Category: Statistics

Cureus. 2026 Mar 23;18(3):e105704. doi: 10.7759/cureus.105704. eCollection 2026 Mar.

ABSTRACT

Background Discharge against medical advice (DAMA) is a significant global healthcare challenge, occurring when a patient or caregiver, in pediatric cases, leaves the hospital against medical recommendations. DAMA can lead to adverse health outcomes, increased hospital readmissions, and strain on healthcare resources. This study examines the characteristics of DAMA in emergency departments (EDs) at Madinah hospitals in Saudi Arabia and explores its distribution according to demographic factors. Methodology A retrospective cross-sectional study was conducted using secondary quantitative data from hospital records at King Fahad Hospital and King Salman Bin Abdulaziz Medical City in Madinah, Saudi Arabia. Ethical approval was obtained, and descriptive statistical analyses were performed to assess demographic trends and reasons for DAMA. Results Starting from January to December 2022, a total of 1,120 DAMA cases were recorded. The highest proportion of cases was observed among middle-aged adults (30-49 years), with males accounting for 57.5% (n = 645) of cases. DAMA was more frequent on weekdays, peaking on Sundays, and most cases occurred in the afternoon and night shifts. A large proportion of patients (59.1%, n = 663) did not provide a reason for DAMA, while 28.7% (n = 322) refused admission, 4.6% (n = 52) cited long wait times, 1.7% (n = 20) had financial constraints, and 2.5% (n = 29) left after feeling better. Conclusion DAMA remains a critical concern in Saudi Arabian EDs, with a higher proportion of recorded cases among males and middle-aged adults. Contributing factors include refusal of medical care, long wait times, financial limitations, and perceived early recovery. The high prevalence of DAMA during peak hours suggests systemic challenges in hospital resource management. Addressing these issues requires improved patient education, streamlined hospital processes, and enhanced communication strategies to reduce DAMA rates and improve patient outcomes.

PMID:42028538 | PMC:PMC13102265 | DOI:10.7759/cureus.105704

Cureus. 2026 Mar 23;18(3):e105702. doi: 10.7759/cureus.105702. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Fishing is a physically demanding occupation involving repetitive movements, heavy lifting, prolonged standing, and unstable working conditions, predisposing workers to work-related musculoskeletal disorders (WMSDs). Community-based evidence from traditional fishing populations in Tamil Nadu is limited.

METHODS: A community-based cross-sectional study was conducted among 125 fishermen aged ≥18 years engaged in fishing for at least one year. Participants were selected through simple random sampling. Data were collected using a pretested structured questionnaire, and musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire. Descriptive statistics were computed, and associations were analyzed using the chi-squared test with statistical significance set at p≤0.05.

RESULTS: The majority of participants were male (76.8%) and aged ≥40 years (60%), with most having >10 years of fishing experience (80.8%) and working >8 hours per day (68.8%). Musculoskeletal pain was highly prevalent, particularly in the lower back (83.2%), shoulders (73.6%), and knees (70.4%) over the past 12 months. Longer working hours (>8 hours/day) and greater duration of fishing (>10 years) were significantly associated with increased prevalence of musculoskeletal pain, especially in the lower back and knees. Male participants also reported significantly higher prevalence of shoulder and lower back pain.

CONCLUSION: Musculoskeletal disorders are highly prevalent among fishermen in Pulicat, predominantly affecting the lower back, shoulders, and knees. Prolonged working hours and extended occupational exposure are key associated factors. These findings highlight the need for targeted ergonomic interventions, structured occupational health education, and inclusion of fisherfolk in occupational health and social protection programs to mitigate the burden of musculoskeletal morbidity and improve overall work capacity.

PMID:42028532 | PMC:PMC13101749 | DOI:10.7759/cureus.105702

Cureus. 2026 Mar 23;18(3):e105714. doi: 10.7759/cureus.105714. eCollection 2026 Mar.

ABSTRACT

The deep inferior epigastric perforator (DIEP) free flap is the gold standard for autologous breast reconstruction. We identified a knowledge gap among dressing clinic nurses in a unit establishing a DIEP reconstruction service. A quality improvement project was undertaken to deliver a structured educational programme for nursing staff involved in postoperative follow-up of these patients. The intervention comprised formal teaching, dissemination of standardised care pathways, case-based discussions, and opportunities for theatre observation. Thirty-seven participants completed pre- and post-intervention questionnaires assessing self-reported confidence and knowledge across five domains, with additional qualitative feedback. Baseline confidence varied, particularly regarding flap assessment, recognition of complications, and patient counselling. Following the intervention, there was a statistically significant improvement in confidence across all five domains (p<0.001). Nearly all participants (97%) recommended the teaching programme. Qualitative feedback highlighted an improved understanding of flap anatomy, enhanced confidence in escalation of concerns, and greater engagement within the multidisciplinary team. Theatre observation was reported as particularly impactful. Our structured educational intervention significantly improved dressing clinic nurses’ confidence and perceived competence in managing patients following DIEP reconstruction. This approach offers a practical framework to support safe service development and multidisciplinary integration when introducing new microsurgical services.

PMID:42028516 | PMC:PMC13102268 | DOI:10.7759/cureus.105714

Cureus. 2026 Mar 23;18(3):e105677. doi: 10.7759/cureus.105677. eCollection 2026 Mar.

ABSTRACT

Introduction Implantation of a permanent cardiac pacemaker (PPM) is critical for managing rhythm disorders and prolonging survival. Beyond clinical outcomes, implantation can affect patients’ quality of life (QoL), encompassing physical and mental dimensions. The present study aimed to evaluate QoL among patients undergoing PPM implantation, both before implantation and at 6 and 12 months post-implantation, as well as the associated perspectives and behaviors after 6 and 12 months. Methods In the present study, 112 patients undergoing PPM implantation were enrolled at a public hospital in Athens between 2023 and 2025. Participants were selected by the method of convenience sampling. Data collection was performed using the 36-Item Short Form Health Survey (SF-36). Scores for the Physical Component Summary (PCS) and the Mental Component Summary (MCS) were calculated using QoL scores that range from 0 to 100, with higher scores indicating higher QoL. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05. Results The PCS presented a mean of 36.2 ± 4.6, and the MCS a mean of 40.9 ± 13.5 before implantation. Post-implantation at 6 and 12 months, the mean PCS score was 34.7 ± 4.9 and 35.3 ± 4.3, respectively, while the mean MCS score was 55.6 ± 8.3 and 59.3 ± 7.7, respectively. Better PCS at 6 and 12 months was associated with adherence to regular follow-up (p = 0.013 and p = 0.027), antiarrhythmic therapy (p = 0.004 and p = 0.041), assistance at home (p = 0.026 and p = 0.012), and being physically active (p = 0.022 and p = 0.004). Better MCS at 6 and 12 months was associated with anxiety about rhythm disorders (p = 0.013 and p = 0.016), participation in social activities (p = 0.001 and p = 0.001), assistance at home (p = 0.001 and p = 0.019), and being physically active (p = 0.001 and p = 0.001). Conclusion Assessing both QoL and patients’ perspectives before and after PPM implantation provides valuable insights into the real-world impact of this therapy and informs patient-centered care.

PMID:42028515 | PMC:PMC13100549 | DOI:10.7759/cureus.105677

Cureus. 2026 Mar 23;18(3):e105691. doi: 10.7759/cureus.105691. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: Adult traumatic brachial plexus injury (BPI) is a severe peripheral nerve injury that frequently results in significant upper limb disability in young individuals. The epidemiology varies with different geographical locations. This study aimed to analyze the demographic profile, mechanisms of injury, injury severity patterns, referral timelines, and reconstructive burden of adult traumatic BPI in a tertiary care institution of northern India.

METHODS: A retrospective observational study was conducted at the All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India, over a two-year period. Adult patients (≥18 years) with clinically and radiologically confirmed traumatic BPI were included. Cases of obstetric and iatrogenic brachial plexus injury were excluded. Data regarding age, sex, mechanism of injury, level and severity of plexus involvement, time to presentation, associated injuries, and management modality were collected. Descriptive statistical analysis was performed.

RESULTS: Seventy-five adult patients were included, with a mean age of 29.1 years; 69 (92%) were male. Road traffic accidents were the predominant cause, with two-wheeler accidents accounting for 78.7% of cases. Complete C5-T1 involvement was observed in 59 patients (78.7%). Forty-five patients (60%) presented more than six months after injury. At the time of analysis, 51 patients (68%) had undergone surgical intervention, including primary nerve transfer and secondary reconstructive procedures, while 24 (32%) had not undergone operative treatment.

CONCLUSION: Adult traumatic BPI in this semi-urban North Indian cohort was predominantly associated with high-energy two-wheeler accidents and a high proportion of complete plexus injuries, with frequent delayed presentation. These findings highlight the substantial reconstructive demand in tertiary centers and underscore the need for improved referral pathways and trauma prevention strategies.

PMID:42028511 | PMC:PMC13101400 | DOI:10.7759/cureus.105691

Cureus. 2026 Mar 23;18(3):e105712. doi: 10.7759/cureus.105712. eCollection 2026 Mar.

ABSTRACT

Objective The purpose of this investigation was to identify the mortality rate at three months and one year for patients 65 years old or older with a nonoperatively managed pelvic ring fracture. Materials and methods A retrospective comparative cohort study was performed at a single level 1 trauma tertiary referral center. From 2014 to 2019, we reviewed all patients older than 65 years who underwent nonoperative treatment for a pelvic ring fracture (Current Procedural Terminology codes 27193 or 27197). Demographics, including age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), were recorded. Mortality status and death dates were determined from our institutional electronic health record and cross-referenced with the TriNetX database (Cambridge, MA, USA). The primary outcome was the standardized mortality ratio (SMR) for one-year mortality, calculated by comparing observed deaths in the study population with expected deaths in the age- and sex-matched general population. Secondary outcomes included three-month and one-year mortality rates, as well as demographic variables associated with mortality. Results A total of 307 patients met the inclusion criteria. There were 41 (13.4%) that died within three months and 77 (25.1%) that died within 1 year. Compared to the general population, pelvic ring fracture patients demonstrated an SMR of 3.12 (95% confidence interval: 2.46, 3.85) for one-year mortality. Compared with patients alive at three months post-injury, deceased patients did not differ significantly in age (80.9 ± 8.6 vs. 81.0 ± 9.7 years; p = 0.964), BMI (24.3 ± 5.2 vs. 25.9 ± 5.9; p = 0.062), or sex (p = 0.507). Alive patients had a lower mean CCI compared to deceased patients (5.4 ± 2.1 vs. 6.8 ± 2.8; p < 0.001). At one year, deceased patients did not demonstrate statistically significant age differences (80.5 ± 8.5 vs. 82.4 ± 9.5 years; p = 0.103), BMI (24.5 ± 5.3 vs. 24.5 ± 5.5; p = 0.922), or sex (p = 0.835), and alive patients had a lower mean CCI (5.2 ± 2.0 vs. 6.6 ± 2.6; p < 0.001). Conclusions Geriatric patients who undergo nonoperative treatment of pelvic ring fractures have a threefold higher one-year mortality compared to their age- and sex-matched peers who do not have pelvic ring fractures. There is an association between mortality and higher comorbidity burden, and clinicians should counsel patients on the elevated risk of post-injury mortality based on comorbidity status. This has implications for counseling patients and their families, as such an approach may inform surgical decision-making and ensure that treatment plans are tailored to the patient’s overall health and prognosis.

PMID:42028491 | PMC:PMC13102135 | DOI:10.7759/cureus.105712

BMC Glob Public Health. 2026 Apr 24;4(1):39. doi: 10.1186/s44263-026-00270-1.

ABSTRACT

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection is a lifelong sexually transmitted infection with substantial disease and economic burdens. Despite its global impact, key features of its transmission dynamics-including sex-specific biological susceptibility (the inherent likelihood of acquiring infection upon exposure, independent of behavioral factors) and sexual mixing patterns (how individuals form sexual partnerships across age and risk groups)-remain poorly quantified.

METHODS: A population-level mathematical model of HSV-2 transmission dynamics was applied to heterosexual transmission in the USA and calibrated to nationally representative data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 1988 and 2016. Bayesian inference was used to estimate: (1) relative biological susceptibility of women compared to men, (2) degree of assortativity in age group mixing, and (3) degree of assortativity in sexual risk behavior group mixing. Assortativity reflects the tendency of individuals to form partnerships with others who share similar characteristics, such as age or level of sexual risk behavior, and was quantified on a scale from 0 (no preferential mixing) to 1 (exclusive within-group mixing).

RESULTS: The model demonstrated robust fits to sex-specific, age-specific, and temporal trends in HSV-2 prevalence across NHANES rounds, supporting the validity of the inferred transmission dynamics. Women were estimated to be 7.12 times (95% credible interval (Crl) 4.36-10.17) more biologically susceptible to HSV-2 infection than men, indicating a substantially higher likelihood of acquiring infection upon exposure. The degree of assortativity in age group mixing was high at 0.83 (95% Crl 0.75-0.88), indicating that most transmission occurs between individuals of similar age. In contrast, assortativity in sexual risk behavior group mixing was moderate at 0.49 (95% Crl 0.43-0.55), indicating that transmission frequently occurs across different risk groups rather than being confined within the same group.

CONCLUSIONS: Women are much more biologically susceptible to HSV-2 infection than men. HSV-2 transmission mostly occurs within similar age groups but often crosses different sexual risk groups, reflecting strong age-assortative and moderate risk-assortative mixing patterns.

PMID:42026694 | DOI:10.1186/s44263-026-00270-1

Pilot Feasibility Stud. 2026 Apr 24. doi: 10.1186/s40814-026-01826-6. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar spinal stenosis is characterized by walking limitations that often lead to physical inactivity and potentially associated health risks. This trial aimed to examine whether a person-centered digital program targeting physical activity (Get Back feasibility) was feasible and whether it contributed to clinically meaningful improvements in intervention outcomes among patients with LSS who were undergoing surgery.

METHODS: A two-arm randomized feasibility trial included physically inactive patients ≥ 18 years with central lumbar spinal stenosis scheduled for decompression surgery. The participants were randomized to Get Back or usual physical therapy. The 12-week intervention comprised person-centered support for behavioral changes in physical activity through video and telephone calls with a physical therapist. The feasibility outcomes included process feasibility, resource feasibility, and treatment fidelity, based on data from screening lists, study-specific questions, patient-reported outcome measures, and semi-structured interviews. The outcomes related to the intervention content included objectively assessed steps per day and physical activity, as well as self-reported fear of movement, pain catastrophizing, and general self-efficacy. Process and resource feasibility, as well as tentative changes in post-intervention outcomes, were assessed and reported using descriptive statistics. The temporal relationships of variables during the intervention were analyzed exploratively using cross-lagged correlations. Treatment fidelity, including treatment dose and adherence to the person-centered approach, was evaluated using descriptive statistics and a mixed-methods approach, respectively.

RESULTS: Of the 226 screened patients, 43% (n = 98) fulfilled the screening criteria. Of those, 67 were asked to participate, and 29 were randomized. The most common reason for declining participation was not wanting a digital intervention. The participants found the video format and outcome measures relevant and useful. The response rates were high (92-100%), except for the accelerometer follow-up (76%). The planned primary outcome for the future randomized controlled trial, steps per day, showed tentative between-group differences in favor of the intervention group. In both groups, fear of movement and pain catastrophizing decreased. The intervention participants attended four video sessions and a median of four telephone sessions (3-5). The physical therapists performed the intervention as planned, with fidelity to the person-centered approach, and behavior-change techniques were used.

CONCLUSIONS: Get Back was feasible for patients with lumbar spinal stenosis who were receiving decompression surgery, with some modifications to strengthen the overall study procedure and intervention before proceeding to a full-scale randomized controlled trial.

TRIAL REGISTRATION: Registered at ClinicalTrials.gov, 04/08/2023, registration no. NCT05806593.

PMID:42026690 | DOI:10.1186/s40814-026-01826-6

Microbiologyopen. 2026 Apr;15(2):e70298. doi: 10.1002/mbo3.70298.

ABSTRACT

The oral cavity may act as a reservoir for antibiotic resistance. This study aimed to directly isolate and identify phenotypically resistant bacteria from the oral biofilm of healthy individuals and patients with periodontitis, using tetracycline, and ciprofloxacin containing selective agar. Furthermore, resistance of selected bacteria towards ampicillin was also evaluated. Plaque samples were collected from 12 patients (six healthy, six with periodontitis). Bacteria were cultured on selective agar containg defined antibiotic concentration and non-selective media under aerobic and anaerobic conditions, identified by MALDI-TOF mass spectrometry and 16S rDNA sequencing. The selected bacteria were subsequently tested for susceptibility using disk diffusion, E-test, and β-lactamase assay. 495 strains representing 106 species were isolated, including 54 aerobes/facultative anaerobes and 52 obligate anaerobes. Antibiotic resistance was observed in all subjects: 15.2% of isolates were resistant to tetracycline, 32.9% to ciprofloxacin, and 0.6% to ampicillin, with no significant differences between healthy and periodontitis groups. Tetracycline resistance was most frequent in the Streptococcus mitis group and Eubacterium spp., while ciprofloxacin resistance was dominated by Actinomyces-Schaalia group. Concluding, prevalence of antibiotic-resistance was comparable between healthy and periodontitis patients. Resistance was most prevalent against ciprofloxacin and tetracycline, highlighting the oral cavity as a relevant reservoir for antibiotic resistance.

PMID:42026669 | DOI:10.1002/mbo3.70298

Mob DNA. 2026 Apr 23. doi: 10.1186/s13100-026-00400-4. Online ahead of print.

NO ABSTRACT

PMID:42026652 | DOI:10.1186/s13100-026-00400-4