Category: Statistics

BMC Med Educ. 2025 Apr 24;25(1):602. doi: 10.1186/s12909-025-07192-w.

ABSTRACT

BACKGROUND: The advancement of science and technology has significantly impacted nursing, emphasizing the importance of professional attitudes and caring behaviors. While previous studies have examined this relationship, limited research has considered the specific educational and sociocultural context of Iranian nursing students. This study addresses this gap by investigating how these factors shape professional attitudes and caring behaviors in an Iranian nursing education setting.

METHODS: Conducted at Tehran University of Medical Sciences in June 2024, the study involved 291 nursing students from their second to fourth years, selected through proportional random sampling. Data were gathered using the Professional Attitude for Student Nurses (IPASN) and Caring Behavior Inventory (CBI) instruments. Descriptive statistics, Pearson correlation, and multiple linear regression analyses were performed using Stata version 14.

RESULTS: A weak but statistically significant positive correlation was found between overall IPASN and CBI scores (r = 0.29, p < 0.01). Multiple regression analysis identified professional attitude (β = 0.257, p < 0.001) and satisfaction with nursing (β = 0.136, p = 0.017) as significant predictors of caring behaviors.

CONCLUSIONS: Enhancing professional attitudes and satisfaction in nursing can improve caring behaviors, highlighting the need for targeted educational interventions and organizational changes.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40275295 | DOI:10.1186/s12909-025-07192-w

Clinics (Sao Paulo). 2025 Apr 23;80:100642. doi: 10.1016/j.clinsp.2025.100642. Online ahead of print.

ABSTRACT

SARS-CoV-2 presents a hyperinflammatory scenario due to systemic inflammatory response syndrome with intense cytokine release, with consequent extrapulmonary involvement in 20 % of patients. The authors studied whether COVID-19 intestinal damage is a direct action of the virus on intestinal epithelial cells, with damage mainly at the tight junction. This is a retrospective observational study in a tertiary hospital emergency department. The authors studied 87 patients (46 patients over 61 years and 41 patients under 60 years old) with severe SARS-CoV-2 infection. The authors measured two plasma markers, LPS-Binding Protein (LBP) and ileal Fatty Acid-Binding Protein (iFABP). Furthermore, the authors evaluated the interaction between the two markers. TNF-α and IL-1 β were higher in bacterial co-infected patients and TNF-α was also higher in the older patients. Plasma iFABP levels were not statistically different in patients with bacterial co-infection; however, higher levels were found in the older population. Plasma LBP levels were higher in patients with bacterial co-infection when compared to patients without infection; however, when comparing plasma LBP levels in the older population with younger patients, no differences could be found. LBP, FABP, and cytokines can discriminate between bacterially infected patients and also discriminate elderly patients. The present study suggests that intestinal barrier dysfunction in SARS-CoV-2 infections is mainly due to damage to the intestinal tight junction complex with a disproportionately lower damage to enterocyte. In the older population, the authors also observed an increase in intestinal epithelial damage.

PMID:40273498 | DOI:10.1016/j.clinsp.2025.100642

Clinics (Sao Paulo). 2025 Apr 23;80:100605. doi: 10.1016/j.clinsp.2025.100605. Online ahead of print.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has a significant impact on the physical and mental health of people around the world. Parkinson’s patients need to visit hospitals regularly to evaluate and adjust the dosage of drugs. Studies have shown that anxiety, exacerbated by existing conditions ‒ including the challenges posed by the COVID-19 pandemic ‒ can aggravate the symptoms of Parkinson’s disease. This study aims to assess the impact of the quarantine period on the severity of movement symptoms, quality of life, non-motor symptoms, and the relationship with sex, education level, and age in patients with Parkinson’s disease.

METHODS: This descriptive cross-sectional study includes 200 patients with Parkinson’s disease who were treated in Bu Ali Hospital from April 2019 to the end of 2021. Primary data was collected using the patients’ files, which included information on age, gender, education level, medications and dosage, duration of Parkinson’s disease, the severity of the disease was evaluated based on the Hohen and Yehr (H&Y) criteria, and Quality of Life (QOL) and the impact of the quarantine period on their illness and quality of life has been collected through the Parkinson’s Disease Questionnaire (PDQ-39) questionnaire. The collected data were analyzed using SPSS software, descriptive statistics, t-test, and analysis of variance.

RESULTS: The quarantine period has a significant effect on the severity of Parkinson’s disease and quality of life. The mean severity of the disease increased from 2.85 before quarantine to 3.30 during quarantine (p < 0.05), indicating an increase in motor symptoms. Similarly, quality of life scores in all dimensions decreased from 62.8 before quarantine to 48.2 during quarantine (p < 0.05), indicating a decrease in quality of life. Pearson’s correlation test was used to investigate the relationship between age and the change in patients’ quality of life and the change in disease severity (p < 0.05).

CONCLUSION: The quarantine period due to the COVID-19 epidemic has had a significant impact on the severity of Parkinson’s disease and the quality of life of patients. The findings of this study indicate the need to develop strategies to provide better health care, social support, and physical activity for patients with Parkinson’s disease during quarantine and the pandemic.

PMID:40273495 | DOI:10.1016/j.clinsp.2025.100605

Clinics (Sao Paulo). 2025 Apr 23;80:100630. doi: 10.1016/j.clinsp.2025.100630. Online ahead of print.

ABSTRACT

OBJECTIVES: To systematically evaluate the efficacy and superiority of glucocorticoids in the treatment of severe pneumonia.

METHOD: Randomized Controlled Trials (RCTs) on glucocorticoids in the treatment of severe pneumonia were retrieved from CNKI, CBM, China Science and Technology Journal Database (VIP), Wanfang Database, and PubMed as of January 1, 2017. The literature was independently and objectively screened, extracted, and evaluated by two researchers, and a meta-analysis of the extracted data was performed using Revman 5.3 software.

RESULTS: Ten studies that met the inclusion criteria were included, with a cumulative total of 1120 cases. The meta-analysis results confirmed that the observation group was superior to the control group in terms of efficacy rate, temperature recovery time, cough relief time, rale disappearance time, and serum CRP level. There was no statistically significant difference in terms of the incidence of adverse reactions, mortality rate, and reinfection rate between the two groups.

CONCLUSIONS: Glucocorticoids showed an obvious clinical efficacy in patients with severe pneumonia. However, due to the small number of included studies and the ambiguity of numerous bias risk assessments, high-quality and large-sample RCTs are still needed to provide corroborating evidence.

PMID:40273494 | DOI:10.1016/j.clinsp.2025.100630

Clinics (Sao Paulo). 2025 Apr 23;80:100654. doi: 10.1016/j.clinsp.2025.100654. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of Omega-3 Fatty Acids (ω-3 PUFAs) on endometriosis.

DESIGN: The authors conducted a comprehensive search of the PubMed, Embase, Cochrane Library and Web of Science databases, focusing exclusively on Randomised Controlled Trials (RCTs) to study the impact of ω-3 PUFAs on endometriosis. The included studies were assessed for methodological quality using the Cochrane bias risk assessment tool and analyzed using data analysis software.

RESULTS: The search yielded five RCTs conducted between the database’s inception and July 2023, with a total sample size of 424 patients with endometriosis. The meta-analysis results showed no statistically significant effects of ω-3 Polyunsaturated Fatty Acids (PUFAs) on pain (Mean Difference [MD = -0.387], 95 % Confidence Interval [95 % CI -1.742-0.967], I² = 93.3 %, z = 0.56, p = 0.575), sexual activity (MD = 0.143, 95 % CI -0.210-0.497, I² = 0 %, z = 0.79, p = 0.427), pain intervention (MD = -0.216, 95 % CI -0.717-0.285, I² = 0.0 %, z = 0.84, p = 0.399), catastrophic thinking (MD = 0.158, 95 % CI -0.315-0.632, I² = 0.0 %, z = 0.66, p = 0.512) and the 12-item short form health survey (MD = 0.001, 95 % CI -0.053-0.503, I² = 0.0 %, z = 0.00, p = 1.000), which were all statistically insignificant. However, ω-3 PUFAs appeared to reduce the inflammatory response in patients with endometriosis (MD = -5.20, 95 % CI -6.21–4.20, I² = 0 %, z = 10.13, p < 0.001).

CONCLUSION: Based on the available evidence, ω-3 PUFAs may reduce the inflammatory response in patients with endometriosis, specifically by decreasing levels of pro-inflammatory cytokines, such as TNF-alpha, IL-6 and IL-1, indicating potential anti-inflammatory properties that warrant further investigation.

TRIAL REGISTRATION: PROSPERO: CRD42023441699.

PMID:40273491 | DOI:10.1016/j.clinsp.2025.100654

Clinics (Sao Paulo). 2025 Apr 23;80:100644. doi: 10.1016/j.clinsp.2025.100644. Online ahead of print.

ABSTRACT

OBJECTIVE: This research aimed to determine the feasibility and accuracy of CLR and clinical features to formulate a prediction model for Peptic Ulcer (PU)-induced Upper Gastrointestinal Bleeding (UGIB).

METHODS: The clinical data of 146 PU patients were prospectively collected, and patients were divided into the UGIB group (n = 48) and the non-UGIB group (n = 98). The factors affecting UGIB were analyzed using multifactorial logistic regression and collinearity analysis. The prediction model of UGIB was constructed, the predictive value of which was analyzed using the Receiver Operating Characteristic Curve (ROC) and Area Under the Curve (AUC), while the accuracy was analyzed using the calibration curve and Hosmer Lemeshow goodness-of-fit tests, and the application value was assessed using decision curve analysis (DCA).

RESULTS: Statistical significance was observed between the two groups regarding HP infection, ulcer diameter, ulcer stage, use of nonsteroidal anti-inflammatory drugs, Neutrophil, LYM, NEUT/LYM Ratio (NLR), CRP, and CLR. HP infection, ulcer stage, use of NSAIDs, NLR, and CLR were independent risk factors for UGIB, and PCT was a non-independent risk factor. The AUC for this model was 0.921. The calibration curve of the model matched the actual curve. The model achieved a better fitting effect in predicting UGIB (χ² = 8.5069, df = 8, p = 0.3856) and had a better clinical application value.

CONCLUSION: A predictive model for PU-induced UGIB, based on CLR and clinical features, can assist in developing clinical treatment plans to prevent UGIB.

PMID:40273489 | DOI:10.1016/j.clinsp.2025.100644

Reprod Biomed Online. 2024 Dec 24;50(6):104781. doi: 10.1016/j.rbmo.2024.104781. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: Does an association exist between maternal, reproductive and perinatal factors, and the risks of major non-chromosomal birth defects?

DESIGN: This population-based cohort study included 1,126,058 naturally conceived singleton live births (21,644 with and 1,104,414 without a major non-chromosomal defect) who were born between 2004 and 2018 in New York, Texas, Massachusetts and North Carolina. All study children were linked to their respective state birth defect registries to identify major birth defects diagnosed within the first year of life, and to state death records. Children with chromosomal defects were excluded. Genitourinary defects were only evaluated in boys. Placental and bleeding issues included placenta previa, placental abruption, uterine bleeding and other excessive bleeding, and, at delivery, blood transfusion or unplanned hysterectomy. Adjusted odds ratios and 95% confidence intervals were modelled using logistic regression.

RESULTS: Among major non-chromosomal defects, the highest significant risks were with pre-gestational diabetes (adjusted OR 2.48, 95% CI 2.25 to 2.74), followed by placental or bleeding issues (adjusted OR 1.82, 95% CI 1.66 to 1.99); this pattern was also evident for congenital heart defects, blastogenesis defects, orofacial defects, gastrointestinal defects and musculoskeletal defects. Hypertension (pre-gestational and gestational), prior caesarean delivery, older maternal age and higher body mass index were also significant risk factors.

CONCLUSIONS: The risk factors most strongly associated with major non-chromosomal birth defects were pre-gestational diabetes and placental or bleeding issues; other significantly increased risks were hypertension (pre-gestational and gestational), prior caesarean delivery, older maternal age and pre-pregnancy body mass index 30 kg/m² or above.

PMID:40273488 | DOI:10.1016/j.rbmo.2024.104781

Clin Neurol Neurosurg. 2025 Apr 14;253:108893. doi: 10.1016/j.clineuro.2025.108893. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is characterized by a wide range in severity. This variation presents a challenge for predicting outcomes and making management decisions, particularly for patients sustaining less severe injury. We present a novel statistical model for the prediction of hospital outcomes in two propensity-matched cohorts to optimize TBI patient management and counseling.

METHODS: Hospitalized patients diagnosed with TBI were selected from the Nationwide Readmissions Database (NRD) from 2010 to 2019 using ICD-9 and ICD-10 codes. Using propensity score matching for baseline characteristics, patients were sorted by GCS score into two cohorts: 1188 patients with mild to moderate TBI (mTBI, GCS > 8) and 1219 patients with severe TBI (sTBI, GCS ≤ 8). Mixed-effects modeling was implemented, and model performance was evaluated using the Area Under the Curve (AUC). Any variance in ROC model prediction between cohorts was compared using DeLong’s test.

RESULTS: After bivariate analysis, the mean length of stay (LOS), hospital cost, and mortality were significantly lower in the mTBI cohort relative to sTBI. GCS scores within the range of 9-15 were predictive of LOS (p < 0.01), with a trend towards significance in the prediction of non-routine discharge (p = 0.06).

CONCLUSION: Using an advanced mixed-effects model, our study found that GCS is an accurate predictor of hospital outcomes after a TBI diagnosis. These results provide insight that may aid in the development of preventative strategies, management decisions, and patient counseling to ensure a safe return to daily life for patients diagnosed with concussion.

PMID:40273479 | DOI:10.1016/j.clineuro.2025.108893

Gen Hosp Psychiatry. 2025 Apr 18;95:44-51. doi: 10.1016/j.genhosppsych.2025.04.004. Online ahead of print.

ABSTRACT

OBJECTIVE: Veterans with schizophrenia or bipolar disorder (SZ/BP) experience excess mortality due to several reasons, including cancer. We evaluated whether disparities exist in stage of non-small-cell lung cancer (NSCLC) diagnosis and survival between Veterans Health Administration (VHA) patients with and without SZ/BP.

METHOD: This retrospective evaluation used VHA data to identify patients newly diagnosed with NSCLC from 2005 to 2014. Bivariate analyses compared NSCLC stage at diagnosis by SZ/BP status. Kaplan-Meier and adjusted Cox proportional hazards regression analyses examined differences in survival by SZ/BP status. Meaningful differences were assessed using statistical significance, p < .01, and effect sizes of least 0.2 less/greater than 1.

RESULTS: The cohort included 64,269 VHA patients with newly diagnosed NSCLC. These included 1605 (2.5 %) patients with schizophrenia and 1099 (1.7 %) with bipolar disorder. Stage at diagnosis did not meaningfully differ between patients with and without SZ/BP. After adjusting for stage of diagnosis and other factors, schizophrenia, but not bipolar disorder, was associated with an increased risk of five-year all-cause mortality compared to no SZ/BP (schizophrenia: HR 1.22, 95 % CI 1.14-1.30; bipolar: HR 1.01, 95 % CI 0.94-1.10).

CONCLUSIONS: VHA patients diagnosed with NSCLC who had schizophrenia experienced greater mortality compared to those without SZ/BP, despite no meaningful differences between the two groups in stage of NSCLC at diagnosis. Further work to understand drivers of this difference (e.g., access to NSCLC treatment) and subsequent interventions are needed.

PMID:40273476 | DOI:10.1016/j.genhosppsych.2025.04.004

Rev Med Inst Mex Seguro Soc. 2025 Mar 3;63(2):e6353. doi: 10.5281/zenodo.14617070.

ABSTRACT

BACKGROUND: SARS-CoV-2 is associated with the activation of innate immunity, with an observed increase in neutrophils, mononuclear phagocytes, and natural killer cells, as well as a decrease in T cells. Interferon plays important roles in restricting viruses and is crucial because it participates in both innate and adaptive immunity. Gamma interferon (IFN-γ) is a cytokine that plays a fundamental role in maintaining homeostasis in the body, both in vitro and in vivo.

OBJECTIVE: An immunological study was conducted to measure the concentrations of IFN-γ in severe SARS-CoV-2-positive patients.

MATERIAL AND METHODS: Around 500 sera from patients with similar respiratory comorbidities at the onset of the disease were analyzed, using healthy patients as controls. The sera from SARS-CoV-2-positive individuals were processed using the ELISA technique, and the statistical treatment of the data involved creating a database with the absorbance readings, which were then converted into concentrations in pg/ml.

RESULTS: We can infer that the amount of IFN-γ expression depends on the patient’s condition; the more severe the patient’s condition, the higher the expression of this cytokine compared to their baseline levels, ranging from 0 to 0.5 μg/ml.

CONCLUSION: It is suggested that the IFN-γ response plays an important role in controlling the disease, and effective therapies are recommended for the treatment of Covid-19, which will lead to the implementation of therapeutic approaches aimed at counteracting the immune system, especially in the more severe forms of the disease.

PMID:40273463 | DOI:10.5281/zenodo.14617070