Treatment.

CLINICAL TRIAL REGISTRATION: The trial was registered in Clinical Trial Registry ( https://clinicaltrials.gov/ ) on 02/01/2024 and the registration number is NCT06510621.

PMID:41514150 | DOI:10.1007/s10006-025-01501-9

J Robot Surg. 2026 Jan 10;20(1):165. doi: 10.1007/s11701-025-03133-3.

ABSTRACT

Laparoscopic adrenalectomy (LA) is the standard minimally invasive approach, whereas robotic adrenalectomy (RA) is increasingly adopted for its ergonomic and technical advantages. Whether these benefits improve perioperative outcomes-particularly by adrenal laterality-remains unclear. This study compared RA and LA outcomes via structured side-specific analysis. A total of 198 patients were screened in this retrospective cohort study, which included adults who underwent minimally invasive adrenalectomy between June 2020 and September 2025. Patients with paragangliomas, recurrent disease, or open adrenalectomy were excluded. Clinical, operative, and postoperative variables were collected, and laterality-specific subgroup analyses and multivariable linear regression were performed. A total of 181 patients were analyzed (126 LA, 55 RA). The length of hospital stay was significantly shorter in the RA group (p = 0.019), whereas the operative time was significantly longer in the RA group than the LA group (p < 0.001). No significant differences were observed between techniques regarding complications, transfusions, or conversion rates (all p > 0.05). When stratified by laterality, the RA consistently demonstrated longer operative times for both right- and left-sided procedures (p = 0.001 and p < 0.001, respectively). In the multivariate analysis, only the surgical approach and tumor diameter independently affected the operative time (both p < 0.001). Robotic adrenalectomy demonstrated perioperative safety comparable to that of laparoscopy while providing the advantage of a shorter hospital stay despite longer operative times. Given its similar complication and conversion profiles, RA represents a feasible and ergonomically favorable procedure in endocrine surgery centers.

PMID:41514123 | DOI:10.1007/s11701-025-03133-3