Tag: statistics

Scand J Psychol. 2025 May 26. doi: 10.1111/sjop.13127. Online ahead of print.

ABSTRACT

Elevated psychological stress reactions among healthcare workers during the COVID-19 pandemic necessitated a need to better understand their possible impact on sickness absence (SA). The study aimed to describe the relation between SA related to mental health problems and symptoms of psychological stress among healthcare workers during the COVID-19 pandemic. We further aimed to identify whether latent profiles of psychological stress reactions exist within the same population. In this observational registry-based study, survey data between May 2020 and March 2021 and SA register data between May 2019 and February 2023 were collected from 1245 Swedish healthcare workers. Differences between symptoms of burnout, depression, anxiety, PTSD, sleep disturbance, lack of detachment, and lack of recovery among groups with no, few (< 90), or many (≥ 90) SA days were analyzed with Kruskal-Wallis tests. Interrelations between symptoms of psychological stress were identified using latent profile analysis. Compared to healthy participants, participants with SA days (in total 6.3%) reported more severe symptoms of psychological stress, were younger, and more likely to work as assistant nurses. Furthermore, they displayed a higher degree of previous SA (prior to the pandemic). No statistically significant differences between groups with few (< 90) and many (≥ 90) days of SA in symptoms were noted. Four latent profiles of psychological stress were identified, but they differed only in the level of experienced symptoms. We conclude that different symptoms of psychological stress are highly interrelated among healthcare workers during a crisis. Although many healthcare workers may experience elevated symptoms in relation to the crisis, it will not necessarily lead to serious mental health problems requiring SA.

PMID:40420252 | DOI:10.1111/sjop.13127

BMC Sports Sci Med Rehabil. 2025 May 26;17(1):130. doi: 10.1186/s13102-025-01169-4.

ABSTRACT

OBJECTIVE: To comprehensively assess the rehabilitation efficacy of telerehabilitation compared with other traditional rehabilitation therapies in postoperative hip fracture patients.

DATA SOURCES: Seven electronic databases: PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP Databases, were searched from inception until October 2023.

STUDY SELECTION: Two independent reviewers selected randomized controlled trials (RCTs) that assessed the efficacy of telerehabilitation intervention approach to postoperative hip fracture rehabilitation. An outcome measure related to hip function, functional independence, anxiety levels, walking ability, quality of life, and treatment adherence were eligible.

DATA EXTRACTION: Two reviewers independently used the Cochrane Risk of Bias 2 (RoB 2) tool for risk of bias and data extraction. RevMan 5.4 and Stata 15.1 were used for statistical analysis.

DATA SYNTHESIS: Seventeen RCTs (n = 1577) met the inclusion criteria. Compared to the usual care group, the telerehabilitation group demonstrated a noteworthy enhancement in hip function, as evidenced by the Harris Hip Score (SMD = 1.05, 95% CI (0.64, 1.45)). Significant improvements in functional independence (Functional Independence Measure: SMD = 1.38, 95% CI (1.08, 1.68)), adherence to rehabilitation treatment (Medical Compliance Behavior Scale: SMD = 1.23, 95% CI (0.71, 1.76)), and quality of life (SMD = 1.04, 95% CI (0.42, 1.65)) were also observed in the telerehabilitation group. However, no statistically significant distinction was observed in anxiety improvement (as assessed by the Self-Rating Anxiety Scale: SMD = -0.67, 95%CI (-1.65, 0.31)) or in terms of walkability (Timed Up and Go Test: SMD = -0.06, 95% CI (-0.32, 0.20)) when compared to the usual care group. This may be related to patient participation, differences in telerehabilitation interventions, and inconsistent follow-up durations among different studies.

CONCLUSIONS: Current evidence suggests that telerehabilitation may help improve hip function, increase functional independence, and improve treatment adherence in patients after hip fracture surgery. Nonetheless, it does not demonstrate a significant impact on reducing patients’ anxiety or improving their walking ability.

PMID:40420240 | DOI:10.1186/s13102-025-01169-4

BMC Med Educ. 2025 May 26;25(1):778. doi: 10.1186/s12909-025-07303-7.

ABSTRACT

BACKGROUND: Medical education is highly demanding, leading to stress, burnout, and anxiety. In this context, accomplishment-progress toward meaningful goals-emerges as a key factor in student well-being. However, its impact on the well-being of medical students, particularly in India, remains underexplored.

OBJECTIVE: This study aims to explore the role of accomplishment in the wellbeing of Indian medical students and to examine how it relates to other elements of PERMA + . We hypothesized that higher levels of accomplishment would correlate with better well-being across other PERMA + dimensions, and that gender differences would influence the relationship between accomplishment and well-being.

METHODS: We conducted a cross-sectional study at Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India, from April to October 2023. A total of 364 medical students participated, completing a pre-designed and pre-validated questionnaire that assessed their sense of accomplishment in three areas: progress toward goals, achievement of important goals, and the ability to handle responsibilities. We used statistical analyses including Chi-square, t-tests, and Pearson correlation tests to analyze the data.

RESULTS: The sample was predominantly made up of students aged 20-22 years (62.4%), with a significant proportion being female (66.2%). Males reported significantly higher levels of accomplishment compared to females. We found that accomplishment was strongly linked to other well-being factors such as engagement (0.379**), relationships (0.386**), meaning (0.487**), health (0.287**), and happiness (0.359**). However, there was no significant link between accomplishment and negative emotions or loneliness.

CONCLUSION: The findings suggest that fostering accomplishment should be prioritized in medical education to support student resilience. Gender differences in accomplishment, with males reporting higher levels, highlight potential challenges for female students, such as societal pressures and academic workload. Addressing these disparities through targeted interventions, like mentorship programs and inclusive support systems, could promote a more equitable learning environment.

PMID:40420220 | DOI:10.1186/s12909-025-07303-7

Chin Med. 2025 May 26;20(1):70. doi: 10.1186/s13020-025-01120-2.

ABSTRACT

BACKGROUND: Allergic rhinitis (AR) is a common allergic condition characterized by frequent sneezing, nasal congestion, nasal itching and rhinorrhea. Chinese medicine formula Yu-Ping-Feng Powder with Variation (YPV) is an empirical formula modified from an ancient Chinese medicine formula named Yu-Ping-Feng Powder, which is widely used for the treatment of allergic diseases such as AR and asthma.

PURPOSE: To evaluate the efficacy and safety of YPV on AR patients with the lung and spleen Qi deficiency type using a randomized, double-blind, placebo-controlled clinical trial (RCT).

STUDY DESIGN AND METHODS: Between April 2022 and June 2023, a total of 58 participants were recruited and randomly allocated to receive either YPV (n = 29) or placebo (n = 29) for 8 consecutive weeks. The changes of the Total Nasal Symptom Score (TNSS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) or the Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores at week 8 were used as the primary outcomes. The secondary outcomes included (1) the change of TNSS at weeks 4, 12 and 16; (2) the RQLQ or the PADQLQ scores at weeks 4, 12 and 16; (3) the change of frequency of AR episodes and their severity Visual Analog Scale (VAS) at weeks 4, 8, 12 and 16; (4) the changes of the gut microbiota composition in stool samples at week 8; and (5) adverse events related to the study treatment.

RESULTS: YPV treatment could significantly improve the RQLQ score in AR patients at weeks 4, 8, 12, and 16 (p = 0.05, p = 0.04, p = 0.04 and p = 0.03, respectively), when compared with the placebo treatment. However, it did not improve the TNSS score at week 8 in AR patients when compared with the placebo group. In addition, YPV treatment could reduce the VAS score in AR patients at weeks 12 and 16 when compared with the placebo group, although the reductions were not statistically significant (p = 0.06 and p = 0.08, respectively). Importantly, no overt adverse effects were observed in both YPV and placebo groups.

CONCLUSION: YPV was well-tolerated and could effectively ameliorate multiple symptoms of AR and improve the quality of life of AR patients after 8-week treatment. Trial registration ClinicalTrials.gov, NCT04976023. Registered 26 July 2021, https://clinicaltrials.gov/study/NCT04976023?cond=The%20Effects%20of%20Using%20Yupingfeng%20Powder%20with%20Variation%20for%20the%20Treatment%20of%20Allergic%20Rhinitis&rank=2.

PMID:40420199 | DOI:10.1186/s13020-025-01120-2

Crit Care. 2025 May 26;29(1):213. doi: 10.1186/s13054-025-05451-2.

ABSTRACT

INTRODUCTION: Renal replacement therapy (RRT) is commonly used in critically ill patients with acute kidney injury (AKI). However, optimal timing of RRT liberation remains controversy. This meta-analysis evaluates novel biomarkers to predict successful RRT liberation in critically ill AKI patients.

METHODS: The systematic review reported following PRISMA guidelines, PubMed, Embase, and Scopus were searched up to May 2, 2025, and were screened using predefined criteria. Methodological quality was assessed using the Newcastle-Ottawa scale. Pooled ROC-AUCs with 95% CIs were calculated; heterogeneity was evaluated using I² statistics.

RESULTS: Sixteen studies (3020 patients) involving 23 biomarkers were included. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) demonstrated fair predictive performance with 4 studies (AUC 0.766, I² = 39.8%). When excluding a study focused on long-term outcomes, the result showed a better predictive ability with low heterogeneity (AUC 0.801, I² = 0%). Plasma proenkephalin A (PENK) and serum NGAL also showed potential, but quantitative synthesis was limited by study number and heterogeneity. The cut-off value also varied widely, complicating clinical translation. In addition, multivariable models combining novel biomarkers with clinical indicators have also demonstrated promising predictive potential. However, due to the limited number of studies and inconsistent conclusions, further exploration is needed.

CONCLUSION: uNGAL moderately predicts short-term RRT liberation, while other biomarkers (e.g., PENK) require further validation. Standardizing definitions of successful liberation and integrating dynamic biomarker changed with clinical indicators (e.g., urine output) may enhance predictive accuracy. Further large-scale, prospective, and multicenter studies are needed to validate these findings.

PMID:40420198 | DOI:10.1186/s13054-025-05451-2

Int J Behav Nutr Phys Act. 2025 May 26;22(1):60. doi: 10.1186/s12966-025-01756-1.

ABSTRACT

BACKGROUND: Overweight and obesity disproportionately affect Black and Hispanic children who also play more video games. Narratives, coupled with home-based active video games (AVGs), may enhance PA and mitigate these disparities. This study tested the effect of narrative-enhanced home-based AVGs among predominantly Black and Hispanic children with overweight and obesity.

METHODS: This 6-month three-group RCT recruited 135 children aged 7-14 from pediatric clinics in Boston, MA (January 2020 – May 2022) during the COVID-19 pandemic. Participants were randomized into: [Narrative + AVG], receiving an Xbox/Kinect with six AVGs interspersed with a narrative animation Ataraxia (72 episodes over six months), which accompanied the AVGs; [AVG Only], receiving the Xbox/Kinect and AVGs without narrative animation; and [Waitlist Control], receiving the intervention post-RCT. The primary outcome was objectively assessed daily moderate-to-vigorous PA (MVPA). Secondary outcomes included body composition (fat and lean mass, total region fat), BMI%, fasting insulin, glucose, lipid panel (Cholesterol, HDL, LDL, and Triglycerides), and C-reactive protein. Assessments occurred at baseline, 3, and 6 months. It was hypothesized that [Narrative + AVG] would outperform [AVG Only], which would outperform [Waitlist Control].

RESULTS: 79 children completed all three visits (Age = 10.9 ± 1.7; 63% Boys; 62% Black; 25% Latino; 11% Mixed; and 1% Asian). No statistically significant improvements in MVPA were observed within any condition at 3 or 6 months. A post-hoc exploratory analysis revealed that over the first three months, [Narrative + AVG] increased daily MVPA by 6.8 min compared to [Waitlist Control]. Over the same period, the [AVG Only] group exhibited 815 g less lean mass gain and 7.2 mg/dL lower HDL cholesterol levels relative to the [Waitlist Control].

CONCLUSIONS: While neither narrative-enhanced AVGs nor AVGs alone consistently increased daily MVPA across the 6-month RCT, participants in the narrative AVGs group demonstrated greater daily MVPA compared to the control group during the initial three months. During this same period, the AVG-only group exhibited reduced lean mass gain and lower HDL cholesterol levels compared to the waitlist control. The added advantage of narratives was inconclusive, likely due to implementation challenges encountered during the pandemic. These findings highlight the need for addressing these challenges in future research in a fully powered study.

TRIAL REGISTRATION: Active Video Games on Physical Activity (Main Trial), NCT04116515. Registered December 25, 2019, https//clinicaltrials.gov/study/NCT04116515.

PMID:40420195 | DOI:10.1186/s12966-025-01756-1

J Orthop Surg Res. 2025 May 26;20(1):516. doi: 10.1186/s13018-025-05928-4.

ABSTRACT

OBJECTIVE: Rotator cuff injuries are common shoulder disorders, particularly affecting middle-aged and older women, and postoperative rehabilitation plays a vital role in restoring function and preventing recurrence. To investigate the knowledge, attitudes, and practices (KAP) related to postoperative rehabilitation among female patients who had undergone rotator cuff repair surgery.

DESIGN: A cross-sectional study.

METHODS: This cross-sectional study was conducted between January and July 2024 at two orthopedic centers in Chengdu, China, using convenience sampling. Demographic data and KAP scores were collected using a validated self-administered questionnaire (Cronbach’s α = 0.851). The primary outcome measures were knowledge, attitude, and practice scores, assessed using a validated KAP questionnaire. Data were analyzed using descriptive statistics, group comparisons via t-tests or ANOVA, Spearman correlation analysis, and structural equation modeling (SEM) to examine the relationships between knowledge, attitudes, and practices.

RESULTS: A total of 499 female participants who met the inclusion criteria were enrolled with a response rate of 99.60%. Among the participants (mean age: 59.8 ± 7.2 years), the mean scores for knowledge, attitude, and practice were 14.59 ± 4.24, 35.17 ± 5.70, and 27.91 ± 4.71, respectively. Knowledge demonstrated positive correlations with practice (rs = 0.106, p = 0.018), while attitude showed strong correlation with practice (rs = 0.572, p < 0.001). SEM analysis showed that practice was directly influenced by knowledge (β = 0.084, 95% CI: 0.013-0.155, p = 0.021), attitude (β = 0.514, 95% CI: 0.441-0.587, p < 0.001), surgery (β = -0.170, 95% CI: -0.301 to -0.039, p = 0.011), training (β = -0.125, 95% CI: -0.207 to -0.044, p = 0.002), and therapy (β = -0.129, 95% CI: -0.212 to -0.046, p = 0.002). Additionally, income (β = 0.035, p = 0.010) had indirect effect on attitude. Knowledge (β = 0.067, p = 0.005), exercise (β = 0.097, p < 0.001), and therapy (β = -0.113, p < 0.001) had indirect effects on practice.

CONCLUSION: Females with rotator cuff injuries demonstrated adequate knowledge and positive attitudes but exhibited suboptimal practices towards postoperative rehabilitation. These findings suggest the need for targeted interventions to bridge the gap between knowledge and practice, with particular focus on enhancing positive attitudes, which were the strongest predictors of rehabilitation adherence. Healthcare providers should consider implementing comprehensive educational programs that address both knowledge transfer and behavioral change strategies to improve patient outcomes.

PMID:40420194 | DOI:10.1186/s13018-025-05928-4

Int J Behav Nutr Phys Act. 2025 May 26;22(1):61. doi: 10.1186/s12966-025-01752-5.

ABSTRACT

BACKGROUND: The out-of-home (OOH) food sector holds the potential to promote healthier and more sustainable diets on a large scale given the high number of people eating OOH regularly. However, information about socioeconomic and dietary characteristics of OOH eaters is limited. This study aimed to identify a typology of OOH consumers by frequency and type of meal consumed OOH and their associated sociodemographic, lifestyle, nutritional, and environmental characteristics.

METHODS: Based on a sub-sample of adults of the French NutriNet-Santé cohort who completed a food frequency questionnaire and a questionnaire on OOH consumption habits in 2014 (n = 29,140, mean age: 53.6 (SD = 14.0) years, 74.3% women), we conducted a Multiple Factor Analysis followed by a clustering procedure. AN(C)OVA models were then used to examine the associations between the identified clusters and socio-demographic, lifestyle, and diet-related characteristics (using dietary scores and environmental indicators including greenhouse gas emissions, land use and energy consumption).

RESULTS: We identified five clusters based on their OOH consumption patterns: Weekday-only eaters (19%), Frequent weekday and weekend eaters (24%), Organic eaters (6%), Weekend and evening eaters (19%), and Home-only eaters (32%). Weekday-only eaters were younger, more likely to be professionally active and to have children at home than the other groups. Frequent weekday and weekend eaters, with the highest OOH consumption, had the lowest dietary quality and the highest diet-related environmental impacts and consisted mostly of younger women with higher socioeconomic status. Organic eaters, often living in urban areas and following specific diets such as vegan or vegetarian ones, had the best dietary quality and the lowest diet-related environmental impacts. Weekend and evening eaters and Home-only eaters had a higher proportion of retired individuals, with Weekend and evening eaters also showing a greater proportion of high-income individuals.

CONCLUSIONS: Our findings indicate a lower dietary quality and higher dietary environmental impacts among frequent OOH eaters, whereas those with higher organic consumption showed opposite trends. This study contributes to the understanding of different OOH consumer characteristics and could provide a basis for further research in the field.

TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT03335644).

PMID:40420193 | DOI:10.1186/s12966-025-01752-5

Vaccine. 2025 May 25;59:127297. doi: 10.1016/j.vaccine.2025.127297. Online ahead of print.

ABSTRACT

PURPOSE: Studies of influenza vaccination during pregnancy and major birth defects generally provide reassuring findings. To maintain public confidence, it is important to continue evaluating the safety of maternal vaccination using well characterized, population-based data. This study extended previous research to examine associations between maternal influenza vaccination and selected birth defects using data from the Birth Defects Study To Evaluate Pregnancy exposureS, a US, multisite case-control study.

METHODS: Mothers of case children (diagnosed with a birth defect) and control children (without a birth defect diagnosis) were identified from population-based birth defect surveillance programs and recruited to complete a telephone interview. Data from 2675 case and 1575 control mothers (participants) with deliveries during 2014-2019 were analyzed. Influenza vaccination exposure during the critical exposure period (one month before pregnancy through the first pregnancy month [B1P1] for spina bifida or through the third pregnancy month [B1P3] for other selected birth defects) was assessed controlling for several participant covariates. Logistic regression with propensity score adjustment was used to estimate adjusted odds ratios (aORs) and 95 % confidence intervals (CIs). Several secondary analyses were conducted. A probabilistic bias analysis examined the effect of exposure misclassification.

RESULTS: The aOR observed between B1P1 influenza vaccination exposure and spina bifida was 0.9 (95 % CI: 0.4-2.0). The aORs for B1P3 exposure and other selected birth defects examined ranged from 0.4 to 1.3, with 95 % CIs including the null except those for cleft lip ± cleft palate (aOR: 0.6; 95 % CI: 0.4-0.9) and gastroschisis (aOR: 0.4; 95 % CI: 0.2-0.7). Results from secondary analyses were similar to the primary analyses, and those from probabilistic bias analysis were similar to respective primary and secondary analyses.

CONCLUSION: Findings showed no statistically significant positive associations between influenza vaccination and the selected birth defects, supporting public health efforts to promote optimal vaccination coverage among pregnant women.

PMID:40418866 | DOI:10.1016/j.vaccine.2025.127297

Eur J Surg Oncol. 2025 May 20;51(9):110180. doi: 10.1016/j.ejso.2025.110180. Online ahead of print.

ABSTRACT

OBJECTIVE: Limited data exists on health-related quality of life (HRQoL) after robot-assisted surgery (RAL) for rectal cancer beyond one-year post-surgery. This study compares long-term HRQoL following RAL total mesorectal excision (TME) to conventional laparoscopic (CL) TME.

METHODS: All rectal carcinoma patients from the 63-center Prospective National CRC cohort (PLCRC) who completed pre- and post-operative HRQoL questionnaires (EQ-5D, QLQ-C30, and QLQ-CR29) were retrospectively included. Delta scores per parameter were calculated by subtracting pre-operative scores from scores at one year. Sensitivity analysis included all patients with beyond one-year post-operative questionnaires, regardless of a pre-operative questionnaire. Data were analyzed using multivariate linear regression.

RESULTS: Patients undergoing RAL TME more often had low rectal tumors, more post-operative complications and more stomas. In patients with both pre- and post-operative questionnaires, no significant differences were found in the EQ-5D delta score (n = 591). The QLQ-C30 (n = 709) showed statistically significant and clinical relevant difference in fatigue favored CL TME (4.4 ± 1.9, p = 0.021). The QLQ-CR29 (n = 696) showed small, statistically significant differences favoring RAL in body image and stoma-related issues, but no clinical relevance. Sensitivity analysis EQ-5D (n = 1250), QLQ-C30 (n = 1423) or QLQ-CR29 (n = 1453) showed no clinically relevant differences.

CONCLUSION: This is the first study comparing long-term HRQoL between CL and RAL surgery for rectal cancer. Although several statistically significant differences were found, no clinically relevant differences were observed except for a small difference in the subdomain fatigue of the EORTC QLQ-C30 favoring CL surgery. Furthermore, the current study underlines the relevance of a pre-operative HRQoL assessment.

PMID:40418864 | DOI:10.1016/j.ejso.2025.110180