Category: Statistics

BMC Endocr Disord. 2025 Jul 23;25(1):184. doi: 10.1186/s12902-025-02007-x.

ABSTRACT

BACKGROUND: Diabetic retinopathy (DR), a major complication of type 2 diabetes mellitus (T2DM), remains a growing global health concern. This study aimed to evaluate the relationship between systemic inflammatory markers and both the presence and severity of DR. Special attention was given to the pan-immune-inflammation value (PIV), a novel composite index of immune response, whose association with DR remains underexplored.

MATERIALS AND METHODS: A prospective cross-sectional study was conducted involving 310 patients with T2DM, grouped based on the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDR): no DR (NDR, n = 100), non-proliferative DR (NPDR, n = 100), and proliferative DR (PDR, n = 110). Clinical and laboratory data-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-HDL cholesterol ratio (NHR), systemic immune-inflammation index (SII), and PIV-were analyzed. Statistical methods included ANOVA, Kruskal-Wallis, and receiver operating characteristic (ROC) analyses.

RESULTS: PDR patients had significantly elevated NLR (p = 0.005), MLR (p < 0.001), NHR (p = 0.016), C-reactive protein-to-albumin ratio (CAR) (p < 0.001), and PIV (p = 0.002) levels. In NPDR, PLR (p = 0.012) and SII (p = 0.005) were significantly higher than in the other groups. NLR showed the highest predictive performance in ROC analysis (sensitivity: 84.8%), followed by SII (78.1%), PLR (76.2%), and PIV (53.3%).

CONCLUSION: Among patients with T2DM, inflammatory markers-particularly NLR, PLR, SII, and PIV-suggested potential relevance in identifying DR and its progression. PLR and SII may have utility in the early identification of NPDR, while PIV appears to be a potentially valuable inflammatory marker. These cost-effective and easily accessible indices may contribute to the screening and monitoring of DR in clinical settings.

PMID:40702514 | DOI:10.1186/s12902-025-02007-x

J Orthop Surg Res. 2025 Jul 23;20(1):696. doi: 10.1186/s13018-025-06077-4.

ABSTRACT

OBJECTIVE: To systematically evaluate the efficacy and safety of intramedullary nails (IMNs) in tibial-talocalcaneal arthrodesis (TTCA) for treating Charcot neuroarthropathy (CN).

METHODS: A comprehensive search for relevant literature was conducted in the PubMed, Embase, Cochrane Library, Web of Science, Scopus and SinoMed databases, covering studies from 2014 to October 30, 2024. The inclusion criteria were based on the PICOS framework: the study population consisted of CN patients, the intervention was TTCA with IMNs, and the outcomes assessed included bone union rate, complication rate, and limb salvage rate. Statistical analysis was performed using Stata 17.0 software. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and case series. This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42025644983).

RESULTS: A total of seven studies involving 147 patients with a mean follow-up of one year were included. The meta-analysis revealed a combined standardized mean difference (SMD) of -4.99 (95% CI: -6.70 to -3.28) for the AOFAS score, with high heterogeneity (I2 = 90.7%). Sensitivity analyses were conducted to assess the stability of the results. The combined estimate for the bone nonunion rate was 3.3% (95% CI: 0.1% to 8.9%), with moderate heterogeneity (I2 = 33.2%). The combined estimate for the infection rate was 12.9% (95% CI: 2.0% to 29.2%). A comparison of preoperative and postoperative scores showed significant improvements in patients’ function and quality of life, highlighting the critical role of the TTCA procedure in improving prognosis.

CONCLUSION: IMNs in TTCA demonstrate high efficacy for CN, with significant functional improvement, low nonunion rates, and favorable limb salvage outcomes. However, infection risks and heterogeneity across studies highlight the need for standardized protocols and larger controlled trials to optimize patient selection and postoperative management.

PMID:40702500 | DOI:10.1186/s13018-025-06077-4

BMC Res Notes. 2025 Jul 23;18(1):317. doi: 10.1186/s13104-025-07392-z.

ABSTRACT

OBJECTIVE: This study aimed to assess the correlation between pre-operative hospital stay, patient characteristics, clinical variables, and the occurrence of surgical site infections (SSIs) among patients undergoing major surgeries at An-Najah National University Hospital in Palestine. The data presented stem from a dedicated retrospective cohort review and are not part of a larger research project.

RESULTS: Out of 200 surgical patients, 7% developed SSIs. Most participants were male (66%), over 50 years old (48%), and underwent elective surgery (88.5%). Significant factors associated with SSIs included smoking, surgical urgency, wound classification, low pre-operative hemoglobin, blood transfusion, type of surgery, hospital stay duration, and use of pre-operative antibiotics. Specifically, smoking was associated with a higher infection risk (p = 0.02), though it only showed borderline significance in multivariate analysis (adjusted odds ratio 5.49; 95% CI 0.96-31.25; p = 0.06). Wound types and other variables did not retain statistical significance after adjustment. These findings suggest the importance of addressing modifiable factors like smoking and optimizing surgical care pathways to reduce infection risk.

PMID:40702496 | DOI:10.1186/s13104-025-07392-z

BMC Public Health. 2025 Jul 23;25(1):2533. doi: 10.1186/s12889-025-23728-7.

ABSTRACT

BACKGROUND: Individuals adopt particular health-related practices according to what is structurally possible for them. Given that many health-related practices and obesity are patterned by socioeconomic position (SEP) and strongly linked with mortality, they may represent mechanisms through which SEP becomes biologically embedded and influences mortality risk. This study quantified whether and to what extent health-related practices (current/former smoking, physical inactivity, low fruit and vegetable intake, excess alcohol intake) and obesity mediate associations between SEP and all-cause and cancer mortality in a nationally representative cohort of adults in Canada.

METHODS: This was a prospective, population-based cohort study of adults (≥ 35 years; n = 308,635) who participated in the cross-sectional Canadian Community Health Survey. Data from eight survey cycles (2000/2001-2011) were linked to mortality records in the Canadian Mortality Database (2000-2013). Household income adequacy and educational attainment were used to generate a latent variable representing SEP at baseline. Participants also self-reported smoking, physical activity, fruit and vegetable intake, alcohol intake and BMI at baseline. Generalized Structural Equation Modeling was performed to evaluate pathways linking SEP with all-cause and cancer mortality mediated by health-related practices (current/former smoking, physical inactivity, low fruit and vegetable intake, excess alcohol intake) and obesity in males and females.

RESULTS: Health-related practices and obesity did not collectively mediate associations between lower SEP and all-cause or cancer mortality in males or females. However, current/former smoking mediated associations between lower SEP and all-cause (males: HR 1.06, 95% CI 1.01, 1.12; females: HR 0.97, 95% CI 0.95, 0.99) and cancer mortality (males: HR 1.06, 95% CI 1.01, 1.12; females: HR 0.97, 95% CI 0.95, 0.99) in males and females, and physical inactivity mediated associations between lower SEP and all-cause mortality in females (HR 1.12, 95% CI: 1.03, 1.21). Low fruit and vegetable intake, excess alcohol intake and obesity did not mediate associations between lower SEP and mortality.

CONCLUSIONS: Smoking and physical activity may represent mechanisms through which SEP becomes biologically embedded and shapes the risk of mortality among adults in Canada. However, most of the associations between SEP and mortality remained unexplained; thus, additional studies are needed to understand other pathways of biological embedding.

PMID:40702492 | DOI:10.1186/s12889-025-23728-7

Parasit Vectors. 2025 Jul 23;18(1):293. doi: 10.1186/s13071-025-06870-4.

ABSTRACT

BACKGROUND: Hepatozoon spp. are apicomplexan parasites with a heteroxenous life cycles, involving vertebrate intermediate hosts and invertebrate definitive hosts. These parasites infect a wide variety of wild and domestic vertebrates causing subclinical infection or mild-to-severe clinical manifestations, depending on the parasite species and vertebrate host. Interestingly, each Hepatozoon spp. have a specific host range, suggesting a close host-parasite coevolutionary relationship.

METHODS: Hepatozoon sequences deposited between 2013 and 2023 were mined from GenBank to test which was the most employed marker for this parasite. We reconstructed the host and parasite phylogenies using 18S rDNA and cytB sequences, respectively. Subsequent analyses were stratified according to host vertebrate orders (Carnivora, Rodentia, and Squamata), and the corresponding sequences of their Hepatozoon parasites. Then, Procrustean Approach to Cophylogeny (PACo) and ParaFit were employed to assess their global cophylogenetic relationships. In addition, eMPRess was used to estimate the most probable co-evolutionary events, such as host switch, duplication, sorting, or cospeciation, accounting for the shared evolutionary history of Hepatozoon spp. and their vertebrate hosts.

RESULTS: Global assessments of congruence between phylogenies of carnivore, rodent, and squamate hosts and those of their Hepatozoon parasites were significant (PACo: all m²_XY < 0.655, all P < 0.001; ParaFit: all ParaFitGlobal Statistics < 72.992, all P < 0.007, all Procrustes R² > 0.25), but not for the association between Hepatozoon spp. and invertebrates (PACo m²_XY = 0.632, P < 0.001; ParaFitGlobal Statistic = 8.810, P = 0.124, R² = 0.37). The most significant links occurred between Hepatozoon felis and felid hosts or Hepatozoon canis and canid hosts, but not between Hepatozoon americanum and domestic dogs or coyotes. Moreover, eMPRess showed that the coevolutionary history between Hepatozoon spp. and vertebrate host phylogenies was mainly explained by host switching and less frequently by cospeciation events.

CONCLUSIONS: These findings highlight the ability of Hepatozoon spp. associated to certain vertebrate orders to infect those with a close phylogenetic relationship. This in turn helps to understand how hepatozoonosis can emerge in susceptible hosts within specific geographical areas by spillover events.

PMID:40702483 | DOI:10.1186/s13071-025-06870-4

BMC Med Educ. 2025 Jul 23;25(1):1101. doi: 10.1186/s12909-025-07691-w.

ABSTRACT

BACKGROUND: Developing critical thinking, research, and presentation skills is essential for healthcare professionals. Structured educational activities, such as Journal Clubs, provide valuable opportunities to enhance these competencies. These skills are particularly important in preparing for future pharmacists and providing them with up-to-date information. This study evaluates the learning outcomes, perceptions, and feedback of undergraduate pharmacy students participating in a Journal Club activity, focusing on differences between 3rd and 5th -year students.

METHODS: This cross-sectional study involved 207 undergraduate pharmacy students from the 3rd and 5th years at Umm Al-Qura University, Makkah, Saudi Arabia. Students were paired, provided with structured guidelines, and tasked with analyzing and presenting research articles. Emphasis was placed on research related to the topics covered in the pharmacology or hospital pharmacy courses the students were taking in that semester. Data was collected via a validated survey covering general experience, learning outcomes, perceptions, and feedback. Statistical analyses included Fisher’s Exact Test, Wilcoxon rank-sum tests, and Cronbach’s alpha, using RStudio (version 2024.9.1.394, Boston, MA, USA) with R version 4.4.2.

RESULTS: A majority (89.4%) reported acquiring new knowledge, and 77.7% noted increased confidence in critically evaluating research. Fifth-year students reported higher critical thinking (58.4% vs. 42.3%, p = 0.031) and presentation skills (72.7% vs. 50.8%, p = 0.002). Strong correlations were observed between learning outcomes and perceptions (R = 0.743, p < 0.001).

CONCLUSION: The Journal Club effectively promoted critical thinking, research, and presentation skills. Differences between academic years highlight the need to adapt activities to student levels.

PMID:40702482 | DOI:10.1186/s12909-025-07691-w

BMC Health Serv Res. 2025 Jul 23;25(1):971. doi: 10.1186/s12913-025-12980-7.

ABSTRACT

INTRODUCTION: Patient satisfaction reflects the discrepancy between anticipated and actual healthcare service delivery, serving as a pivotal metric for strategic healthcare decision-making. This systematic review and meta-analysis aimed to assess the magnitude of patient satisfaction with pharmacy services and its determinants in Ethiopia.

METHODS: A systematic search was performed across multiple electronic databases, including PubMed, Hinari, Semantic Scholar, EMBASE, Scopus, Web of Science, and Google Scholar, to identify both published and unpublished relevant studies. Methodological quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) critical appraisal tools and in accordance with the PRISMA 2020 guidelines. Statistical analyses were conducted using Stata version 17.

RESULTS: In total, 19 articles were included in the qualitative synthesis, of which 11 were selected for the quantitative analysis. The pooled prevalence of patient satisfaction with pharmacy services in Ethiopia was 56% (95% CI: 50-62), with significant associations observed with sociodemographic, socioeconomic, provider communication, and healthcare facility-related factors.

CONCLUSION: Approximately 40% of patients expressed dissatisfaction with pharmacy services, underscoring significant systemic deficiencies. To improve healthcare quality, policymakers and healthcare administrators should prioritize the optimization of pharmacy service delivery by implementing evidence-based interventions targeting the key contributing factors identified in this study.

PMID:40702479 | DOI:10.1186/s12913-025-12980-7

BMC Public Health. 2025 Jul 23;25(1):2526. doi: 10.1186/s12889-025-23686-0.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has exposed the vulnerabilities of lower-income countries due to limited healthcare infrastructure and socioeconomic constraints, highlighting the need for effective containment measures that minimize socioeconomic costs and prepare for future pandemics alike, which are expected to become more frequent. Although prior studies have examined various strategies in these regions, a significant gap remains in quantitative research on affordable measures to combat the highly transmissible SARS-CoV-2 Omicron variant, which greatly challenges effective measures for previous strains. Studies on targeted containment measures for Omicron have dramatically declined even in higher-income regions, and their findings could be much less applicable in lower-income regions due to substantial socioeconomic disparities.

METHODS: This study addresses this gap by focusing on South Africa. A spatial Susceptible-Exposed-Infected-Recovered (SEIR) model was developed to simulate the virus spread during the country’s first Omicron wave from November 2021 to April 2022, integrating multisource statistics to overcome the typical scarcity of inter-city mobility data in lower-income countries. Three affordable containment measures were examined: (1) restricting inter-city mobility in epicenter provinces, while allowing nationwide intra-city movement for livelihood activities; (2) home isolation for positive cases, alongside quarantine for co-residents, accounting for high rates of asymptomatic cases, underreporting, and delays of self-isolation; and (3) prioritizing booster vaccinations for high-risk healthcare workers.

RESULTS: The findings indicate that restricting inter-city mobility in the epicenter Gauteng, which only accounted for 3.6% of national mobility, could reduce national infections by 15.0%. Quarantining households with positive cases could reduce infections by 10.9%, despite the high rates of asymptomatic cases and presymptomatic transmission. Prioritizing booster vaccinations was also effective when healthcare workers had a much higher infection risk than others. Meanwhile, these measures incurred minimal socioeconomic costs compared to earlier pandemic strategies. Additionally, the spatial variation of containment measure effectiveness suggests that timely implementation of these measures before the infection rate escalates is critical for ensuring their effectiveness.

CONCLUSIONS: This research provides essential insights for lower-income countries to manage current and future pandemics within their economic and healthcare constraints, especially regarding targeted mobility restriction, quarantine, prioritized vaccination, and timing of containment measures.

PMID:40702473 | DOI:10.1186/s12889-025-23686-0

BMC Nurs. 2025 Jul 23;24(1):965. doi: 10.1186/s12912-025-03636-2.

ABSTRACT

BACKGROUND: Community-based nursing today faces significant challenges regarding the future supply of healthcare professionals such as registered nurses. This may be due to numerous challenges, such as registered nurses being principally responsible for coordinating care and aligning with the transition to integrated person-centred care, which affects the work environment in community-based nursing. The work environment also affects career advancement prospects, personal motivations, and the desire to make a meaningful contribution to the quality of care. It is, therefore, essential to shed light on registered nurses’ experiences of their working situation within community-based nursing to identify factors that can create a better working situation.

AIM: To describe registered nurses’ experiences of the work situation in Swedish community-based nursing.

METHOD: The study employed a mixed-methods design. Data were collected through (a) a quantitative sample and (b) a qualitative sample of free-text answers to open-ended questions in the questionnaire. The quantitative material was analysed through descriptive statistics, and the qualitative material was analysed with deductive direct content analysis based on the Fundamental of Care framework’s three dimensions.

RESULTS: The overall experience in community-based nursing was that the registered nurse’s work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship, the integration of care and the context of care.

CONCLUSION: Registered nurses’ work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship with both the person being cared for and their next of kin. In comparison with continuity, good personal knowledge and presence are promoting factors to good caring relationships. The establishment of a care relationship, satisfying basic care and creating organisational conditions take place in collaboration and are the foundations for being able to work person-centred, which also are elements described in the Fundamental of Care framework.

PMID:40702471 | DOI:10.1186/s12912-025-03636-2

BMC Nurs. 2025 Jul 23;24(1):966. doi: 10.1186/s12912-025-03632-6.

ABSTRACT

BACKGROUND: Missed nursing care (MNC) has compromised the quality of care provided, and patient safety and well-being. Given that internal aspects of nurses, such as personality traits and decision-making processes, influence the provision of care, this study aims to analyze the influence of nurses’ personality traits and decision-making on MNC.

METHODS: Quantitative cross-sectional descriptive-correlational study. A convenience sample of 296 nurses completed a questionnaire developed for this study consisting of the European Portuguese versions of the MISSCARE Survey, the Nursing Decision-Making Instrument (NDMI-PT), and the Ten-Item Personality Inventory (TIPI-P). Structural equation modeling was used to analyze the association between MNC, MNC-related factors, and nurses’ decision-making and personality traits.

RESULTS: A positive and statistically significant correlation was found between nurses’ personality traits and MNC-related factors and MNC (β = 0.14; p = 0.03; β = 0.27; p = 0.001, respectively). A negative, statistically significant correlation was found between nurses’ decision-making and MNC (β = -0.16; p = 0.03).

CONCLUSIONS: Given the direct influence of nurses’ personality traits and decision-making on MNC, nurse managers should implement training programs to promote personal and professional development, thus ensuring the quality of nursing care.

PMID:40702465 | DOI:10.1186/s12912-025-03632-6