Tag: pubmed

BMC Surg. 2025 Aug 9;25(1):360. doi: 10.1186/s12893-025-03047-9.

ABSTRACT

BACKGROUND: The delay in the starting of first elective surgical cases frequently occurs in the operation theatre. Its magnitude ranges from 24.8 to 99.3% and is contributed by many factors and it has the potential to induce major effects on the efficiency of the healthcare system.

OBJECTIVE: To assess the magnitude and factors of delayed incision time of first cases among elective surgery at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia, 2022/23.

METHOD: A hospital-based cross-sectional study was conducted on 421 elective surgical first-cases in Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia, from January to April 28, 2023. The primary outcome of this study was the magnitude of delayed first cases’ incision time of surgical patients. The data were collected using a structured questionnaire and systematic sampling method. Data was analyzed using statistical software for social sciences version 26. A chi-square test and logistic regression analysis were used for data analysis. Binary and multivariable logistic regression analysis was computed to determine the association between the independent and dependent variables. Independent variables with P < 0.20 were selected for multivariable analysis. Variables with P < 0.05 in a 95% confidence interval after multivariate analysis were selected as statistically significant.

RESULTS: a total of 924 cases were scheduled as the first cases in the study period and 422 cases were recruited. The magnitude of delayed first-case incision time was 56.5% with a mean delayance of 33 min. A multivariate analysis identified a lack of anesthesia and/or adjuvant drugs [AOR = 2.65(1.14-6.16), P < 0.05], late anesthesia induction [AOR = 19.65(10.07-38.34), P < 0.01], surgeons’ or residents’ late arrival to the operation theatre [AOR = 2.37(1.1-5.14), P < 0.05], surgical positions other than supine [AOR = 2.47(1.23-4.97), P < 0.05] and type of surgery as a significant predictors of delayed first case start of elective surgeries.

CONCLUSION AND RECOMMENDATION: The magnitude of delayed first cases’ incision time among elective surgery was high (56.5%) with a mean time of delayance of 33 min. Lack of anesthetics or adjuvants, late anesthesia induction, late arrival of the surgical team, surgical position other than supine, and surgery types were significantly associated factors. It is recommended to develop an improvement plan to minimize first-case incision time delayance and improve surgical efficiency among elective surgeries.

PMID:40783754 | DOI:10.1186/s12893-025-03047-9

BMC Neurol. 2025 Aug 9;25(1):329. doi: 10.1186/s12883-025-04320-3.

ABSTRACT

BACKGROUND: Post-stroke fall is a common incidence among stroke survivors, and it has several detrimental effects on this group of people. It significantly influences their well-being, increasing morbidity and reducing functional independence. It also leads to limiting activity and participation, increasing dependence and developing a fear of movements. In addition, it delay the progress of motor and cognitive recovery, as the patients may avoid activities that increase their risk of falling. Therefore, assessing post-stroke falls and their associated factors is necessary to address their consequences.

SUBJECTS: Stroke survivors who attended stroke units and physiotherapy outpatient clinics at hospitals in Jimma town, Oromia Regional State, South west Ethiopia.

METHOD: A hospital-based cross-sectional study with a systematic random sampling technique was employed, and the data collection occurred through chart review, physical examination, and face-to-face interviews. The collected data was analyzed on SPSS Version 25. Bi-variable analysis was used to determine potential candidate variables. Finally, an adjusted odds ratio with a P value < 0.05 and a 95% confidence interval was considered statistically significant.

RESULT: Among the study participants, 59.5% (235) of stroke survivors experienced post-stroke falls. Key factors includes an older age group (AOR = 3.2; 95% CI = 1.159-9.020), hemorrhagic type of stroke (AOR = 1.8; 95% CI = 1.036-3.088), spastic muscle tone (AOR = 2.7; 95% CI = 1.343-5.394), altered mental status (AOR = 1.7; 95% CI = 1.019-2.819), less number one caregiver (AOR = 1.8; 95% CI = 1.119-3.026), and late admission to hospital (AOR = 2.1; 95% CI = 1.115-3.952).

CONCLUSION: More than half of stroke survivors had a history Post-stroke falls in the Jimma town with key factors including older age, type of stroke, spastic muscle tone, ≤one caregiver, late admission to hospital, and altered mental status.

PMID:40783749 | DOI:10.1186/s12883-025-04320-3

BMC Neurol. 2025 Aug 9;25(1):326. doi: 10.1186/s12883-025-04350-x.

ABSTRACT

BACKGROUND: Migraine is a complex neurological disorder characterized by recurrent, disabling headaches and various sensory symptoms, affecting about 15% of the global population annually. It is the second most common neurological condition worldwide, causing significant disability. While current prophylactic treatments include beta-blockers, tricyclic antidepressants, anticonvulsants, and monoclonal antibodies targeting the CGRP pathway, not all patients respond adequately. Atogepant, an oral CGRP receptor antagonist, has emerged as a promising option for migraine prevention with improved tolerability.

METHODS: This meta-analysis follows PRISMA guidelines, involving a comprehensive search of Cochrane CENTRAL, PubMed/MEDLINE, and Google Scholar databases up to July 2024. Efficacy outcomes included mean monthly migraine days (MMDs), mean monthly headache days (MHDs), monthly acute medication use days and the percentage of patients with a ≥ 50% reduction in MMDs. Safety outcomes were measured by adverse events (AEs). Statistical analysis employed the Inverse Variance and Mantel-Haenszel random-effects models, with heterogeneity assessed using the I² index.

RESULTS: Six RCTs with 4325 patients (3054 on Atogepant, 1271 on placebo) met the inclusion criteria. The combined analysis indicated a significant reduction in MMDs favoring Atogepant over placebo (SMD – 0.39, 95% CI: -0.45 to -0.33; p < 0.00001; I²=0%). Similarly, significant reductions were observed in MHDs, monthly acute medication use days, and the proportion of patients achieving a ≥ 50% reduction in MMDs.

CONCLUSION: Atogepant is an effective and safe option for migraine prophylaxis, showing significant reductions in MMDs. Further extensive trials are recommended to assess the long-term efficacy, safety, and cost efficiency of Atogepant compared to other preventive medications.

PMID:40783748 | DOI:10.1186/s12883-025-04350-x

BMC Public Health. 2025 Aug 9;25(1):2720. doi: 10.1186/s12889-025-24033-z.

ABSTRACT

BACKGROUND: Though there are a growing number of programs seeking to prevent violence against women and children, adolescent girls often fall into a gap between these approaches. This article focuses on the impact of a violence prevention program, Rethinking Power, on the lives and wellbeing girls and young women aged 10-23.

METHODS: The study utilized a quasi-experimental, mixed-methods design. The results focus on data collected with girls and young women (N = 1,627) who were of adolescent age during program implementation. A difference-in-difference approach explored the impact of the program on key outcomes using cross-sectional data from three timepoints. A survey of girls’ groups participants was also undertaken (N = 752) and qualitative data was collected with adolescents and community stakeholders (52 focus groups and 61 interviews). Regression was utilized to analyze girls’ group data and thematic analysis to analyze qualitative data. Data for mixed methods analysis was brought together using a convergent approach.

RESULTS: The results show girls and young women the intervention areas reported less experiences of physical or sexual IPV in the past 12 months over time (from 25.7% at baseline to 15.7% at endline) and reduced, though non-significant due to small samples, odds of experiencing IPV compared to the controls (OR: 0.78; p = .51). Qualitative data also showed changes in violence, acceptance of violence and gender attitudes. Girls and young women in the intervention area (rather than control) had more than twice the odds of reporting that they could choose who to be friends with (OR: 2.59; p = .047) and had greater odds of agreeing that girls should be allowed to socialize just as boys (OR: 3.87; p <.001) and that a man should not have the final word at home (OR: 1.94; p = .019). Participants in girls’ groups saw improvements on indicators related to gender attitudes, acceptance of violence, self-esteem and agency.

CONCLUSIONS: While not all results are statistically significant due to small sample sizes, they suggest that girl-focused programming, alongside a wider community-change process, can improve the lives of adolescent girls.

TRIAL REGISTRATION: The full trial was retrospectively registered in ISRCTN (ISRCTN12311597) on April 4th, 2024.

PMID:40783733 | DOI:10.1186/s12889-025-24033-z

BMC Surg. 2025 Aug 9;25(1):358. doi: 10.1186/s12893-025-03118-x.

ABSTRACT

BACKGROUND: The quality and completeness of surgery remains critical for optimal oncological outcomes in breast cancer. A key indicator of surgical completeness is the resection margin status, which should ideally be negative, indicated by no ink on invasive tumor. However, such data is rarely reported from sub-Saharan Africa. This study aims to describe the clinical characteristics of women with non-metastatic breast cancer who underwent a mastectomy, and identify the factors influencing the resection margin status at a cancer hospital in Tanzania.

METHODOLOGY: This was a retrospective cohort study analyzing clinical and pathological data of female patients, with a histologically confirmed breast cancer at stage I-III, who underwent a mastectomy at Muhimbili National Hospital in Tanzania. Data were extracted from histopathology reports and clinical records, focusing on margin status and associated variables including age, tumor size (T-status), nodal involvement (N-status), histological subtype, grade, luminal subtype, laterality, and receipt of neo-adjuvant therapy. The primary outcome was margin status post mastectomy. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were applied to assess associations between variables and margin status. Statistical significance was set at p < 0.05.

RESULTS: Out of the 1,020 patients analyzed, margin status was documented for 976 cases. Among these, 801 patients (82.1%) had negative margins, while 175 (17.9%) had positive or close margins; of the latter, 88.6% were positive and 11.4% close. Most patients with margin involvement (88%) had only a single margin affected. The deep margin was most frequently involved in 87% of patients with involved margins, followed by the superior margin in 57%. Margin involvement was significantly higher among younger patients, particularly those under 30 years of age (p < 0.001), and was also strongly associated with advanced T-status (p < 0.001), especially T4 tumors, where 31.7% had involved margins. No significant associations were found with histological subtype, luminal classification, laterality, receipt of neoadjuvant therapy.

CONCLUSION: This study revealed a high rate of margin positivity following mastectomy, largely driven by advanced tumor stage and young age at presentation. To improve surgical outcomes in low-resource settings, we recommend interventions to improve earlier diagnosis and expanded use of neoadjuvant therapy for patients with locally advanced disease.

PMID:40783732 | DOI:10.1186/s12893-025-03118-x

BMC Surg. 2025 Aug 9;25(1):350. doi: 10.1186/s12893-025-03078-2.

ABSTRACT

BACKGROUND: Laparoscopic rectal surgery in female patients poses challenges due to limited pelvic space and obstructing reproductive structures. Uterine manipulators, widely used in gynecological surgery, may enhance intraoperative exposure during rectal resections, but evidence in colorectal settings is sparse.

METHODS: This retrospective cohort study included 40 female patients undergoing laparoscopic rectal cancer surgery between October 2024 and January 2025. Patients were divided into two groups based on the use of a uterine manipulator. Preoperative characteristics, intraoperative findings, and postoperative outcomes were compared, including exposure quality, operative time, lymph node harvest, neoadjuvant treatment response, and recovery parameters.

RESULTS: Intraoperative exposure was significantly better in the manipulator group (VAS 8.8 ± 0.9 vs. 6.05 ± 1.5; p < 0.001). Other perioperative parameters such as operative time, bleeding, lymph node harvest, and ICU admission showed no statistically significant differences. Among patients who received neoadjuvant therapy, pathological response did not differ between groups. Hospital stay was slightly shorter and pain scores marginally higher in the manipulator group, without statistical significance.

CONCLUSION: Uterine manipulators significantly improve exposure during laparoscopic rectal surgery in women without adversely affecting oncological or perioperative outcomes. They may be considered a useful adjunct in challenging pelvic dissections.

PMID:40783731 | DOI:10.1186/s12893-025-03078-2

BMC Surg. 2025 Aug 9;25(1):362. doi: 10.1186/s12893-025-03128-9.

ABSTRACT

BACKGROUND: Abdominal re-operation, or relaparotomy, refers to any repeat surgical intervention performed for intra-abdominal or wound complications during the same hospital admission or within 60 days of the initial operation. However, the regional level of relaparotomy remains unknown in East Africa. Hence, the objective of this systematic review and meta-analysis was to estimate the prevalence of relaparotomy and its associated factors in East Africa.

METHODS: Studies were accessed through an electronic web-based search strategy from PubMed, Cochrane Library, Google Scholar, Embase, PsycINFO, and CINAHL by using a combination of search terms. The quality of each included article was assessed using criteria adapted from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). All statistical analyses were done using STATA version 17 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results.

RESULTS: The overall prevalence of relaparotomy was determined to be 17.36% (95% CI: 7.03-27.68; I² = 99.89%). Patients OR latency of > 60 h was 2.33 times more likely to undergo re-laparotomy compared with patients operated in < 60 h (AOR = 2.33 (95%CI [1.22-3.45)). Patients with anastomotic leak were 2 times more likely to undergo re-laparotomy compared to patients without leak (AOR = 2 (95%CI [1.35-2.64)). Older patients were 4.13 times more likely to undergo re-laparotomy compared to young patients (AOR = 4.13 (95%CI [-4.62-12.89)).

CONCLUSION: This meta-analysis provides valuable insights into the prevalence and associated factors of relaparotomy, highlighting key regional variations and patient characteristics. The study identified several factors influencing the prevalence of relaparotomy, including the duration of illness, low systolic blood pressure, anastomotic leaks, delayed surgical intervention, and age.

PMID:40783728 | DOI:10.1186/s12893-025-03128-9

BMC Public Health. 2025 Aug 9;25(1):2719. doi: 10.1186/s12889-025-24078-0.

ABSTRACT

BACKGROUND: Stunting, a condition in which children fail to achieve their expected height for age, is a significant public health problem, particularly in low- and middle-income countries. The nutrition and caring practices of mothers and children during the first 1000 days of life determine the ability of a child to develop, learn, and thrive; however, mothers who work may not be able to ensure that their child is receiving adequate nutrition in the early stages of life. This study aimed to identify the determinants of working mothers’ stunting prevention behavior, including individual factors, work-related stress, well-being, knowledge, and attitudes toward the behavior of working mothers in supporting the prevention of stunting in West Java Province, Indonesia.

METHODS: This study used a cross-sectional design with a total sample of 225 working mothers in 78 offices mapped in Bandung city, Bekasi city, Bekasi Regency, Karawang Regency, West Bandung Regency, and Sumedang Regency in West Java Province, Indonesia. The inclusion criteria were as follows: working mothers aged 18 and above who reside and work in 6 cities/regencies of the study, have at least one child under the age of 5 years, and have consented to participate. The questionnaire consisted of demographic data and health characteristics, as well as questionnaires on knowledge, attitudes, work-related stress, well-being, and stunting prevention behavior. The data were analyzed using chi-square tests and logistic regression.

RESULTS: Among the 19 variables, two determinant factors influence stunting prevention behavior among working mothers in West Java Province, Indonesia. These factors are working mothers’ well-being (OR 3.30, P < 0.001) and knowledge about stunting prevention (OR 2.79, P < 0.001). A low level of well-being among working mothers increases the risk of poor stunting prevention behavior by 3.30 times. Similarly, insufficient knowledge about stunting prevention increases this risk by 2.79 times. The interplay between well-being and knowledge may improve mothers’ stunting prevention behavior.

CONCLUSIONS: Working mothers’ well-being and knowledge of stunting prevention affect their stunting prevention behavior. This study is the first in Indonesia to explore the determinant factors of stunting prevention behavior among working mothers. Working mothers should receive special attention from the government regarding their rights to improve their well-being and knowledge related to their health. Further research should adopt longitudinal and intervention-based designs, include other caregivers, and explore diverse geographic and employment settings. Research on workplace and policy-level support systems is also recommended to inform more comprehensive strategies for improving child health outcomes.

PMID:40783720 | DOI:10.1186/s12889-025-24078-0

BMC Nephrol. 2025 Aug 9;26(1):447. doi: 10.1186/s12882-025-04380-0.

ABSTRACT

BACKGROUND: Low socioeconomic status (SES) has been linked to poorer outcomes among patients with advanced chronic kidney disease, including those undergoing maintenance hemodialysis. Limited data are available from Sub-Saharan Africa. In this region, traditional SES indicators like education and income can be challenging to measure. Household wealth may serve as a more reliable SES indicator. Our aim was to evaluate SES using household wealth, its association with non-adherence, quality of life, anxiety and depression among hemodialysis patients in Cameroon.

METHODS: A cross-sectional study was conducted over four months in one urban and one semi-urban hemodialysis facilities in Cameroon. Consenting adult patients on maintenance hemodialysis for at least three months were included. Patients with cognitive impairment or language barriers (English or French) were excluded. Household wealth was assessed using the World Bank’s household wealth index adapted for Cameroon. Non-adherence was defined as missing ≥ 2 hemodialysis sessions within a six-week period. Quality of life was evaluated using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire. Anxiety and depression risk were assessed using the Hospital Anxiety and Depression Scale (HADS); p-values < 0.05 were considered statistically significant.

RESULTS: A total of 199 participants were included, with 52.8% (n = 109) males and a median age of 46 [IQR 36-56] years. Poverty affected 47.7% (n = 95) of participants, urban dwellers being more susceptible (52.5% n = 73 vs. 36.7% n = 22, p = 0.039). Poor participants had a greater percentage of patients < 46 years (56.8% n = 58 vs. 49% n = 40, p = 0.001) and unmarried status (43.1% n = 41 vs. 28.9% n = 30, p = 0.014). Non-adherence frequency was higher among poorer participants (42% n = 40 vs. 25% n = 26, p = 0.01). Globally, the quality of life was low across all household wealth groups. However, poorer participants experienced less physical function impairment (39% n = 37 vs. 52.9% n = 55, p = 0.04), fewer emotional role limitations (9.5% n = 9 vs. 19.2% n = 20, p = 0.048), and less depression (13.7% n = 13 vs. 26% n = 27, p = 0.04). In multivariate analysis, poverty increased the risk of non-adherence by 4.3 (95%CI 2.063-8.969, p < 0.001) and decrease the risk of depression by 0.7 (95%CI 0.063-0,963, p = 0.045).

CONCLUSION: Poverty, as assessed by household wealth, is common among hemodialysis patients, particularly the younger patients and urban dwellers. It is associated with increased risk of non-adherence but a lesser risk of depression.

PMID:40783719 | DOI:10.1186/s12882-025-04380-0

BMC Med Res Methodol. 2025 Aug 9;25(1):194. doi: 10.1186/s12874-025-02639-6.

ABSTRACT

BACKGROUND: We performed a systematic survey to collate studies on prediction models developed on the basis of meta-analysis in medicine and summarize key steps involved in model development.

METHODS: We systematically searched Web of Science, PubMed and Embase until April 2023 and included those that developed prediction models on the basis of meta-analysis. The data were summarized via narrative synthesis.

RESULTS: The search strategy identified 23 studies with 25 prediction models that met the eligibility criteria. The predicted outcomes focused on complications of diabetes, mortality, cognitive impairment, gestational diabetes, bronchopulmonary dysplasia, bacterial sinusitis, seizures, and psychosis. Twenty-three prediction models reported AUCs, with a median value of 0.77 (range: 0.59-0.91). Ten prediction models were developed with sample sizes exceeding 10,000 participants. The key steps in developing prediction models via meta-analysis include (1) confirming that the prediction model meets clinical needs before starting, (2) collecting data through meta-analysis to select predictors, (3) developing prediction models, (4) validating prediction model performance, (5) presenting and interpreting models and (6) reporting models.

CONCLUSION: The development of prediction models based on meta-analysis may represent a promising approach, which demonstrates good discrimination. Guidance is necessary to support the design, implementation and reporting of future prediction model development via meta-analysis.

PMID:40783714 | DOI:10.1186/s12874-025-02639-6