Tag: statistics

J Orthop Surg Res. 2026 Apr 6. doi: 10.1186/s13018-026-06835-y. Online ahead of print.

ABSTRACT

INTRODUCTION: The learning curve refers to the relationship between a learner’s execution of a task and the number of attempts or time necessary to perform it in a predictable, reliable, and optimal fashion. The learner’s competence in a task should improve over time as they execute the job more frequently. The present investigation aims to clarify the learning curve associated with robotic-assisted total knee arthroplasty (TKA).

METHODS: Consecutive patients undergoing total knee arthroplasty at the Department of Orthopaedic Surgery, Eifelklinik St. Brigida, Simmerath, Germany, between 2021 and 2025 were prospectively screened for participation in this clinical study. All procedures were performed through a medial parapatellar approach, following a functional alignment strategy. Implantation was performed in accordance with the manufacturer’s recommendations using the Smith & Nephew Legion Genesis II system with a posterior-stabilised polyethylene insert. Both femoral and tibial components were cemented with Palacos cement (Heraeus Medical GmbH, Wehrheim, Germany). Postoperative physiotherapy followed the standard institutional protocol. At hospital admission, demographic variables including age, body mass index (BMI), and sex were recorded. Operative time was documented for each procedure and defined as the interval from skin incision to completion of wound closure.

RESULTS: The first 200 robotic-assisted TKAs were monitored. 66% (112 of 200 patients) were women, and 47.5% (95 of 200 TKAs) were performed on the right side. The mean age of the patients was 68.6 ± 8.1 years, and their BMI was 28.6 kg/m². The exponential decay model revealed a characteristic learning curve, characterised by initial rapid gains followed by a plateau. The estimated asymptotic operative time was approximately 89.2 minutes, with a learning rate coefficient of 0.035. This implies that the majority of efficiency improvements occur early, but meaningful reductions persist beyond the 20th case. Block-wise comparisons supported the existence of an earlier functional learning threshold. Statistically significant reductions in operative time, compared with the first 10 cases, were observed from the 41st to 50th procedure block (p = 0.02), with stabilisation in the 90-minute range thereafter.

CONCLUSION: The most efficient gains occur early, and operative times stabilise at around 90 minutes after approximately 40 procedures.

REGISTRATION: German Registry of Clinical Trials (ID DRKS00030614).

PMID:41943084 | DOI:10.1186/s13018-026-06835-y

Trials. 2026 Apr 7. doi: 10.1186/s13063-026-09679-3. Online ahead of print.

ABSTRACT

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections, contributing to increased antibiotic consumption and high healthcare costs. Clinical studies suggest that probiotics can be effective dietary supplements reducing the risk factors for the development of infections in the intestine and vagina. In this study, we investigate the effect of the orally ingested probiotic combination ASTARTE™ on the composition of bacteria in vaginal and fecal samples, as well as on the occurrence of bacteriologically confirmed UTIs in women of reproductive age.

METHODS: A randomized, placebo-controlled, double-blind study evaluating the effect of the probiotic combination ASTARTE™ (Chr. Hansen A/S, Part of Novonesis Group, Denmark) on reducing the number of recurrent urinary tract infections (rUTIs) in women aged 18-40 years. Participants are randomized (1:1) to receive one daily probiotic capsule (5 × 10⁹ CFU) containing Lactobacillus crispatus LBV 88™ (DSM22566), Lacticaseibacillus rhamnosus LBV 96™ (DSM22560), Lactobacillus jensenii LBV 116™ (DSM22567), and Lactobacillus gasseri LBV 150N™ (DSM22583), or placebo, for 6 months. Assessments, including symptom questionnaires, urine culturing and microbiome analysis of vaginal and rectal samples by shotgun sequencing, are conducted at baseline, 2, 4, and 6 months. Compliance is tracked by unused capsule counts. Follow-up visits occur at 8, 10, and 12 months. The primary outcome is the incidence of symptomatic bacteriologically confirmed UTIs during the 6 months intervention period. The secondary objective is the effect of ASTARTE™ on changes in vaginal and gut microbiome.

DISCUSSION: This randomized, placebo-controlled, double-blind study investigates the effectiveness of ASTARTE™ in restoring beneficial microbiomes and reducing UTI recurrence. The findings will provide valuable evidence on the effectiveness of a non-antibiotic strategy for the prevention of rUTI as well as insights into the complex interactions between the vaginal and gut microbiome and the risk of rUTI.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05553652. Registered 21 September 2022.

PMID:41943076 | DOI:10.1186/s13063-026-09679-3

BMC Nurs. 2026 Apr 6. doi: 10.1186/s12912-026-04610-2. Online ahead of print.

NO ABSTRACT

PMID:41943066 | DOI:10.1186/s12912-026-04610-2

Confl Health. 2026 Apr 6. doi: 10.1186/s13031-026-00793-2. Online ahead of print.

ABSTRACT

BACKGROUND: Globally, around 40% of people lack access to handwashing facilities with soap and water, a proportion likely higher in crisis-affected settings such as refugee camps. This increases vulnerability to hygiene-related diseases including diarrhea and respiratory infections. This study assessed whether improved access to handwashing facilities (Jengu) increases handwashing with soap (HWWS) among refugees in Dadaab camp, Kenya. Jengu is a foot-operated handwashing facility which is designed to integrate water storage, soap placement, and drainage in a compact structure suitable for household use in resource-constrained environments.

METHODS: A randomized control study was conducted in Dadaab refugee camp in Kenya between June 2023 to July 2024. The sample size was 300 households across nine camp sections. Households were randomly assigned to receive either an intervention group receiving a Jengu handwashing facility with a 20-L jerry can and regular soap supply (n = 150) or a control group receiving soap provision only (n = 150). Soap was distributed bi-monthly to both groups. Data were collected through structured observations and household surveys at baseline, one-month post-intervention, and endline. Surveys assessed sociodemographic factors, knowledge, attitudes, and practices, while observations captured HWWS behavior at predefined critical hygiene moments. Descriptive statistics summarized baseline data. Logistic regression and a difference-in-differences approach were used to evaluate predictors and intervention effects.

RESULTS: Among respondents, 75.4% were female (mean age 42 ± 12.7 years), 62.3% of household heads had no formal education. Across all rounds, 4,323 critical handwashing events were observed, of which 38.5% involved HWWS. HWWS prevalence rose from 28.4% at baseline to 61.0% one-month post-intervention, then declined to 32.4% at endline, remaining above baseline. Total HWWS moments nearly doubled (350 to 597), with the largest relative increase before child feeding (sixfold rise). HWWS before eating was significantly greater in the intervention group at endline (OR = 1.77, 95% CI: 1.13-2.77, p = 0.013). Soap and water availability were key predictors, HWWS odds were 2.53 times higher with soap (95% CI: 2.08-3.06, p < 0.001) and 1.23 times higher with water (95% CI: 1.02-1.49, p = 0.027). Compared to baseline, HWWS odds tripled at one month(OR = 3.05, 95% CI: 2.47-3.73, p < 0.001) and remained elevated at endline (OR = 1.20, 95% CI: 1.01-1.42, p = 0.037).

CONCLUSIONS: Enhanced handwashing facilities, consistent soap provision, and improved water access substantially increased HWWS in this refugee setting. Soap availability was critical for sustaining behaviors, while the Jengu facility prompted short-term gains. Integrated WASH interventions combining infrastructure, supply continuity, and behavior change strategies are essential for lasting hygiene improvements in humanitarian contexts.

PMID:41943053 | DOI:10.1186/s13031-026-00793-2

BMC Public Health. 2026 Apr 6. doi: 10.1186/s12889-026-26736-3. Online ahead of print.

ABSTRACT

BACKGROUND: On-site oral health surveys conducted to epidemiologically assess dental diseases require strategies to prevent a decline in the number of participants and maintain data quality; however, few studies have examined measures to address this issue. This study aimed to identify the preferred conditions for promoting participation in on-site oral health surveys using conjoint analysis.

METHODS: A cross-sectional study using an online survey was conducted in Japan in January 2024. From a panel of an online research company, 1,260 individuals (420 residents of urban, intermediate, and rural areas) were randomly sampled. The participants were evaluated under 16 hypothetical scenarios for oral health surveys, each consisting of seven attributes and their respective levels. Monetary incentives were excluded as attributes, because such measures are typically not applicable to government-administered surveys.

RESULTS: In total, 955 individuals were analysed (324 in urban areas; 333 in intermediate areas; and 298 in rural areas). Our conjoint analysis showed that in all three areas, the preferred conditions to promote participation in oral health surveys were nearby dental clinics, conducting the survey on a Saturday or Sunday, providing an explanation of oral health status by a dentist after the survey, and provision of small gifts such as toothbrushes. Conversely, the following conditions were rated unfavourably: location-home visits by investigators, and day of the week-weekdays. The modified Poisson regression analysis revealed that those who did not intend to participate in all 16 hypothetical scenarios were statistically significantly more likely to be older in urban and intermediate areas (prevalence ratio, urban, 60-69 years: 2.52; intermediate, 60-69 years: 2.19).

CONCLUSIONS: Our findings suggest that an effective strategy to promote participation in on-site oral health surveys includes conducting a survey at nearby dental clinics on holidays, providing participants with an explanation of their oral health status by a dentist, and distributing small gifts such as toothbrushes after the survey. In addition, targeted approaches may be required to encourage participation among older adults, particularly in urban and intermediate areas.

PMID:41942986 | DOI:10.1186/s12889-026-26736-3

BMC Neurol. 2026 Apr 6. doi: 10.1186/s12883-026-04789-6. Online ahead of print.

NO ABSTRACT

PMID:41942980 | DOI:10.1186/s12883-026-04789-6

BMC Oral Health. 2026 Apr 7. doi: 10.1186/s12903-026-08189-7. Online ahead of print.

NO ABSTRACT

PMID:41942970 | DOI:10.1186/s12903-026-08189-7

BMC Psychiatry. 2026 Apr 6. doi: 10.1186/s12888-026-08046-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Neuropsychiatric symptoms (NPS) may signal dementia risk or early pathology, yet clinical evidence regarding the association between pre-diagnostic NPS and outcomes remains limited. This preliminary study explored NPS features and their potential associations with dementia progression.

METHODS: The study was conducted on 201 dementia patients from Shanghai Mental Health Center (ICD-10 diagnosed). NPS history was extracted from medical records. Statistical analyses included chi-square tests (demographics/subtypes), ANOVA (preclinical intervals), and logistic regression (AD vs. non-AD factors).

RESULTS: 69.2% of patients had pre-dementia NPS, which was associated with a shorter interval to dementia (23.4 vs. 42.2 months, p < 0.001) and a higher likelihood of non-AD dementia risk. Psychiatric disorders (74.1%) were the most prevalent NPS domain, followed by sleep disturbances (46.8%) and affective dysregulation (39.8%), with psychiatric symptoms showing the shortest dementia transition (34.3 ± 37.8 months). Females exhibited higher hallucination/delusion rates than males (30.2% vs. 15.4%; 26.2% vs. 9.6%). AD predominated (68.7%), followed by DLB (12.4%) and others. Psychiatric-to-dementia intervals differed significantly between AD (52.3 ± 47.6months) and DLB (26.5 ± 19.9months). Female sex, hallucinations, and behavioral dysregulation were identified as independent factors associated with AD (p < 0.05).

CONCLUSION: Pre-dementia NPS, particularly psychiatric manifestations, may link to early dementia. However, given the exploratory nature of the results, which is needed to confirm these findings. Clinicians should consider prodromal dementia in older adults with late-onset psychiatric symptoms to enable early intervention.

PMID:41942959 | DOI:10.1186/s12888-026-08046-5

BMC Psychiatry. 2026 Apr 6. doi: 10.1186/s12888-026-08039-4. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the impact of antipsychotic treatment (APs) alone and a combination of antipsychotics and non-invasive brain stimulation (APNIBS) on blood lipid levels in patients with schizophrenia.

METHODS: A retrospective study was conducted. General demographic information and clinical and laboratory data, were collected from hospitalized patients who had received at least one lipid profile test after initiating therapy at the psychiatric hospital between January 2021 and October 2023. Lipid profiles, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C), were measured at baseline and multiple time points during treatment. The longitudinal changes in lipid profiles within each group (from baseline to each follow-up) and the differences in these trajectories between the two groups were assessed using linear mixed-effects models.

RESULTS: A total of 1,171 patients were included (APs group: n = 704; APNIBS group: n = 467). At baseline, mean levels of TC, HDL-C, and LDL-C were within normal ranges, whereas TG was slightly elevated in the APs group. Linear mixed-effects model analysis revealed no statistically significant differences in the longitudinal trajectories of change between the two treatment groups for any lipid parameter (TG, TC, HDL-C, and LDL-C; all between-group P > 0.05). However, within-group analyses indicated divergent patterns: TG levels exhibited a progressive increase from baseline in the APs group at all follow-ups, while showing a more variable trajectory in the APNIBS group, with a increase at the second assessment after adjustment followed by decreasing trends later. Similarly, the APNIBS group demonstrated reductions from baseline in TC and LDL-C at the third and fourth tests, whereas no such reductions were observed in the APs group.

CONCLUSION: Exploratory within-group analyses revealed favorable lipid trends in the APNIBS group. However, no statistically significant between-group differences were observed in longitudinal lipid trajectories. These hypothesis-generating findings warrant further prospective investigation into the potential role of NIBS in blood lipids management in schizophrenia.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41942953 | DOI:10.1186/s12888-026-08039-4

BMC Pregnancy Childbirth. 2026 Apr 7. doi: 10.1186/s12884-026-08987-5. Online ahead of print.

ABSTRACT

BACKGROUND: Exposure to chemical products during pregnancy is a growing threat to maternal and fetal health.

OBJECTIVE: The aim of this study is to investigate the effectiveness of Motivational Interviewing (MI) based education in reducing the use of products that may contain chemicals among pregnant women and in creating a change in attitudes towards the use of these chemicals.

METHODS: The study was conducted using a pretest-posttest randomized controlled design with 130 pregnant women. Intervention group received three face-to-face MI based education sessions aimed at reducing the use of products that may contain chemicals. Participants reported using frequencies of personal care and domestic products that may contain chemicals. Attitudes toward avoiding potentially harmful chemicals were additionally measured using an Endocrine Disrupting Attitude Scale (EDAS).

RESULTS: A statistically significant difference was found when comparing the differences (pre-test-post-test) in personal care and domestic products that contain chemicals usage between the experimental and control groups p < 0.05. In the experimental group, a decrease in the use of most products was observed in the post-test. While the pretest EDAS mean scores of the pregnant women in the intervention and control groups were similar, the posttest EDAS mean scores increased. Results indicated a significant main effect in traction between group and time for EDAS (F13.06; η2 = .093, P < .001).

CONCLUSION: MI based education was an effective method to reduce the use of products that may chemicals and develop positive attitude towards protection against use of products.

TRIAL REGISTRATION: The study was registered retrospectively with the Clinical Trials Protocol Registration and Results System. NCT06380634. (registered 24.04.2024).

PMID:41942949 | DOI:10.1186/s12884-026-08987-5