Tag: statistics

Int Health. 2026 Apr 23:ihag039. doi: 10.1093/inthealth/ihag039. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increased facility-based childbirth in Nepal, stagnant neonatal and high maternal mortality highlight a critical ‘know-do’ gap in care quality. To address this, a modular, competency-based learning resource package (LRP) was developed for maternal and newborn health providers.

METHODS: A mixed-methods exploratory pilot study involved curriculum alignment with international standards, multidisciplinary co-design and a single-group pre-post evaluation among 24 nursing professionals in Gandaki Province. Feasibility and acceptability were evaluated utilizing objective structured clinical examinations (OSCEs) and qualitative interviews.

RESULTS: Non-parametric analyses revealed significant educational gains. Median knowledge scores increased from 64.0 to 88.0. Statistically significant median improvements (p<0.001) were documented across all OSCE clinical domains: antenatal care (30.0 to 92.1), postnatal care (53.8 to 90.4), infection prevention (31.8 to 90.0) and respectful maternity care (30.0 to 92.9). Qualitative data indicated high acceptability; however, heavy clinical workloads and linguistic diversity constrained programmatic sustainability.

CONCLUSIONS: The LRP is a feasible intervention to bridge clinical competency gaps. Definitive national scale-up requires larger controlled trials assessing patient-level outcomes along with essential systemic investments in supply chains, healthcare infrastructure and continuous post-training mentorship.

PMID:42023467 | DOI:10.1093/inthealth/ihag039

Actas Esp Psiquiatr. 2026 Apr 15;54(2):287-300. doi: 10.62641/aep.v54i2.2043.

ABSTRACT

BACKGROUND: Non-suicidal self-injury (NSSI) in adolescents and young adults is a serious public health concern. The COVID-19 pandemic significantly impacted mental health worldwide. This longitudinal study aimed to investigate the differential impacts of COVID-19 on psychological health, social support, and academic performance among young adults with and without previous history of NSSI.

METHODS: From an initial sample of 603 college students, 241 (40%) completed this 2.5-year follow-up study. The first assessment was in January-February/2020 (pre-pandemic) and the second in June-July/2022 (post-pandemic). Participants were grouped based on the pres-ence or absence of NSSI at baseline. Variables assessed included sociodemographic data, academic performance, COVID-19-related experiences, clinical characteristics, and perceived social support.

RESULTS: A significant reduction in the prevalence of NSSI behaviors was observed over the follow-up period, decreasing from 35% to 8.7%. The NSSI group endorsed worse academic performance post-pandemic. While they maintained stable clinical severity with no observed worsening, during pandemic period they experienced an improvement in perceived social support. In contrast, the Non-NSSI group experienced a decline in perceived social support during the same period.

CONCLUSIONS: Contrary to previous studies, our findings indicate that young adults with NSSI significantly reduced self-harm behaviors after the COVID-19 pandemic. Although their academic performance was negatively affected, their clinical severity and social support did not worsen compared to those without NSSI. Findings indicate that the COVID-19 outbreak did not increase NSSI behaviors or exacerbate psychopathology in individuals with NSSI.

PMID:42023465 | DOI:10.62641/aep.v54i2.2043

Actas Esp Psiquiatr. 2026 Apr 15;54(2):335-347. doi: 10.62641/aep.v54i2.2066.

ABSTRACT

BACKGROUND: The Scale of Externalizing Problem Behaviors in Adults (SEPBA) was developed as a hybrid psychometric instrument designed to assess both dimensional traits and categorical diagnoses associated with externalizing psychopathology. Based on an integrative operational framework drawing on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Hierarchical Taxonomy of Psychopathology (HiTOP) model, the SEPBA assesses 15 traits/facets and 6 disorders within the domains of antagonism and disinhibition.

METHODS: The present study analyzed the psychometric properties of the SEPBA in a combined community and prisoner sample (n = 922). The final version of the SEPBA included 144 items rated on a 4-point Likert scale. Reliability (α, ω), item discrimination, convergent/discriminant validity, confirmatory factor analyses, and gender measurement invariance were examined.

RESULTS: The results indicated adequate item discrimination and internal consistency across all scales. Confirmatory factor analyses supported the unidimensionality of the individual scales and the hypothesized hierarchical organization of traits and facets. Gender invariance of the measure was demonstrated. In addition, evidence of convergent and discriminant validity was provided through correlations with external measures.

CONCLUSION: The findings support the SEPBA as a suitable assessment instrument. Its hybrid structure offers an integrative approach to transdiagnostic assessment, enhancing both the clinical utility of categorical diagnoses and the empirical applicability of dimensional profiles for assessing externalizing behaviors in adults.

PMID:42023463 | DOI:10.62641/aep.v54i2.2066

Actas Esp Psiquiatr. 2026 Apr 15;54(2):545-555. doi: 10.62641/aep.v54i2.2089.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death among adolescents worldwide. Suicide is a complex multifactorial issue and, in 2025, became the third-leading cause of death among individuals aged 15-29. We sought to evaluate the effectiveness of technology-assisted interventions (TIs) in reducing both suicidal behaviour and non-suicidal self-injury among adolescents.

METHODS: For this meta-analysis, we searched the EBSCO (APA PsycArticles, APA PsycInfo, MEDLINE, APA PsycTherapy, Psychology and Behavioral Sciences Collection), PubMed and Cochrane databases from inception until May 2025, seeking out articles featuring data (quantitative outcomes related to suicidal ideation or behaviour) on evaluated suicide or self-harm interventions among children and adolescents (aged 13-18) that incorporated digital technologies in some manner. We used random effects meta-analysis to estimate the effect size for suicidal ideation reduction. We assessed heterogeneity using the I² statistic, and, due to the small number of considered studies, publication bias was assessed using an adaptation of Cochrane’s guidelines for the assessment of bias risk. The review was registered with INPLASY, with the code INPLASY202570073.

RESULTS: After applying the eligibility criteria, six studies were selected for the analysis. Although the initial conceptual aim pertained to suicidal risk and self-harm more broadly, suicidal ideation was the only outcome consistently reported across the eligible studies; therefore, it served as the primary meta-analytic outcome.

CONCLUSIONS: The results highlight that technology-assisted interventions yield an overall statistically significant moderate reduction in suicidal ideation, providing valuable support for the implementation of such interventions during adolescence, although further rigorous research is needed to strengthen the evidence base.

PMID:42023461 | DOI:10.62641/aep.v54i2.2089

Actas Esp Psiquiatr. 2026 Apr 15;54(2):443-454. doi: 10.62641/aep.v54i2.2115.

ABSTRACT

BACKGROUND: Psychometric screening tools for persons in penitentiary centers (PPC) are key to assessing their mental health needs, given the shortage of both time and mental health personnel. Depression and anxiety are among the most prevalent mental health problems in PPC. Inadequate diagnosis can lead to increased symptom severity and even suicide. Therefore, validating instruments to assess depression and anxiety in PPC populations is essential to reduce the risk of misdiagnosis and its consequences.

METHODS: A cross-sectional study was conducted to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in 272 men (>18 years old) deprived of liberty in a penitentiary center in Mexico. Both exploratory and confirmatory factor analyses were performed. Concurrent and discriminant validity were assessed using the depression and anxiety scales of the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) Primary Health Care (PHC). Receiver Operating Characteristic curves were plotted to determine the best cut-off points in both instruments.

RESULTS: Both the PHQ-9 and GAD-7 showed items that were representative of their underlying constructs and supported the original one-factor structure, with satisfactory goodness-of-fit indices in both exploratory and confirmatory analyses. Both instruments exhibited good internal consistency in the sample of Mexican men incarcerated in penitentiary centers (α = 0.87 and α = 0.89, respectively). Furthermore, both scales showed strong correlations with the ICD-11 PHC depression and anxiety scales, along with adequate sensitivity, specificity, false positive, and false negative rates, resulting in a low misclassification rate.

CONCLUSIONS: The PHQ-9 and GAD-7 can be used to briefly and reliably assess depression and anxiety among male PPC in Mexico City and in populations with similar institutional and sociodemographic conditions Given the specific characteristics of PPC populations across different countries, it remains necessary to continue testing these instruments in underrepresented populations to ensure the development of reliable and valid tools that help identify potentially confusing items and minimize diagnostic errors.

PMID:42023458 | DOI:10.62641/aep.v54i2.2115

Actas Esp Psiquiatr. 2026 Apr 15;54(2):362-368. doi: 10.62641/aep.v54i2.2161.

ABSTRACT

OBJECTIVE: This study aims to identify predictive factors for significant cognitive improvement following transcranial direct current stimulation (tDCS) in patients with post-stroke cognitive impairment (PSCI), thereby providing evidence for individualized clinical intervention.

METHODS: A total of 123 patients with PSCI who received tDCS treatment were retrospectively enrolled. Based on changes in Mini-Mental State Examination (MMSE) scores, patients were classified into a cognitive improvement group (n = 61) and a non-improvement group (n = 62). Baseline clinical characteristics were collected, and activities of daily living were using the Modified Barthel Index (MBI). Univariate analyses were performed to compare differences between the two groups, and variables with statistical significance in univariate analysis were further entered into a multivariate logistic regression model to identify independent predictors of significant cognitive improvement following tDCS treatment.

RESULTS: The proportion of patients with a university education or above was significantly in the cognitive improvement group higher than in the non-improvement group (p < 0.001); whereas the proportion of patients with a history of stroke in the non-improvement group was significantly higher (p < 0.05). Patients in the cognitive improvement group had a significantly shorter disease duration compared to those in the non-improvement group (p < 0.05); meanwhile, a higher proportion of patients with Fazekas grade 0-1 was observed in the improvement group (p < 0.05). Results of the multivariate Logistic regression analysis indicated that educational level and disease duration were independent predictive factorsforsignificant cognitive improvement after tDCS treatment (p < 0.05).

CONCLUSION: PSCI patients with higher educational level and shorter disease duration have a better cognitive improvement effect following tDCS treatment.

PMID:42023448 | DOI:10.62641/aep.v54i2.2161

Actas Esp Psiquiatr. 2026 Apr 15;54(2):398-408. doi: 10.62641/aep.v54i2.2174.

ABSTRACT

BACKGROUND: This research aimed to examine the effects of multi-role collaborative palliative care on anxiety, cancer-related fatigue (CRF), psychological status, and quality of life in patients with advanced lung cancer, and to explore potential mechanisms using correlation analysis and structural equation modelling.

METHODS: We conducted a retrospective study of the medical records of 200 patients with advanced lung cancer. Based on the care they received, patients were divided into two groups: a control group (n = 100) that received standard nursing care, and a combined nursing group (n = 100) that received multi-role collaborative palliative care. Anxiety, CRF, psychological status, and overall quality of life were compared between the two groups based on the record documented before and after nursing care. Adverse events recorded during the nursing period were also reviewed and analysed. Path analysis of variables was conducted using the AMOS module of SPSS.

RESULTS: Following nursing care, the combined group showed significantly lower CRF and anxiety scores, and significantly higher psychological state and quality of life scores compared with both pre-nursing scores and the control group (all p < 0.05). There was no statistically significant difference in the rate of adverse event between the two groups (36.00% vs. 28.00%, p > 0.05). Path analysis indicates that multi-role collaborative palliative care is associated with lower levels of anxiety. This association has a direct relationship and indirect relationships through its connection with the reduction of CRF and the improvement of psychological condition. Path analysis shows that multirole collaborative palliative care not only directly alleviates patients’ inner anxiety, but also may indirectly reduce inner anxiety by lowering CRF and improving psychological conditions.

CONCLUSIONS: Implementing multi-role collaborative palliative care for patients with advanced lung cancer can help alleviate CRF, relieve anxiety, improve psychological state and enhance quality of life. Exploratory path analysis suggests that this nursing model has a significant direct statistical association with lower anxiety. This association may also involve indirect interrelations with lower CRF and a better psychological state.

PMID:42023445 | DOI:10.62641/aep.v54i2.2174

Acad Emerg Med. 2026 Apr;33(4):e70285. doi: 10.1111/acem.70285.

ABSTRACT

BACKGROUND: Adult epiglottitis is an uncommon but potentially life-threatening condition requiring rapid recognition and airway-focused management, yet evidence regarding early medical therapy is limited. We evaluated temporal trends in adult epiglottitis and examined associations between early corticosteroid or antibiotic therapy and clinically important outcomes.

METHODS: We conducted a retrospective cohort study of adults (≥ 18 years) presenting to U.S. emergency departments with acute epiglottitis between 2014 and 2024 using the TriNetX Research Network. Cases were identified using the ICD-10 code J05.1; patients with preexisting tracheostomy were excluded. Early therapy was defined as systemic corticosteroid or parenteral antibiotic administration within 24 h of presentation. The primary outcome was endotracheal intubation; secondary outcomes included ICU admission, 30-day ED recidivism, and 30-day mortality. Propensity score matching (1:1) and multivariable Cox proportional hazards models were used to estimate risk ratios (RRs) and hazard ratios (HRs).

RESULTS: The annual incidence proportion of adult epiglottitis increased from 0.002% in 2014 to 0.005% in 2024 (RR per year 1.09; 95% CI 1.08-1.10), with the steepest rise among adults aged 60-74 years. In matched cohorts, early corticosteroid therapy was associated with lower risks of intubation (RR 0.48; 95% CI 0.26-0.88) and ICU admission (RR 0.71; 95% CI 0.55-0.92). Early antibiotic therapy demonstrated similar associations for intubation (RR 0.54; 95% CI 0.34-0.85) and ICU admission (RR 0.72; 95% CI 0.60-0.86). In adjusted Cox models, early steroids (HR 0.33; 95% CI 0.25-0.44) and early antibiotics (HR 0.50; 95% CI 0.34-0.75) were independently associated with lower hazards of intubation. Older age, comorbidities, and hypoxia were strong predictors of airway compromise.

CONCLUSIONS: Adult epiglottitis incidence has increased over the past decade, particularly among older adults. Early corticosteroid and antibiotic therapy were independently associated with lower risks of intubation and ICU admission, supporting current clinical practice favoring timely medical therapy in adults with suspected epiglottitis.

PMID:42023439 | DOI:10.1111/acem.70285

Disaster Med Public Health Prep. 2026 Apr 23;20:e92. doi: 10.1017/dmp.2026.10352.

ABSTRACT

Few reports detail the operation of Japan’s unique disaster countermeasures, mobile pharmacy vehicles (MPVs). This case report draws on the authors’ direct operational experience and anonymized, retrospective open-access data to describe the current system and actual operations of MPVs and examine the feasibility of their international implementation. During the Noto Peninsula Earthquake in January 2024, 13 MPVs were deployed to the affected areas following dispatch requests, and 1,834 disaster prescriptions were issued. In accordance with the local medical care delivery system, the deployment of MPVs was coordinated by the disaster pharmacy coordinator, contributing to the rapid and flexible provision of medical services. These results demonstrate the potential international applicability of the MPV system. Further development of information management and operational systems, along with their adaptation for other uses, may enhance the utility of the MPV model as a component of disaster medical support in other countries.

PMID:42023420 | DOI:10.1017/dmp.2026.10352

Biomater Investig Dent. 2026 Apr 16;13:45703. doi: 10.2340/biid.v13.45703. eCollection 2026.

ABSTRACT

BACKGROUND: Rebonding of orthodontic brackets requires effective surface conditioning to restore adequate adhesive retention.

OBJECTIVE: To compare the shear bond strength (SBS) of rebonded metal brackets using four light-curing resins.

MATERIAL AND METHODS: Eighty premolars were allocated to two conditioning protocols (n = 40 per group): G1 – enamel etching with 37% phosphoric acid; G2 – sandblasting of bracket bases followed by enamel etching. Each group was subdivided according to the resin used (n = 10 per subgroup): Orthocem (FGM), Bracespace (3M), Transbond XT (3M), and Z250 (3M). Brackets were bonded, debonded, reconditioned, and rebonded. SBS was tested using a universal testing machine (0.5 mm/min). Data were analyzed using Kruskal-Wallis and Dunn’s post-hoc tests (α = 0.05).

RESULTS: In the acid-etched group, there was no statistically significant difference in SBS among the four resins (Kruskal-Wallis, p = 0.097). In the sandblasting group, a significant intergroup difference was observed (p = 0.044). Dunn’s post-hoc test identified higher SBS for Bracespace (3M) and Transbond XT (3M) compared with Orthocem (FGM) and Z250 (3M). When comparing conditioning methods within each resin, sandblasting of the bracket bases resulted in significantly higher SBS only for Bracespace and Transbond XT, whereas Orthocem and Z250 showed no significant change.

CONCLUSIONS: Rebonding of metal brackets showed comparable SBS among resins after acid etching. However, when the bracket bases were sandblasted, Bracespace and Transbond exhibited significantly higher bond strengths. Surface preparation of the bracket base is therefore a key factor influencing SBS in rebonding procedures.

PMID:42023411 | PMC:PMC13097089 | DOI:10.2340/biid.v13.45703