Tag: pubmed

Arch Public Health. 2025 Jul 11;83(1):183. doi: 10.1186/s13690-025-01673-6.

ABSTRACT

BACKGROUND: Regular dental visits are essential for oral health, yet disparities between regions exist due to socioeconomic and geographic factors. While national surveys provide valuable data on dental care utilization, they generally lack sufficient sample sizes at the local level to generate reliable county-level estimates. Small area estimation techniques, such as multilevel regression and post-stratification (MRP), can help address this gap by producing robust estimates for smaller geographic areas. However, the MRP approach relies on detailed population data in the form of joint distributions and cannot be applied when only marginal distributions are available.

METHODS: This paper introduces a hybrid approach combining multilevel modeling with the raking procedure. We used individual-level data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and census data from American Community Survey to estimate county-level dental care utilization among adults in California.

RESULTS: The county-level dental care utilization in California ranged from 52.5 to 73.1%, with a median of 63.1%. Our model-based estimates matched direct BRFSS estimates at metropolitan and micropolitan statistical area levels. Furthermore, we found significantly positive correlations between our model-based estimates and direct estimates from the California Health Interview Survey for 41 counties (Pearson coefficient: 0.801, P < 0.001).

CONCLUSIONS: The proposed approach accounts for individual- and area-level factors while overcoming data constraints that limit the application of MRP. The findings demonstrate the feasibility of this approach in generating county-level estimates, supporting public health planning and targeted interventions to reduce disparities in dental care utilization.

PMID:40646604 | DOI:10.1186/s13690-025-01673-6

BMC Nurs. 2025 Jul 11;24(1):904. doi: 10.1186/s12912-025-03561-4.

ABSTRACT

BACKGROUND: Patient safety is a critical indicator of healthcare quality. The professional self-efficacy and skills of nursing students regarding patient safety should be developed and assessed throughout their education. This study aimed to evaluate the impact of e-learning and high-fidelity simulation methods on the self-efficacy of nursing students.

METHODS: A comparative quasi-experimental study was conducted with 52 senior nursing students enrolled at a state university in Ankara. Participants completed a pre-test and were randomly assigned to either a high-fidelity simulation group or an e-learning group, with 26 students in each. Both groups were exposed to five standardized case scenarios. The high-fidelity group participated in face-to-face simulations, while the e-learning group engaged in online discussions centered on the same scenarios. Following these sessions, both groups underwent debriefing before undertaking the first post-test. Subsequently, all students undertook a 3-week clinical placement focused on Patient Safety and Quality, followed by a second post-test. Data were collected using a demographic questionnaire, the Health Professionals’ Education in Patient Safety Survey, and the Patient Safety Competency Self-Efficacy Scale. Data analysis involved descriptive statistics for sociodemographic characteristics, independent samples t-tests and Mann-Whitney U tests for between-group comparisons, and analysis of variance and Friedman test for within-group comparisons.

RESULTS: The e-learning and high-fidelity simulation interventions both resulted in statistically significant improvements in students’ scores on the Patient Safety Competency Self-Efficacy Scale and its subscales, as well as the Health Professionals’ Education in Patient Safety Survey. However, no significant difference was observed between the two groups.

CONCLUSION: Both high-fidelity simulation and e-learning methods focusing on patient safety were equally effective in improving nursing students’ self-efficacy. These results suggest that either method or a combination of both, using case scenarios that reflect real clinical situations, can be effectively employed to improve students’ self-efficacy in patient safety.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40646597 | DOI:10.1186/s12912-025-03561-4

Diabetol Metab Syndr. 2025 Jul 11;17(1):261. doi: 10.1186/s13098-025-01832-3.

ABSTRACT

BACKGROUND: The stress hyperglycemia ratio (SHR) is a clinical index that quantifies acute stress-induced hyperglycemia by comparing immediate blood glucose levels with chronic glucose control (reflected by HbA1c). It is especially valuable in cardiovascular disease and surgical prognosis. However, there is still a lack of research on the relationship between SHR and new-onset atrial fibrillation (AF) in patients after coronary artery bypass grafting (CABG). This study investigates the impact of postoperative SHR on AF risk following CABG.

METHODS: This study is a retrospective cohort analysis conducted through the MIMIC-IV database, which included adult patients who underwent CABG and were admitted to the ICU. These patients were categorized into three distinct groups according to the tertiles of the baseline SHR level, and the primary outcome was the incidence of postoperative atrial fibrillation (POAF). We employed logistic regression models, restricted cubic splines (RCS), threshold effect analysis, ubgroup analysis, Boruta algorithm, lasso algorithm, and receiver operating characteristics (ROC) to analyze the relationship between SHR and POAF incidence comprehensively.

RESULTS: 2112 patients undergoing CABG were included in this study, with a median age of 69 years (IQR: 62-76), of whom 1643 (77.79%) were male. Logistic regression results showed that the incidence of AF was significantly increased in patients in the highest third of the SHR group compared with the lowest third group (OR = 1.31, 95%CI = 1.03-1.67; P = 0.0275). SHR was an independent risk factor for the incidence of POAF (OR = 1.63, 95%CI = 1.19-2.23; P = 0.0023). At the same time, RCS analysis showed that SHR was positively and linearly correlated with the incidence of POAF in patients after cardiac surgery (P = 0.009, P for Nonliner = 0.848). Threshold effect analysis identified no significant threshold and further supported a linear relationship between SHR and POAF. In addition, SHR was double-screened by Boruta and Lasso algorithms, indicating that it was statistically and biologically significantly associated with AF after CABG.

CONCLUSION: SHR is significantly related to AF after CABG. As SHR increases, the risk of POAF increases. Incorporating SHR into post-CABG risk assessment enhances AF prediction, offering a valuable reference for clinical decision-making. It may also be a potential biomarker for studying pathological mechanisms in patients after cardiac surgery. In the future, combining multi-omics data with clinical intervention trials is necessary to verify its clinical application value further.

PMID:40646596 | DOI:10.1186/s13098-025-01832-3

BMC Nurs. 2025 Jul 11;24(1):902. doi: 10.1186/s12912-025-03565-0.

ABSTRACT

BACKGROUND: The phenomenon of “quiet quitting” performing only the minimum required duties without emotional investment-has gained prominence in both the workplace and educational settings.

AIM: This study was conducted to determine the quiet quitting levels of nursing students and to analyze how these levels vary according to gender, year of study, motivation for choosing the profession, and satisfaction with the department.

METHODS: Descriptive and cross-sectional comparative design. The study was conducted with 210 nursing students selected through stratified sampling from a total population of 511. Data were collected via a personal information form and the Quiet Quitting Scale (16 items, 4 subscales). Non-parametric statistical tests (Mann-Whitney U, Kruskal-Wallis H, Spearman correlation) were employed using SPSS 26.0.

RESULTS: The mean total score on the Quiet Quitting Scale was 50.04 ± 10.06, indicating a moderate level of disengagement. Male students reported significantly higher quiet quitting scores compared to females (p < 0.05). It was observed that self-protection subscale scores were higher among senior students (p < 0.05). Seniors scored higher on the self-protection subscale, suggesting increased risk awareness. Students who selected nursing due to internal motivation demonstrated lower levels of quiet quitting than those influenced by external factors (p < 0.05). A significant negative correlation was observed between satisfaction with nursing education and all dimensions of quiet quitting (p < 0.05).

CONCLUSIONS: Quiet quitting is notably present among nursing students and is influenced by gender, academic seniority, motivation for choosing the profession, and satisfaction with the educational experience. Curricular changes, active engagement strategies, and psychosocial support may help strengthen students’ professional identity and reduce passive disengagement. Mentorship programs, professional identity modules, and targeted support for students at higher risk of disengagement-including male students, those with low satisfaction, and those who chose nursing due to external motivations-could further address disengagement risks. These findings may inform international educational policies and contribute to the development of strategies to enhance student commitment and patient safety.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40646584 | DOI:10.1186/s12912-025-03565-0

Trials. 2025 Jul 11;26(1):243. doi: 10.1186/s13063-025-08947-y.

ABSTRACT

BACKGROUND: The StratosPHere 2 trial will evaluate the efficacy of hydroxychloroquine and phenylbutyrate in pulmonary arterial hypertension caused by mutations in BMPR2 by focussing on the novel biomarker and other endpoints including safety.

STUDY DESIGN: StratosPHere 2 is a three armed, placebo-controlled, phase 2 trial with two strata based on the mutation groups. It is response adaptive where the allocation of treatments follows a Bayesian response-adaptive randomisation algorithm. An expected number of 20 patients will be randomised in each stratum to one of the three arms containing hydroxychloroquine, phenylbutyrate and placebo. The primary outcome is a novel endpoint considering the change in the bone morphogenetic receptor type 2 (BMPR2).

METHOD: The final primary analysis on the efficacy of each active treatment against control is assessed using a one-sided nonparametric Wilcoxon test computed on the continuous biomarker data collected up to 8 weeks from the start of treatment.

DISCUSSION: This manuscript presents the key elements of the StratosPHere 2 implementation and statistical analysis plan. This is submitted to the journal before the first interim analysis to preserve the scientific integrity under a response-adaptive design framework. The StratosPHere 2 trial closely follows published guidelines for the content of Statistical Analysis Plans in clinical trials.

TRIAL REGISTRATION: The ISRCTN Registry ISRCTN10304915 (22/09/2023).

PMID:40646581 | DOI:10.1186/s13063-025-08947-y

Genome Biol. 2025 Jul 11;26(1):201. doi: 10.1186/s13059-025-03672-w.

ABSTRACT

BACKGROUND: Admixed populations offer valuable insight into the genetic architecture of complex traits. Many studies have proposed methods for genome-wide association study (GWAS) in admixed populations and various simulation studies have evaluated their performances. In this work, we propose another direction of comparison of recently proposed methods for admixed GWAS from a population genetic viewpoint.

RESULTS: Our theoretical approach mathematically and directly compares the power of methods given that the causal variant is tested. This is done by deriving the variance formula of the methods from the population genetic admixture model. Our results analytically confirm previous observation that the standard GWAS test is more powerful than alternative tests due to leveraging allele frequency heterogeneity in which alternatives do not. As a by-product, we obtain a simple method to improve the power of multi-degrees-of-freedom tests only using summary statistics. We further investigate the problem when the causal variant is not directly known but is detected by tagging variants in linkage disequilibrium (LD). The analysis shows that a genetic segment from admixed genomes may exhibit distinct LD patterns from the single-continental counterpart of the same ancestry.

CONCLUSIONS: While the classic admixture model is successful in predicting GWAS power, its popular extension in the literature falls short in explaining the LD patterns found in simulations and real data, warranting an improved model for LD in admixed genomes.

PMID:40646547 | DOI:10.1186/s13059-025-03672-w

Confl Health. 2025 Jul 11;19(1):41. doi: 10.1186/s13031-025-00683-z.

ABSTRACT

BACKGROUND: Although both marriage and childbearing are potentially influenced by humanitarian emergencies, and for many individuals are intrinsically linked life-course events, they are rarely explored together in the literature on humanitarian emergencies. Additionally, literature on child marriage focuses largely on females, neglecting the experiences of males.

OBJECTIVE: To understand how trajectories of family formation for adolescent females and males have been affected by mass displacement. We compare time to first marriage and time to first birth following marriage between age cohorts of 15-19 and 20-24 year-old female and male Forcibly Displaced Myanmar Nationals.

METHODS: We use data from 1,565 females and 722 males aged 15-24, collected within fifteen camps in Cox’s Bazar, to estimate hazard of first marriage and of child marriage and data from 643 married females to estimate hazard from marriage to first birth.

RESULTS: Females aged 20-24 had a 31% increased hazard of marriage overall and 42% increased hazard of child marriage relative to females aged 15-19 (95% CI: 1.07-1.87) and an 84% higher incidence rate (95% CI: 1.46-2.33). For males, there was a higher hazard of marriage by age 25 amongst males aged 20-24 relative to age 15-19 (HR: 1.80, 95% CI: 1.10-2.94), but no statistically significant difference in the hazard of marriage by age 18. Approximately 20% of females gave birth within a year of marriage and 70-75% within three years post-marriage, across age cohort and age at marriage. There were no statistically significant differences in hazard of first birth by either age cohort or age at marriage.

DISCUSSION: Displacement may have increased risk of child marriage for adolescents, as evidenced by higher child marriage rates amongst males and females who were age 14-18 at the time of displacement. Displacement did not affect time to childbirth following marriage, which remains high amongst both age cohorts. Efforts to reduce child marriage and adolescent child marriage must address limited opportunities for adolescents in situations of displacement.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40646545 | DOI:10.1186/s13031-025-00683-z

J Orthop Surg Res. 2025 Jul 11;20(1):640. doi: 10.1186/s13018-025-06051-0.

ABSTRACT

INTRODUCTION: Nonunion of pediatric femoral neck fractures is a difficult situation for orthopedic surgeons. It can result in devastating results if left untreated. The purpose of the present study was to assess and compare the results of the treatment of nonunited pediatric femoral neck fractures by closed reduction and subtrochanteric valgus osteotomy with two different fixation methods.

PATIENTS AND METHODS: Seventeen patients with nonunion femoral neck fractures were treated with closed reduction, subtrochanteric osteotomy and fixation with either the proximal humerus internal locking system (PHILOS plate) (group A) (10 patients) or the Wagner technique (group B) (7 patients). The mean age of the patients was 7 years, and the mean follow-up period was 16 months.

RESULTS: At the end of the follow-up, all patients, the fractures were united. We did not observe any cases of implant failure. There was a statistically significant improvement in the neck shaft angle in both groups from 88.70 ± 3.36 to 129.35 ± 7.34 in group A and from 87 ± 1.91 to 126.78 ± 4.06 in group B. Regarding the clinical outcome and according to the Ratliff concept, half of the cases were good in group A and 57.1% were good in group B. There was no statistically significant difference between the groups regarding time to union, degree of coxa vara correction or the Ratliff concept.

CONCLUSION: Both the PHILOS plate and the Wagner technique offer good stable fixation options for nonunited pediatric femoral neck fractures.

PMID:40646543 | DOI:10.1186/s13018-025-06051-0

AIDS Res Ther. 2025 Jul 11;22(1):67. doi: 10.1186/s12981-025-00767-z.

ABSTRACT

BACKGROUND: This multi-institutional, retrospective cohort study using TriNetX database aims to explore the relationship between HIV infection and uveitis.

METHODS: HIV patients were propensity-matched to individuals from our non-HIV cohort (1:1 ratio) based on variables such as age (every 5 year), sex, ethnicity, race, and relevant comorbidities. The Cox proportional hazards regression model was utilized to assess the impact of variables on uveitis risk, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). Kaplan-Meier survival analysis and log-rank tests were applied to estimate the cumulative incidence of uveitis. Statistical significance was set at a two-sided p-value < 0.05.

RESULTS: We found that adult patients with HIV infection had a significantly increased risk of developing uveitis compared to non-HIV counterparts, with an overall HR of 3.02 (95% CI: 2.70 – 3.39). The risk remained elevated across designated follow-up intervals of 1 year (HR = 4.68 [3.69 – 5.92]), 2 years (HR = 4.44 [3.65 – 5.41]), and 3 years (HR = 4.06 [3.42 – 4.81]), with consistent increases noted when dividing into different uveitis types except for anterior uveitis. The risk was higher among patients with acquired immunodeficiency syndrome (AIDS) compared to asymptomatic HIV (HR = 2.64 [1.30 – 5.35]). Furthermore, HIV patients receiving treatment within three months exhibited a notably increased risk (HR = 2.87 [2.33 – 3.54]).

CONCLUSIONS: This study reveals that individuals with HIV face a significantly heightened risk of developing uveitis. Our findings indicate that this risk is most substantial for intermediate and posterior uveitis, challenging the long-held belief that anterior uveitis is the predominant form in this population.

PMID:40646533 | DOI:10.1186/s12981-025-00767-z

BMC Med Educ. 2025 Jul 11;25(1):1035. doi: 10.1186/s12909-025-07628-3.

ABSTRACT

BACKGROUND: High quality professional education requires good educators who show engagement with teaching in addition to content knowledge and didactic skills. In health professions education it is common that teaching faculty combine their teaching role with roles in patient care and/or research. However, previous studies on work engagement have mainly focused on jobs as a whole and not considered people who combine roles or tasks that could have different demands. This study aims to describe how health professions educators’ work engagement in teaching, in combination with research and patient care, evolved over time at an academic medical center in the Netherlands.

METHODS: All teaching faculty at the center were invited to complete the same online questionnaire in 2011, 2016, and 2022, where their work engagement was measured using the Utrecht Work Engagement Scale (UWES-9) and they rated 22 items affecting their engagement in teaching. We calculated descriptive statistics; computed engagement score means for overall work and individual task areas (teaching, research, and patient care); and compared means across groups with various task area combinations and across years. We also performed content analysis of responses to the open-ended questions in the questionnaire.

RESULTS: Work engagement scores overall and for each task area (teaching, research, and patient care) fluctuated over time. Job-related aspects enhancing engagement in teaching included ‘autonomy’ and ‘appreciation.’ ‘Teaching about my own specialty’ consistently scored high.

CONCLUSION: Teaching faculty in our center are engaged with teaching tasks and their work engagement is consistently high over time. Combining roles might be positively related to teaching engagement by maintaining balance when job demands in other tasks increase. To maintain and increase teaching engagement, organizations should focus on the provision of time, autonomy, and support to health professions educators. Teaching engagement may increase more through content knowledge and autonomy in teaching than by facilitating educational research and dissemination opportunities.

PMID:40646526 | DOI:10.1186/s12909-025-07628-3