Tag: statistics

SAGE Open Nurs. 2026 Apr 7;12:23779608261433262. doi: 10.1177/23779608261433262. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Although e-learning has become routine in nursing education, many courses still lack explicit, structured guidance targeting students’ motivation in online environments. Evidence remains limited regarding whether such motivational guidelines improve objective learning achievement, particularly in maternity nursing.

OBJECTIVE: To evaluate the effect of e-learning motivational guidelines on motivation and learning achievement among maternity nursing students.

METHODS: A quasi-experimental design with intervention and control groups was conducted at the Faculty of Nursing during the 2021-2022 academic year. A systematic random sample of 261 students was assessed using three tools: (1) a computer skills assessment sheet, (2) a motivation for e-learning assessment sheet, and (3) an auditing checklist to evaluate learning achievement. The intervention group received an e-learning course integrated with structured motivational guidelines, whereas the control group received the usual e-learning course.

RESULTS: Postintervention, 69.7% of the intervention group exhibited high motivation across all domains of total motivation for e-learning, compared with approximately 62% of the control group who demonstrated positive motivation across related items. A strong, statistically significant positive correlation was found between total learning achievement and total motivation in the intervention group (r = .983, p < .001).

CONCLUSION: Embedding structured motivational guidelines within e-learning was associated with higher motivation and improved learning achievement among maternity nursing students, addressing a key gap by linking explicit motivational support to measurable academic outcomes in this specialty context.

PMID:41960443 | PMC:PMC13058182 | DOI:10.1177/23779608261433262

Front Mol Neurosci. 2026 Mar 25;19:1741854. doi: 10.3389/fnmol.2026.1741854. eCollection 2026.

ABSTRACT

INTRODUCTION: Carriers of the FMR1 gene premutation (PM) are at increased risk for Fragile X-associated PM Conditions (FXPAC). Some clinically significant symptoms can be further classified as Fragile X-associated Neuropsychiatric Disorders (FXAND). Many FXAND-related cases may go underrated and untreated. This study aimed to investigate the rates of FXAND-related symptoms among female PM carriers.

METHODS: The study was conducted at the Belgrade Fragile X Clinic on a clinical sample of 35 women with the PM and 35 controls using an adapted version of the Symptom Impact Questionnaire and the Fatigue Assessment Scale. The survey was designed to collect data on FXAND symptoms, including chronic pain, fatigue, anxiety, and depressive symptoms. Each symptom was self-rated by participants on a scale from 0 to 10. Data were analyzed using appropriate statistical methods.

RESULTS: Women with the PM (mean age: 44.51 ± 12.90 y.; 90.51 ± 22.04 CGG repeats) had statistically significant higher frequency and severity of chronic pain (p = 0.03; p = 0.02) and fatigue (p = 0.001 for both) in contrast to age-matched controls. Although the prevalence of anxiety symptoms was not significantly different between groups, the severity of anxiety symptoms were significantly higher in the PM group (p < 0.001), and was positively correlated with chronic fatigue (p = 0.003 vs. p = 0.27 in controls). Depressive symptom frequency and severity did not differ between groups (p = 0.47; p = 0.55), but there were a significant positive correlation between anxiety and depressive symptoms in the PM group (p = 0.003). Depressive symptoms were also positively correlated with chronic fatigue in the PM group (p = 0.02), but not in controls (p = 0.58). Compared to controls, PM carriers reported more frequently lower energy, poorer sleep, greater memory issues, cognitive difficulties, balance problems, and increased sensory sensitivity (p ≤ 0.001, all).

CONCLUSION: Female PM carriers experience significantly higher frequency and severity of FXAND-related symptoms. Our findings of an association between fatigue, anxiety, and depressive symptoms highlight the need for comprehensive screening and underscore the importance of recognizing and treating individuals with FXAND.

PMID:41960422 | PMC:PMC13057454 | DOI:10.3389/fnmol.2026.1741854

Lancet Reg Health West Pac. 2026 Mar 26;69:101836. doi: 10.1016/j.lanwpc.2026.101836. eCollection 2026 Apr.

ABSTRACT

BACKGROUND: Predicting which individuals with M. tuberculosis (M. tb) infection will progress to active disease remains challenging. We evaluated whether a pragmatic serial, quantitative ESAT6-CFP10 (EC) antigen-based skin test strategy improves risk stratification for targeted prevention in a large-scale prospective cohort.

METHODS: We enrolled 73,761 contacts identified during school-based tuberculosis outbreaks in Jiangsu, China, from 2020 to 2024. Participants underwent baseline EC test, chest radiography, and symptom screening. EC-negative individuals were retested after 8-12 weeks. Incident tuberculosis was identified through active surveillance and registry linkage. We compared single vs. serial test strategies using Cox models, receiver operating characteristic (ROC) curves and precision-recall (PR) curves.

FINDINGS: Among 73,761 close contacts, 108 had prevalent tuberculosis and 190 developed incident cases (overall incidence 151.2 per 100,000 person-years). EC response size predicted incident tuberculosis in a steep, dose-dependent manner. Each 1-mm increase in the maximum response diameter was associated with a 7% higher hazard. The serial test strategy, utilizing the maximum response from two measurements, substantially outperformed single test [C-statistic: 0.806 vs. 0.722]. At the ≥5 mm threshold, this combined strategy yielded a sensitivity of 65.0% and specificity of 96.1%. The subgroup of recent converters had a PPV of 3.4% (95% CI: 2.8-4.1), corresponding to an NNT of approximately 30, and a hazard ratio (HR) of 45.12 (95% CI: 32.50-62.63). Preventive treatment completion was strongly protective (aHR 0.17; 95% CI: 0.11-0.25).

INTERPRETATION: The “test twice, take maximum” EC strategy provides superior risk stratification for tuberculosis prevention. This approach identifies high-risk contacts for targeted intervention. Despite limited sensitivity, these results suggest that quantitative EC skin testing can provide a practical alternative for programmatic risk stratification. In settings where IGRAs are constrained by cost or infrastructure, this approach may enable more efficient targeting of preventive treatment.

FUNDING: National Natural Science Foundation of China (82504476, 82473693, 82574173); Jiangsu Province Preventive Medicine Research Project (Ym2023039); The Special Scientific Research Project for Talent Introduction of the First Affiliated Hospital of Wannan Medical College (KY2960YR2530); Jiangsu Province Postgraduate Research and Innovation Project (KYCX24_2061).

PMID:41960411 | PMC:PMC13058989 | DOI:10.1016/j.lanwpc.2026.101836

Front Public Health. 2026 Mar 25;14:1758447. doi: 10.3389/fpubh.2026.1758447. eCollection 2026.

ABSTRACT

INTRODUCTION: Dementia is a neurodegenerative disease that affects more than 45 million patients worldwide. Treatment options for dementia include lecanemab for mild cognitive impairment, acetylcholinesterase inhibitors, which are mainly used for mild to moderate dementia, as well as N-methyl-D-aspartate receptor antagonists for patients with severe dementia or certain antipsychotics. Pharmaceutical approaches are limited by potential side effects. To alleviate symptoms or at least slightly improve cognitive functions, additional herbal medicines (HM) such as Ginkgo biloba and non-pharmacological approaches, e.g., behavioral, exercise, music, and reminiscence therapy, yoga, tai chi, or acupuncture, have been used with heterogeneous results. Helleborus niger, a plant containing multiple bioactive compounds such as ecdysteroids and bufadienolide, is used clinically for its immunomodulatory, anti-inflammatory, analgesic, and antioxidant properties. In a German hospital specializing in geriatric patients, an association between the subcutaneous application of Helleborus niger 12x and changes in dementia was observed.

METHODS: Retrospective study on the effect of subcutaneous application of Helleborus niger 12x for an average of 3 weeks in patients with dementia. Eligible patients were aged ≥ 60 years and treated at the Humboldt Clinic in Bad Steben, Bavaria, Germany, with two different treatment regimens: standard care with conventional medication alone (control group, CG) vs. standard care with conventional medication plus Helleborus niger 12x preparations (Helleborus group, HG). The primary outcome was the between-group difference in pre-post (T0 vs. T1) changes in the Mini-Mental State Examination (MMSE). Secondary outcomes were pre-post changes in the Dementia Detection test (DemTect), the Shulman clock-drawing test (CDT) and the Geriatric Depression Scale (GDS).

RESULTS: For the primary outcome, there was a statistically significant difference in MMSE between the groups (p < 0.001; d = 1.5) at T1 with significantly higher values in HG compared to CG. Regarding the secondary outcomes, significantly improved values were seen in HG compared to CG for DemTect, CDT and GDS with medium to high effect sizes.

CONCLUSION: The study gives preliminary evidence that Helleborus niger 12x applied subcutaneously might improve cognitive function in patients with dementia at least during the three-week administration. Further randomized, blinded studies with longer follow-up are needed to confirm preliminary results.

CLINICAL TRIAL REGISTRATION: Identifier, DRKS00033972.

PMID:41960405 | PMC:PMC13057344 | DOI:10.3389/fpubh.2026.1758447

Front Public Health. 2026 Mar 25;14:1813165. doi: 10.3389/fpubh.2026.1813165. eCollection 2026.

ABSTRACT

INTRODUCTION: E-cigarette use is an emerging public health concern among adolescents and young adults, with limited population-based evidence on recent use and correlates in Thailand beyond school-based samples. Our study aimed to examine e-cigarette use and its associated factors among adolescents and young adults aged 15-29 years in Northern Thailand using data from a population-based household survey.

METHODS: We conducted a cross-sectional analysis of data from the 2024 population-based household survey on substance use in Northern Thailand. The analytic sample included 911 adolescents and young adults aged 15-29 years. Past-year e-cigarette use was the primary outcome. Explanatory variables encompassed sociodemographic characteristics, perceived accessibility, online information-seeking, perceived health harms, household stigma, and co-use of other substances. Descriptive statistics summarized prevalence, and logistic regression models estimated crude and adjusted associations, reporting odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05.

RESULTS: Overall, 11.5% of participants reported past-year e-cigarette use. In adjusted analyses, higher perceived accessibility (AOR = 3.18; 95% CI: 1.31, 7.69, p = 0.010), online information-seeking (AOR = 4.22; 95% CI: 2.36, 7.55, p < 0.001), and past-year alcohol use (AOR = 5.88; 95% CI: 2.83, 12.22, p < 0.001) were associated with higher odds of e-cigarette use. In contrast, perceiving e-cigarettes as harmful (AOR = 0.40; 95% CI: 0.23, 0.69, p = 0.001) and anticipating household stigma (AOR = 0.55; 95% CI: 0.32, 0.95, p = 0.031) were associated with lower odds of use.

CONCLUSION: E-cigarette use among adolescents and young adults in Northern Thailand remains a public health concern shaped by accessibility, online exposure, alcohol co-use, and risk perceptions, underscoring the need for strengthened youth tobacco control, digital regulation, and integrated prevention.

PMID:41960396 | PMC:PMC13057327 | DOI:10.3389/fpubh.2026.1813165

Front Public Health. 2026 Mar 25;14:1763427. doi: 10.3389/fpubh.2026.1763427. eCollection 2026.

ABSTRACT

INTRODUCTION: This paper presents work in the continuum of campus-community partnerships to train health science students to advance health equity. The authors share the development, implementation, and evaluation of “Interprofessional Approaches to Health Disparities” (IAHD), a course offered at the University of Illinois Chicago, a large, urban, public, academic institution.

METHODS: The IAHD course focuses on selected vulnerable populations: Geriatrics, HIV/AIDS, Homelessness, Immigrant and Refugee Health, Incarcerated Populations, and Intimate Partner Violence. Health science students from medicine, nursing, pharmacy, dentistry, and public health learn in interprofessional teams, with didactic and experiential learning activities. Training includes addressing social determinants of health through interprofessional education and mentored community-based participatory research projects. The Kirkpatrick’s framework was used for program evaluation, with a retrospective pre-post design to measure self-efficacy for competence in interprofessional collaborative practice (IPC) using IPECC-SET, a validated instrument. The evaluation goal was to explore the impact of the learning experiences on attainment of learning objectives. Descriptive analysis of quantitative data explored the extent to which the learning objectives were met. Paired t-tests examined pre-post differences in self-efficacy for competence in IPC. Thematic analysis was conducted for open-ended qualitative data.

RESULTS: Since its inception, 202 students have participated in the course. Program evaluation results indicate that students view the learning experiences positively; cumulatively, over 90% agreed that the course learning objectives were met. Analysis of the IPECC-SET data demonstrated statistically significant (p < 0.001) increases in self-efficacy for IPC across all 38 items, in all four domains. Qualitative data analysis yielded themes regarding the most effective aspects of the course and how learning experiences prepared students for their future work.

DISCUSSION: Thus far, eleven cohorts of interprofessional health science students have been trained as a cadre of future health professionals, encouraged to continue practicing advocacy, leadership, scholarship, and interprofessional teamwork to advance health equity. The IAHD course is an exemplar of “Education in Action” and has led to meaningful contributions to the training of the future health professions workforce. It addresses workforce development needs, with a special focus on mitigating health disparities and advancing health equity to meet the challenges of the 21st century.

PMID:41960395 | PMC:PMC13057566 | DOI:10.3389/fpubh.2026.1763427

Front Public Health. 2026 Mar 25;14:1805252. doi: 10.3389/fpubh.2026.1805252. eCollection 2026.

ABSTRACT

BACKGROUND: Amidst the rapidly evolving global healthcare environment, junior nurses must develop greater adaptability. However, issues such as workplace bullying significantly undermine their adaptive performance. Guided by the Job Demands-Resources Theory and Emotion Regulation Theory, this study examines the chain-mediating role of cognitive reappraisal, expressive suppression, and work engagement in the relationship between workplace bullying and adaptive performance.

METHODS: From April to May 2024, a cross-sectional survey was conducted in 17 hospitals in Southwest China. The study utilized a comprehensive set of measurement tools, including the General Information Questionnaire, the Negative Acts Questionnaire-Revised, the Emotion Regulation Questionnaire, the Work Engagement Questionnaire, and the Adaptive Performance Questionnaire. All statistical analyses were performed with SPSS and Mplus.

RESULTS: A total of 988 junior nurses were included in this study. Adaptive performance was negatively correlated with workplace bullying (r = -0.335) and expressive suppression (r = -0.180) and positively correlated with cognitive reappraisal (r = 0.556) and work engagement (r = 0.576) (all p < 0.01). The indirect effect of workplace bullying on adaptive performance via emotion regulation and work engagement was significant (standardized indirect effect = -0.188, 95% BC CI [-0.238, -0.138]), accounting for 51.8% of the total standardized effect.

CONCLUSION: There was a significant negative correlation between workplace bullying and adaptive performance of junior nurses, in which cognitive reappraisal, expressive suppression, and work engagement played a mediating role. This suggests that when healthcare institutions and nursing administrators develop strategies to enhance adaptive performance, they should mitigate workplace bullying and enhance cognitive reappraisal capabilities, reduce expressive suppression tendencies, and strengthen work engagement levels. However, the cross-sectional design precludes causal inferences, and the regional sample may limit generalizability.

PMID:41960394 | PMC:PMC13057310 | DOI:10.3389/fpubh.2026.1805252

Front Public Health. 2026 Mar 25;14:1731670. doi: 10.3389/fpubh.2026.1731670. eCollection 2026.

ABSTRACT

BACKGROUND: Cultivating public protective behaviors is essential for the successful prevention and control of emerging infectious diseases epidemics, such as COVID-19. Government information release plays an important role in promoting proactive public protective behaviors. The existing literature lacks comprehensive understanding of the impact of government information release on public protective behaviors under different conditions.

METHODS: This research proposes a number of research hypotheses for the effect of government information release on public protective behaviors mediated by risk perception and institutional trust. The Mediator, also known as the mediating variable, is a significant statistical concept employed to analyze the mechanism of influence between the independent and dependent variables.

RESULTS: The empirical research during the normalization phase of COVID-19 epidemics prevention and control in China indicates that government information release significantly influences public protective behaviors by the mediating roles of risk perception and institutional trust.

CONCLUSION: The research provides insights for designing strategies for cultivating public protective behaviors from the perspective from the information release and fostering institutional trust.

PMID:41960388 | PMC:PMC13057391 | DOI:10.3389/fpubh.2026.1731670

Front Public Health. 2026 Mar 25;14:1703400. doi: 10.3389/fpubh.2026.1703400. eCollection 2026.

ABSTRACT

BACKGROUND: Hearing loss and tinnitus in children are increasingly recognized as important public health concerns with potential long-term consequences for development and communication. The aim of this study was to determine the prevalence of hearing loss and tinnitus in children, and to examine the concordance between parental subjective assessments and otoacoustic emission (OAE) results. Secondary aims were to investigate the association between hearing loss and sociodemographic factors, parents’ level of education, and to evaluate the effectiveness of different diagnostic methods in detecting pediatric hearing impairment.

METHODS: This cross-sectional study involved 1,250 children aged 7-17 years. Participants underwent tympanometric, hearing threshold and OAEs testing and were divided into two groups according to age. Parents completed a questionnaire regarding hearing loss and presence of tinnitus.

RESULTS: The prevalence of positive hearing screening results was 3.5%, with a higher incidence in younger children, (the difference was not statistically significant). The prevalence of hearing loss was 4.5% among boys and 2.5% among girls (p = 0.097). A statistically significant discrepancy was observed between parental reports of hearing status and OAE results (p = 0.006). The prevalence of tinnitus in children and adolescents aged 7-17 years was 4.7%, with no significant statistical difference observed between age groups. Abnormal results in OAE were not associated with tinnitus (the results were not statistically significant). A statistically significant association was observed between hearing loss detected by OAE and caregiver education (p = 0.040, Z = -2.05), and between hearing loss and increased healthcare costs (p = 0.015). The effectiveness of hearing loss detection differed significantly between the diagnostic methods used (p = 0.030), with OAE testing showing the highest detection rate.

CONCLUSION: This study identifies a measurable prevalence of hearing loss and tinnitus among children, with a greater burden of hearing impairment observed in younger age. There is need for systematic, school-based hearing screening programs and improved parental and educator awareness of early hearing loss indicators. These findings support the integration of standardized pediatric hearing monitoring into public health strategies and underscore the importance of addressing socioeconomic disparities in access to early diagnosis and intervention.

PMID:41960387 | PMC:PMC13057448 | DOI:10.3389/fpubh.2026.1703400

Front Public Health. 2026 Mar 25;14:1766801. doi: 10.3389/fpubh.2026.1766801. eCollection 2026.

ABSTRACT

OBJECTIVE: This study evaluated the effectiveness of a health education program based on the PRECEDE-PROCEED model in improving self-care, QOL, and biochemical outcomes among HD patients in Indonesia.

METHODS: A quasi-experimental study was conducted involving 90 HD patients allocated to intervention (n = 45) and control (n = 45) groups using a systematic assignment approach. The intervention group received an eight-session PRECEDE-PROCEED-based education program over 4 weeks, while the control group received standard care. Self-care was measured using the Chronic Kidney Disease Self-Management (CKDSM) Questionnaire, QOL was assessed using the SF-36, and biochemical outcomes were evaluated via serum urea and creatinine levels. Data were analyzed using appropriate parametric and non-parametric statistical tests, and effect sizes were calculated using Cohen’s d.

RESULTS: Post-intervention, the intervention group showed significantly greater improvements in self-care (mean difference = 18.33; p < 0.001), QOL (mean difference = 17.25; p < 0.001), and reductions in urea and creatinine levels (p < 0.001 and p = 0.006, respectively), compared to the control group. Large effect sizes were observed for self-care and QOL.

CONCLUSION: The PRECEDE-PROCEED-based educational intervention was associated with improvements in self-care and quality of life, and with favorable short-term changes in selected clinical outcomes among patients undergoing hemodialysis.

PMID:41960384 | PMC:PMC13057427 | DOI:10.3389/fpubh.2026.1766801