Category: Statistics

Nutr Metab (Lond). 2026 May 29. doi: 10.1186/s12986-026-01143-y. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the serial mediating roles of insulin re-sistance (IR) and abdominal obesity in the association between the Dietary Inflamma-tory Index (DII) and hyperuricemia (HUA), and whether abdominal obesity moder-ated this pathway.

METHODS: We analyzed data from 8,232 adults in the National Health and Nutrition Examination Survey (2007-2016). The triglyceride-glucose (TyG) index served as a surrogate for IR. We employed serial mediation and moderated me-diation models.

RESULTS: Higher DII was associated with increased HUA risk. This re-lationship was serially mediated through the pathway: DII → TyG index → abdominal obesity → HUA. This indirect pathway accounted for 52.3% of the total effect, with abdominal obesity being the most potent mediator (contribution: 31.0%). Importantly, the mediating effect of the TyG index was significant only in individuals with a normal waist circumference (β = 0.0016, 95% CI: 0.0006, 0.0026) but was attenuated to non-significance in those with abdominal obesity.

CONCLUSION: Our findings suggest that IR and abdominal obesity may serially mediate the link between a pro-inflammatory diet and HUA. The me-diating role of IR appears to be prominent in individuals without abdominal obesity, whereas in those with obesity, obesity itself becomes the dominant factor. However, given the cross-sectional design, causal inferences cannot be drawn. These findings support developing stage-specific HUA prevention strategies, targeting insulin sensitivity or weight control based on an individual’s obesity status.

PMID:42216202 | DOI:10.1186/s12986-026-01143-y

Implement Sci Commun. 2026 May 29. doi: 10.1186/s43058-026-00967-2. Online ahead of print.

ABSTRACT

BACKGROUND: Rigorous development and evaluation of implementation outcome measures is needed to advance the field of implementation science. The Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), and the Intervention Appropriateness Measure (IAM) are commonly used, psychometrically validated measures. The objective of the current analysis was to analyze use of the AIM, FIM, and IAM in a single-center pediatric intensive care (PICU) unit study.

METHODS: This was a secondary analysis of a mixed-methods interventional study. The initial project studied development of a novel cardiac arrest ventilation rate metronome to improve adherence to guideline-recommended ventilation rates during CPR; study components included contextual inquiry, participatory intervention design, and simulation usability testing. Using a purposive sampling strategy for pre-implementation contextual inquiry, eligible participants included multidisciplinary PICU clinicians. The pre-implementation questionnaire asked about current cardiac arrest ventilation practices and perceived acceptability, appropriateness, and feasibility of our proposed intervention (AIM, FIM, and IAM). Five-point scale Likert data were summarized using descriptive statistics (medians and interquartile ranges). A score of > 3 was considered favorable.

RESULTS: Of 133 started instances of the pre-implementation survey, 107 were completed (80.5%). The response rate was 30.6% (107/350). Respondents included 34 nurses (31.8%), 18 respiratory therapists (16.8%), and 55 ordering providers (physicians and nurse practitioners; 51.4%). Most respondents (79/107; 73.8%) had previously participated in > 10 PICU cardiac arrests. Appropriateness, acceptability, and feasibility of the ventilation metronome were favorable (appropriateness median: 4 [IQR 4,5]; acceptability median: 4 [IQR 3,5]; feasibility median: 4 [IQR 4,4.5]). For each AIM, IAM, and FIM statement, ≥24.3% of all responses were the highest value on the 5-point scale. Of the 19.5% of survey instances with only partial responses, all but one (26/27; 96.3%) were stopped at the AIM, IAM, FIM matrix of statements.

CONCLUSIONS: In this single-center PICU study utilizing the previously validated Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure, there were several challenges associated with the use of these scales, including (1) survey responses that were terminated at the portion of the questionnaire presenting the AIM, IAM, and FIM and (2) ceiling effect.

PMID:42216201 | DOI:10.1186/s43058-026-00967-2

Reprod Health. 2026 May 29. doi: 10.1186/s12978-026-02367-0. Online ahead of print.

ABSTRACT

BACKGROUND: Short birth interval (SBI) is a major public health concern, associated with adverse outcomes such as preterm birth, low birth weight, and maternal depletion. Identifying its influential predictors is essential for improving family planning and maternal health interventions. The study aimed to predict SBI and identify its influential predictors using stacked machine learning and SHAP explainability.

METHODS: This study used data, obtained from the Bangladesh Demographic and Health Survey (BDHS), 2022. The dataset comprised 11,872 respondents, of whom 2,137 experienced SBI (18.0%). Class imbalance problem was addressed by applying class weighting during model training. Boruta and least absolute shrinkage and selection operator-based methods were applied to identify the most important predictors of SBI. Subsequently, multiple machine learning models (including logistic regression, random forest, extreme gradient boosting, categorical boosting, artificial neural network, and stacking ensemble) were used to predict SBI and evaluated their model performances using accuracy, precision, sensitivity, F1-score, and the area under the curve (AUC). Finally, SHAP explainability were employed to identify the most influential predictors of SBI.

RESULTS: The stacking ensemble model achieved the highest predictive performance compared to the individual models, with an accuracy of 65.8%, precision of 42.6%, sensitivity of 72.3%, F1-score of 53.6%, and modest AUC of approximately 0.667. The SHAP analysis showed that no educated respondents, higher parity, and do not intend to use contraceptive method were the most influential predictors of SBI.

CONCLUSION: Interventions could therefore focus on improving female education, expanding access to contraceptives, and promoting awareness of optimal birth spacing. Policymakers may incorporate SHAP explainability to support data-driven reproductive health strategies to reduce SBI in Bangladesh.

PMID:42216193 | DOI:10.1186/s12978-026-02367-0

BMC Public Health. 2026 May 29. doi: 10.1186/s12889-026-27966-1. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic HBV infection remains a global health priority, contributing to over 800,000 annual deaths. In sub-Saharan Africa, high endemicity persists despite the availability of preventive vaccines. This study assessed the HBsAg seroprevalence and identified independent socio-demographic and clinical correlates among pregnant women in the Jirapa Municipality, providing the evidence base required for targeted maternal-child health interventions in the UWR of Ghana.

METHODS: A facility-based cross-sectional study was conducted among 235 pregnant women in the Jirapa Municipality using a mixed purposive-consecutive sampling approach. HBV infection status was determined via prospective data abstraction of laboratory-confirmed HBsAg rapid diagnostic test results. Firth’s penalized logistic regression was employed to minimize small-sample bias and ensure parameter stability. Model performance was validated through sensitivity analyses comparing penalized likelihood with complementary log-log regression. Final model selection was guided by Akaike (AIC) and Bayesian (BIC) Information Criteria, with specification verified via the link test. All analyses were performed in Stata 16.0, with significance set at p < 0.05.

RESULTS: The clinical prevalence of HBsAg seropositivity among the sampled population was 10.6% (95% CI: 7.0-15.3%), categorizing the Jirapa Municipality as a region of high HBV endemicity per WHO criteria. Bivariate analysis identified maternal age, marital status, number of co-wives, parity, religion, prior blood transfusion, hospital admission, gestational age, and ANC visit frequency as significant correlates (p < 0.05). However, in model 2, only the number of co-wives remained a persistent independent correlate. Specifically, having exactly one co-wife was associated with significantly lower odds of HBV infection compared to other marital structures (AOR = 0.05; 95% CI: 0.00-0.72; p = 0.027). Other socio-demographic and clinical factors did not retain statistical significance after adjustment for confounding variables.

CONCLUSION: The 10.6% HBsAg prevalence documented in the study classifies Jirapa Municipality as a high-endemicity cluster. The independent association between HBV infection and spousal marital structure suggests antenatal care should serve as a gateway for family-centered interventions. The study recommends adopting a “Triple-Linkage” model integrating universal screening, reflex HBeAg risk stratification, and partner-inclusive counseling. Transitioning to this proactive care continuum is essential to strengthen the clinical infrastructure required to mitigate the regional burden of chronic hepatitis B.

PMID:42216187 | DOI:10.1186/s12889-026-27966-1

BMC Health Serv Res. 2026 May 29;26(1):771. doi: 10.1186/s12913-026-14795-6.

ABSTRACT

BACKGROUND: Patient satisfaction is an important indicator of healthcare quality. However, time constraints in primary care limit effective communication and history-taking. Digital medical history systems have the potential to improve the quality of medical consultations by enabling patient preparation and providing physicians with comprehensive pre-consultation information. This study aimed to evaluate the impact of a novel medical history-taking app (DASI app) on patient satisfaction in out-of-hours practices (OOHP) in Germany.

METHODS: We conducted a two-center, cluster-randomized trial over 12 months. Within each practice, weeks were randomized to either an intervention or control group, resulting in a cluster-randomized trial (CRT) with clustering in weeks within the same practice. Patients either used the DASI app before consultations (intervention group) or received standard care (control group). The DASI app is a patient-facing tool that guides patients through a dynamic questionnaire adapted to the selected complaints and previous answers. Patient satisfaction was measured using 17 items from the EUROPEP instrument covering relation and communication, medical care, and information and support. Additionally, we collected sociodemographic data. Statistical analyses included Mann-Whitney U tests for individual items and t-tests for domain scores. Analyses were performed with R, version 4.5.2.

RESULTS: Among 1,460 approached patients, 1,040 (71%) were enrolled and 1,034 included in analyses. Patient median age was 31 years, with 60% female participants. Patients in the intervention group (n = 496) showed significantly better ratings in 12 of 17 EUROPEP items compared to controls (n = 538) and demonstrated significantly higher satisfaction across all three EUROPEP domains. Between 78 and 96% of patients rated care as excellent or very good, with intervention group patients more likely to select top-level evaluations in 9 of 17 items.

CONCLUSIONS: Digital medical history taking significantly enhanced patient satisfaction in urgent care settings. The app likely improved satisfaction through multiple pathways including increased patient empowerment, better consultation preparation, and more efficient physician-patient interactions. These findings demonstrate that user-friendly digital tools can meaningfully enhance patient experience without disrupting existing workflows, supporting healthcare digitalization efforts while maintaining high-quality patient-centered care.

TRAIL REGISTRATION: German register for clinical trials (DRKS00026659; date of registration: 2021-11-03).

PMID:42216184 | DOI:10.1186/s12913-026-14795-6

BMC Med Inform Decis Mak. 2026 May 29. doi: 10.1186/s12911-026-03597-9. Online ahead of print.

ABSTRACT

The aim of this study was to assess the level of user satisfaction with an electronic medical record system (OpenClinic) among healthcare service providers in a hospital setting and its implication on their performance. The study was conducted at the “Centre Hospitalier Universtaire de Kigali”, which has been implementing OpenClinic as an Electronic Medical Record system since 2007. The study was a cross-sectional mixed research using explanatory embedded design. The data was collected on a convenient sample of 217 OpenClinic users through the questionnaires including closed and open ended questions in order to capture both quantitative and qualitative data. The study used the descriptive and inferential statistical tests for analysis for quantitative data, and content analysis for qualitative data. The OpenClinic user satisfaction was found to be high (91%) as well as the proportion of users who perceived it as having positive impact on their performance (94%). The relationship between user satisfaction and perceived impact was statistically significant (p < 0.001), and satisfied users were 20 times more likely to perceive it having positive impact than non-satisfied users (Fisher’s odds ratio = 20.5 [CI: 5.3, 85.1], Wald’s odds ratio = 21.2 [CI: 6.3, 71.1]. Important concerns were expressed by users and the main ones are the poor functionality of the system due to unstable internet, the limited capacity of use and the scarcity of computers. Therefore, the Electronic Medical Record system implementation at the hospital has been successful and its user satisfaction led to perceived positive impact, but it needs further improvements for optimal success.

PMID:42216182 | DOI:10.1186/s12911-026-03597-9

BMC Musculoskelet Disord. 2026 May 29. doi: 10.1186/s12891-026-09975-8. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to evaluate the positional changes in the deep femoral artery (DFA) during intramedullary nail surgery. We hypothesized that the femur and DFA may be closer due to the medial compression of the thigh on a traction table during the surgery.

METHODS: This within-subject comparative study included 20 patients with femoral trochanteric fracture (five males, 15 females; mean age: 83 ± 10.2) who underwent intramedullary nailing. Procedures were performed by five orthopedic surgeons. We performed computed tomography (CT) scans on the healthy thigh in the neutral and surgical limb positions. In the surgical limb position, we performed CT scans 2 weeks postoperatively in the lateral recumbent position with a simulated groin post-compression. Axial images 135 mm distal to the greater trochanter were reconstructed to evaluate the position of the DFA relative to the femur and the transverse locking screw axis. The distance from the medial femur edge to the DFA, medial soft tissue thickness, and the angle between the screw and the DFA were measured. Statistical analyses were performed to compare these parameters between the two positions.

RESULTS: The femur-DFA distance significantly decreased from 19.4 ± 3.5 mm in the neutral position to 12.5 ± 3.6 mm in the surgical position (P < 0.001). Medial soft tissue thickness also significantly reduced from 44.7 ± 15.0 mm to 31.0 ± 12.1 mm (P < 0.001). The two positions had no significant difference in the DFA angle (neutral: -23.1 ± 11.1°, surgical: -20.0 ± 10.6°; P = 0.17). The DFA was consistently positioned posterior to the screw insertion axis.

CONCLUSIONS: The surgical position during intramedullary nail insertion significantly reduces the femur-DFA distance and compresses soft tissues, which may increase the risk of DFA injury. Therefore, maintaining the hip joint in a neutral position during transverse locking screw insertion should be considered. Extra caution is warranted for taller patients and males owing to anatomical factors. Future studies should validate these findings and optimize surgical techniques.

PMID:42216179 | DOI:10.1186/s12891-026-09975-8

BMC Nurs. 2026 May 29. doi: 10.1186/s12912-026-04818-2. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses play a crucial role in preventing deterioration-related morbidity and mortality among hospitalized patients. This study assessed nurses’ knowledge and reported practices of identifying early warning signs of critical illness among adult patients in general wards and contextual factors that influence these practices.

METHODS: An analytical cross-sectional study involving general ward nurses was conducted in three tertiary referral hospitals. A self-administered questionnaire was distributed to 235 randomly selected participants. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics and inferential tests, including independent sample t-test and ANOVA, were used to examine associations between knowledge and demographic/workplace factors.

RESULTS: Knowledge of early warning signs was low (mean = 41.5%, SD = 10.41). Scores were significantly higher among bachelor’s-prepared nurses and those working at the national referral hospital (p = 0.007; p = 0.003, respectively). Nurses mainly identified deterioration using vital signs, monitoring, and response to deterioration practices varied, and resource availability was inconsistently perceived. Heavy workload, inadequate training, and resource constraints were common barriers despite generally positive self-ratings of ward practices. Job satisfaction was the only significant independent predictor of knowledge (B = 2.847, p = 0.006). Other variables were not significant. The model explained 6.4% of the variance (R² = 0.064, F(5, 229) = 3.114, p = 0.010).

CONCLUSIONS: Despite nurses’ positive reported practices in identifying patient deterioration, nurses’ overall knowledge of early warning signs of critical illness was low. Staff training, protocol standardization, and resource enhancement are essential to enhance nurses’ ability to recognize and respond effectively to early signs of deterioration and critical illness. Given the limited awareness and utilization of structured early warning systems identified in this study, there is a need for training, contextual adaptation, and phased implementation of standardized tools such as National Early Warning Score (NEWS).

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42216174 | DOI:10.1186/s12912-026-04818-2

BMC Cancer. 2026 May 29. doi: 10.1186/s12885-026-16068-1. Online ahead of print.

ABSTRACT

BACKGROUND: Nanomaterials (NMs) with tunable physicochemical and redox properties offer powerful tools for probing cellular regulatory pathways. Accumulating evidence suggests that nanoparticles (NPs) exposure can engage autophagy, a conserved lysosome‑dependent stress‑adaptation process. In this context, iron oxide-gold core-shell nanoparticles (Fe₂O₃/Au NPs) provide a rational platform to investigate nanoparticle‑mediated modulation of autophagy‑related gene (ATG) expression in cancer cells.

METHODS: MCF-7 breast cancer cells and human umbilical vein endothelial cells (HUVECs) were cultured under standard conditions and treated with Fe₂O₃/Au core-shell NPs (20 µg/mL). Nanoparticle uptake was quantified by inductively coupled plasma mass spectrometry (ICP-MS). Gene expression of Beclin1 (BECN1), autophagy-related gene 5 (ATG5), autophagy-related protein light chain 3 (LC3-II), Sequestosome 1 (SQSTM1 or p62), and NBR1 was measured using quantitative polymerase chain reaction (RT-qPCR), normalized to Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and analyzed via the 2^-ΔΔCt method. Statistical analyses were conducted with GraphPad Prism 6, with significance set at p < 0.05. Bioinformatics validation was performed using Gene Expression Omnibus (GEO) dataset GSE116436, focusing on five ATGs.

RESULTS: ICP-MS confirmed efficient nanoparticle internalization, with higher uptake in MCF-7 cells than in HUVECs. In MCF-7 cells, Fe₂O₃/Au NPs significantly upregulated BECN1, ATG5, and LC3-II, while p62 and NBR1 were downregulated (p < 0.05), indicating considerable autophagy activation and enhanced without direct flux validation. In contrast, HUVECs showed only mild, non-significant changes, consistent with partial or protective autophagy (p > 0.05). Bioinformatic analysis of the GEO dataset GSE116436 confirmed significant dysregulation of five core ATGs (BECN1, ATG5, SQSTM1/p62, NBR1, and MAP1LC3B) in chemotherapy‑resistant MCF‑7 cells, with BECN1 and ATG5 showing the strongest statistical significance. Gene ontology/ Kyoto Encyclopedia of Genes and Genomes (GO/KEGG) enrichment indicated involvement of autophagy, mechanistic target of rapamycin (mTOR), p53, and stress‑response pathways. Kaplan-Meier (KM) survival analysis in the Cancer Genome Atlas-breast cancer (TCGA‑BRCA) cohort revealed gene‑specific, heterogeneous prognostic associations higher BECN1 and NBR1 linked to improved survival, while elevated ATG5 and SQSTM1 correlated with poorer outcomes. STRING‑based protein-protein interaction (PPI) analysis highlighted enrichment of growth factor signaling, extracellular matrix (ECM) organization, and focal adhesion networks, supporting functional coordination among dysregulated genes and associated stromal‑adaptive signaling modules.

CONCLUSION: Fe₂O₃/Au core-shell NPs selectively altered the transcription of key ATGs in MCF‑7 breast cancer cells, with minimal effects in non‑malignant HUVECs. Bioinformatic analyses in chemotherapy‑resistant MCF‑7 models confirmed persistent dysregulation of the same ATGs and enrichment of stress‑adaptive pathways. Collectively, these findings indicate a cancer‑selective, autophagy‑associated transcriptional response and support a hypothesis‑generating link to adaptive features of resistant breast cancer cells.

PMID:42216165 | DOI:10.1186/s12885-026-16068-1

BMC Infect Dis. 2026 May 29. doi: 10.1186/s12879-026-13595-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Complicated urinary tract infections (c-UTI) are expensive and frequently require hospitalization. This study estimated the impact of patient comorbidities, readmissions and treatment delay on the costs of complicated urinary tract infections in both inpatient and outpatient settings. A related aim is to provide the first estimates of the potential savings of treating patients currently treated as inpatients that have clinical characteristics similar to, though less complicated, to patients treated as outpatients.

DESIGN: Using one of the largest national claims data sets (30 million lives per year) on privately insured adults and dependents between 2019 and 2022, with regression models we estimate the treatment costs of complicated urinary tract infection (c-UTI) patients identified and treated in the hospital, identified and treated in an outpatient setting and identified in an outpatient setting but subsequently admitted. We statistically estimate potential savings associated with treating inpatient cases in the outpatient setting.

SETTING: Our study was a retrospective analysis of claims data among privately insured adults and dependents with claims from February 1, 2019, to May 31,2022. Our analysis relies on the Merative- MarketScan Commercial Claims and Encounter database which is among the largest commercially insured set of claims data covering adults and dependents in the U.S. that included de-identified person-level claims data including inpatient, outpatient, and prescription drugs use and spending. It also included health plan spending, patient demographics, diagnosis, procedure and national drug codes covering more than 30 million active employees, early retirees, COBRA extenders, and dependents with data contributed by more than 160 employers and 40 health plans nationally each year.

PARTICIPANTS: Data were obtained for 93,228 c-UTI patients treated in both inpatient and outpatient settings in the United States.

RESULTS: Treatment costs are highly positively skewed with a mean cost per episode of those identified in hospital of $42,000 and median cost of $27,784. High costs were in part linked to long lengths of stay for roughly 10% of patients of 15 days or longer. At the other extreme we found that many low-acuity patients were hospitalized. Switching antibiotics also increased treatment costs. The results show that 27% of c-UTI patients admitted to the hospital were low-acuity patients that potentially could be treated in an outpatient setting for over $31,000 per case less.

CONCLUSIONS: The results highlight several areas of opportunity to reduce dramatically the costs of treating c-UTI including treating currently hospitalized low-acuity patients without complications in an outpatient setting, reducing readmissions, and length of stay.

PMID:42216163 | DOI:10.1186/s12879-026-13595-x