Tag: statistics

BMC Psychol. 2026 May 16. doi: 10.1186/s40359-026-04697-x. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the association of the cumulative effects of excess weight with depressive and anxiety symptoms in Chinese adolescents and the role of sleep quality in the above-mentioned association. This study aimed to assess this issue.

METHODS: A cohort study was conducted annually during 2021 (wave 1), 2022 (wave 2) and 2023 (wave 3). The cumulative effects of excess weight, based on body mass index, from wave 1 to wave 3 were calculated using the trapezoid rule. We evaluated sleep quality, depressive symptoms, and anxiety symptoms based on the Pittsburgh Sleep Quality Index, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder Questionnaire in wave 3, respectively. We performed sensitivity analyses using overweight/obesity-years to define the cumulative effects of excess weight.

RESULTS: This study included 39,442 participants (male: 51.6%; mean age: 13.7 years) without depressive and anxiety symptoms in wave 1 and 2. Logistic models with restricted cubic splines showed a significant linear association between the cumulative effect of excess weight and depressive symptoms. We noted a mediating role of sleep quality in the above-mentioned association (percentage of mediation = 9.7%; P < 0.001). Compared with participants without the incident cumulative effect of excess weight and sleep disturbance, those with the above-mentioned two conditions were more likely to have anxiety symptoms (odds ratio = 5.94; P < 0.001). The sensitivity analyses yielded similar results.

CONCLUSION: Our results indicate that the cumulative effect of excess weight may directly affect depressive symptoms, and indirectly affect anxiety symptoms through sleep quality.

PMID:42141495 | DOI:10.1186/s40359-026-04697-x

Trials. 2026 May 15. doi: 10.1186/s13063-026-09761-w. Online ahead of print.

ABSTRACT

BACKGROUND: Therapeutic exercises that help reduce stress and anxiety, both mentally and physically, are called relaxation techniques. In order to ascertain the benefits of the two relaxation techniques on pain, urine incontinence, sleep quality, and activities of daily living, this study will compare them with the conventional physiotherapy exercise in lower segmental cesarean sections (LSCS).

METHODS: Forty-six LSCS subjects with pain, urine incontinence, sleep quality, and activities of daily life will participate in a comparative study that is a blinded (statistical) analysis. The participants will be divided into two groups following randomization: (1) Benson’s relaxation and (2) Mitchell’s relaxation, and both groups will receive exercises from conventional physiotherapy. Every group will go through the initial evaluation and a post-intervention assessment.

DISCUSSION: This study is anticipated to improve pain, urinary incontinence, sleep quality, and activities of daily living following a lower segmental cesarean section. Following the completion of the study, the data will be published. If the benefits are demonstrated, Benson’s or Mitchell’s relaxation approach is used in conjunction with conventional physiotherapy exercises after lower-segmental cesarean sections.

RESULT: The protocol would be given for 4 weeks. The initial assessment would be conducted before the intervention, and the post-assessment would be performed after the completion of the 4 weeks of intervention.

TRIAL REGISTRATION: Trial REF/2025/03/102462, Registration number- CTRI/2025/04/085318. Date of registration-22/04/2025.

PMID:42141474 | DOI:10.1186/s13063-026-09761-w

BioData Min. 2026 May 15. doi: 10.1186/s13040-026-00559-9. Online ahead of print.

ABSTRACT

BACKGROUND: Survival analysis in high-dimensional (HD) and multi-block (MB) settings, such as omic and multi-omic studies, poses major methodological challenges due to multicollinearity, low events-per-variable ratios, and limited model interpretability. While Cox Proportional Hazards models remain widely used, their applicability is restricted in HD scenarios. Machine learning approaches can handle such complexity but often lack interpretability. Survival models based on Partial Least Squares (PLS) offer an attractive compromise, yet existing implementations provide limited support for model optimization, evaluation, and interpretation.

RESULTS: To overcome these limitations, we introduce Coxmos, a CRAN R package that integrates adapted Cox regression models with HD-adapted variable selection, and optimized PLS-based approaches tailored for HD and MB data. Coxmos also provides validation, comparison, interpretation, and visualization tools. Benchmarking on a diverse set of clinical, single-omic, and multi-omic cancer datasets – including breast (BRCA), head and neck (HNSC), and ovarian (HGSOC) cancer – demonstrated that Coxmos outperformed other state-of-the-art machine learning methods, while enhancing interpretability. We illustrated the package’s functionalities through two case studies (HGSOC and HNSC), showing how Coxmos facilitates model selection, validation, and biological interpretation in a complex HD and MB survival analysis.

CONCLUSIONS: Coxmos provides a robust, flexible, and interpretable solution for survival analysis in HD and MB data. By combining optimized PLS-based methodologies with rigorous evaluation and rich visualization tools, Coxmos enables reliable survival prediction and facilitates the identification of relevant risk and protective factors in complex biomedical studies. The package fills an important methodological gap and represents a valuable resource for reproducible and interpretable survival modeling in the big data scenario.

AVAILABILITY: Coxmos is available at CRAN repository: https://cran.r-project.org/web/packages/Coxmos.

PMID:42141472 | DOI:10.1186/s13040-026-00559-9

Nutr J. 2026 May 16. doi: 10.1186/s12937-026-01333-7. Online ahead of print.

ABSTRACT

BACKGROUND: Carotenoids are common natural anti-inflammatory antioxidants produced by plants and some microorganisms. However, there are limited reports on the association between carotenoids and risk of rheumatoid arthritis (RA).

METHODS: We analyzed data of participants from the National Health and Nutrition Examination Survey (NHANES) and UK Biobank (UKB). In the NHANES, a total of 40,410 and 13,440 participants were included to evaluate the association of dietary carotenoid intake and serum carotenoid levels with RA, respectively. Among 179,171 participants in the UKB, 2,156 individuals developed RA over a median follow-up of 7.74 years. A weighted multivariable logistic regression model and quantile G-Computation (QGC) model were established to investigate single and joint effect of carotenoid levels (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin) on RA in NHANES by cross-sectional study design. Furthermore, Cox proportional hazards regression model was used to validate the potential association in UKB cohort, and restricted cubic spline (RCS) regression was applied to estimate the possible nonlinear association.

RESULTS: Compared to the lowest quartile (Q1), dietary intake level of alpha-carotene in Q3 were consistently associated with a decreased risk of RA in NHANES (odds ratio [OR]: 0.771, 95% confidence interval [CI]: 0.628 to 0.946, P-value = 0.013) and UKB (hazards ratio [HR]: 0.875, 95% CI: 0.775 to 0.987, P-value = 0.030). At serum level, all kinds of carotenoids in Q4 were significantly inversely associated with RA when compared with Q1. In QGC model, each one-quartile increase in the intake (OR: 0.886, 95% CI: 0.841 to 0.933, P-value < 0.001) or serum levels (OR: 0.795, 95% CI: 0.732 to 0.864, P-value < 0.001) of the six carotenoids showed a negative correlation against of RA in NHANES. RCS analysis indicated that dietary intake of total carotene (P-value = 0.0020 for nonlinear), alpha-carotene (P-value = 0.0175 for nonlinear), and beta-carotene (P-value = 0.0021 for nonlinear) exhibited a nonlinear relationship with the risk of RA in UKB. The protective effects against RA were found within the ranges of log natural transformation for total carotene (5.28 to 8.69 µg/day), and beta-carotene (5.18 to 8.61 µg/day).

CONCLUSION: Both cross-sectional and prospective studies indicate that carotenoids, as natural and effective anti-inflammatory antioxidants, were negatively associated with RA. Daily intake of an appropriate dose can significantly reduce the risk of RA.

PMID:42141470 | DOI:10.1186/s12937-026-01333-7

Nurs Open. 2026 May;13(5):e70602. doi: 10.1002/nop2.70602.

ABSTRACT

OBJECTIVES: To examine whether nurses’ job well-being is associated with their innovative behaviour and whether knowledge sharing mediates that relationship.

DESIGN: A cross-sectional study.

METHOD: This study used convenience sampling to select 1,025 nurses from 8 hospitals. The data was collected between June and November 2023 using the Nurses Job Well-being Scale, Nurses Innovative Behaviour Scale, and Knowledge Sharing Scale. The data analysis process included descriptive statistics, correlation analysis, multivariate regression, and hypothesis testing.

RESULTS: Job well-being was positively correlated with innovative behaviour (r = 0.63, p < 0.001) and with knowledge sharing (r = 0.73, p < 0.001). Knowledge sharing was also significantly associated with innovative behaviour (r = 0.55, p < 0.001). Regression analysis indicated that both job well-being (β = 0.38, p < 0.001) and knowledge sharing (β = 0.23, p < 0.001) significantly predicted innovativebehaviour. Mediation analysis showed a significant indirect effect of job well-being on innovative behaviour through knowledge sharing (indirect effect = 0.52, 95% CI [0.44, 0.60]).

CONCLUSION: Nurses’ job well-being promotes innovative behaviour both directly and indirectly through knowledge sharing. Interventions targeting psychological well-being and structured knowledge-sharing mechanisms may enhance innovation in nursing practice.

PATIENT OR PUBLIC CONTRIBUTION: This study did not involve patients or the public in the design, conduct, or reporting of the research.

PMID:42141459 | DOI:10.1002/nop2.70602

BMC Nurs. 2026 May 15. doi: 10.1186/s12912-026-04751-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Contemporary nursing education increasingly relies on evidence-informed teaching strategies that improve learning outcomes while supporting students’ psychological well-being. High-fidelity simulation (HFS) is a well-established educational method; however, less is known about the role of individual learner characteristics, such as creativity, in shaping its effectiveness.

AIM OF THE STUDY: This study aimed to examine creativity in the cognitive and characterological domains and to analyze its relationship with satisfaction, self-confidence, perceived learning outcomes, and stress experienced during high-fidelity simulation classes among nursing students.

MATERIALS AND METHODS: A cross-sectional study was conducted among 286 first-year undergraduate nursing students participating in HFS classes during the 2022/2023 and 2023/2024 academic years. Data were collected using an author-designed questionnaire, the Student Satisfaction and Self-Confidence in Learning Scale (SSCL), and the Creative Behavior Questionnaire (KAHN III). Statistical analysis included Spearman’s rank correlation coefficient and the Mann-Whitney U test, with the level of significance set at p < 0.05.

RESULTS: Higher levels of creativity in both the cognitive and characterological domains were positively associated with students’ satisfaction, self-confidence, and selected perceived learning outcomes. Characterological creativity was positively associated with perceived development of knowledge, practical skills, and social competencies, whereas cognitive creativity was associated with perceived development of knowledge and social competencies. Higher creativity was also associated with lower levels of stress related to independent task performance, patient communication, and procedural execution during simulation scenarios.

CONCLUSIONS: The findings suggest that creativity may be an important learner-related factor associated with more favorable educational experiences in high-fidelity simulation. Higher creative dispositions were linked to greater satisfaction and self-confidence, as well as lower stress during simulation activities. These results support the inclusion of creativity-supportive elements in the design of nursing simulation curricula.

TRIAL REGISTRATION: Not applicable.

PMID:42141458 | DOI:10.1186/s12912-026-04751-4

BMC Med Educ. 2026 May 16. doi: 10.1186/s12909-026-09251-2. Online ahead of print.

ABSTRACT

BACKGROUND: The Script Concordance Test (SCT) is an effective tool for clinical reasoning assessment. However, many faculty members are still unfamiliar with this modality, and there are challenges in recruiting panelists who are mandatory for the assessment of SCT. The aim of this study was to assess the benefits of providing training in the quality of SCTs produced by junior faculties members.

METHODS: This was a randomized, single-blind, two-centre trial. The intervention consisted of 2 h of interactive training. The primary outcome was a comparison of the percentage of post-intervention valid SCT between the trained and the control group. The secondary outcome was to determine the factors associated with the quality of SCT.

RESULTS: In two medical schools in the Paris area, 115 participants were recruited in February 2024; they produced 460 SCT. Nine panels of experts were assembled. The percentage of post-intervention valid SCTs was significantly higher in the trained group (41% versus 16%, p < 0.001). This was confirmed in a sensitivity analysis performed on all the SCTs, adjusted for unbalanced variables between the two randomization arms (“risk” of producing a valid SCT when the participants were in the trained arm: aOR 2.53 [1.57; 4.13], p < 0.001).

CONCLUSION: Our prospective randomized study suggested the significant benefits for inexperienced physicians of an initial training in SCT writing quality.

PMID:42141456 | DOI:10.1186/s12909-026-09251-2

Mol Med. 2026 May 15. doi: 10.1186/s10020-026-01497-2. Online ahead of print.

ABSTRACT

BACKGROUND: T1 non-muscle-invasive bladder cancer (NMIBC) represents a biologically aggressive subgroup with substantial heterogeneity in recurrence and progression risk. Current clinicopathological risk stratification tools lack sufficient precision to identify patients at the highest risk of progression to muscle-invasive bladder cancer (MIBC).

OBJECTIVE: To characterize transcriptomic differences between T1 and < T1 (Ta/Tis) NMIBC and to explore the association of fibroblast activation protein-α (FAP) gene expression with disease progression.

METHODS: Transcriptomic profiling was performed on formalin-fixed paraffin-embedded (FFPE) tumor tissue from 66 patients with primary, treatment-naïve NMIBC and 5 patients with T2 disease (included for exploratory comparisons). Analyses included differential gene expression, gene set enrichment analysis (GSEA), molecular subtyping, immune cell deconvolution, and evaluation of FAP expression in relation to recurrence and progression. External validation of FAP was conducted in three independent NMIBC cohorts.

RESULTS: T1 tumors demonstrated a distinct transcriptomic profile compared with < T1 tumors, characterized by enrichment of cell cycle-related and metabolic pathways and a higher prevalence of aggressive molecular subtypes. Despite these molecular differences, no statistically significant differences in recurrence-free, progression-free, cancer-specific, and overall survival were observed, likely reflecting limited event numbers. Among recurrent tumors, early recurrences (≤ 24 months) were associated with epithelial-mesenchymal transition signatures. FAP expression increased with tumor stage (p = 0.0005) and was associated with progression (p = 0.002) and mortality (p = 0.01). Patients with tumors in the highest quartile of FAP expression had worse progression-free survival. This association was consistently observed in three external NMIBC cohorts.

CONCLUSIONS: T1 NMIBC exhibits distinct transcriptomic features suggestive of increased biological aggressiveness. Elevated FAP expression is reproducibly associated with progression risk across multiple cohorts, supporting its potential role as a biomarker of aggressive disease. Given the limited number of progression events, these findings should be considered hypothesis-generating and warrant prospective validation before clinical implementation.

PMID:42141426 | DOI:10.1186/s10020-026-01497-2

BMC Urol. 2026 May 16. doi: 10.1186/s12894-026-02169-3. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter displacement during urodynamic studies remains a common challenge, potentially introducing artifacts, compromising test accuracy, and decreasing patient comfort. Despite the clinical significance of stable catheter fixation, evidence-based recommendations for optimal fixation techniques are lacking. This study seeks to address this gap by comparing the effectiveness and patient comfort associated with three commonly used catheter fixation methods during urodynamic study.

METHODS: We retrospectively collected data from non-randomized patients who underwent urodynamic studies (UDS) at West China Hospital of Sichuan University between April and June 2023. Patients were selected based on predefined inclusion and exclusion criteria and assigned to one of three catheter fixation methods. The effectiveness of the following fixation techniques was evaluated: waterproof tape fixation (Group 1: catheter secured to the skin with adhesive tape), (2) patient-manual fixation (Group 2: patient holds the catheter manually throughout the procedure), and (3) silk thread fixation (Group 3: catheter secured with silk suture tied and fixed externally).

RESULTS: A total of 168 patients were enrolled in the study, with 56 patients in each group. The median ages for Groups 1, 2, and 3 were 66 (47.25, 76), 67 (61,71), and 66 (48, 76.75) years, respectively. There were no statistically significant differences among the three groups in terms of maximum cystometric capacity (MCC), bladder compliance (BC), maximum flow rate (Qmax), detrusor pressure at Qmax (Pdet.Qmax), bladder contractility index (BCI), or bladder outlet obstruction index (BOOI) (P > 0.05). The overall incidence of catheter displacement was 35.71% in Group 1, 0% in Group 2, and 14.29% in Group 3. Statistically significant differences in Comfort-B scale scores were observed between Group 1 and Group 2, and between Group 2 and Group 3 (P < 0.000). Similarly, visual analogue scale (VAS) scores also showed significant differences between Group 1 and Group 2, and between Group 2 and Group 3 (P < 0.000).

CONCLUSIONS: Our preliminary assessment indicated that the three catheter fixation methods did not significantly influence urodynamic parameters. Notably, patient-manual fixation achieved the lowest catheter displacement rate (0%) but was associated with the highest pain and discomfort scores. In contrast, waterproof tape and silk thread fixation offered better patient comfort but with higher displacement rates. These findings highlight a trade-off between catheter stability and patient comfort, suggesting that fixation method selection should be individualized based on patient characteristics and procedural requireme.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42141422 | DOI:10.1186/s12894-026-02169-3

BMC Infect Dis. 2026 May 15. doi: 10.1186/s12879-026-13417-0. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the clinical characteristics and prognosis of immunocompromised and non-immunocompromised patients with sepsis and to develop a novel mortality prediction model for these patients.

METHODS: This prospective cohort study was conducted between February and October 2023 in the emergency department (ED) of Peking Union Medical College Hospital and included 145 sepsis patients (67 with immunocompromised state and 78 without). The primary outcome was 90-day all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were employed to assess the relationship between immune status and mortality risk, identify independent risk factors, and develop a predictive nomogram.

RESULTS: The 90-day mortality rate in immunocompromised patients was significantly higher than that in the control group (55.2% vs. 34.6%, p = 0.013). Multivariate Cox proportional hazards regression analysis identified immunocompromised state as an independent risk factor for mortality (HR = 2.980, 95% CI: 1.679-5.288; p < 0.001). In the subgroup analysis, autoimmune diseases (HR = 3.926, 95% CI: 1.763-8.744), poorly controlled diabetes (HR = 4.432, 95% CI: 1.638-11.992), and malignant neoplasms (HR = 3.195, 95% CI: 1.203-8.486) were significantly associated with an increased mortality risk. After statistical adjustment, seven factors were significantly associated with sepsis mortality (p < 0.05), including respiratory tract infection, urinary tract infection, intensive care unit (ICU) admission, the Sequential Organ Failure Assessment (SOFA) score, immunocompromised state, septic shock, and urgent surgery. The nomogram model based on these factors demonstrated strong predictive ability and accuracy, with a C-index of 0.808 (p < 0.001).

CONCLUSION: Immunocompromised state is an independent risk factor for mortality in sepsis patients, and different types of immunosuppression exert varying impacts on prognosis. The nomogram model developed on the basis of these findings offers valuable guidance for individualized risk assessment in clinical practice.

PMID:42141420 | DOI:10.1186/s12879-026-13417-0