Tag: statistics

J Multidiscip Healthc. 2026 Aug 25;19:624664. doi: 10.2147/JMDH.S624664. eCollection 2026.

ABSTRACT

BACKGROUND: As newly employed nurses transition into clinical practice, understanding and implementing Entrustable Professional Activities (EPAs) is crucial for ensuring quality patient care and professional development. This study aims to assess the knowledge, attitudes, and practices (KAP) of newly employed nurses regarding EPAs.

METHODS: A cross-sectional, multicenter study was conducted between September 2024 and November 2024 in six general hospitals. The study included newly employed nurses who voluntarily consented to participate. A self-designed questionnaire was used to collect demographic characteristics and KAP scores.

RESULTS: A total of 240 valid questionnaires were collected. Among the participants, 193 (80.42%) were female, and 219 (91.25%) held an associate or bachelor’s degree. Additionally, 142 respondents (59.17%) reported working 40 to 49 hours per week, while 172 (71.67%) had received training related to EPAs. The median (interquartile range) scores for knowledge, attitude, and self-reported practice were 16 (13-18.5), 46 (40-50), and 40 (38-49), respectively. Exploratory path analysis showed that knowledge was negatively associated with self-reported practice after accounting for attitude (β = -0.121, P = 0.012), whereas attitude was positively associated with self-reported practice (β = 0.514, P = 0.012). The path from knowledge to attitude (β = 0.111, P = 0.115) and the indirect association between knowledge and self-reported practice through attitude (β = 0.057, P = 0.127) were not statistically significant.

CONCLUSION: Newly employed nurses demonstrated insufficient knowledge but positive attitudes and proactive self-reported practices regarding EPAs. Positive attitudes were associated with higher self-reported practice scores, whereas the association between knowledge and self-reported practice was more complex. Targeted education combining EPA-related knowledge, practical training, and mentorship may support self-reported practice, although its effects on actual clinical performance and patient outcomes require evaluation in future longitudinal or interventional studies.

PMID:42668973 | PMC:PMC13525766 | DOI:10.2147/JMDH.S624664

PeerJ. 2026 Aug 24;14:e21643. doi: 10.7717/peerj.21643. eCollection 2026.

ABSTRACT

BACKGROUND: Among low- and middle-income countries, noncommunicable diseases (NCDs) are a significant health burden among the elderly. Mobile health interventions provide resource-constrained health education that is scalable.

AIMS: Determine the viability, acceptability, and preliminary effects of culturally adapted Short Message Service (SMS)-based nutrition and lifestyle change on the knowledge, attitudes, and practices (KAP) of older adults in Jordan towards prevention of noncommunicable diseases (NCDs).

METHOD AND MATERIALS: A total of 79 older adults (mean age 57.33 ± 9.37 years) with NCDs received 30 culturally tailored SMS messages daily for one month. Messages were based on Social Cognitive Theory and addressed dietary habits, physical activity, and NCD risk reduction. A validated Arabic-adapted KAP questionnaire was administered pre- and post-intervention.

STATISTICAL ANALYSIS: Paired-samples t-tests were used to compare pre- and post-KAPs. Effect sizes were calculated using Cohen’s d. Sociodemographic factors associated with KAP improvement were examined through multiple linear regression (p ≤ 0.05).

RESULTS: Significant improvements occurred in knowledge (mean difference = 40.62, p ≤ 0.001; Cohen’s d = 3.29) and attitudes (mean difference = 24.43, p ≤ 0.001; Cohen’s d = 1.77). There was no significant change in practice scores (p = 0.175). Overall KAP improved significantly (p ≤ 0.001; Cohen’s d = 2.15), driven primarily by gains in knowledge and attitudes; practice scores did not change significantly. Greater improvement in KAP was associated with higher education (β = 0.379, p ≤ 0.001), younger age (β = – 0.646, p ≤ 0.001), female sex (β = – 0.067, p = 0.007), and living alone (β = 0.150, p = 0.031).

CONCLUSIONS: The pilot study indicates that culturally adapted SMS messaging among older adults with NCDs is feasible and acceptable in Jordan, and its early impacts on knowledge and attitudes are promising. These results provide preliminary evidence and effect size estimates needed to design a fully powered randomized controlled trial to determine effectiveness.

PMID:42668969 | PMC:PMC13525760 | DOI:10.7717/peerj.21643

Patient Prefer Adherence. 2026 Aug 25;20:615467. doi: 10.2147/PPA.S615467. eCollection 2026.

ABSTRACT

BACKGROUND: Thalassemia is a chronic blood disorder requiring lifelong blood transfusions and iron chelation therapy (ICT) to reduce iron overload.

PURPOSE: In Pakistan, limited evidence exists on how medication adherence, clinical outcomes, and health-related quality of life (HRQoL) interact simultaneously in β-thalassemia major (β-TM) children. This study therefore aimed to evaluate these variables and examine their interrelationships in pediatric β-TM patients receiving ICT.

METHODS: A cross-sectional observational study was conducted among 622 patients aged 5-12 years across six thalassemia centers in Punjab, Pakistan (September 2024-February 2025). For data collection, Treatment Adherence Scale (TAS) and Paediatric Quality of Life Inventory™ (PedsQL™) 4.0 Generic Core Scales were used. Clinical outcomes were assessed via hematological and iron overload parameters. Statistical analyses, including non-parametric tests, Friedman test, multiple regression analysis, and Spearman’s rank correlation, with p < 0.05 considered significant.

RESULTS: The total adherence score was 6 IQR (3-8). Clinical outcomes showed significant improvement in hemoglobin levels, while serum ferritin remained elevated. Younger age, urban residency, and deferasirox monotherapy were significantly associated with higher adherence and HRQoL. The total QoL score was 67.3 IQR (50-84.4). Family history, deferoxamine use, and serum ferritin were identified as negative predictors of adherence and HRQoL, whereas urban residency, splenectomy, and higher adherence to ICT were positive predictors of HRQoL. A significant positive correlation was found between adherence and HRQoL (ρ = 0.420, p < 0.001), while serum ferritin was negatively correlated with adherence (ρ = -0.476, p < 0.001) and HRQoL (ρ = -0.329, p < 0.001).

CONCLUSION: Pediatric β-TM patients reported moderate overall adherence to ICT. Clinical outcomes showed improvement in anemia and increased iron overload. HRQoL was moderately affected, especially in school functioning. Patients with low adherence had lower HRQoL and increased serum ferritin levels, reflecting suboptimal clinical outcomes.

PMID:42668965 | PMC:PMC13525769 | DOI:10.2147/PPA.S615467

Iowa Orthop J. 2026;46(1):293-301.

ABSTRACT

BACKGROUND: This study aimed to comprehensively assess the most recent data on the prognostic effects of hematologic markers, including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII), on deep vein thrombosis (DVT) following lower limb fractures.

METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in PROSPERO (CRD420251006336). We performed a comprehensive search in the PubMed, EMBASE, Web of Science, and Scopus electronic databases. Date of publication and language were not restricted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated and all statistical analyses were performed using Stata 18 software.

RESULTS: Ten studies, involving a total of 6183 patients with lower extremity fractures, of whom 896 developed DVT, were included in the final analysis. The results indicated that, compared to the non-DVT group, patients with DVT had higher levels of NLR (SMD = 0.48, 95% CI = 0.02-0.94, p = 0.04) and SII (SMD = 1.01, 95% CI = 0.121.89, p = 0.02). However, PLR and MLR level was not different between the two groups. Among the evaluated biomarkers, SII demonstrated the highest specificity (80%, PLR = 74%), while NLR had the highest sensitivity (68%).

CONCLUSION: The literature supported that, compared to the non-DVT group, patients with DVT had higher levels of NLR and SII. Among these biomarkers, SII demonstrated the highest specificity, while NLR had the highest sensitivity. Composite inflammatory markers, particularly SII, may hold value in DVT risk stratification during post-fracture period.Level of Evidence: II.

PMID:42668964 | PMC:PMC13525540

Pak J Med Sci. 2026 Aug;42(8):1934-1942. doi: 10.12669/pjms.42.8.16082.

ABSTRACT

OBJECTIVES: To evaluate the effects of different anesthesia procedures and surgical approaches on maternal and neonatal outcomes in cases of abnormal placental invasion (API), and to determine the factors that predict the transition from spinal anesthesia to general anesthesia.

METHODOLOGY: This retrospective cohort study included 115 patients who underwent API surgery at University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; between 2015 to 2023. Demographic, obstetric, anesthetic, surgical, and neonatal data were analyzed. Comparisons were made based on the anesthesia type (spinal, general, and spinal-to-general conversion) and depth of invasion.

RESULTS: Placenta percreta was detected in 67% of the cases. As the severity of invasion increased, the operative time, blood and fluid replacement, and hospital stay were significantly prolonged (p<0.05). The American Society of Anesthesiologists (ASA) score, blood product consumption, and intraoperative complication rates were significantly higher in patients undergoing general anesthesia (p<0.001). Spinal anesthesia was the first choice (91.3%), and 47.6% of the cases required intraoperative conversion to general anesthesia. ROC analysis revealed that colloid use, ASA score, and fibrinogen requirement were significant predictors. There were no statistically significant differences in neonatal outcomes between the groups.

CONCLUSION: In API cases, initiating neuraxial anesthesia, which allows for transition to general anesthesia when necessary, may improve maternal safety. Parameters such as colloid use and ASA score may guide early identification of high-risk cases. Prospective multicenter studies are required to establish standard management protocols for this high-risk group.

PMID:42668945 | PMC:PMC13525536 | DOI:10.12669/pjms.42.8.16082

Pak J Med Sci. 2026 Aug;42(8):1980-1986. doi: 10.12669/pjms.42.8.7502.

ABSTRACT

OBJECTIVE: To determine the sensitivity, specificity, and diagnostic accuracy of caesarean scar tenderness in predicting uterine dehiscence or rupture during per-operative findings.

METHODOLOGY: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, JPMC, Karachi, from November 2021 to July 2024. Women with singleton pregnancies having previous caesarean were given Trial of Labor After Caesarean (TOLAC) after informed consent using consecutive sampling. Exclusion criteria included uterine abnormalities, hypertension, diabetes mellitus, multiple pregnancies, and pre-eclampsia. Data were collected on demographic details, clinical findings, and operative outcomes. Statistical analysis was performed using SPSS Version 27.

RESULTS: A total of 385 women were included in the study. Scar tenderness was present in 67.8% of women. Uterine rupture was found in 22.3% of cases, while scar dehiscence was present in 49.9%. The sensitivity of scar tenderness in predicting uterine rupture and dehiscence was 85.6%, and the specificity was 78.5%. The positive predictive value (PPV) was 91.2%, and the negative predictive value (NPV) was 67.7%. The overall diagnostic accuracy was 83.6%.

CONCLUSIONS: Scar tenderness is a useful clinical predictor of uterine scar complications during TOLAC, particularly in low-resource settings.

PMID:42668942 | PMC:PMC13525533 | DOI:10.12669/pjms.42.8.7502

Int J Microbiol. 2026 Aug 29;2026:3336189. doi: 10.1155/ijm/3336189. eCollection 2026.

ABSTRACT

Tropical peatlands are among the largest global carbon sinks and face increasing impacts from drainage, fire, and land-use change. These disturbances modify soil physicochemical characteristics and influence bacterial community structure. However, the response of bacterial communities to these changes is incompletely understood. This study examined bacterial community composition at six peatland sites in the Giam Siak Kecil-Bukit Batu Biosphere Reserve, Riau, Indonesia. The sites represent various land-use types: secondary forest, restored peat, burned peat, oil palm, rubber, and acacia plantations. The analysis employed 16S rRNA gene sequencing combined with measurements of soil physicochemical properties. Results showed that key bacterial phyla, such as Acidobacteriota, Pseudomonadota, and Actinomycetota, were consistently found across sites, though their relative abundances varied. Burned sites had increased abundances of Bacillota and other copiotrophic groups and decreased abundances of several oligotrophic taxa. Beta diversity analysis showed differences in community patterns among sites, but multivariate analysis did not show significant differences between land-use types. Variation in bacterial community composition is associated with soil pH and nutrient availability, including available phosphorus, exchangeable potassium, and exchangeable magnesium, although these relationships are not always statistically supported. A small number of ASVs were detected across all sites, suggesting overlapping community members amid high spatial heterogeneity. Overall, tropical peatland bacterial communities form within a narrow environmental framework in which distinctive physicochemical properties constrain which microbes can survive. Land-use changes are primarily associated with shifts in the relative abundance of bacterial taxa rather than complete community turnover. Given the limited number of samples and single time-point observations, these findings are exploratory and provide a basis for further research.

PMID:42668938 | PMC:PMC13525552 | DOI:10.1155/ijm/3336189

Pak J Med Sci. 2026 Aug;42(8):2123-2128. doi: 10.12669/pjms.42.8.12258.

ABSTRACT

OBJECTIVE: To compare the effectiveness of oral lactase enzyme versus lactose-free formula in the management of secondary lactose intolerance in persistent and severe persistent diarrhea.

METHODS: This randomized controlled trial was conducted at the pediatric unit of Ziauddin University Hospital, Kemari, Karachi, Pakistan, from June, 2023 to July,2024. A total of 50 children were included in this study following the inclusion criteria of both genders aged 6-24 months and presented with persistent or severe persistent diarrhea due to secondary lactose intolerance. In Group-A, five drops of lactase enzyme (200 units lactase/drop)/ounce of milk were added 5-30 minutes before feeding, while in Group-B, lactose-free formula milk/diet was advised. They were monitored from day one through day five and assessed for outcome measures, comprising clinical (on day five) and laboratory assessments (stool pH and reducing substances on day six), success or failure, and duration of hospital stay (less or more than five days).

RESULTS: In a total of 50 children, the median age was 11 (9-15.3) months. There were 30 (60.0%) children who presented with vomiting, while 14 (28.0%) had severe dehydration. At day five, lactase enzyme children showed significantly less episodes of diarrhea versus lactose free formula (20.0% vs. 48.0%, p=0.037), while all other complaints were statistically similar (p>0.05). The duration of hospital stay was significantly less among children in lactase enzyme group versus lactose free formula group (p=0.001).

CONCLUSION: The effectiveness of lactase enzyme supplementation was better than lactose-free formula in children with persistent diarrhea due to secondary lactose intolerance.Clinical Trial Registration: NCT06827405 (https://clinicaltrials.gov).

PMID:42668931 | PMC:PMC13525527 | DOI:10.12669/pjms.42.8.12258

Pak J Med Sci. 2026 Aug;42(8):2045-2051. doi: 10.12669/pjms.42.8.15956.

ABSTRACT

OBJECTIVES: To assess the frequency of bullying and its association with depression, anxiety, stress, and coping strategies among undergraduate dental students.

METHODOLOGY: A cross-sectional study was conducted among 124 dental undergraduates at Bibi Aseefa Dental College, Larkana, Pakistan (August 2025-January 2026). Bullying exposure was assessed using an adapted 15-item Negative Acts Questionnaire-Revised (NAQ-R), while psychological distress was measured using the 21 items Depression, Anxiety, and Stress Scale (DASS-21), Coping strategies were evaluated using the 24 items Brief-COPE inventory and were categorized as adaptive and maladaptive. Data were analyzed using descriptive statistics, Chi-square tests, and Spearman’s correlation, with a p-value < 0.05 considered statistically significant.

RESULTS: Most students reported high bullying exposure (74.2%). Moderate to extremely severe depression was observed in 50.8%, severe to extremely severe anxiety in 54.0%, and moderate to severe stress in 29.9% of participants. Bullying exposure was significantly associated with depression (χ² = 18.2, p = 0.020), stress (χ² = 16.6, p = 0.035), and anxiety (χ² = 29.2, p < 0.001). Spearman’s correlation revealed that bullying was positively correlated with anxiety (ρ = 0.427, p < 0.001) and maladaptive coping (ρ = 0.403, p < 0.001), while maladaptive coping strongly correlated with anxiety (ρ = 0.648, p < 0.001). Adaptive coping showed weaker positive correlations with anxiety, suggesting increased coping efforts in response to distress. Multivariable analysis identified high bullying exposure (OR ≈6.0, p<0.001) and maladaptive coping (OR ≈ 1.18, p<0.001) as significant independent predictors of moderate to severe anxiety.

CONCLUSION: Bullying is highly prevalent among dental students and strongly associated with anxiety, depression, and maladaptive coping. Targeted interventions, including bullying prevention, mental health support, and resilience training, are essential to safeguard student well-being.

PMID:42668930 | PMC:PMC13525524 | DOI:10.12669/pjms.42.8.15956

Cureus. 2026 Jul 30;18(7):e113650. doi: 10.7759/cureus.113650. eCollection 2026 Jul.

ABSTRACT

INTRODUCTION: Acute leukemias are the most common hematologic malignancies in children, but detailed epidemiological and immunophenotypic data are limited in Morocco. A better characterization of these diseases is needed to optimize diagnostic strategies.

OBJECTIVE: To describe the epidemiological, clinical, and biological features of pediatric acute leukemias and to evaluate the diagnostic contribution of flow cytometry in a Moroccan university hospital center, based on available diagnostic tools.

METHODS: We conducted a retrospective, single-center study at the hematology laboratory of Ibn Sina University Hospital, Rabat, including all children under 15 years diagnosed with acute leukemia between January 1, 2022, and January 1, 2024. Diagnosis was based on bone marrow cytology, cytochemistry, and flow cytometry. Cases were classified according to the World Health Organization (WHO) 2008 classification based on the available diagnostic tools, as cytogenetic and molecular studies were not available in our setting. Cytochemical staining for myeloperoxidase (MPO) was systematically performed. Positivity thresholds for flow cytometry followed European Group for the Immunological Characterization of Leukemias (EGIL) recommendations. Statistical analyses used Fisher’s exact and Kruskal-Wallis tests, with p < 0.05 considered significant.

RESULTS: A total of 106 children with a mean age of 6.9 years were included. Acute lymphoblastic leukemia (ALL) accounted for 81.1% (n = 86), acute myeloid leukemia (AML) for 16.0% (n = 17), and biphenotypic acute leukemia (BAL) for 2.8% (n = 3). Three cases of Burkitt lymphoma were identified and excluded from the ALL group. The overall male-to-female ratio was 1.86 (69 boys, 37 girls), with no significant difference between subtypes (p = 0.46). Subtype distribution varied significantly with age (p = 0.02). The main clinical features were tumor syndrome (84.0%), fever (67.0%), and hemorrhagic syndrome (50.9%). Fever was significantly more frequent in B-ALL than in other subtypes (p < 0.001), as was hemorrhagic syndrome (p = 0.03). Significant differences between subtypes were also observed for leukopenia (p = 0.04), leukocytosis (p = 0.003), pancytopenia (p = 0.03), and major hyperleukocytosis (>100 × 10⁹/L, p < 0.001). Hypercellular marrow was found in 84.4% of cases, with a median blast count of 88% (interquartile range, IQR: 78-92), significantly higher in ALL than in AML (p = 0.008). Immunophenotyping allowed reclassification of six of the 95 MPO-negative suspected ALL cases: four were reclassified as acute myeloid leukemia with minimal differentiation and two as BAL. In addition, one BAL was identified among the 14 MPO-positive cases, raising the total number of BAL to three.

CONCLUSIONS: Flow cytometry is a valuable tool for the diagnosis of pediatric acute leukemias in resource-limited settings, contributing to the classification of ALL, identification of acute myeloid leukemia with minimal differentiation, and diagnosis of BAL based on cytology, cytochemistry, and immunophenotyping. The high frequency of aberrant antigen expression supports the need for a standardized diagnostic algorithm combining cytology, cytochemistry, and immunophenotyping. Larger prospective studies with cytogenetics and follow-up are needed to refine prognostic value.

PMID:42668927 | PMC:PMC13525706 | DOI:10.7759/cureus.113650