Tag: statistics

BMC Sports Sci Med Rehabil. 2026 May 26. doi: 10.1186/s13102-026-01767-w. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aims to examine the impact of badminton training programs on the attention and motor skills performance of students with specific learning disabilities (SLDs).

METHODS: The study was carried out with students at a public middle school. The study group consisted of a total of 44 volunteer students with SLD, with 22 participants in the experimental group (mean age 12.41 ± 0.90) and 22 participants in the control group (mean age 11.64 ± 0.49). Over a 12-week period, the experimental group regularly participated in two hours of badminton training per week in addition to their daily activities. Meanwhile, the control group was not included in any additional physical activity program and maintained their daily routines. Prior to the start of the study, information regarding the participants was recorded using a personal information form. The Bourdon Attention Test, Togu Balance Test, and Sit-and-Reach Flexibility Test were administered to the participants prior to the study and following the badminton training. To isolate the impact of differences in pre-test scores between the groups on the post-test, an Analysis of Covariance (ANCOVA) for Repeated Measures was conducted.

RESULTS: Following the 12-week badminton training program, a statistically significant difference was observed in terms of the pre- and post-test results for balance and attention performance in the experimental group (p < 0.05), while no statistically significant difference was found in terms of the pre- and post-test results for flexibility performance (p > 0.05). In the control group, no statistically significant differences were identified in the pre- and post-test results for any of the parameters (p > 0.05).

CONCLUSIONS: It can be concluded that the 12-week badminton training program is an effective method for improving static balance and selective attention skills in students with SLD. However, it is thought that more long-term or specific exercise content may be needed to achieve changes in flexibility.

PMID:42185927 | DOI:10.1186/s13102-026-01767-w

BMC Endocr Disord. 2026 May 25. doi: 10.1186/s12902-026-02332-9. Online ahead of print.

ABSTRACT

BACKGROUND: Metformin is the preferred initial therapy for type 2 diabetes mellitus (T2DM) and gradual upward dose titration is recommended to reach target blood glucose levels. The aim of this study was to assess the pattern of metformin dose up-titration and its effect on glycemic control among T2DM patients.

METHODS: A retrospective cohort study of people with T2DM was conducted at Ayder Comprehensive Specialized Hospital from January to March 2020. Participants with fasting plasma glucose above 140 mg/dl after one month of initiating metformin were followed over the course of treatment. Multivariable binary logistic regression models were used to evaluate independent variables associated with metformin dose up-titration and glycemic control. The output of the logistic regression was expressed as adjusted odds ratios at 95% confidence intervals. Test results were considered statistically significant when p < 0.05. A total of 284 T2DM patients on metformin were included in the study.

RESULTS: The mean age and SD of the study participants was 54.0 ± 10.5. Metformin dose was up-titrated at least once in 61.6% of the study participants. Almost half of the study participants had achieved glycemic control (HbA1c ≤ 7). Having a duration of treatment less than five years, initiating metformin at a daily dose of 500 mg and the addition of hypoglycemic medications were independent predictors of metformin dose up-titration. T2DM patients whose metformin dose was up-titrated had two times higher odds of having controlled blood glucose levels compared to those not up-titrated (P-value: 0.015; OR: 1.823; 95% CI: 1.121-2.963). A gradual metformin dose titration at later than the 4th month was associated with better glycemic control. T2DM patients whose metformin dose was titrated only once were less likely to achieve glycemic control (P-value: 0.038; OR: 0.482; 95% CI: 0.242-0.962).

CONCLUSIONS: In this resource-constrained setting, metformin dose up-titration was less commonly practiced than adding another hypoglycemic agent in the management of T2DM. However, dose up-titration was associated with a higher likelihood of achieving glycemic control. These findings suggest that optimizing metformin dosing may improve glycemic outcomes before intensifying therapy with additional agents, although prospective studies are needed to confirm this association.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42185896 | DOI:10.1186/s12902-026-02332-9

BMC Oral Health. 2026 May 26. doi: 10.1186/s12903-026-08626-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Immediate implant placement with flap elevation and guided bone regeneration in Type II sockets often leads to midfacial gingival recession and compromised esthetics. To address these limitations, vestibular socket therapy (VST) has been proposed as an alternative technique. Our objective is to compare vestibular socket therapy using pericardium membrane versus conventional flap and guided bone regeneration (GBR) for immediate implant placement in type II sockets regarding bone and soft-tissue outcomes.

MATERIALS AND METHODS: Twenty patients with Type II sockets were divided into two equal groups. Group-I: received immediate implant placement through a vestibular incision with pericardium membrane placement; the defect was grafted with a mixture of allograft and xenograft. Group-II: received immediate implant placement with conventional open-flap surgery using the same membrane and grafting materials. Radiographic evaluation of labial bone was performed at 3 and 6 months using CBCT assessments. Volumetric analyses of buccal soft-tissue contours were recorded preoperatively and at 6 months. Clinical assessment of pink esthetic score (PES) and modified sulcus bleeding index (mSBI) also were performed at 6 months.

RESULTS: Both groups showed statistically significant increases in buccal bone thickness and height from baseline to 3 and 6 months. Volumetric change and mSBI values demonstrated no statistically significant differences between groups (p > 0.05). Mean PES was significantly higher in the study group (12.78 ± 0.83) compared to controls (11.56 ± 1.24) (p = 0.03).

CONCLUSIONS: Pericardium membrane with VST offers a promising approach for immediate implant placement in type-II sockets, achieving predictable bone regeneration and better esthetic outcomes, as reflected by higher PES.

TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov (NCT07337837) (13/1/2026).

PMID:42185891 | DOI:10.1186/s12903-026-08626-7

BMC Med Educ. 2026 May 26. doi: 10.1186/s12909-026-09524-w. Online ahead of print.

ABSTRACT

BACKGROUND: Flexible bronchoscopic intubation (FBI) is a vital skill for anaesthesiologists managing difficult airways. Traditional training models often fail to replicate real difficult airway scenarios, limiting their educational value. This study aimed to assess the effectiveness of three-dimensional (3D) printed difficult airway models, developed from patient CT/MRI images, in improving FBI skills among anaesthesia residents compared to conventional manikin models.

METHODS: Twenty-eight anaesthesia residents were randomised equally into the 3D-printed model group and the AirSim manikin group. Each resident received a standardised lecture, followed by FBI training using their assigned model and then a crossover with the alternate model. Educational effectiveness was assessed using a global rating scale, performance on the ORSIM simulator scenarios, and a trainee-reported questionnaire measuring suitability, realism, and educational effectiveness.

RESULTS: The global rating scales of operative performance and FBI time improved significantly after training in both groups. The post-training performance on the ORSIM simulator did not differ significantly between both groups. Compared with the AirSim manikin model, the 3D-printed model had a higher trainee-reported educational effectiveness (8.6 ± 1.0 vs. 7.9 ± 1.0; p = 0.050). Exploratory post-hoc analyses suggested that prior FBI experience modified the training response.

CONCLUSIONS: Both 3D-printed difficult airway models and conventional manikins were associated with improvement in FBI performance, with no statistically significant between-group differences in objective skill-acquisition outcomes. Trainees perceived the 3D-printed model as more educationally effective.

TRIAL REGISTRATION: Not applicable. The study was launched based on simulation models and without enrollment of patients nor animals; hence the protocol registration number was not attributed.

PMID:42185890 | DOI:10.1186/s12909-026-09524-w

Trop Med Health. 2026 May 25. doi: 10.1186/s41182-026-00984-w. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria and dengue fever are transmitted by female mosquitoes of the Anopheles and Aedes genera, respectively. These diseases are among the most prevalent in sub-Saharan Africa, with dengue fever posing an increasingly significant threat. In this context, studying the species diversity of vectors, as well as their bionomics, including their ecological and behavioral traits, is essential for a better understanding of transmission dynamics, and for guiding appropriate vector control strategies. This study aims to characterize the species diversity and human bite rates of malaria and dengue vectors in central and northern Benin simultaneously, using a multimethod sampling approach combining larval surveys, captures on human volunteers, oviposition trap use, and pyrethrum spraying captures.

RESULTS: Combined diurnal and nocturnal collections yielded a total of 2,337 adult mosquitoes across the five study communes. Species composition was dominated by the genera Aedes and Anopheles, with marked spatial heterogeneity among localities. The statistically significant intercommunal differences (p < 0.001) indicated a heterogeneous spatial distribution of the mosquito populations, which was further supported by the diversity indices. During larval surveys, 993 potential breeding sites were inspected, of which 51.0% were positive. In the study area, household containers such as buckets, jars, and jerry cans are the most abundant and productive breeding sites for Aedes. After emergence, 1,988 adult mosquitoes were identified, representing seven species: Aedes aegypti, Ae. albopictus, Ae. vittatus, Anopheles gambiae, Culex nebulosus, Cx. quinquefasciatus, and Cx. tigripes. Pyrethrum spray collection revealed five species and confirmed the presence of endophilic vectors, notably An. gambiae and Cx. quinquefasciatus. Analysis of biting activity revealed a pronounced circadian pattern: Aedes aegypti exhibited predominantly diurnal biting activity, whereas Anopheles gambiae showed a marked increase in nocturnal activity. The concurrent detection of Anopheles gambiae s.l. and Aedes aegypti during both daytime and nighttime, even at relatively low abundance levels, represents a noteworthy epidemiological signal suggesting a potential combined risk of malaria and dengue transmission.

CONCLUSION: The multimethod approach highlights the importance of integrated entomological surveillance to anticipate emerging epidemiological dynamics and adapt vector control strategies to local ecological conditions.

PMID:42185885 | DOI:10.1186/s41182-026-00984-w

BMC Psychol. 2026 May 26. doi: 10.1186/s40359-026-04842-6. Online ahead of print.

ABSTRACT

OBJECTIVES: Mental imagery plays a crucial role in cognitive and motor functioning. The present study aimed to translate, culturally adapt, and psychometrically evaluate the Persian version of Sheehan’s shortened form of Betts’ Questionnaire Upon Mental Imagery (QMI) among Iranian university students. This study represents the first comprehensive cultural adaptation and psychometric validation of the Betts’ Questionnaire Upon Mental Imagery (QMI) in Persian-speaking populations.

METHODS: A total of 379 students from Shahid Beheshti University (166 women, 213 men; mean age = 20.97 ± 2.95 years) voluntarily participated in the study. The original QMI includes 35 items across seven sensory modalities (visual, auditory, cutaneous, kinesthetic, gustatory, olfactory, and organic), scored on a 7-point Likert scale (1 = vivid image, 7 = no image). A rigorous forward-backward translation protocol involving a multidisciplinary expert panel was implemented. Confirmatory factor analysis (CFA), Cronbach’s alpha, and gender comparison using independent t-tests were conducted. Robust Maximum Likelihood Estimation was used in CFA due to non-normality.

RESULTS: CFA confirmed the original seven-factor structure with good fit by multiple indices (CFI=0.96, TLI=0.95, SRMR=0.06, RMSEA=0.06 [90% CI: 0.05, 0.07], p-close = .12; PGFI = 0.73, PNFI = 0.84, χ2/df = 2.18. Internal consistency was strong (Cronbach’s alpha = 0.87 overall; all subscales α = 0.65-0.78; McDonald’s ω = 0.68-0.92). No statistically significant gender differences were observed in total or subscale scores (p > .05).

CONCLUSIONS: The QMI demonstrates sound psychometric properties, confirming its applicability for assessing vividness of multisensory imagery in Persian-speaking populations, however, further validation is required before its broad application in specialized clinical or elite athletic contexts.

PMID:42185875 | DOI:10.1186/s40359-026-04842-6

BMC Psychol. 2026 May 25. doi: 10.1186/s40359-026-04824-8. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence indicates that smartphone addiction is associated with a series of psychological problems. However, there is still a lack of sufficient understanding regarding smartphone addiction that occurs in both negative and positive mental health conditions in youths. We aimed to map the network linking smartphone addiction (SMA) with negative (depression, anxiety, stress, loneliness) and positive (life satisfaction, social support, resilience, and self-efficacy) mental health factors in youths.

METHODS: In a cross-sectional sample of 701 youths (aged 18.27 ± 1.57 years, 16-20 years old, 47.6% male, Chinese), participants completed validated self-report scales. A regularized Gaussian graphical model was estimated to identify conditional associations and central nodes. Bootstrapped exploratory graph analysis was used to detect communities, and a PC-algorithm-based directed acyclic graph (DAG) was used to explore potential directional associations.

RESULTS: Compared with non-SMA individuals, youths with SMA reported higher depression, anxiety, stress, and loneliness, and lower life satisfaction, social support, resilience, and self-efficacy (p < 0.05). The strongest edges were self-efficacy-resilience (weight = 0.47) and depression-anxiety (weight = 0.42), SMA was most strongly linked to stress (0.23). Anxiety (Expected Influence = 0.80) and depression (EI = 0.77) showed the highest centrality with good stability. The DAG suggested potential directional pathways from SMA to stress and depression, stress was statistically associated with subsequent nodes of depression and loneliness.

CONCLUSIONS: SMA is embedded within a tightly connected cluster of negative mental health factors and diminished positive resources. Stress and depression appear to be key pathways from SMA to broader psychopathology, highlighting intervention targets (stress regulation and depression management) alongside strengthening mental health promotion in SMA youths in the future.

PMID:42185874 | DOI:10.1186/s40359-026-04824-8

BMC Health Serv Res. 2026 May 25. doi: 10.1186/s12913-026-14550-x. Online ahead of print.

ABSTRACT

BACKGROUND: India faces a shortage of skilled health professionals (SHPs). There is limited research measuring SHP deficits in rural public health centres. We estimated the current and future SHP densities and deficits, along with costs for SHP scale-up to achieve Sustainable Development Goal (SDG) 2030 targets.

METHODS: We used the number of SHPs (doctors, nurses, and midwives) at rural primary and community health centres from the Rural Health Statistics reports (2009-2019) to calculate average annual percentage changes (AAPCs) at national and state levels using JoinPoint regression. Using AAPC values, we projected SHP counts and estimated densities (per 10,000 people) for years until 2030. The projected deficits for 2030 were calculated for three target density thresholds, aligning with the Millennium and Sustainable Development Goals. For scale-up costs, a state-wise statistical average of salaries for SHP groups was calculated assuming a 5% annual increase in allowance.

RESULTS: During 2009-19, SHP density grew annually by 2.59% (95% CI: 0.93-4.28). The national SHP density would increase from 8.85 SHPs per 10,000 in 2019 to 11.47 in 2030. In 2030, India is expected to have a deficit of 0.47-1.83 million SHPs. The scale-up costs to cover these deficits would range from INR 1.46-4.96 trillion, about 15% of India’s government health spending.

CONCLUSION: At the current rate, Indian rural public health centres will not achieve the target SHP density by 2030. The costs for scaling up the recruitment and retention of rural SHPs are relatively small, making it feasible.

PMID:42185866 | DOI:10.1186/s12913-026-14550-x

Clin Epigenetics. 2026 May 25. doi: 10.1186/s13148-026-02131-y. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia affecting millions of patients globally. While epigenetic modifications play a significant role in cardiovascular diseases, their contribution to AF remains incompletely understood. Annexin A4 (ANXA4), a calcium-dependent phospholipid-binding protein, is implicated in inflammation and immune-mediated diseases, but its epigenetic regulation and mechanistic role in AF pathogenesis have not been systematically explored.

METHODS: This study employed a multi-omics approach, integrating Mendelian randomization (MR), DNA methylation quantitative trait loci (mQTL)-mediated analysis, bulk and single-cell transcriptomics, and clinical validation. Two-sample MR utilized plasma proteome quantitative trait loci data from 4759 Icelandic individuals and AF genome-wide association study summary statistics from FinnGen and OpenGWAS databases. mQTL-based mediation analysis leveraged data from 27,750 individuals, and ANXA4 promoter methylation in atrial tissue was assessed in the GSE62727 dataset. Clinical validation involved qPCR for ANXA4 mRNA and CpG sites cg11942603 and cg22792910 in peripheral blood from 130 participants (77 AF patients and 53 sinus rhythm controls). Additionally, ANXA4 protein levels in peripheral blood leukocytes were analyzed using Western Blotting. Machine learning models were used to assess diagnostic performance, and logistic regression analyzed clinical associations.

RESULTS: MR analysis provided evidence consistent with genetically predicted higher ANXA4 levels increasing AF risk (odds ratio = 1.17, 95% CI 1.11-1.23, P = 1.73 × 10^-10), with Bayesian colocalization supporting a shared genetic signal at rs17037076. mQTL-based mediation analysis indicated that hypomethylation at cg11942603 and cg22792910 significantly mediated the association between ANXA4 and AF. Peripheral blood and atrial tissue analyses confirmed lower methylation levels at cg11942603 in AF patients. qPCR confirmed significantly elevated ANXA4 mRNA expression in the peripheral blood of AF patients. Western Blot analysis further revealed a significant increase in intracellular ANXA4 protein levels within peripheral blood leukocytes of AF patients (P = 0.01). Single-cell RNA sequencing showed higher ANXA4 expression across various immune cell types in AF. Larger left atrial diameter, log-transformed NT-proBNP, and ANXA4 mRNA were independently associated with AF, while higher ANXA4 methylation was associated with lower odds of AF. Machine learning models demonstrated high discriminative ability for AF diagnosis (AUC 0.949-0.962).

CONCLUSIONS: Our multi-omics approach provides evidence that hypomethylation at specific ANXA4 CpG sites is associated with increased gene expression and elevated AF risk. Increased ANXA4 mRNA and protein levels are associated with an enhanced immune response, particularly in myeloid cells, suggesting its potential as a diagnostic candidate to differentiate AF from sinus rhythm. Machine learning models further support the predictive value of ANXA4. Furthermore, decreased ANXA4 methylation levels were associated with TET2 upregulation. ANXA4 expression and promoter methylation may serve as potential diagnostic indicators and candidate targets for future precision medicine strategies in AF.

PMID:42185861 | DOI:10.1186/s13148-026-02131-y

BMC Public Health. 2026 May 25. doi: 10.1186/s12889-026-27762-x. Online ahead of print.

ABSTRACT

BACKGROUND: Among the key strategies for protecting the environment are education, modifying people’s behavior, fostering pro-environmental values, and promoting active citizenship. With this in mind, the present study sought to investigate the effect of an educational intervention based on the Theory of Planned Behavior (TPB) on environmentally responsible behaviors (ERBs) among lower secondary students.

METHODS: This quasi-experimental study was conducted among 100 lower secondary school students in Piranshahr, Iran, selected using a multistage cluster sampling method. Schools were randomly allocated to the intervention or control groups, resulting in 50 students in each group. A demographic form and a researcher-developed questionnaire, grounded in the constructs of the TPB and centered on environmental issues as well as ERBs, served as the data collection instruments. The educational program, also designed according to TPB constructs, focused on three key aspects of ERBs. This program was delivered to intervention group students over three 45-minute sessions, along with a separate 60-minute session for parents and school staff. Data gathering took place at two time points: prior to the educational intervention and again three months later.

RESULTS: In the intervention group, following the educational intervention, there was a statistically significant increase in the mean scores of TPB constructs-including attitude, subjective norms, perceived behavioral control, intention, and behavior-as well as in knowledge about the environment and ERBs, compared with the pre-test and the control group (p < 0.05).

CONCLUSION: The educational intervention grounded in the TPB was found to be effective in enhancing ERBs among lower secondary school students. Given that students are the future builders of society, environmental education holds particular importance for this group. Therefore, the intervention developed in this study is proposed as a straightforward, low-cost strategy that can complement existing school programs. The adoption of such interventions has the potential to significantly reinforce ERBs and, over time, lead to better environmental outcomes.

PMID:42185857 | DOI:10.1186/s12889-026-27762-x