Tag: pubmed

BMC Health Serv Res. 2026 Jun 27. doi: 10.1186/s12913-026-14683-z. Online ahead of print.

ABSTRACT

BACKGROUND: Moral distress is a relevant occupational health issue in hospital settings, particularly in high-complexity environments such as surgical units, where organizational constraints, ethical dilemmas, and interprofessional dynamics shape professionals’ experiences. Comparative evidence is needed to understand how moral distress manifests across professional groups working within the same clinical context.

METHODS: This cross-sectional comparative study examined moral distress among physicians and nursing staff working in surgical settings at a public university hospital in southern Brazil. Data were collected from 245 healthcare professionals (167 physicians and 78 nursing staff) using the Brazilian Moral Distress Scale – Short Version (EDME-BR-VR). Group differences in moral distress dimensions were assessed using descriptive statistics and Mann-Whitney U tests. Comparative structural analyses were conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM), with separate models estimated for each professional group to examine similarities and differences in structural relationships.

RESULTS: Significant differences between physicians and nursing staff were observed in selected moral distress dimensions, particularly Safe and Qualified Care, Defense of Values and Rights, and Working Conditions. Across both groups, Recognition, Power, and Professional Identity emerged as a central antecedent of moral distress, showing significant associations with teamwork, working conditions, safe and qualified care, and ethical violations. Comparative PLS-SEM results indicated similar overall relational patterns across groups, with differences in the magnitude of specific structural paths reflecting profession-specific dynamics.

CONCLUSIONS: Moral distress among physicians and nursing staff in surgical settings is shaped by shared organizational factors as well as profession-specific ethical pressures. Comparative analysis highlights the central role of professional recognition and identity while underscoring the need for differentiated organizational strategies to address moral distress across professional groups. These findings provide actionable insights for healthcare managers seeking to promote ethical practice, psychological safety, and sustainable work environments in surgical care.

PMID:42365313 | DOI:10.1186/s12913-026-14683-z

BMC Public Health. 2026 Jun 27. doi: 10.1186/s12889-026-28173-8. Online ahead of print.

ABSTRACT

BACKGROUND: Vaccination remains one of the most effective public health measures, yet many children in Nigeria continue to miss essential vaccines, leaving them exposed to preventable diseases. Understanding the geographic and temporal patterns of missed vaccinations is important for designing targeted and equitable immunization strategies. This study investigates the geospatial variations in the prevalence of children who missed diphtheria-pertussis-tetanus vaccination in Nigeria.

METHODS: Data were obtained from the Nigeria Demographic and Health Surveys conducted between 2003 and 2023/2024. Bayesian geostatistical models were fitted within the Integrated Nested Laplace Approximation (INLA) framework to estimate the prevalence of zero-dose and under-immunized children across states and survey periods. Exceedance probability maps were used to identify states with a high likelihood that the prevalence of zero-dose children exceeded ten percent.

RESULTS: The results show clear geographic clustering, with persistently higher prevalence of missed vaccinations in the northern regions compared to the south. Dropout between consecutive DPT doses has decreased over time, indicating improved follow-through once children start vaccination; however, each successive dose still shows a higher prevalence of missed vaccinations than the preceding one. Exceedance probability maps further highlight states such as Kebbi, Sokoto, Zamfara, and parts of Niger, Kwara, Borno, Yobe, Taraba, and Kogi, where the likelihood of zero-dose prevalence surpassing 10% remains high.

CONCLUSION: Despite improvements in childhood vaccination coverage, large geographic disparities persist, especially in northern states. The continued presence of states with a high probability of zero-dose prevalence suggests that national progress has not resulted in equitable gains. Strengthening local immunization systems, addressing regional barriers, and prioritizing targeted interventions are needed to ensure that all children benefit from routine vaccination services.

PMID:42365312 | DOI:10.1186/s12889-026-28173-8

BMC Oral Health. 2026 Jun 27. doi: 10.1186/s12903-026-08993-1. Online ahead of print.

ABSTRACT

BACKGROUND: The evaluation of three-dimensional fracture mapping may offer significant benefits for clinicians, as well as for engineers involved in the design of advanced implants. The specific objectives of this study were to perform three-dimensional mapping of mandibular fractures based on the unique fracture morphologies of a defined cohort and to assess fracture distribution according to demographic variables, etiological factors, mandibular third molar impaction status, and fracture characteristics.

METHODS: This retrospective single-center cohort study included patients with mandibular fractures who were admitted to the Department of Oral and Maxillofacial Surgery at a tertiary healthcare center between January 2018 and February 2025. The primary outcome was the three-dimensional mapping of mandibular fracture distribution, visualized as fracture line density using color-coded heat maps. Covariates included demographic, etiological, mandibular third molar-related, and fracture-related variables. Fracture mapping was performed at the fracture level, whereas statistical analyses evaluating the association between impacted third molars and fracture location were conducted at the patient level.

RESULTS: One hundred fifty eight patients with mandibular fractures were analyzed, including 103 males (65.2%) and 55 females (34.8%) patients. The mean age of the patients was 36.8 ± 13.7 years. A total of 239 fractures were identified, and 267 fracture lines were delineated. In three-dimensional mapping, mandibular fractures most frequently clustered in the retromolar area, condylar neck, canine socket, and mental foramen regions. Mandibular fractures were most frequently observed in young male patients. The angle/ramus region was the most commonly fractured anatomical site, and assault was the predominant etiological factor. Impacted mandibular third molars were associated with a higher frequency of angle/ramus fractures, whereas condylar process fractures were more common in patients without impacted third molars. (OR = 2.04, 95% CI = 1.08-3.85, p = .027; and OR = 0.40, 95% CI = 0.20-0.80, p = .015, respectively).

CONCLUSIONS: Three-dimensional fracture mapping revealed clustering of mandibular fractures in the retromolar area, condylar neck, canine socket, and mental foramen regions, indicating areas of higher observed fracture-line density in this cohort.

PMID:42365309 | DOI:10.1186/s12903-026-08993-1

BMC Womens Health. 2026 Jun 27. doi: 10.1186/s12905-026-04595-9. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the factors associated with the use of different modern contraceptives (MCs) by Nigerian married or in-union women of reproductive age with a demand for family planning (DFP). These MCs are permanent methods and long-acting reversible contraceptives (PLARCs), medium-acting reversible contraceptives (MARCs), and short-acting reversible contraceptives (SARCs).

METHODS: An unweighted sample size of 9,983 women nested in a total of 1,118 communities was extracted from the 2024 Nigeria Demographic and Health Survey. A multilevel multivariable multinomial logistic regression analysis was carried out using Stata 17.0. Two levels of analysis were utilised: the individual and the community level, with the accompanying variables adjusted for.

RESULTS: The DFP satisfied by modern methods (DFPSM) was approximately 33.9%, with the DFP satisfied by PLARCs, MARCs, and SARCs estimated as approximately 17.1%, 9.1%, and 7.8%, respectively. We found large remaining significant between-community variances in the odds of women satisfying their DFP with the different MCs. This was shown by the various estimated median odd ratios for the DFP satisfied by PLARCs, MARCs, and SARCs: approximately 3.870, 4.830, and 4.532, respectively. These remaining between-community variances were of greater relevance than the associated effects of most of the adjusted individual and household-level variables. This was with the exception of only the regression effects on DFP satisfied with MARCs of women in households with 1 to 2 dejure children at most 5 years old (aOR = 5.514, 95%CI = 2.226 to 13.658, p < 0.001); and those in households with no children at most 5 years old (aOR = 9.359, 95%CI = 3.656 to 23.954, p < 0.001). However, other variables that significantly increased the use of the different types of MCs by women with a DFP were their formal education level and women being usual residents of communities with high age at first marriage/cohabitation, low fertility clusters, and low polygyny clusters.

CONCLUSION: To increase the very low DFPSM in Nigeria using different types of MCs, government policies/interventions aimed at improving the educational level of girls beyond the primary level should be implemented. A greater concentration should be within communities with low age at first marriage/cohabitation, high polygyny, and high fertility clusters.

PMID:42365305 | DOI:10.1186/s12905-026-04595-9

BMC Pediatr. 2026 Jun 27. doi: 10.1186/s12887-026-07197-4. Online ahead of print.

ABSTRACT

BACKGROUND: Non-allergic rhinitis syndrome (NAR) is a chronic rhinitis characterized by the significant absence of an allergy history, negative skin prick test results, and normal serum IgE levels. Nasal cytology is a valuable diagnostic method that enables qualitative and quantitative assessment of inflammatory cells – including eosinophils, neutrophils, mast cells, and lymphocytes – in the nasal mucosa. This study aimed to evaluate the levels of nasal eosinophilia in a pediatric NAR population and to evaluate the correlation of this local inflammatory biomarker with clinical severity scales such as ARIA and PRQLQ.

METHODS: This prospective, cross-sectional study included 103 children aged 5-18 years: 53 with NAR and 50 healthy controls. Symptom duration and severity were classified according to ARIA 2019 criteria. The Paediatric Rhinitis Quality of Life Questionnaire (PRQLQ) was used for quality of life assessment. Nasal cytology specimens were collected by nasal swab from the middle meatus and the eosinophil percentage was calculated by counting a total of 100 cells in the area of highest cell density.

RESULTS: A total of 103 children were enrolled: 53 NAR patients and 50 healthy controls. Median age was 10 (8-13) years in the study group and 11 (8-14) years in the control group. Family history of allergy was significantly higher in the study group (30.2%) compared to controls (12.0%) (p = 0.024). Median nasal eosinophil level was 7.0 (3.5-15.5) in the study group and 0 (0-3.0) in controls; the difference was statistically significant (p < 0.001). The nasal eosinophil cut-off value was determined as 3.5%. No significant difference was found between nasal eosinophil groups (< 3.5% and ≥ 3.5%) and any PRQLQ subscale or total score (p > 0.05).

CONCLUSIONS: Nasal cytology may serve as a simple, non-invasive diagnostic tool to identify NAR subtypes and to determine clinical severity in pediatric patients.

PMID:42365301 | DOI:10.1186/s12887-026-07197-4

BMC Oral Health. 2026 Jun 27. doi: 10.1186/s12903-026-08999-9. Online ahead of print.

ABSTRACT

BACKGROUND: Dental caries is a highly prevalent chronic childhood condition, yet longitudinal evidence linking early oral hygiene behaviours to long-term outcomes remains limited. This study estimated whether twice-daily toothbrushing at age 2-3 years was associated with lower incident dental caries through adolescence, under a target trial emulation framework.

METHODS: Data were from the Longitudinal Study of Australian Children (LSAC) B-cohort (N = 5,107). Children with caries at or before Wave 2 (age 2-3) were excluded, yielding an incident sample of 2,970. Associations were estimated using multivariable logistic regression, propensity score matching, inverse probability of treatment weighting (IPTW), targeted maximum likelihood estimation (TMLE), and g-computation. The outcome was carer-reported dental caries. Confounders were identified via directed acyclic graph (DAG) analysis. Effect modification by area-level socioeconomic position (SEP) was assessed through a pre-specified equity analysis.

RESULTS: Among 2,941 children in the analytic sample, 1,559 (53.0%) developed carer-reported caries by age 14-15. Caries incidence was lower among children who brushed twice daily: 660 of 1,359 (48.6%) versus 899 of 1,582 (56.8%) in the less frequent group. The primary adjusted odds ratio (aOR) was 0.73 (95% CI: 0.63-0.85, p < 0.001). A dose-response gradient was observed (p-trend < 0.001). Effect estimates were similar across analytical approaches (OR range: 0.72-0.75). In non-disadvantaged areas, protective associations were observed (aOR = 0.65, 95% CI: 0.54-0.79). In disadvantaged areas, the association was weaker and not statistically significant (aOR = 0.91, 95% CI: 0.71-1.17; interaction p = 0.035). An exploratory falsification analysis using dental pain yielded a null result (aOR = 1.06, 95% CI: 0.91-1.23, p = 0.47), but this outcome was interpreted cautiously because dental pain may lie downstream of caries.

CONCLUSIONS: Twice-daily toothbrushing by age 2-3 years was associated with a lower risk of incident adolescent caries. Estimates from multiple causal inference approaches were consistent with an absolute risk reduction of approximately 8% points (NNT ≈ 13), under assumptions of no unmeasured confounding, adequate positivity, and correct model specification. Protective associations appeared concentrated in non-disadvantaged areas, suggesting that oral hygiene promotion should be combined with broader preventive strategies addressing structural determinants of oral health.

PMID:42365300 | DOI:10.1186/s12903-026-08999-9

Subst Abuse Treat Prev Policy. 2026 Jun 27. doi: 10.1186/s13011-026-00742-5. Online ahead of print.

ABSTRACT

BACKGROUND: Substance Use Disorder represents a complex global public health challenge, yet the effectiveness of treatment centers remains debated due to lack of consensus on standardized international indicators and heterogeneity of treatment modalities. This systematic review aimed to identify and synthesize key international indicators for measuring treatment success, compare effectiveness of different modalities, and assess impact on social reintegration.

METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Population, Intervention, Comparison, Outcome frameworks, we conducted systematic searches of PubMed, Scopus, Web of Science, and Cochrane Library. Two reviewers independently screened 4,234 records, extracted data from 28 included studies, and assessed quality using Cochrane Risk of Bias 2 and Newcastle-Ottawa Scale. Heterogeneity was quantified using I-squared and tau-squared statistics.

RESULTS: Core indicators emerged in three domains: physiological (abstinence, daily functioning), psychological (reduced anxiety/depression, craving reduction), and social (employment, family relations). Medication-Assisted Treatment with methadone and buprenorphine demonstrated consistent effectiveness in reducing substance use and preventing relapse. Psychosocial interventions, particularly Cognitive Behavioral Therapy and Mindfulness-Based Relapse Prevention, significantly enhanced quality of life. Integrated models combining pharmacological and psychosocial approaches outperformed single-modality treatments. However, 78.6% of studies originated from four high-income countries, and only 17.9% reported outcomes beyond 12 months.

CONCLUSIONS: Effective Substance Use Disorder treatment requires integrated models with standardized, multidimensional outcome indicators. Future research must prioritize long-term outcomes and address the substantial evidence gap in low- and middle-income countries.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42365295 | DOI:10.1186/s13011-026-00742-5

BMC Med Educ. 2026 Jun 27. doi: 10.1186/s12909-026-09811-6. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare professionals other than dietitians are widely perceived as credible sources of nutrition information by patients, despite many of these professionals having received limited nutrition training. Little is known about where healthcare professionals obtain nutrition information and how reliance on various sources of nutrition information relates to their self-perceived nutrition competence. This study aimed to investigate the association between the frequency of accessing nutrition information from evidence-based and non-evidence-based sources and healthcare professionals’ self-perceived nutrition competence.

METHODS: A cross-sectional online survey was conducted using a questionnaire adapted from the NUTrition COMPetence (NUTCOMP) tool. Independent variables included self-reported frequencies of accessing various nutrition information sources in the preceding 30 days, measured by Likert-scale questions. The primary outcome was self-perceived nutrition competence assessed by NUTCOMP scores. A robust linear regression model was created to evaluate associations between NUTCOMP scores and frequencies of accessing different nutrition information sources, adjusting for age, sex, profession, education level, workplace, and previous nutrition education. The statistical significance level was set at 0.05.

RESULTS: A total of 450 healthcare professionals working in healthcare facilities across China were enrolled, including 302 (67.11%) nurses and 124 (27.56%) doctors. The median NUTCOMP score was 120 (interquartile range 102-141). The most popular information sources were colleagues (n = 293), social media (n = 222), and professional websites (n = 121). More frequent access to nutrition information from colleagues (β = 3.75, p < 0.001), friends or family members (β = 2.71, p = 0.02), and academic webinars or continuing education (β = 3.92, p = 0.002) were significantly associated with higher NUTCOMP scores.

CONCLUSIONS: Healthcare professionals in China frequently accessed nutrition information from both evidence-based and non-evidence-based sources. Frequencies of accessing nutrition information from colleagues, friends or family members, and academic webinars or continuing education were positively associated with self-perceived nutrition competence. The association observed with non-evidence-based sources highlights the need to better understand how information-seeking behaviors influence professional confidence and clinical practice. Future research is needed to develop strategies to strengthen evidence-based nutrition information sharing that may enhance nutrition competence.

PMID:42365293 | DOI:10.1186/s12909-026-09811-6

Health Qual Life Outcomes. 2026 Jun 27. doi: 10.1186/s12955-026-02565-1. Online ahead of print.

ABSTRACT

BACKGROUND: Although visual impairment (VI) is known to affect children’s development, there is limited evidence on how VI influences health-related quality of life (HRQoL) among children in Ghana. This study aimed to assess the relationship between childhood VI and HRQoL.

METHODS: A cross-sectional study was conducted among children aged 2 to 18 years in selected districts of the Ashanti Region, Ghana. Comprehensive ocular assessments including visual acuity (VA), refraction, and anterior and posterior segment evaluations were performed. Health-related quality of life was measured using the PedsQL 4.0 across physical, emotional, social, and school functioning domains. Data were analyzed using descriptive statistics, independent-sample t-tests, and linear regression.

RESULTS: A total of 581 children participated (mean ± SD age: 8.64 ± 4.00 years), with females representing 53.0% of the sample. Both child-reported and parent-reported scores showed significantly reduced HRQoL among children with VI across all PedsQL domains compared with children without VI, with school (p < 0.001) and emotional (p = 0.005) functions of child-reported showing statistical significance. Presenting VI was a significant predictor of poor overall HRQoL in both simple (β= -10.351, p < 0.001) and multiple linear regression models (β= -5.650, p = 0.016). No significant associations (p > 0.05) were found between HRQoL and sociodemographic variables, including sex, age, ethnicity, work status, and health insurance.

CONCLUSIONS: Childhood VI is associated with substantial reductions in multiple dimensions of HRQoL. These findings underscore the need to strengthen early detection, clinical management, and school-based vision support services to improve pediatric eye care in Ghana.

PMID:42365291 | DOI:10.1186/s12955-026-02565-1

BMC Oral Health. 2026 Jun 27. doi: 10.1186/s12903-026-08978-0. Online ahead of print.

ABSTRACT

BACKGROUND: Sufficient information is not available regarding the selection of ideal post and core types or the preferred method to access the subgingival margin to achieve optimal marginal integrity in the reconstruction of teeth with deep cervical lesions. This study aimed to evaluate how the position of the finish line and different post and core types, combined with deep marginal elevation (DME) and crown lengthening (CL) procedures, affect the marginal integrity of monolithic zirconia crowns in endodontically treated premolars.

METHODS: In the present laboratory experiment, 60 endodontically treated maxillary first premolars were assigned to six groups (n = 10): composite core supported by prefabricated fiber post (FP/CC) with DME (FP/CC-DME), composite core reinforced with polyethylene fiber (PEF/CC) with DME (PEF/CC-DME), cast post and core (CPC) with DME (CPC-DME), FP/CC-CL, PEF/CC-CL, and CPC-CL. Marginal integrity was assessed at the TheraCem-core, core-tooth, TheraCem-dentin, and TheraCem-enamel interfaces. Data were analyzed statistically (α = 0.05).

RESULTS: In the DME approach, the lowest marginal integrity was noted at the TheraCem-core and core-tooth interfaces in the CPC group, followed by FP/CC and PEF/CC (P < 0.05). In the CL approach, there was no significant variation among the groups (P > 0.05). With FP/CC, TheraCem-core, core-tooth, and TheraCem-dentin interfaces showed comparable marginal integrity (P > 0.05). With PEF/CC, the least marginal integrity was recorded at the TheraCem-dentin interface, followed by the TheraCem-core and core-tooth interfaces. With CPC, the TheraCem-core and core-tooth interfaces showed lower marginal integrity than dentin (P < 0.05).

CONCLUSIONS: The type of post and core significantly affected the marginal integrity in the DME approach (PEF/CC > FP/CC > CPC) but not in the CL approach. DME, compared with CL, increased the marginal integrity with PEF/CC, decreased the marginal integrity with CPC, and did not affect the marginal integrity with FP/CC.

PMID:42365290 | DOI:10.1186/s12903-026-08978-0