Tag: statistics

BMC Public Health. 2026 May 14;26(1):1559. doi: 10.1186/s12889-026-27638-0.

ABSTRACT

BACKGROUND: Adherence to COVID-19 measures depended on a range of factors, including trust in authorities, knowledge of the virus, and public perception. This study compares Germany and India to examine the association of these factors on compliance and contributes to the debate between knowledge and trust. It also explores public acceptance of virus-deactivating technologies, which could reduce reliance on individual preventive behaviours and surveillance tools, offering new insights for pandemic response and public health strategies.

METHODS: Data was collected through an online primary survey using stratified random sampling in India and Germany. The questionnaire consisted of five sections: socio-demographics, knowledge, trust, preventive behaviours, and technology acceptance. The data was analysed using descriptive statistics and statistical analyses of linear regression and ordinal logistic regression.

RESULTS: Almost all preventive behaviours were more frequent in India than in Germany, while German respondents had higher overall knowledge scores. The regression analysis showed no significant relationship between knowledge and trust in India. In contrast, Germany showed a weak positive association, indicating knowledge is modestly associated with trust, though other factors are also significant. The logistic regression analysis highlighted that trust was associated with all preventive behaviours during the COVID-19 pandemic in India and Germany, consistently emerging as a significant factor. While socio-demographic factors like age, education, and income also predicted some behaviours, knowledge had only a limited association. Similar results were found for the acceptance of virus-deactivating air-purification technologies in both Germany and India. Specifically, UV-light-based air purification systems, seen as a potential replacement for measures like masks and school closures, showed high acceptance: 76% in Germany and 57% in India, suggesting a likelihood of real-world implementation.

CONCLUSIONS: This study adds to existing discussions on the role of knowledge, finding that trust showed a stronger association with adherence to COVID-19 measures. Comparing Germany and India, findings show that despite vast differences in healthcare systems and priorities, trust played a similarly crucial role in both contexts for preventive behaviours and acceptance of virus-deactivating technologies. Transparent communication, co-design and co-creation approaches, as well as reflexive socio-technical collaboration may support trust-building and improve public health strategies during crises.

PMID:42135767 | DOI:10.1186/s12889-026-27638-0

Confl Health. 2026 May 14. doi: 10.1186/s13031-026-00800-6. Online ahead of print.

ABSTRACT

BACKGROUND: Maintaining routine health services during epidemics and humanitarian crises is instrumental to reduce preventable mortality and morbidity. Given the health service disruptions observed during the COVID-19 pandemic worldwide, we aimed to investigate the evolution of health care service utilization for acute and routine chronic care among refugees in Jordan during distinct phases of the COVID-19 pandemic and discuss the interventions that may have contributed to the observed changes in utilization.

METHODS: We conducted a mixed-methods study with three components: (1) interrupted time-series analysis of routine health data in Azraq and Zaatari camps; (2) a household survey among refugees in and out-of-camps (descriptive statistics and comparisons across pandemic periods using Poisson models with household-correlated robust variance estimation); 3) focus group discussions among refugees in and out-of-camps (inductive and deductive thematic content analysis). The analyses compared outcomes across four study periods: (1) Pre-COVID-19 (January 2018-March 2020); (2) Lockdown (April 2020-June 2021); (3) Post-lockdown (July 2021-April 2022); (4) Normalization (May 2022-March 2023), and three refugee groups (Syrian in-camps, Syrian out-of-camps, non-Syrian out-of-camps). Study outcomes included health care utilization for acute and chronic conditions (average number of outpatient consultations per person per year) and self reported health care seeking behaviour.

RESULTS: Acute care utilization declined sharply during the lockdown and recovered gradually to pre-pandemic level during the post-lockdown period. Diabetes care utilization was low before the pandemic across groups. After a reduction during lockdown, it increased significantly during the normalization phase to above pre-pandemic rates. A package of service adaptations was introduced to facilitate access to services and medicines: multi-months drug prescription; new distribution system for medication home delivery; home visits; telephonic follow-up; hotline for questions. Study participants reported different experiences in accessing care, from spontaneous support to perceived barriers and limited access. While challenges were highlighted (waiting time, transportation, cost), most participants appreciated the intervention package and praised the comprehensiveness of the provided services.

CONCLUSIONS: This paper investigates changes in health care services utilization of acute and routine chronic care among refugees in Jordan during the COVID-19 pandemic. We learned that acute care will likely rebound back to pre-shock levels and that the utilization of chronic care benefitted from introduced changes in the approach of service delivery, namely a package of complementary interventions that proved helpful in facilitating access to care and medicines for NCD patients while reducing COVID-19 exposure. By documenting UNHCR’s and partners’ efforts, we provide examples of concrete interventions that should be implemented to improve future pandemic responses.

PMID:42135758 | DOI:10.1186/s13031-026-00800-6

Confl Health. 2026 May 14. doi: 10.1186/s13031-026-00798-x. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region.

METHODS: An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis.

RESULTS: Among 3455 participants (median age 29 years; 56.5% female), 94% (n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation.

CONCLUSION: Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.

PMID:42135757 | DOI:10.1186/s13031-026-00798-x

BMC Med Educ. 2026 May 14. doi: 10.1186/s12909-026-09436-9. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to comparatively examine the dental caries and periodontal health status of dental (DS) and medical students (MS) and to evaluate their quality of life related to oral health using the Oral Health Impact Profile-14 (OHIP-14) scale.

MATERIALS AND METHODS: The cross-sectional study included a total of 400 systemically healthy volunteers from 1st-5th year DS (n = 200) and MS (n = 200) students of Recep Tayyip Erdoğan University. Participants’ body mass index was recorded; clinical dental (decayed, missing, and filled teeth (DMFT)) and periodontal parameters (plaque index (PI), gingival index (GI), bleeding on probing index (BOP), and probing pocket depth (PPD)) were measured. Oral Health-Related Quality of Life (OHRQoL) was assessed using the OHIP-14 questionnaire. Statistical analyses were performed to compare the two faculties across all academic years (1st-5th year) and evaluate the associations between variables. Additionally, adjusted multiple linear regression analyses were conducted to determine the independent effect of academic year on oral health parameters while controlling for gender and body mass index. The significance level was set at p < 0.05.

RESULTS: In DS, the PI, GI, BOP, and PPD parameters were found to be significantly lower than in MS (p < 0.05). In intra-faculty comparisons, DS generally showed a positive trend in dental, periodontal, and OHRQoL as their class level increased, while the opposite was observed in MS. In inter-faculty comparisons at each class level, significant differences were obtained at all parameters in all classes except the first year (p < 0.05). Class level was determined to be an associated factor for all oral health parameters in students of both faculties.

CONCLUSION: This cross-sectional study showed that, unlike DS, lower levels were observed in dental and periodontal health status and OHRQoL were observed in MS as their class level increased. In this context, including topics related to oral health awareness and daily care habits in MS curricula could be beneficial.

TRIAL REGISTRATION: This study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07425860) on February 10, 2026.

PMID:42135748 | DOI:10.1186/s12909-026-09436-9

BMC Med Res Methodol. 2026 May 14;26(1):116. doi: 10.1186/s12874-026-02875-4.

ABSTRACT

Joint models offer an unbiased statistical approach for analyzing the effects of longitudinal biomarkers on time-to-event outcomes, providing an alternative to time-varying Cox proportional-hazards regression and the two-stage approach. However, whether available implementations of these methods perform reliably across different practically relevant scenarios remains insufficiently studied. We conducted a simulation study based on the Berlin Initiative Study examining kidney function and survival in older adults. In a manner comparable to phase IV studies in clinical research, our evaluation aims to provide insights into the practical performance of commonly used R package implementations of these methods, mostly under their default settings. By varying data generating scenarios, we assessed how different numbers of events and longitudinal measurements affect performance of Bayesian (JMbayes2) and frequentist joint model implementations (JM and joineRML), time-varying Cox PH regression (survival), and the two-stage approach (nlme and survival), focusing on bias in parameter estimates. Results revealed substantial variability across implementations. The JM package exhibited considerable bias and frequent convergence issues. In contrast, joineRML performed robustly with approximately unbiased estimates for association parameters and high convergence frequencies comparable to the implementations of the simpler methods across diverse scenarios. However, both frequentist packages systematically underestimated the effects of baseline covariates in the survival model. The Bayesian JMbayes2 was largely unbiased, but performance deteriorated under two conditions: with few events (< 70), convergence was low and bias persisted even in converged models; and with observation-to-event ratios below 2, convergence declined, although estimates from converged models remained approximately unbiased. Time-varying Cox PH regression and the two-stage approach showed more bias than JMbayes2 in certain settings but tended to achieve more robust performance and convergence across most scenarios.

PMID:42135742 | DOI:10.1186/s12874-026-02875-4

BMC Med Educ. 2026 May 14. doi: 10.1186/s12909-026-09389-z. Online ahead of print.

ABSTRACT

BACKGROUND: Physiotherapy (PT) education must foster both clinical competencies and non-technical skills such as communication, empathy, and self-efficacy to prepare students for professional practice. Simulation-Based Learning (SBL) offers a structured and safe environment to develop these skills. While the benefits of SBL have been documented in nursing and medical education, evidence in PT programs, particularly across different academic years, remains limited. This study examined changes in perceived self-efficacy, academic engagement, and empathy following SBL participation, and to explore differences between second-, third-, and fourth-year PT students.

METHODS: A prospective quasi-experimental study was conducted between December 2023 and June 2024 involving second-, third-, and fourth-year undergraduate PT students from a single Spanish university (corresponding to the fourth, sixth, and eighth semesters, respectively). Students participated in SBL sessions designed according to international standards and adapted to their academic level. Outcomes were assessed pre- and post-SBL through validated questionnaires: the Academic Situation-Specific Perceived Self-Efficacy Scale, the Utrecht Work Engagement Scale for Students, and the Jefferson Scale of Empathy. All instruments demonstrated adequate internal consistency in the study sample (Chronbach’s α ≥ 0.80). Post-SBL perceptions were further assessed using the Student Satisfaction and Self-Confidence in Learning Questionnaire and the Educational Practices Questionnaire-Spanish Version.

RESULTS: Out of 451 eligible students, 409 participated in the baseline assessment and 378 completed post-SBL assessments. Statistically significant improvements were found in self-efficacy (p = 0.001), academic engagement (vigor, absorption, and total score; p = 0.008; p = 0.007, and p = 0.023, respectively), and empathy (compassionate care and total score; p < 0.001, and p = 0.007, respectively) across the full sample. When results were examined by academic year, patterns of change differed, with third- and fourth-year students showing consistent improvements across most dimensions, while second-year students exhibited more variable responses, including small decreases in selected engagement and empathy subscales. Post-SBL evaluations indicated high levels of satisfaction and self-confidence in learning, with large effect sizes observed in the more advanced academic years. Students’ perceptions indicated strong endorsement of SBL practices, especially in high expectations and learning diversity.

CONCLUSIONS: SBL was associated with improvements in key learning-related competencies, particularly among students in more advanced academic years. Differences across cohorts highlight the need to tailor SBL design to students’ developmental stage, especially during early exposure. Future studies should incorporate control groups, qualitative data, and follow-up assessments to better understand the sustainability and contextual factors influencing SBL outcomes.

TRIAL REGISTRATION: NCT06852482 (registered on 28 February 2025).

PMID:42135739 | DOI:10.1186/s12909-026-09389-z

BMC Med Educ. 2026 May 14. doi: 10.1186/s12909-026-09443-w. Online ahead of print.

ABSTRACT

BACKGROUND: Simulation-based training (SBT) has emerged as a structured educational strategy to support safe transition into clinical imaging practice. In nuclear medicine technology (NMT), where high-risk procedures require precision and adherence to radiation protection standards, variability in clinical-based training (CBT) exposure may affect skill acquisition. Evidence evaluating structured simulation integration within undergraduate nuclear medicine education remains limited. This study aimed to evaluate performance outcomes associated with SBT and CBT using a structured OSCE framework to assess competency acquisition, procedural performance, and radiation safety preparedness among undergraduate nuclear medicine students.

METHODS: A comparative educational evaluation was conducted involving two undergraduate NMT cohorts from separate institutions in Riyadh, Saudi Arabia (SBT, n = 30; CBT, n = 30). Students underwent a structured four-station objective structured clinical examination (OSCE) in a controlled hot laboratory environment assessing theoretical knowledge, radiopharmaceutical dose preparation, dose calibrator operation, and radiation safety management. Normality of the data was assessed using the Shapiro-Wilk test, and homogeneity of variances was evaluated using Levene’s test. Independent-samples t-tests with Welch’s correction were used to compare group means between SBT and CBT groups. For variables where assumptions were violated, the non-parametric Mann-Whitney U test was applied. Bonferroni correction was applied to account for multiple comparisons (p < 0.0125).

RESULTS: Students trained using simulation demonstrated higher mean scores across all OSCE stations compared with clinically trained peers. Statistically significant differences were observed in stations 2, 3, and 4 (all p < 0.001), favoring the SBT group and remaining significant after Bonferroni correction. Higher mean performance was also observed in theoretical knowledge; however, this difference was not statistically significant.

CONCLUSIONS: Simulation-based training was associated with higher mean performance across assessed competencies, with statistically significant differences observed in practical and safety-related OSCE stations (stations 2-4). While no significant difference was observed in theoretical knowledge, these findings suggest that structured simulation may enhance procedural readiness and reinforce radiation safety behaviors in undergraduate nuclear medicine education when integrated alongside clinical training.

PMID:42135738 | DOI:10.1186/s12909-026-09443-w

BMC Nurs. 2026 May 14. doi: 10.1186/s12912-026-04723-8. Online ahead of print.

ABSTRACT

AIM/OBJECTIVE: This study aimed to examine the role of perceived academic mentorship and self-efficacy in enhancing self-directed learning readiness (SDLR) among undergraduate nursing students.

BACKGROUND: Self-directed learning readiness is essential for nursing students to effectively manage their learning in complex and evolving healthcare environments. While academic mentorship and self-efficacy have been associated with learning outcomes, their combined relationships with SDLR remain insufficiently explored.

METHODS: A descriptive correlational cross-sectional design was used. Data were collected from 500 undergraduate nursing students at the Faculty of Nursing, Damanhour University, Egypt, during the 2025-2026 academic year. Data were collected using three validated self-report scales measuring perceived academic mentorship, self-directed learning readiness, and self-efficacy. Data were analyzed using descriptive statistics, correlation, regression, and mediation analysis.

RESULTS: Perceived academic mentorship showed moderate positive correlations with self-directed learning readiness (r = 0.48, p < 0.01) and self-efficacy (r = 0.52, p < 0.01), while self-efficacy was also positively correlated with SDLR (r = 0.46, p < 0.01). Regression analysis indicated that demographic and academic variables explained 26.9% of the variance in SDLR. Mediation analysis revealed that self-efficacy partially mediated the relationship between perceived academic mentorship and SDLR (β = 0.15, 95% CI [0.10-0.20]).

CONCLUSIONS: The findings indicate that students’ readiness for self-directed learning is not shaped by academic mentorship alone, but by how mentorship experiences translate into stronger beliefs in their ability to manage learning demands. This suggests that efforts to enhance students’ readiness for self-directed learning should prioritize mentorship approaches that move beyond guidance alone toward intentionally fostering students’ confidence, independence, and engagement in their learning processes.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42135737 | DOI:10.1186/s12912-026-04723-8

BMC Surg. 2026 May 14. doi: 10.1186/s12893-026-03819-x. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative abdominal wall dehiscence (AWD) or burst abdomen (BA) is a relevant complication after abdominal surgery that causes additional surgical procedures, prolonged hospital stays and long-term morbidity. Several underlying risk factors exist and have been described in literature and consist of surgical and medical factors. Recently, CT-derived body composition is of rising interest to provide new prognostic factors in surgical patients. The present study aims to explore the association between CT-defined body composition and postoperative BA.

MATERIALS AND METHODS: A database of patients who underwent abdominal surgery and developed post-operative wound infections in our institution between 2015 and 2018, was assembled. The subgroup of patients with BA was compared to a control group without BA. CT-defined body composition was evaluated in L3-level measuring skeletal muscle index (SMI) for sarcopenia assessment, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Clinical risk factors and CT-defined body composition were used to predict the occurrence of postoperative BA using discriminatory and binary logistic regression analyses.

RESULTS: A total of 118 patients, 92 (78%) with BA and 26 (22%) without BA were included in the analysis. CT derived body composition parameters for visceral obesity and sarcopenia showed statistically significant differences between the two cohorts. Patients with burst abdomen showed higher VAT (157.6 cm² vs. 84.9 cm², p = 0.001) and a significantly lower SMI (46.9 cm²/m² vs. 53.8 cm²/m², p = 0.016). Consequently, visceral obesity and sarcopenia were significantly more frequent in patients with BA (p = 0.02 and 0.01, respectively). In the multivariable Firth’s penalized logistic regression, visceral obesity (OR = 4.87, 95% CI 1.32-21.91 p = 0.02), sarcopenia (OR = 5.94, 95% CI 1.65-26.68 p = 0.006), intestinal resection (OR = 9.33, 95% CI 2.33-55.65 p < 0.001) and length of the surgical wound (OR = 1.12, 95% CI 1.04-1.22 p = 0.001) were independently associated with the occurrence of burst abdomen.

CONCLUSION: CT-defined body composition with sarcopenia and visceral obesity are strongly associated with postoperative BA. This analysis should be further acknowledged as a potentially important risk factor in surgical care and could aid in clinical decision making.

PMID:42135717 | DOI:10.1186/s12893-026-03819-x

J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-04094-w. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis is a critical condition that leads to significant morbidity and mortality. Accurate prediction of patient outcomes is essential for effective management. This meta-analysis evaluates the prognostic value of echocardiographic cardiac function parameters, particularly left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LVGLS), in predicting short-term outcomes in sepsis patients.

METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted from inception to January 19, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies assessing echocardiographic parameters and short-term mortality in adult sepsis were included. Random-effects meta-analysis was performed using standardized mean differences (SMDs). Sensitivity analyses included leave-one-out procedures and restricted maximum likelihood with Hartung-Knapp adjustment. Publication bias was evaluated using funnel plots and Egger’s regression test.

RESULTS: Nine cohort studies published between 2014 and 2021 were included. LVGLS was significantly more impaired in non-survivors than in survivors (SMD – 0.40, 95% confidence interval [CI] – 0.62 to – 0.18; I² = 51.1%). Results remained robust with Hartung-Knapp adjustment (SMD – 0.55, 95% CI – 0.79 to – 0.30). In a septic shock-only sensitivity analysis, the association persisted (SMD – 0.76, 95% CI – 1.01 to – 0.51; I² = 0%). Subgroup analysis showed no significant difference between Sepsis-2 and Sepsis-3 studies (P = 0.45). LVEF was not associated with short-term mortality (SMD 0.06, 95% CI – 0.08 to 0.20; I² = 27.2%). Funnel plot inspection showed no clear asymmetry, and Egger’s test was not statistically significant.

CONCLUSIONS: LVGLS is associated with short-term mortality in sepsis and may provide incremental prognostic information beyond conventional LVEF assessment. Prospective studies are needed to define clinically meaningful thresholds and evaluate incremental value over established risk scores.

PMID:42135714 | DOI:10.1186/s13019-026-04094-w