Category: Statistics

Ann Saudi Med. 2025 Jul-Aug;45(4):256-269. doi: 10.5144/0256-4947.2025.256. Epub 2025 Aug 7.

ABSTRACT

BACKGROUND: Stroke rehabilitation is a vital component of post-stroke care, and the length of stay (LOS) in hospitals and rehabilitation centers varies across healthcare systems. This systematic review and meta-analysis assessed LOS among stroke survivors in Arab countries.

METHODS: A comprehensive literature search identified studies reporting LOS in stroke rehabilitation. A comprehensive literature search from the inception until March 2025 identified studies reporting LOS in stroke rehabilitation.

RESULTS: A total of 18 publications (25 datasets) involving 12 690 individuals were included in the meta-analysis. The pooled mean LOS was 25.67 days [95% confidence interval (CI): 16.22-35.11]. Subgroup analyses showed a longer LOS in Saudi Arabia (37.03 days, 95% CI: 24.11-49.95) compared to other Arab countries (8.87 days, 95% CI: 4.90-12.84), and in rehabilitation centers (46.71 days, 95% CI: 33.18-60.24) compared to acute hospital settings (9.07 days, 95% CI: 5.27-12.86). LOS varies widely across Arab countries and care settings.

CONCLUSION: These findings highlight the need to examine whether differences in LOS are associated with functional recovery and healthcare efficiency. However, substantial heterogeneity across studies and a lack of outcome data limit the interpretability of the results.

PMID:40753459 | DOI:10.5144/0256-4947.2025.256

Ann Saudi Med. 2025 Jul-Aug;45(4):243-248. doi: 10.5144/0256-4947.2025.243. Epub 2025 Aug 7.

ABSTRACT

BACKGROUND: Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored.

OBJECTIVE: To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences.

DESIGN AND SETTINGS: A single-center retrospective study.

PATIENTS AND METHODS: Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25-29.9, ≥30.0 kg/m²).

MAIN OUTCOME MEASURES: Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates.

SAMPLE SIZE: 60 patients (30 in each group).

RESULTS: The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories (P <.001). Vault suturing time was shorter in the 3D HD laparoscopy group (P =.002), and total operative time was reduced in overweight patients (P =.015). Obese patients in the 3D group had lower haemoglobin drop (P =.01) and reduced blood loss compared to 2D laparoscopy group (P =.017).

CONCLUSION: 3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis-highlighting its value in overcoming challenges of minimally invasive gynecologic surgery.

LIMITATIONS: The study’s retrospective design and modest sample size limit generalizability.

PMID:40753458 | DOI:10.5144/0256-4947.2025.243

IISE Trans Occup Ergon Hum Factors. 2025 Aug 2:1-17. doi: 10.1080/24725838.2025.2539781. Online ahead of print.

ABSTRACT

OCCUPATIONAL APPLICATIONSAmong the three commonly used mathematical models for estimating overhead position from inclination data, the trigonometry model showed the most consistent alignment with in-lab motion capture data, with no statistically significant differences observed. Strong correlations were found between accelerometer-based wearable and inclination outputs during upright drilling and hammering tasks involving shoulder elevation above 150°. While no statistically significant differences were observed between observational and inclination-based estimates of overhead frequency, discrepancies were present in overhead duration estimates. These findings suggest that, with appropriate signal processing and modeling techniques, inclination data collected at the upper arm may offer a practical approach for estimating overhead exposures in field research. This method could support more refined monitoring and assessment of overhead work, potentially informing interventions aimed at reducing musculoskeletal strain and improving worker safety.

PMID:40753457 | DOI:10.1080/24725838.2025.2539781

BMC Med Educ. 2025 Aug 2;25(1):1141. doi: 10.1186/s12909-025-07689-4.

ABSTRACT

BACKGROUND: Medical training is a highly stressful environment for students. In previous studies, many instruments have been used to measure stress levels among medical students. However, these stress measurements are not specific tools for medical settings. This study aims to adapt the Medical Student Stressor Questionnaire (MSSQ) to Turkish, conduct validity and reliability studies, and provide a practical tool to evaluate medical school-related stressors of medical students in Turkey.

METHODS: All students studying at the (Manisa Celal Bayar University) School of Medicine were invited to the study. The data was collected between January-March 2024. The research was completed with 412 students. The MSSQ consists of 40 items and 6 subscales. The psychometric properties of the MSSQ were evaluated through tests for validity and reliability. Using RStudio version 1.3.1093 (R Studio, PBC) with the lavaan package, confirmatory factor analysis (CFA) with the “diagonally weighted least squares (DWLS)” estimator was conducted. Internal consistency was tested by Cronbach’s alpha coefficient and test-retest reliability was examined by intraclass correlation coefficient (ICC).

RESULTS: A total of 412 students participated in this study. The median (minimum-maximum) age of the students was found to be 20.00 (18.00-26.00) years. CFA was performed and the appropriate modification indices suggested by the model were added to the model. All 40 items loaded 0.38 or higher. The fit indices calculated as a result of the CFA were determined to be Root Mean Square Error of Approximation (RMSEA) = 0.060 (95% CI: 0.057-0.064)(p < 0.001), Comparative Fit Index (CFI) = 0.899 and Tucker-Lewis Index (TLI) = 0.888. The fit indices were at acceptable level. In the analyses conducted for the subscales, the Cronbach Alpha Coefficients were adequate.

CONCLUSION: In conclusion, this study has provided preliminary evidence for the validity and reliability of a Turkish version of the MSSQ. The six-factor structure was confirmed by CFA. We propose using the Turkish version of MSSQ to evaluate the stress level of medical students. Therefore, further research is needed to investigate the relationship between MSSQ and the other scales which used to measure stress.

PMID:40753444 | DOI:10.1186/s12909-025-07689-4

BMC Womens Health. 2025 Aug 2;25(1):383. doi: 10.1186/s12905-025-03757-5.

ABSTRACT

BACKGROUND: Menopause marks the cessation of menstrual cycles and brings significant changes to a woman’s body, including oral health alterations. While hormone replacement therapy (HRT) is commonly used to alleviate menopause symptoms, its impact on oral health, particularly periodontal conditions, has not been well studied in Saudi Arabia. Periodontitis, a disease that destroys the bone and soft tissue of the mouth, becomes more prevalent post-menopause. This study investigates the effect of HRT on periodontal health in post-menopausal women.

METHODOLOGY: A case-control study was conducted with 372 post-menopausal Saudi women from multiple healthcare facilities in Jeddah, Kingdom of Saudi Arabia. The study included 186 women with periodontitis (cases) and 186 women with healthy periodontium (controls). Periodontal health was assessed using the American Academy of Periodontology (AAP) 2017 classification and a validated questionnaire. Secondary objectives concerning periodontal parameters like Clinical attachment loss (CAL), saliva secretion rate, and bone loss were also measured in HRT users compared to non-users. Odds ratios (OR) and logistic regression were used for categorical data analysis, while t-tests and linear regression examined the relationship between numerical variables.

RESULTS: HRT use was significantly associated with a lower prevalence of periodontitis. The odds of having periodontitis were 3.2 times lower in HRT users compared to non-users (OR = 0.31, p < 0.05, 95% CI: 0.11-0.89). After adjusting for medical and demographic variables, HRT users had approximately six times lower odds of having periodontitis (OR = 0.17, p < 0.05, 95% CI: 0.04-0.81). However, HRT use did not significantly impact the severity of periodontitis once the disease was present. When secondary outcomes were measured, HRT usage had a significant association with decreased clinical attachment loss (Coef = -1.13, p < 0.05, 95% CI: (-2.26, -0.02)); however, this significance was lost after adjusting for medical and social variables. HRT usage did not have a significant effect on bone loss and saliva level, which were measured both as categorical and numerical variables.

CONCLUSION & RECOMMENDATIONS: HRT is associated with a lower prevalence of periodontitis but does not affect its severity. While collaborative care between dental and medical professionals is recommended, further research is needed to address study limitations and explore different HRT formulations and their impact on periodontal health.

PMID:40753442 | DOI:10.1186/s12905-025-03757-5

Trials. 2025 Aug 2;26(1):265. doi: 10.1186/s13063-025-08985-6.

ABSTRACT

BACKGROUND: High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden on individuals and their social environment, there are no specific, cost-effective treatments to reduce aggression in BPD. In previous studies, we and others have been able to infer specific biobehavioral mechanisms underlying patterns of reactive aggression in BPD that can be used as potential treatment targets. To address this, we developed a mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets the biobehavioral mechanisms underlying outward-directed aggression in BPD. A previously conducted proof-of-concept study had suggested beneficial effects for this neglected group of patients.

METHODS: In this multicenter, confirmatory, randomized-controlled-clinical-trial, MAAP, which consists of multifaceted, evidence-based treatment elements adapted from other sophisticated treatment programs such as Dialectical Behavior Therapy and Mentalization-Based Treatment, is tested for efficacy against a non-specific supportive psychotherapy (NSSP) program focusing on non-specific general factors of psychotherapy at seven different sites in Germany. Both treatment arms, based on one individual and 13 group therapeutic sessions (1.5 h per session, twice a week), are delivered over a period of 7-10 weeks. A total of N = 186 patients will be recruited, half of whom will be cluster-randomized to MAAP. Outcomes are assessed at baseline, immediately, and 4, 12, 20, and 24 weeks post-treatment using ecological momentary assessment, clinical interviews, questionnaires, and online tasks.

DISCUSSION: If proven superior, MAAP can be incorporated into standard psychiatric care, filling a critical gap in the current therapeutic landscape by offering a structured, cost-effective, and evidence-based treatment that directly targets the biobehavioral mechanisms underlying reactive aggression in BPD. By potentially improving clinical outcomes and reducing the burden of reactive aggression in BPD, MAAP could be beneficial for both individuals and their social environments. The study’s large, multicenter design enhances the generalizability of the results, making them more relevant for broader clinical applications.

TRIAL REGISTRATION: This study was registered in the German Clinical Trials Register DRKS (DRKS00031608) on 31.10.2023 ( https://drks.de/search/de/trial/DRKS00031608 ).

PMID:40753432 | DOI:10.1186/s13063-025-08985-6

BMC Public Health. 2025 Aug 2;25(1):2632. doi: 10.1186/s12889-025-23906-7.

ABSTRACT

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome, characterized by interconnected cardiovascular, renal, and metabolic dysfunctions, poses a growing global health burden. While both light at night (LAN) and air pollutants have independently been linked to adverse health outcomes, their synergistic and joint effects on CKM syndrome risk remain poorly understood. This study aimed to assess the independent, interactive, and joint associations of LAN, air pollutants, and PM_2.5 components with CKM syndrome.

METHODS: Data from 4,361 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015) were analyzed. Cox proportional hazards regression models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CKM syndrome risk. Multiplicative and additive interactions between LAN and air pollutants were assessed using likelihood ratio tests and relative excess risk due to interaction (RERI). Joint effects were evaluated by categorizing exposures into tertiles.

RESULTS: Over a median follow-up of 4.2 years, 792 incident CKM syndrome cases were identified. Adjusted models indicated that higher LAN exposure (highest vs. lowest quartile: HR = 1.46, 95% CI: 1.18-1.80) and increased levels of NO₂ (HR = 1.44, 95% CI: 1.18-1.75), PM_2.5 (HR = 1.49, 95% CI: 1.19-1.87), PM₁₀ (HR = 1.75, 95% CI: 1.40-2.18), NO₃⁻ (HR = 1.42, 95% CI: 1.15-1.75), and NH₄⁺ (HR = 1.42, 95% CI: 1.15-1.75) were independently associated with elevated CKM risk. Significant multiplicative interactions were observed between LAN and all pollutants except O₃, NO₃⁻, and NH₄⁺ (P for interaction < 0.05). In the additive interaction analysis, the RERI values ranged from 0.158 to 0.792, indicating a significant synergistic effect between LAN and air pollutants, which increases the risk of CKM syndrome. Joint exposure analysis showed that the combination of high LAN and high PM₁₀ increased CKM risk by 56.3% (HR = 1.563, 95% CI: 1.092-2.238), while moderate co-exposure to LAN and PM_2.5 elevated risk by 33.4% (HR = 1.334, 95% CI: 0.872-2.041).

CONCLUSION: This study provided evidence that LAN, air pollutants, and PM_2.5 components were positively associated with CKM syndrome, and significant synergistic and joint effects existed, increasing the risk of CKM syndrome in older adults. These results highlighted the urgency of comprehensive environmental intervention measures and emphasized the necessity of incorporating multi-factor joint exposure assessment in future CKM syndrome research.

PMID:40753430 | DOI:10.1186/s12889-025-23906-7

BMC Public Health. 2025 Aug 2;25(1):2631. doi: 10.1186/s12889-025-24016-0.

ABSTRACT

INTRODUCTION: The research aimed to assess the linkages between alcohol propensity and stress and coping styles among Poles during the COVID-19 pandemic. The project also focused on investigating the significance of differences in alcohol propensity, taking into account selected sociodemographic characteristics.

MATERIALS AND METHODS: A total of 1246 people (23.93 ± 2.88 y.o.) participated in the research, including 928 women (23.84 ± 2.89 y.o.) and 318 men (24.21 ± 2.85 y.o.). A self-administered questionnaire, CISS, PSS-10 and AUDIT were used for the study. The statistical procedures used the Pearson correlation coefficient, as well as the Mann-Whitney U test and the Kruskal-Wallis test.

RESULTS: Positive correlations were found between the intensity of stress symptoms and emotional style in female and male groups. Among adults, factors contributed to high-intensity of alcohol propensity included: male gender, childlessness, living in cities of more than 100.000 inhabitants, people with secondary education, lack of a close personal relationship or being in a partnership, as well as a professional situation related to occasional or casual employment.

CONCLUSIONS: Alcohol consumption is associated with an emotion- and avoidant-oriented stress-coping styles. 39% women and 43% men of the surveyed were among those at risk of developing alcohol addiction. It implies that the age group remains one of the social groups most exposed to the development of alcohol use disorders. Such situation requires development of prevention programmes that take into account the needs of young people.

PMID:40753429 | DOI:10.1186/s12889-025-24016-0

BMC Public Health. 2025 Aug 2;25(1):2628. doi: 10.1186/s12889-025-23891-x.

ABSTRACT

BACKGROUND: With rising obesity and hypertension rates, cardiovascular disease and mortality issues have become increasingly severe. The weight-adjusted waist circumference index (WWI) is an innovative metric that accurately reflects body composition and shows superior potential in predicting obesity-related health risks. This study aims to explore the association between WWI and all-cause and cardiovascular mortality in hypertensive patients.

METHODS: Adult participants with hypertension were included from the National Health and Nutrition Examination Survey (2003-2016). Cox regression models and restricted cubic splines (RCSs) were used to assess the relationship between WWI and mortality. Stratified, interaction, and sensitivity analyses further examined the robustness of the results. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of WWI for mortality.

RESULTS: This study included 14,350 hypertensive individuals. As WWI levels increased, the risk of all-cause and cardiovascular mortality rose progressively. Each one-unit increase in WWI was associated with a 19% higher risk of all-cause mortality and a 23% higher chance of cardiovascular mortality in the fully adjusted continuous model. The highest WWI quartile had an increased risk of all-cause mortality (HR 1.38, 95% CI 1.21-1.57, P for trend < 0.001) and cardiovascular mortality (HR 1.70; 95% CI 1.28-2.25, P for trend = 0.005). Furthermore, RCS analysis revealed a nonlinear association between WWI and all-cause mortality (P-non-linear < 0.001). Stratified and interaction analyses confirmed that these associations were consistent and stable in various demographics, except for the diabetic population. Sensitivity analyses further confirmed these results. ROC analysis indicated that WWI had a higher predictive capability for all-cause and cardiovascular mortality than body mass index, waist circumference, and waist-to-height ratio.

CONCLUSION: This study provides new evidence for the association of WWI with all-cause and cardiovascular mortality in hypertensive patients. WWI may serve as a valuable indicator of adiposity risk in this population.

PMID:40753426 | DOI:10.1186/s12889-025-23891-x

BMC Womens Health. 2025 Aug 2;25(1):381. doi: 10.1186/s12905-025-03916-8.

ABSTRACT

OBJECTIVE: To describe the patient cohort accessing a quaternary-level pelvic mesh referral service, identify their requirements and ensure services can meet their needs. To determine areas of future research.

DESIGN: Retrospective and prospective observational study.

SETTING: Quaternary-level pelvic mesh complications service in the U.K.

POPULATION: Women accessing a pelvic mesh complications service over 5 years.

METHODS: All women attending the mesh complication service between 2018 and 2023 were included. Data was collected on referral rates, demographics, mesh complications experienced, management options selected, and post operative complications suffered. Mesh complications were compared against mesh devices and management options chosen.

RESULTS: 785 women were managed in the mesh service over 5 years. Of 765 women with confirmed mesh devices, 92% (n = 707/765) were referred with a painful mesh complication and 54% (n = 416/765) reported pain alone. 58% requested surgical management (n = 403/692). Of 288 who received surgery, 52% (n = 150/288) requested complete mesh excision. The recurrent Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) rate was 66% (n = 141/215) and 23% (3/13) respectively. 18% (n = 51/288) experienced a surgical complication however only 0.7% (2/288) were considered serious.

CONCLUSIONS: This study has identified patients reporting ‘pain alone’ as the commonest patient cohort attending a UK pelvic mesh centre between 2018 and-2023, suggesting that mesh associated pain exerts considerable burden on affected individuals and maybe more prevalent than once thought. This group has the greatest variation in treatment. Further research is required to understand the pathophysiology of mesh related pain to inform effective treatment options.

PMID:40753424 | DOI:10.1186/s12905-025-03916-8