Tag: statistics

BMC Public Health. 2025 Apr 26;25(1):1555. doi: 10.1186/s12889-025-22700-9.

ABSTRACT

BACKGROUND: Achieving gender equality in education is crucial for promoting social equity, driving economic growth, and improving overall population health. In Nepal, deeply rooted socio-cultural norms, economic disparities, and patriarchal values greatly impact women’s access to educational opportunities, particularly in the field of medicine. Although there has been an increase in female enrollment in medical programs, pervasive biases, gendered expectations, and informal cultural scripts-often referred to as the “hidden curriculum”-continue to influence their aspirations, specialty choices, and professional journeys. Understanding these dynamics is vital for ensuring women’s full engagement in the medical workforce.

METHODS: This qualitative study employed semi-structured interviews with fifteen final-year female undergraduate medical students at a private medical college in Bharatpur, Nepal. Thematic analysis was employed to identify and interpret the key themes.

RESULTS: Five key themes emerged: (1) The Marriage Mandate: Negotiating Family, Tradition, and Professional Aspirations; (2) The Gendered Clinic: Unveiling Bias in Medical Education and Practice; (3) Investing in Daughters, Expecting Returns: The Gendered Economics of Medical Education; (4) Transnational Aspirations: Negotiating Mobility, Marriage, and Medical Careers and (5) Claiming Space: Agency, Resistance, and Redefining Success in the Medical Profession.

DISCUSSION: The pervasive “hidden curriculum” of gendered barriers persists despite policy efforts, constitutional safeguards, and increasing female representation in medical schools. These challenges, if unaddressed, risk perpetuating a cycle of underutilizing women’s talents, limiting the diversity of the healthcare workforce, and hindering progress toward achieving equitable health outcomes. The findings underscore the urgent need for gender-transformative approaches that acknowledge and actively dismantle these deeply rooted biases at institutional, community, and policy levels. These approaches should focus on creating supportive structures that empower women to fully contribute to the medical profession.

CONCLUSION: Female medical graduates encounter significant obstacles, including entrenched patriarchal norms, systemic inequalities, and a pervasive “hidden curriculum” of biases. However, they demonstrate remarkable resilience and determination in challenging stereotypes, redefining success, and reimaging their professional identities. Their experiences align with global efforts toward gender parity in education and employment. Equitable representation of women in the medical workforce is not only a moral imperative but also a strategic necessity for advancing public health, strengthening healthcare systems, and promoting social justice.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40287720 | DOI:10.1186/s12889-025-22700-9

World J Surg Oncol. 2025 Apr 26;23(1):168. doi: 10.1186/s12957-025-03817-y.

ABSTRACT

BACKGROUND: Globally, the most common malignancy in women today is breast cancer. Numerous factors affect the incidence of breast cancer; therefore, we examined the connections involving age, body mass index (BMI), serum lipid levels, and breast cancer risk in women.

METHODS: This was a cross-sectional analytical study. 382 female patients with a breast cancer diagnosis in this study, and 11842 healthy, age-matched females who were selected from physical examination centers in the same period. Univariate analysis was conducted first, after which factors with statistically significant differences were used to construct a multi-factor binary logistic regression equation. We explored associations across different ages, BMI, triglyceride (TG), and high-density lipoprotein-cholesterol (HDL-C) levels, and breast cancer risk.

RESULTS: Age, BMI, TG, and HDL-C were the risk factors that showed the most significant association with breast cancer. Age, BMI, low-density lipoprotein-cholesterol (LDL-C) and TG levels in the breast cancer group were higher than those in the control group, but HDL-C and total cholesterol (TC) levels were lower. As BMI and TG levels increased, the risk of developing breast cancer increased, and, as HDL-C levels decreased, the risk of developing breast cancer increased. Women aged ≥ 40 years old had an increased breast cancer risk. There were no significant variations in TC and LDL-C levels between groups.

CONCLUSIONS: In this study, a lower risk of breast cancer was linked to high HDL-C levels, while a higher risk of breast cancer was linked to high BMI and TG levels. Women aged ≥ 40 years old had an increased breast cancer risk.

PMID:40287713 | DOI:10.1186/s12957-025-03817-y

BMC Health Serv Res. 2025 Apr 26;25(1):610. doi: 10.1186/s12913-025-12639-3.

ABSTRACT

BACKGROUND: Addressing disparities in reproductive, maternal, newborn, and child health services is crucial in achieving the Sustainable Development Goal of universal health coverage. The persistence of social and geographic disparities in maternal health service coverage and utilization poses significant challenges. Ensuring equity in health service access and utilization as part of universal health coverage requires evidence whether these inequities exist. This study aimed to measure socio-economic and geographic equity in coverage and effective coverage of both antenatal care and skilled birth attendance.

METHODS: We conducted a secondary analysis of data collected from the Performance Monitoring for Action Ethiopia from 2019 to 2020, including 2714 postpartum women at around six weeks and service delivery point assessment data from 462 health facilities. We measured inequities in the utilization of four or more antenatal care visits and skilled birth attendance using equiplots and concentration index. Moran’s I, Getis-Ord Gi statistics and Kriging interpolations were employed to analyze geographic variations of maternal health service utilization.

RESULTS: In this study, 40% (95%CI: 36, 45) utilized four or more ANC visits, and 12% (95%CI: 11, 14) received quality antenatal care. Over half (54%, 95%CI: 48, 59) of women utilized skilled birth attendance, but only 7% (95%CI: 4, 8) received quality delivery care. The absolute equity gap between the least poor and the poorest women was 43 percentage points for ANC visits and 65 percentage points for skilled birth attendance. A higher proportion of women in Central and Northern parts of Ethiopia had four or more ANC visits and utilized skilled birth attendance, while most parts of the Eastern part of the country and most areas in the South had low levels of utilization.

CONCLUSION: The coverage of four or more antenatal care visits and skilled birth attendance was low and inequitable, with the poorest women receiving fewer services. The coverage varied across different parts of the country. Interventions that target groups of women and geographic areas with low coverage of services are crucial for reaching the goal of universal health coverage.

PMID:40287709 | DOI:10.1186/s12913-025-12639-3

BMC Health Serv Res. 2025 Apr 26;25(1):609. doi: 10.1186/s12913-025-12806-6.

ABSTRACT

BACKGROUND: The COVID-19 pandemic presented unprecedented complexity for health care seeking globally. Little is known on how people living with HIV (PLHIV) and other co-morbidities including hypertension accessed healthcare services in resource limited settings like Uganda. Therefore, we explored qualitatively how the COVID-19 pandemic which was characterized by travel restrictions, social distancing requirements, and a heightened COVID-19 response impacted health care seeking for PLHIV and health care provision by providers in this context. We explored experiences of both PLHIV with hypertension who sought care and healthcare providers who offered HIV and hypertension services at two peri-urban HIV clinics; Kira Health center and Kisubi Hospital, in Uganda.

METHODS: We conducted 32 in-depth interviews at two peri-urban HIV clinics in Uganda with PLHIV and hypertension and their health care providers. We sought to understand PLHIV’s experiences seeking health care services and health care providers’ experiences delivering chronic care. We used an inductive thematic analysis drawing on the socio-ecological framework to explore this research question.

RESULTS: Our findings reveal that that the COVID-19 pandemic presented an extraordinary set of challenges for individuals with chronic conditions who required routine healthcare services. The Uganda government’s stringent public health measures apparently made it difficult for patients to access health care, impacted jobs, resulted in job losses, reduced income, and food scarcity. Additionally, healthcare providers prioritized COVID-19 related health services, diverting both material and human resources away from PLHIV with co-morbidities, which impacted continuity of care.

CONCLUSION: These findings highlight how the COVID-19 pandemic exacerbated PLHIV’s fragility suggesting that health systems may need support to cope with the demands of chronic care management especially during health emergencies such as pandemics. There is an urgent need to strengthen the health system in Uganda enabling resilience to deal with shocks resulting from major health outbreaks.

PMID:40287702 | DOI:10.1186/s12913-025-12806-6

J Ovarian Res. 2025 Apr 26;18(1):85. doi: 10.1186/s13048-025-01671-w.

ABSTRACT

BACKGROUND: Tri-ortho-cresyl phosphate (TOCP), a widely used plasticizer, has been shown to impair ovarian function. While tanshinone IIA exhibits ovarian protective effects in aging models, its potential to counteract TOCP-induced ovarian damage and associated signaling mechanisms remains unexplored. This study investigates the therapeutic effects of tanshinone IIA on TOCP-damaged ovaries in mice, with focus on Hippo, AKT, and MAPK pathways.

RESULTS: TOCP exposure (200 mg/kg/d for 28 days) significantly reduced ovarian follicle counts (primordial, preovulatory, and mature follicles) and disrupted hormone levels (elevated Estrogen(E2), decreased Follicle stimulating hormone(FSH)/ Anti-Mueller tube hormone(AMH)) in mice. Treatment with high-dose tanshinone IIA restored ovarian structure and function: growing follicle counts increased significantly (p < 0.001), FSH (p < 0.001) and AMH (p < 0.001) levels surged to marked degrees, while E2 (p < 0.001) levels decreased significantly. All changes were statistically significant. Immunohistochemistry and Western blot analysis revealed that tanshinone IIA restored ovarian AMH and Follicle-Stimulating Hormone Receptor (FSHR) protein expression, which were suppressed by TOCP. In vitro experiments further demonstrated that TOCP dose-dependently inhibited granulosa cell viability (p < 0.001) and proliferation (p < 0.001). Co-treatment with tanshinone IIA (0.01 mM) rescued cell viability (p < 0.01) and proliferation (p < 0.05). Mechanistically, tanshinone IIA suppressed ovarian apoptosis (p < 0.01) and modulated multiple signaling pathways: it attenuated Hippo signaling (p < 0.05) and reactivated PI3K/AKT (p < 0.05), p38 (p < 0.05), and ERK1/2 (p < 0.01) pathways.

CONCLUSIONS: Tanshinone IIA alleviates TOCP-induced ovarian dysfunction primarily through coordinated modulation of Hippo signaling and AKT/MAPK pathway activities, offering a potential therapeutic strategy for chemical-induced ovarian injury.

PMID:40287698 | DOI:10.1186/s13048-025-01671-w

BMC Med Educ. 2025 Apr 26;25(1):615. doi: 10.1186/s12909-024-06435-6.

ABSTRACT

INTRODUCTION: Surgical trainees spend key years of their reproductive potential in training. However, their family planning needs are seldom addressed and remain poorly understood. This study was designed to understand the current landscape of family planning among General Surgery (GS) trainees and to identify the career-specific barriers they face.

METHODS: We created a 26-question survey to assess GS trainee experiences surrounding family planning. The survey was distributed to residency and fellowship program directors nationwide. Outcome measures were evaluated using Pearson’s Chi-Square test and Fisher’s exact test.

RESULTS: Two hundred thirty-four US GS surgical trainees completed the survey (male = 32.1%, female 66.2%, unreported = 1.7%). Work hours (p = 0.007) and female gender (p = 0.002) were associated with delayed childbirth. Time (93.2%), career/education goals (63%), and cost (59.5%) were most reported to prohibit childbearing. Females were significantly more impacted by time (p = 0.021) and career/education goals (p = 0.001) and more frequently considered fertility preservation (p < 0.001).

CONCLUSION: Time constraints and career goals are disproportionally more prohibitive to female surgeons when considering childbearing. Institutional resources should be tailored to gender-specific needs and address barriers to family planning.

PMID:40287697 | DOI:10.1186/s12909-024-06435-6

J Health Popul Nutr. 2025 Apr 26;44(1):138. doi: 10.1186/s41043-025-00856-9.

ABSTRACT

BACKGROUND: The increasing prevalence of adolescent overweight and obesity poses significant public health challenges, particularly in China. With the rapid adoption of the Internet, adolescents’ lifestyles, including dietary habits and physical activity levels, have undergone substantial changes. However, the causal relationship between Internet use and adolescent nutritional outcomes, especially in transitional economies, remains underexplored.

METHODS: This study employs longitudinal data from the China Health and Nutrition Survey (CHNS) and China Family Panel Studies (CFPS) to investigate the impact of Internet use on adolescents’ BMI-for-age z-scores and overweight status. An endogenous switching regression (ESR) model addresses potential self-selection bias. Heterogeneity analyses examine urban-rural and gender differences, while mechanism analyses identify dietary pathways influencing outcomes.

RESULTS: Internet use increases BMI-for-age z-scores and the likelihood of being overweight among adolescents, with more intensive Internet use further amplifying these effects. These effects hold across urban and rural areas as well as for both boys and girls, though the magnitude may vary. Mechanism analyses suggest that Internet use enhances protein intake while also leading to higher consumption of fast food and soft drinks.

CONCLUSION: Internet use increases BMI-for-age z-scores and overweight risks among adolescents, reinforcing the need for targeted interventions to mitigate its negative health impacts. Policies promoting healthier online behaviors and better access to nutritional education are essential to ensuring that adolescents develop healthy lifestyle habits in the digital age. Addressing these challenges can help policymakers develop equitable health strategies for adolescents in transitional economies.

PMID:40287688 | DOI:10.1186/s41043-025-00856-9

Cardiovasc Diabetol. 2025 Apr 26;24(1):183. doi: 10.1186/s12933-025-02742-4.

ABSTRACT

BACKGROUND: Cardiovascular-Kidney-Metabolic (CKM) syndrome, as a new clinical concept, emphasizes the multifaceted interaction between metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD). Some evidence suggests atherogenic index of plasma (AIP) is strongly linked to cardiovascular mortality. However, data on its association with mortality across CKM syndrome remain scarce. Our study aimed to investigate the association between AIP and all-cause and cardiovascular mortality among individuals with CKM syndrome.

METHODS: This study included 15,703 participants with CKM syndrome from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The AIP index is calculated as log10(triglycerides/high-density lipoprotein cholesterol [TG/HDL-C]). Mortality outcomes were determined by linking NHANES participants with the National Death Index (NDI), with follow-up data available through December 31, 2019. Kaplan-Meier (K-M) survival curves, Cox regression analysis, restricted cubic spline (RCS) and subgroups analysis were used to explore the relationship between AIP levels and mortality in individuals with CKM syndrome.

RESULTS: Over a median follow-up of 7.67 years, a total of 1570 deaths were documented, including 344 cardiovascular deaths. Kaplan-Meier survival analysis demonstrated that the lowest all-cause and CVD mortality rates were observed in the lowest AIP tertile. Compared with individuals in the lowest AIP tertile, Cox analysis indicated that those in highest tertile were associated with a higher risk of all-cause and CVD mortality (HR = 1.19, 95% CI 1.08-1.31, P < 0.001; HR = 1.38, 95% CI 1.22-1.57, P < 0.001) after adjusting for covariates, respectively. As a continuous variable, AIP levels had an approximate positive linear dose-response relationship with all-cause and CVD mortality. Subgroup analysis revealed no significant interactions with the examined variables, except for gender.

CONCLUSIONS: This study demonstrated that elevated AIP levels in individuals with CKM syndrome are strongly linked to higher mortality risks, notably all-cause mortality in advanced stages and CVD mortality across both non-advanced and advanced stages. These findings further highlight the importance of AIP as a valuable risk biomarker, providing a simple and effective tool for identifying mortality risk in individuals with CKM syndrome.

PMID:40287685 | DOI:10.1186/s12933-025-02742-4

BMC Health Serv Res. 2025 Apr 26;25(1):608. doi: 10.1186/s12913-025-12746-1.

ABSTRACT

BACKGROUND: Given the home health care industry’s growth, increasing demand for workers, and complex patient care needs, investigating initiatives to maintain home health care workers’ health and ability to work is crucial. This study aims to assess the feasibility of an organizational intervention for equal distribution of physical and psychosocial work demands among home health care aides.

METHOD: We conducted a 7-week quasi-experimental feasibility study at a Danish home health care institution with 27 home health care aides. The 6SQuID framework was used to develop, test and evaluate the feasibility of the organizational intervention, inspired by the ‘Goldilocks Work Principle’. The intervention consisted of three activities: (1) classification workshop, (2) individual dialogue with a schedule coordinator, and (3) reorganizing work schedules. Feasibility was assessed through: (1) acceptability evaluated by interview and questionnaire post-intervention, (2) fidelity assessed by documentation during intervention, and (3) potential effects on selected psychosocial factors and physical work demands evaluated pre-post intervention with technical measurements and questionnaire.

RESULTS: Nineteen home health care aides participated in the evaluation of the intervention. Most of the home health care aides (73.33%) reported to like or really like the intervention. The interviewees expressed general acceptance of both the intervention activities and the overall aim of the intervention. Most home health care aides (77.8%) participated in the Classification workshop and 124 citizens were classified. All home health care aides participated in the Individual dialogue. No significant changes were seen in the Reorganized work schedules (p > 0.05). Physical and emotional fatigue and physical exertion showed statistically significant change (p < 0.05), with a mean difference of 17 and 11 (100 point scale), and 1.7 (10 point scale) points respectively.

CONCLUSION: This study found components of the intervention to be feasible, but concludes that adaptions to enhance implementation addressing barriers related to time pressure, improving fidelity to the intervention, and ensuring practical applicability within the home health care context are critical for future success.

TRIAL REGISTRATION: The study was registered in the ISRCTN registry under registration number ISRCTN15131198 on August 8, 2023.

PMID:40287681 | DOI:10.1186/s12913-025-12746-1

BMC Public Health. 2025 Apr 26;25(1):1565. doi: 10.1186/s12889-025-22394-z.

ABSTRACT

BACKGROUND: Recent Western studies link long-term particulate matter (PM) exposure to type 2 diabetes mellitus (T2DM) progression, but little is known for low- and middle-income countries. This study aimed to estimate the relationship between PM exposure and T2DM progression in China, and also assess urban-rural disparities.

METHODS: Using 7-year cohort data of 1.3 million Chinese over 40, a multistate model estimated the associations of PM exposure with T2DM progression. Covariates included demographics, socioeconomic status, health behaviors, medication, and meteorological factors. Sub-sample analyses were done for rural and urban areas.

RESULTS: For participants exposed to high levels of ${\text{PM}}_{2.5}$ , the 5-year absolute risks of developing T2DM and its complications were 4.31% (95% CI: 4.22-4.40) and 31.04% (95% CI: 29.97-32.08), respectively. In the low- ${\text{PM}}_{2.5}$ -exposure group, these risks were 3.82% (95% CI: 3.74-3.91) and 30.55% (95% CI: 29.43-31.65). For each 10 µg/m³ increase in ${\text{PM}}_{2.5}$ exposure, the HRs (95% CI) for the progression from no T2DM diagnosis to a T2DM diagnosis were 1.13 (1.13-1.14), and for the progression from T2DM to the development of T2DM complications were 1.04 (1.03-1.06). Moreover, the HRs (95% CI) for mortality risk were 1.09 (1.08-1.09) for participants without T2DM, 1.06 (1.00-1.14) for those with T2DM, and 1.10 (1.05-1.16) for those with T2DM complications. Similar associations were observed for other PM-related metrics. In rural areas, PM exposure was more strongly associated with the progression from T2DM and its complications to death. Conversely, in urban areas, PM exposure had a stronger association with the progression from a non-T2DM state to a formal T2DM diagnosis. Urban residents are exposed to higher levels of toxic components like heavy metals, potentially increasing T2DM risk, yet urban healthcare infrastructure offers protection against T2DM-related mortality.

CONCLUSIONS: PM exposure is significantly associated with T2DM progression. Urban areas should focus on primary prevention, while rural areas need to improve secondary and tertiary prevention like healthcare services.

PMID:40287677 | DOI:10.1186/s12889-025-22394-z