Tag: statistics

BMC Health Serv Res. 2026 Jul 4. doi: 10.1186/s12913-026-14986-1. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited.

OBJECTIVE: To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India.

METHODS: A quasi-experimental pre-post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner-a pictorial educational pamphlet-over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen’s dz.

RESULTS: Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (p < 0.001) with large to very large effect sizes (Cohen’s dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training.

CONCLUSIONS: Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre-post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.

PMID:42401919 | DOI:10.1186/s12913-026-14986-1

BMC Chem. 2026 Jul 4. doi: 10.1186/s13065-026-01831-z. Online ahead of print.

ABSTRACT

A sensitive, simple, and environmentally friendly electrochemical voltammetric approach has been developed for the determination of Mirabegron (MRG) in drug substances, drug products, and spiked human plasma samples. For the first time, MRG was measured using a combination of electrochemistry and nanotechnology. A Multiwalled carbon nanotubes/sugar polymer/ zinc oxide nanoparticles carbon paste electrode (MWCNT/ZnO NPs/PS/CPE) was fabricated and used to study the electrochemical behavior of MRG showing a good anodic response in Britton-Robinson buffer (B-R buffer) pH 3.0 utilizing cyclic (CV) and square wave voltammetry (SWV). Linear relationships were recorded between the peak current (I_p ) and MRG concentration ranges of 0.2 × 10^{– 9} – 100 × 10^{– 6} M in bulk with correlation 0.9990 and 0.30 × 10^{– 9} – 100 × 10^{– 9} M in plasma with correlation of 0.9993. Method sensitivity was demonstrated by the calculation of the detection and quantification limits, which were found to be 6 × 10^{– 12} M and 19 × 10^{– 12} M, respectively. Method validation has been evaluated as per ICH guidelines. The acquired results were statistically compared with those of the reported one profitably. Method greenness was evaluated by ECO scale, the Modified Green Analytical procedure index (MOGAPI) and Analytical Greenness Metric Approach (AGREE). The results indicate an excellent green profile, so the developed new voltametric method will be dedicated to the quality control laboratories to contribute to MRG analysis.

PMID:42401918 | DOI:10.1186/s13065-026-01831-z

BMC Health Serv Res. 2026 Jul 4. doi: 10.1186/s12913-026-14941-0. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational asthma (OA) is a significant public health concern due to its high prevalence and socioeconomic burden. In Tunisia, direct costs of OA have not been previously evaluated, highlighting an important knowledge gap for health policy planning. This study aimed to assess the direct cost of OA in the private sector of central Tunisia and identify factors influencing this cost.

METHODS: A retrospective claims-based cohort study was conducted using data from the National Health Insurance Fund (CNAM) on OA cases recognised between 2015 and 2017 in the governorates of Sousse, Monastir, Mahdia and Kairouan, central Tunisia. Direct costs were estimated from the CNAM payer perspective. The costs were tracked from the date of recognition until 31 December 2020 and expressed in 2020 Tunisian dinars (TND). Statistical analyses included univariate tests and generalized linear models (GLM) with gamma family and log link for right-skewed cost data, reporting adjusted incidence rate ratios (aIRR) with Huber-White (HC1) robust standard errors.

RESULTS: A total of 157 cases of OA were analyzed, predominantly female (75.8%), with a mean age of 43.41 ± 7.29 years. The textile sector represented 72% of cases. High-molecular weight allergens, particularly vegetable textile dust (70.7%), were the agents most frequently implicated. The median total direct cost was 4,593.52 TND (€1,467.24) per case [IQR: 3,408.00-6,871.72]. The median annualized cost was 1,114.03 TND (€355.94) per person-year. Cash benefits (96.8% of patients) dominated over in-kind benefits (22.9%). In multivariate analysis, age ≥ 40 years was the only significant independent predictor of medical costs (adjusted incidence rate ratio [aIRR] = 2.84, 95% CI: 1.59-5.07; p < 0.001), whereas no clinical or demographic factor predicted indemnity costs. Univariate analysis additionally identified male sex (p = 0.04), higher PPD rate (p < 0.001), and absence of prior occupational disease history (p = 0.001) as factors associated with higher total direct costs.

CONCLUSIONS: This study highlights the considerable direct costs associated with occupational asthma in central Tunisia’s private sector, and the resulting burden placed on the healthcare system and the affected workforce. These findings underscore the need to strengthen primary prevention strategies, particularly in the textile industry, to reduce both the health and economic impact of this disease.

PMID:42401908 | DOI:10.1186/s12913-026-14941-0

Reprod Health. 2026 Jul 4. doi: 10.1186/s12978-026-02404-y. Online ahead of print.

ABSTRACT

BACKGROUND: Dysmenorrhea is a common gynaecological condition among young women, with non-steroidal anti-inflammatory drugs (NSAIDs) recommended as first-line therapy. However, a substantial proportion of women experience inadequate pain relief despite NSAID use. This study aimed to determine the prevalence of NSAID-resistant dysmenorrhea and to identify predictors as well as alternative pain management strategies among female undergraduate students at Afe Babalola University, Ado-Ekiti, Nigeria (ABUAD).

METHODS: A descriptive cross-sectional study was conducted among 271 female undergraduate students of ABUAD. Data were collected using a structured, self-administered electronic questionnaire that assessed socio-demographic characteristics, menstrual history, dysmenorrhea severity, NSAID use, perceived effectiveness, and alternative pain management strategies. NSAID-resistant dysmenorrhea was operationally defined as persistent menstrual pain despite reported use of recommended NSAID dosages. Descriptive statistics were used to summarize data. Bivariate analyses were conducted using Chi-square, Fisher’s exact, and Mann-Whitney U tests, as appropriate. Multivariate logistic regression was performed to identify independent predictors of NSAID resistance. Statistical significance was set at p ≤ 0.05.

RESULTS: The prevalence of dysmenorrhea among participants was 70.8% (192/271). Of those with dysmenorrhea, 62.5% (120/192) reported NSAID use for pain management. Among NSAID users, 63 students were classified as having NSAID-resistant dysmenorrhea, representing 52.5% of NSAID users and 32.8% of all students with dysmenorrhea. Perceived delayed onset of NSAID action (adjusted odds ratio [AOR] = 16.91; 95% CI: 2.00-141.60; p = 0.009) and lower NSAID effectiveness scores (AOR = 0.72; 95% CI: 0.57-0.90; p = 0.004) were significant predictors of NSAID resistance. Common coping strategies among NSAID-resistant students included activities such as use of alternative medications (25.4%), NSAID dose escalation (23.8%), rest or sleep (6.3%), as well as medications including antispasmodics (31.7%), and herbal remedies (11.2%).

CONCLUSION: NSAID-resistant dysmenorrhea is common among undergraduate students. Perceived delayed onset and reduced effectiveness of NSAIDs are key predictors of resistance and contribute to reliance on alternative and potentially unsafe coping strategies. These findings highlight the need for improved education on appropriate dysmenorrhea management, early identification of NSAID non-responders, and access to evidence-based alternative treatment options.

PMID:42401901 | DOI:10.1186/s12978-026-02404-y

BMC Med Educ. 2026 Jul 4. doi: 10.1186/s12909-026-09683-w. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare professionals’ knowledge and training are important contributors to adequate medical care for headache disorders. Since most headaches are treated in primary care, undergraduate medical education represents an important stage for strengthening headache-related knowledge and clinical preparedness. This study aimed to evaluate headache education among final-year medical students in Türkiye.

METHODS: This cross-sectional, web-based survey study was conducted among final-year medical students from ten medical faculties in Türkiye between June and December 2022. A 32-item questionnaire developed by the authors was used to assess headache-related educational exposure, self-reported preparedness, and theoretical knowledge. Thirteen knowledge-based questions were used to calculate the total knowledge score. Descriptive statistics, group comparisons, and Spearman correlation analysis were performed.

RESULTS: A total of 523 final-year medical students participated. The mean knowledge score was 9.14 ± 1.87 out of 13. Although 94.8% reported receiving headache education, only 46.5% had received outpatient clinic-based training, 11.7% had attended a headache subspecialty clinic, and 9.6% were familiar with the national headache guideline. Participants who had received didactic headache education scored higher than those who had not (9.18 vs. 8.37; mean difference 0.81, 95% CI 0.09 to 1.54; p = 0.019), as did those who had received outpatient clinic-based training (9.38 vs. 8.93; mean difference 0.45, 95% CI 0.13 to 0.77; p = 0.009) and those who had received structured instruction on headache history-taking (9.30 vs. 8.58; mean difference 0.72, 95% CI 0.34 to 1.11; p = 0.001). Higher total headache-related lesson time was weakly but significantly correlated with higher knowledge scores (Spearman’s rho = 0.12, 95% CI 0.04 to 0.21; p = 0.005). Most participants reported feeling insufficiently prepared to treat pregnant women with migraine, as well as pediatric and geriatric patients with migraine.

CONCLUSIONS: The findings suggest that undergraduate headache education in Türkiye may benefit from further curricular strengthening, particularly through structured teaching, clinical exposure, and improved familiarity with headache management guidelines. Further studies using validated tools and longitudinal designs are needed to evaluate the educational and clinical impact of such interventions.

PMID:42401888 | DOI:10.1186/s12909-026-09683-w

Cardiovasc Diabetol. 2026 Jul 4. doi: 10.1186/s12933-026-03208-x. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic fatty liver disease (NAFLD) are closely linked to insulin resistance and elevated cardiovascular risk, triglyceride-glucose (TyG)-related indices, the atherogenic index of plasma (AIP), and the cardiometabolic index (CMI) have emerged as practical surrogate markers for cardiometabolic risk assessment in these populations. However, it remains unclear whether the associations of these indices with adverse cardiovascular events remain consistent when transitioning from the NAFLD to the newly defined MASLD framework, and a comprehensive comparison of these indices across both diagnostic criteria is lacking.

METHODS: This study included 4693/3266, 74,173/67,864, and 7823/10,576 individuals with MASLD/NAFLD from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and China Pudong cohort, respectively. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and time-dependent receiver operating characteristic curves were employed to assess associations. Linear regression models evaluated relationships between TyG-related indices and cortical/subcortical structural volumes. Mediation analyses examined the role of oxidative stress, phenotypic aging, and inflammatory markers.

RESULTS: Most IR-related indices demonstrated nonlinear, predominantly J-shaped associations with cardiovascular disease (CVD) and related mortality, especially within the UKB. TyG-WC optimally predicted 3-year CVD mortality in MASLD/NAFLD across UKB and NHANES, as well as ischemic stroke (IS) in UKB-MASLD. TyG-WHTR was the strongest predictor for CVD mortality in the Pudong cohort and myocardial infarction (MI) in UKB-MASLD. Notably, elevated TyG-WHTR was consistently associated with heightened risks across all endpoints: CVD mortality (NAFLD: UKB: HR 1.60, 95%CI 1.38-1.84, NHANES: 1.90, 1.34-2.70, Pudong: 1.24, 1.10-1.40; MASLD: UKB: 1.59, 1.38-1.82, NHANES: 1.86, 1.36-2.54, Pudong: 1.70, 1.43-2.03), MI (NAFLD: 1.20, 1.09-1.33; MASLD: 1.22, 1.11-1.34), and IS (NAFLD: 1.41, 1.24-1.61; MASLD: 1.39, 1.23-1.57). Structural neuroimaging analyses revealed significant negative correlations between TyG-WC/TyG-WHTR and subcortical volumes (P < 1 × 10^-4). Mediation analyses indicated that oxidative stress, phenotypic aging, and inflammatory markers collectively accounted for 1.4-27% of the observed associations.

CONCLUSIONS: Insulin Resistance-Related Indices demonstrate robust clinical utility in predicting CVD and mortality in NAFLD/MASLD across three distinct cohorts, with oxidative stress, inflammatory activation, and accelerated aging serving as potential mechanistic pathways.

PMID:42401883 | DOI:10.1186/s12933-026-03208-x

BMC Pregnancy Childbirth. 2026 Jul 4. doi: 10.1186/s12884-026-09595-z. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cerclage reduces the risk of preterm birth, but factors associated with its success may not be uniform. Among singleton pregnancies with ultrasound- or physical examination-indicated cerclage (no history-based indication), we examined whether factors associated with delivery differ by gestational-age threshold.

METHODS: This single-center historical cohort included 114 women undergoing cerclage between May 2020 and December 2025: ultrasound-indicated with cervical length 10 to < 20 mm (Group 1, n = 41) or < 10 mm (Group 2, n = 32), and physical examination-indicated cervical dilatation (Group 3, n = 41). All cerclages used the McDonald technique with polypropylene monofilament suture. The primary outcome was gestational age at delivery, assessed at ≥ 34, < 32, and < 28 weeks. Firth penalized multivariable logistic regression evaluated study group, maternal age, and gestational age at cerclage as primary covariates; post-cerclage cervical length was analyzed separately as a secondary post-treatment-adjusted variable. All models were exploratory, and p values were nominal.

RESULTS: In these exploratory models, factors associated with delivery differed across thresholds. For delivery ≥ 34 weeks, gestational age at cerclage was the only covariate independently associated with the outcome (aOR 1.28 per week, 95% CI 1.04 to 1.59; p = 0.021). For delivery before 32 weeks (aOR 2.96, 95% CI 1.08 to 8.66; p = 0.034) and before 28 weeks (aOR 9.36, 95% CI 1.98 to 91.11; p = 0.003), physical examination-indicated cerclage was the only covariate that reached significance; 11 of the 14 deliveries before 28 weeks occurred in this group, so this estimate is imprecise and near-separating. The numerically higher rate of delivery ≥ 34 weeks in Group 2 than Group 1 (78.1% vs. 70.7%) was not statistically significant. Apparent discrimination was moderate (AUC 0.69 to 0.77), without internal validation.

CONCLUSIONS: In this exploratory single-center cohort, the factors associated with delivery varied with the gestational-age threshold examined. Near term, later gestational age at cerclage was associated with delivery ≥ 34 weeks; at earlier thresholds, physical examination-indicated cerclage identified a higher-risk group for very and extreme preterm delivery, although these estimates were imprecise and partly confounded by indication severity and co-interventions. Findings should be interpreted as hypothesis-generating and require confirmation in larger prospective studies.

PMID:42401881 | DOI:10.1186/s12884-026-09595-z

BMC Med Inform Decis Mak. 2026 Jul 4. doi: 10.1186/s12911-026-03661-4. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostic prediction following gastric cancer surgery plays a pivotal role in postoperative management, helping to optimize therapeutic strategies and improve patient survival. Standard clinicopathological indicators, including tumor differentiation and lymph node metastasis, continue to serve as the basis for outcome evaluation; however, they do not adequately represent the host’s systemic inflammatory response and immunonutritional status, both of which significantly affect tumor progression and postoperative recovery. Systemic inflammatory markers, such as the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR), have emerged as reliable, noninvasive prognostic indicators. However, the complex and nonlinear interactions among inflammatory, clinical, and demographic variables pose a limitation for traditional statistical methods.

METHODS: This study proposes a novel deep learning framework that integrates three major components: Gradient-Boosted Decision Tree, Tree-Driven Encoder (TDE), and one-dimensional Convolutional Neural Network (1D-CNN) for postoperative prognostic prediction in gastric cancer. The GBDT module captures intricate dependencies among clinical and inflammatory variables, the TDE transforms tree-based structures into unified binary embeddings, and the 1D-CNN component learns high-level feature representations from these embeddings to predict postoperative prognosis. The model’s performance was evaluated using cross-validation and compared with various traditional machine learning algorithms and advanced deep learning architectures for tabular data.

RESULTS: Experimental findings demonstrate that the proposed hybrid framework consistently outperforms both traditional and general deep learning models in predicting postoperative prognosis. By combining tree-based feature structuring with deep representation learning, the model effectively captures nonlinear and hierarchical relationships among systemic inflammatory markers and clinicopathological features. This approach achieves high predictive accuracy, robustness, and generalization capability, particularly in identifying high-risk patients characterized by elevated inflammatory activity. Moreover, the model exhibited stable performance across multiple random seeds and data partitions, confirming its reproducibility and reliability under different experimental conditions.

CONCLUSIONS: This study presents a data-driven and interpretable deep learning framework for postoperative prognostic prediction in gastric cancer. By integrating the strengths of gradient-boosted tree modeling and deep neural representation learning, the proposed model provides a more comprehensive understanding of the interplay among inflammation, nutrition, and tumor biology, supporting personalized treatment planning and evidence-based clinical decision-making. Future research will focus on external validation using independent cohorts, real-time clinical application, and enhancing model explainability to facilitate clinical adoption.

PMID:42401875 | DOI:10.1186/s12911-026-03661-4

BMC Womens Health. 2026 Jul 4. doi: 10.1186/s12905-026-04657-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Across sub-Saharan Africa, and Nigeria in particular, young women and adolescent girls aged 15 to 24 continue to face a disproportionate risk of HIV – and a large part of that risk comes down to unprotected sex. Knowing about HIV is widely assumed to lead to safer behaviour, yet the evidence that knowledge actually translates into condom use is far from straightforward. This study takes a closer look at that relationship, comparing comprehensive HIV knowledge and condom non-use among unmarried adolescent girls and young women (AGYW) in Nigeria across three points in time.

METHODS: We drew on data from the Nigeria Demographic and Health Surveys conducted in 2008, 2013, and 2018. Condom non-use at last sexual intercourse – a standard DHS indicator – served as our measure of risky sexual behaviour. The analysis focused on sexually active unmarried women in two age groups: adolescent girls aged 15 to 19, and young women aged 20 to 24. We excluded participants with missing or unclear responses for the outcome variable or key covariates. Weighted descriptive statistics and survey-weighted binary logistic regression models were run separately for each age group and survey year, with all analyses accounting for the clustered, stratified sampling design of the NDHS. Stata 16.1 was used throughout.

RESULTS: HIV knowledge improved over the study period, particularly among young women in the older age group, while trends in condom use followed a less predictable pattern. Among adolescent girls, comprehensive HIV knowledge was not meaningfully linked to condom use in 2008, but that association became statistically significant by 2013 and held through 2018. Importantly, though, condom non-use actually rose in 2018 even as knowledge levels reached their highest point – a clear sign that knowing is not the same as doing. Socioeconomic status and region of residence were both significantly associated with condom use.

CONCLUSION: Comprehensive HIV knowledge among unmarried AGYW in Nigeria has grown, but it has not reliably translated into condom use. This gap between what young women know and what they are able to do points to barriers that go well beyond information – structural, social, and economic forces that shape the choices available to them. Closing that gap will require interventions that take those realities seriously.

PMID:42401873 | DOI:10.1186/s12905-026-04657-y

BMC Surg. 2026 Jul 4. doi: 10.1186/s12893-026-04021-9. Online ahead of print.

ABSTRACT

BACKGROUND: Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approach is universally required, or whether selective ligation guided by intraoperative findings is acceptable in lower-risk recipients, remains unresolved.

METHODS: This single-centre retrospective cohort study included adult recipients who underwent right lobe LDLT without inclusion of the middle hepatic vein at a high-volume transplant centre (approximately 150 adult LDLTs per year) between November 2021 and May 2025. Eligible patients had intraoperatively measured segment 5 and/or segment 8 veins ≥ 5 mm. Venous management was determined intraoperatively and was not randomized: reconstruction was preferred in recipients judged at higher risk of congestion, and all recipients with graft-to-recipient weight ratio (GRWR) < 0.8 were managed in the reconstruction group. The primary endpoints were postoperative day 7 (POD7) international normalized ratio (INR), total bilirubin, and ascites volume. Multivariable adjustment was prespecified for postoperative ascites only, adjusting for ligation status, MELD score, and GRWR. Prespecified sensitivity analysis restricted to GRWR ≥ 0.8 was performed. Partial Olthoff early allograft dysfunction (EAD) and approximate ILTS-iLDLT small-for-size syndrome (SFSS) were assessed as secondary analyses.

RESULTS: A total of 170 recipients were included (16 selective ligation; 154 reconstruction). Baseline variables did not differ statistically, but all 20 recipients with GRWR < 0.8 were in the reconstruction group. POD7 outcomes were comparable: INR 1.24 vs. 1.27 (p = 0.80), bilirubin 1.46 vs. 1.70 mg/dL (p = 0.35), ascites 1100 vs. 1250 mL (p = 0.89). In multivariable analysis (n = 91), selective ligation was not independently associated with ascites (β = 0.202; 95% CI – 0.359 to + 0.764; p = 0.476); MELD was the only significant predictor (p = 0.024). The GRWR ≥ 0.8 sensitivity analysis confirmed these findings. Partial Olthoff EAD was 25.0% vs. 15.7% (p = 0.42); approximate SFSS was 27.3% vs. 24.7% (p = 1.00). Post-hoc power for the ascites comparison was 80% only for Cohen’s d ≥ 0.90, far larger than the observed d = 0.02.

CONCLUSIONS: In carefully selected recipients with adequate graft volume and favourable intraoperative findings, selective ligation of segment 5 and/or 8 veins ≥ 5 mm was not associated with worse early graft function in this cohort. Given the small ligation group, non-randomized allocation, and substantial missing data, these preliminary results are consistent with the feasibility of selective ligation in a selected lower-risk subgroup but cannot establish its safety, clinical applicability, or equivalence to reconstruction. Prospective, adequately powered, multicentre validation is required before any change in current clinical practice can be considered.

CLINICAL TRIAL NUMBER: not applicable.

PMID:42401871 | DOI:10.1186/s12893-026-04021-9