Tag: pubmed

Crit Care. 2025 Feb 11;29(1):73. doi: 10.1186/s13054-025-05307-9.

ABSTRACT

The p-value has changed from a versatile tool for scientific reasoning to a strict judge of medical information, with the usual 0.05 cutoff frequently deciding a study’s significance and subsequent clinical use. Through an examination of five critical care interventions that demonstrated meaningful treatment effects yet narrowly missed conventional statistical significance, this paper illustrates how rigid adherence to p-value thresholds may obscure therapeutically beneficial findings. By providing a clear, step-by-step illustration of a basic Bayesian calculation, we demonstrate that clinical importance can remain undetected when relying solely on p-values. These observations challenge current statistical paradigms and advocate for hybrid approaches-including both frequentist and Bayesian methodologies-to provide a more comprehensive understanding of clinical data, ultimately leading to better-informed medical decisions.

PMID:39934845 | DOI:10.1186/s13054-025-05307-9

World J Surg Oncol. 2025 Feb 11;23(1):48. doi: 10.1186/s12957-025-03673-w.

ABSTRACT

PURPOSE: This study aimed to investigate the expression and clinical relevance of the androgen receptor (AR) in breast cancer.

METHODS: This retrospective study examined the expression of AR in breast cancer and its correlation with patients’ clinicopathological and immunohistochemical characteristics. A total of 521 patient records were gathered and assessed. Patients were categorized as either positive or negative for AR expression, and statistical analyses were conducted using the chi-square test, logistic regression in SPSS 26.0, and Kaplan-Meier analysis.

RESULTS: AR was detected in 83.7% of the 521 patients studied. There was a statistically significant difference in the prevalence of AR positivity among different molecular subtypes, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and epidermal growth factor receptor (EGFR) (P < 0.05). Logistic regression analysis further revealed that ER and PR positivity were identified as risk factors for AR expression, and Kaplan-Meier curve analysis demonstrated the potential of AR as a prognostic indicator for breast cancer outcomes. Additionally, AR positivity was associated with a favorable prognosis.

CONCLUSIONS: The results suggest a strong correlation between AR expression and ER and PR co-expression in breast cancer. Additionally, AR positivity in the absence of ER and PR expression is associated with a favorable prognosis, indicating potential therapeutic value as a novel target in breast cancer treatment. Particularly in endocrine resistance or triple-negative breast cancer (TNBC), AR may serve as a significant prognostic indicator, warranting further investigation.

PMID:39934842 | DOI:10.1186/s12957-025-03673-w

BMC Med Educ. 2025 Feb 12;25(1):226. doi: 10.1186/s12909-025-06824-5.

ABSTRACT

BACKGROUND: Diversity competence, diversity itself, and a corresponding awareness of possible (intersectional) discrimination mechanisms have not been anchored in the German National Competence based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog 2.0., NKLM) yet, highlighting a systemic gap in national competency frameworks. We present our first experience with a prospective diversity-specific intervention in medical students to assess its short-term impact on students’ diversity acceptance (DA) and to develop actionable recommendations for integrating diversity into medical education.

METHODS: We designed a prospective cohort study using a control group (CG) and intervention group (IG) design. The IG absolved a five-day diversity-specific intervention (50 h; field trip; seminar). Quantitative data were collected using the validated DWD-O5 scale at baseline (T0), three months (T3), and six months (T6), complemented by qualitative responses (diversity issues in the medical curriculum; perceptions and criticisms) categorized using Mayring’s content analysis. Descriptive and non-parametric statistics were performed.

RESULTS: Thirty-one medical students (n = 10, IG vs n = 21, CG) were enrolled. The IG demonstrated a short-term improvement in diversity competence (+ 9.72%) across all DWD-O5 factors during the intervention. While scores slightly declined at T6, they remained above baseline levels. 35% (CG) vs. 56% (IG) have experienced discrimination in context of medical studies on their own. Participants in both groups stressed the importance of integrating diversity criteria into curricula at an early stage (100% agreement). Findings revealed three key themes: perceived inadequacies in current curricula, self-reported discrimination experiences, and a strong desire for practical diversity training, such as simulation-based learning.

CONCLUSION: The intervention shows promise as an initial step toward addressing diversity gaps in medical education. By combining historical, cultural, and experiential learning approaches, the program fosters essential competencies such as empathy, self-reflection, and bias recognition. More broadly, sustained improvements in diversity competence require longitudinal integration of diversity training across curricula and systemic reforms to national frameworks like the NKLM. Future research should explore the long-term impact of such interventions and strategies for institutionalizing equity-focused medical education.

PMID:39934836 | DOI:10.1186/s12909-025-06824-5

BMC Nurs. 2025 Feb 11;24(1):158. doi: 10.1186/s12912-025-02789-4.

ABSTRACT

INTRODUCTION: Globally, the management of low-risk pregnancies by midwives often leads to a more natural childbirth process, which enhances physical and psychological outcomes for mothers and their babies. Midwives implement various models of maternal care in practice. This study investigates and compares maternal and neonatal outcomes associated with midwifery-led care versus routine midwifery care in private hospitals in Iran.

METHODS: This retrospective cohort study was conducted in Iran in 2022. The study population consisted of two groups including 387 women in the Routine Care Group (RCG) and 397 women in the Private Care Group (PCG). Participants were selected through continuous sampling in accordance with the inclusion criteria. The two groups were compared in terms of some maternal and neonatal outcomes. The research data collection tool was a researcher-made checklist with variables adjusted according to the ‘Iman’ system of the Iran Ministry of Health. Based on this tool, the data were extracted from the mentioned system and analyzed with SPSS software.

FINDINGS: The results indicated no significant difference between the two groups in terms of the type of delivery (p = 0.999), the use of forceps or vacuum (P = 0.5) and transferring the mother to the operating room (OR) or the intensive care unit (ICU) immediately after delivery (P = 0.744). However, there was a statistically significant difference between the two groups in terms of labor pain control (P < 0.001), induction of labor (P < 0.001), and the use of episiotomy (P < 0.001). Regarding neonatal outcomes, there was no statistically significant difference between the two groups in relation to the average infant weight (P = 0.46), Apgar score (P = 0.75), need for resuscitation (P = 0.999), skin-to-skin contact (P = 0.626), initiation of breastfeeding (P = 0.241) and admission to the neonatal intensive care units (NICU) (P = 0.66).

CONCLUSION: Given the positive impact of private care on key maternal outcomes, it is recommended that health policymakers create the conditions necessary for establishing a continuous midwifery care model in both governmental and private hospitals. Besides, more quantitative, qualitative, and especially mixed methods research should be conducted to explore the challenges and facilitators of this model across various settings.

PMID:39934823 | DOI:10.1186/s12912-025-02789-4

BMC Oral Health. 2025 Feb 11;25(1):222. doi: 10.1186/s12903-025-05567-5.

ABSTRACT

BACKGROUND: The decisions individuals make regarding oral health reflect their values. Prioritizing oral and dental health is essential for public health. This study aimed to evaluate the validity and reliability of the Persian version of the Oral Health Values Questionnaire.

METHODS: A cross-sectional study was conducted involving 500 adults aged 18 years and older at health centers in Shiraz in 2023. The Original Oral Health Values Scale (OHVS) questionnaire was translated into Persian using a forward-backward translation. Participants completed the Persian version of the OHVS, which comprises a 12-item scale with a four-factor structure: professional dental care, appearance and health, flossing, and preservation of natural teeth. The Content Validity Index (CVI), Content Validity Ratio (CVR) and Scale-Level Content Validity Index (S-CVI/Ave) were assessed. Test-retest reliability and Cronbach’s alpha were used to evaluate the internal consistency of the questionnaire. To determine the adequacy of the sample size, the Kaiser-Meyer-Olkin (KMO) index, with a minimum value of 0.7, Bartlett’s test of sphericity, eigenvalues greater than 1, and the Varimax rotation method were utilized, using SPSS Version 24 statistical software.

RESULTS: All questions demonstrated satisfactory Content Validity Ratio (CVR) and Content Validity Index (CVI), scoring above the expected thresholds of 0.8 and 0.9, respectively. The test-retest correlation results confirmed the reliability of the questionnaire, with correlation coefficients exceeding 0.7 for all questions and their sub-areas. Internal consistency was also established usings domains. Factor analysis revealed four primary components with eigenvalues greater than 1, which collectively accounted for 58.963% of the total variance.

CONCLUSIONS: The Persian version of the OHVS demonstrated excellent validity and reliability. Consequently, it can be regarded as a reliable and valuable tool for epidemiological and behavioral dental studies.

PMID:39934814 | DOI:10.1186/s12903-025-05567-5

BMC Health Serv Res. 2025 Feb 11;25(1):233. doi: 10.1186/s12913-025-12368-7.

ABSTRACT

INTRODUCTION: In low-income countries such as the Democratic Republic of the Congo (DRC), the strategies implemented to combat tuberculosis (TB) are threatened by the emergence of non-communicable diseases (NCDs), such as diabetes mellitus (DM). Very little data on the implementation of services to manage TB-DM are generally available in these low-income countries. The aim of this study was therefore to assess the level of implementation of DM screening and treatment activities in TB unit clinics (TUCs) in Lubumbashi, DRC.

METHODS: A cross-sectional study was conducted using the Service Availability and Readiness Assessment (SARA) questionnaire from June to July 2023. Fourteen tracer items, divided into 4 domains-i) guidelines and staff, ii) basic equipment, iii) diagnostic capacity, and iv) drugs and products-were assessed. The readiness indices were compared according to the managerial instance and the activity package organized in each of the selected TUCs. A Chi² test with a significance level set at p = 0.05 was used for this comparison, and Cronbach’s α coefficient was calculated to estimate the reliability or consistency of the questionnaire.

RESULTS: Of the 35 TUCs visited, 19 (54.3%) were public health facilities, and 20 (57.1%) had a supplementary package of activities (SPA). The readiness of TUCs for providing DM diagnostic and treatment services was around 50%. A statistically significant difference was observed based on the managerial instance overseeing the TUC (p = 0.00) and the package of activities offered within these institutions (p = 0.00).

CONCLUSION: The current study has underscored the limited capability of TUCs in Lubumbashi to provide services for managing TB-DM comorbidity in DRC. It is imperative to implement strategies aimed at enhancing this capacity and taking into account the local context and influencing factors.

PMID:39934811 | DOI:10.1186/s12913-025-12368-7

BMC Musculoskelet Disord. 2025 Feb 11;26(1):136. doi: 10.1186/s12891-025-08330-7.

ABSTRACT

BACKGROUND: Thoracic hyperkyphosis (HK), common in older adults, has been linked to impairments in physical function, mobility, balance, gait, and falls. Our pilot study used a novel 4-week manual therapy and exercise intervention for HK and showed improved posture and function. This secondary analysis aims to explore 1) the changes in gait parameters after a novel intervention for HK, 2) the correlations between posture and gait variables at baseline, and 3) pre- to post intervention.

METHODS: This secondary analysis uses data from a quasi-experimental, single group pilot study. Participants with HK underwent pre- and post intervention measurements in posture, function, and unique to this secondary analysis, gait parametrics of velocity (V), step length (SL), double limb support (DLS), and step width (SW) using the GAITRite® electronic walkway. Paired t-tests compared pre- and post intervention gait parameters. Pearson correlation coefficients were utilized to investigate correlations between all variables at baseline and in pre- and post intervention change values.

RESULTS: Fourteen women and 8 men (aged 65.9 years ±9.2; range 52 – 90) completed 12 treatments (3 times/week for 4-weeks). Statistically significant improvement (p≤.001) occurred pre- to post for postural measures: height (M=0.73cm ±0.54), Kyphotic index (-2.41 ±2.96), Block (-1.17cm ±1.22), Acromion to table (ATT) (-1.85cm ±1.42), and 3 gait measures: V (M=0.087m/s ±0.09), SL (2.34cm ±2.55), and DLS (- 0.031sec ±0.04). SW improvement was not statistically significant. Block and ATT measures were moderately correlated with V, SL, SW (Block only), and DLS (ATT only) at baseline. Strong correlations were found among V, SL, and DLS at baseline and in pre- to post change scores, but no correlation between change scores of posture and gait.

CONCLUSIONS: This study shows that a clinically practical 4-week PT intervention may benefit older adults with HK by demonstrating improved posture and gait parameters. Further research is warranted.

TRIAL REGISTRATION: This study was retrospectively registered on 16/09/2019 under ClinicalTrials.gov Identifier: NCT04114331.

PMID:39934800 | DOI:10.1186/s12891-025-08330-7

Malar J. 2025 Feb 12;24(1):40. doi: 10.1186/s12936-025-05278-w.

ABSTRACT

BACKGROUND: Rwanda has made significant strides in malaria control. This study reviews malaria epidemiology and control strategies in Rwanda from 2018 to 2023, documenting their impact, persistent gaps and emerging challenges.

METHODS: Data on Rwanda’s malaria context from 2018 to 2023 were obtained through a literature review of peer-reviewed articles and grey literature, including annual reports from the malaria programmes, partners, the African Union, and the World Health Organization (WHO). Specific keywords used for the search included “malaria”, “Rwanda”, “case management”, “control”, “treatment”, and “prevention”. Moreover, epidemiological data for this period was extracted from the Health Management Information System (HMIS). Data analysis was done using R & R-Studio, ANOVA to assess the statistical significance (P < 0.05) of observed trends and T-test to compare the focal and blanket IRS techniques.

RESULTS/DISCUSSION: Between 2018 and 2023, all malaria indicators showed improvement. Malaria incidence dropped from 345 to 40 cases per 1000 persons (P = 0.00292), the severe malaria rate decreased from 112 to 10/100,000 persons (P = 0.018), and the mortality rate fell from 2.72 to 0.258 deaths /100,000 persons (P = 0.00617). Among children under 5 years of age, incidence decreased significantly from 331 to 52/1,000 persons (P = 0.00123), the severe malaria rate dropped from 214 to 29/100,000 persons (P = 0.00399), and mortality declined from 5 to 0.453/100,000 persons (P = 0.00504). Over the same period, key malaria interventions expanded. The proportion of cases treated by CHWs increased significantly, improving access to early diagnosis and treatment (from 13 to 59%), and the new generations of ITNs (PBO and dual-active ingredient nets) were deployed in 9 districts. Since 2019, a blanket spraying technique has been adopted in 12 IRS districts replacing the focal spraying technique contributing to the significant decrease of malaria incidence from 2019 to 2023 (P = 0.0025). However, new challenges have emerged, including the rise of the K13 R561H mutation associated with artemisinin resistance, the spread of insecticide resistance, and limited intervention coverage due to resource constraints.

CONCLUSION: To sustain the progress achieved, it is essential to intensify malaria control efforts, foster compliance with intervention strategies, enhance surveillance systems for timely and effective responses, and secure long-term funding to sustain these measures.

PMID:39934796 | DOI:10.1186/s12936-025-05278-w

BMC Public Health. 2025 Feb 11;25(1):570. doi: 10.1186/s12889-025-21757-w.

ABSTRACT

BACKGROUND: The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) (NHHR) served as a novel comprehensive lipid indicator. This study aimed to explore the association between NHHR and the incidence of cardiometabolic multimorbidity (CMM).

METHODS: This study included 8191 individuals from the China Health and Retirement Longitudinal Study (CHARLS) database. We used multivariable cox proportional hazards regression, logistic regression, and restricted cubic splines (RCS) analysis to evaluate the association between NHHR and CMM. Subgroup analyses and interaction tests were also performed.

RESULTS: The incidences of CMM among participants in quartiles (Q) 1-4 of NHHR were 7.03%, 8.3%, 10.06%, and 16.55%, respectively. The NHHR was significantly higher in individuals with CMM compared to those without CMM (P < 0.001). When assessed as a continuous variable, NHHR was independently associated with the risk of CMM, as demonstrated by both multivariable cox proportional hazards regression analysis (HR = 1.05, 95% CI = 1.02-1.07, P < 0.001) and logistic regression analysis (OR = 1.09, 95% CI = 1.04-1.15, P < 0.001). Compared to individuals in the lowest quartiles of the NHHR (Q1), the risk of CMM in the highest quartiles (Q4) was increased by 1.25-fold according to multivariable cox proportional hazards regression analysis (HR = 2.25, 95% CI = 1.73-2.93, P < 0.001) and by 1.48-fold according to logistic regression analysis (OR = 2.48, 95% CI = 1.86-3.31, P < 0.001). This association was consistent across nearly all subgroups. RCS analysis revealed a significant nonlinear association between NHHR and CMM. Additionally, the predictive ability of NHHR for CMM was 0.613, which was superior to that of both HDL-C and non-HDL-C (P < 0.05). Furthermore, the composite variable comprising NHHR and other traditional risk factors exhibited the highest predictive value (C statistic = 0.679).

CONCLUSION: A higher NHHR was closely associated with an increased risk of CMM. Further studies on NHHR could be beneficial for preventing and treating CMM.

PMID:39934789 | DOI:10.1186/s12889-025-21757-w

Semin Arthritis Rheum. 2025 Feb 1;71:152649. doi: 10.1016/j.semarthrit.2025.152649. Online ahead of print.

ABSTRACT

OBJECTIVES: Assess reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric self-report and parent-proxy report fixed short forms in juvenile myositis (JM).

METHODS: Children with JM (8-17yo) and parents of 5-17 yo JM patients completed PROMIS measures (Physical Function, Pain Interference, Fatigue, Emotional Distress), PedsQL Generic Core scales and Rheumatology Module (PedsQL-GC/-RM). Internal consistency reliability was assessed via Cronbach’s alpha. Patient-parent agreement was assessed via intraclass correlations (ICC). Concurrent and construct validity were assessed via Spearman’s correlations between PROMIS versus PedsQL-GC/-RM and clinical/lab data respectively. Known-groups validity was assessed by comparing PROMIS T-scores between clinically distinct JM patients.

RESULTS: We enrolled 75 JM participants, with 57 administered self-report and all 75 administered parent-proxy report measures per participant age. PROMIS measures were feasible (>96% completion), with high internal consistency reliability (Cronbach’s alpha >0.8). Patient-parent assessments demonstrated moderate agreement (ICC >0.5) for Mobility, Upper Extremity, and Fatigue domains, and smaller correlations (ICC 0.41-0.47) as expected for Pain Interference, Depressive Symptoms, and Anxiety. Concurrent validity was demonstrated by moderate correlation (Spearman’s rho >0.5) for all but 1 hypothesized relationships of PROMIS and PedsQL-GC/-RM domains. Although low disease activity and small sample size limited statistical power, construct validity and known-groups validity were demonstrable for multiple PROMIS pediatric self-report and parent-proxy report measures.

CONCLUSION: PROMIS measures show evidence of reliability and validity in JM. Child and parent reports differ sufficiently to suggest both should be collected. PROMIS measures can be considered for clinical and research use in JM.

PMID:39933204 | DOI:10.1016/j.semarthrit.2025.152649