Tag: statistics

BMC Health Serv Res. 2025 Aug 16;25(1):1088. doi: 10.1186/s12913-025-13121-w.

ABSTRACT

BACKGROUND: This study aims to examine unmet healthcare needs and the burden of out-of-pocket (OOP) payments in Bangladesh among hypertensive adults using the most recent survey data.

METHODS: A total of 5086 hypertensive patients aged 18 to 80 were recruited from 75 pharmacies in Bangladesh in 2023, 35 being located in urban areas and 40 in rural areas. Unmet healthcare needs was the primary outcome variable, while the incidence of catastrophic health expenditures (CHE) was the secondary outcome variable. A multilevel logistic regression model was performed to identify factors associated with unmet healthcare needs and CHE. A multilevel Tobit regression model was used to identify the determinants of OOP health expenditures.

RESULTS: The study indicated that the prevalence of unmet healthcare needs among hypertensive adults was around 26% and incidence of CHE was 46% at 10% threshold of total consumption in Bangladesh. The most common reason for unmet healthcare needs was affordability, long waiting times, lack of availability, and transportation issues etc. Unmet healthcare needs were more prevalent among men, individuals with no education, divorced/separated, non-Muslims and poor population. Regression models suggested that older people, men, those with higher education, Muslim, married people, larger household, overweight and obese people, and rural residents were more likely to burden of OOP expenses.

CONCLUSIONS: High unmet needs and CHE prevalence in Bangladesh reveal inadequate health risk protection. Prioritizing affordability, addressing disparities, and strengthening financial risk protection can improve access and outcomes for hypertensive adults.

PMID:40819056 | DOI:10.1186/s12913-025-13121-w

BMC Public Health. 2025 Aug 16;25(1):2795. doi: 10.1186/s12889-025-24048-6.

ABSTRACT

INTRODUCTION: The health of the elderly represents a critical public health concern that can be positively influenced by the adoption of health-promoting lifestyle behaviors. This quasi-experimental study aimed to evaluate the effectiveness of multimodal educational interventions in improving the lifestyle of older adults.

MATERIALS AND METHODS: This quasi-experimental intervention study was conducted with 118 eligible elderly participants recruited from health service centers in Qom, Iran. Data were collected using a two-part questionnaire comprising demographic information and the Health-Promoting Lifestyle Profile II (HPLP-II). The intervention group participated in eight 30-minute group sessions (organized into six groups), held twice weekly, covering topics such as nutrition, physical activity, stress management, and mental health. The control group did not receive any educational intervention during the study period. Two months following the completion of the educational program, the questionnaire was re-administered to both groups. Data were analyzed using SPSS version 21. Descriptive statistics were employed to summarize participant characteristics and study variables. Inferential analyses included Box’s M test to assess the homogeneity of variance-covariance matrices, as well as univariate and multivariate analyses of covariance (ANCOVA and MANCOVA), with the significance level set at 0.05.

FINDINGS: The mean scores for lifestyle dimensions-including health responsibility, physical activity, nutrition, stress management, interpersonal relationships, spiritual growth, and self-actualization-did not differ significantly between the intervention and control groups prior to the educational program. However, following the intervention, the mean scores in the intervention group increased significantly across all dimensions (p < 0.0001).

CONCLUSION: The findings indicate that the educational intervention had a positive effect on all six dimensions of lifestyle-related behaviors among the elderly.

PMID:40819050 | DOI:10.1186/s12889-025-24048-6

BMC Musculoskelet Disord. 2025 Aug 16;26(1):794. doi: 10.1186/s12891-025-09062-4.

ABSTRACT

BACKGROUND: Hip fractures are a significant public health issue among the elderly. While early surgical intervention’s effects on morbidity are well-documented, the impact of delayed surgery on mortality and morbidity is less understood. This study aims to examine the medium-term morbidity and mortality in patients who underwent delayed surgery with an average preoperative waiting period of 14 days.

MATERIALS: This retrospective study used data from hospital records, Social Security Institution death records, and telephone surveys. Included were patients aged 65 and older with femoral neck or pertrochanteric fractures. Excluded were those younger than 65, with pathological or subtrochanteric fractures, and without adequate preoperative and postoperative follow-up. Preoperative waiting time, mobilization status, ASA score, NLR, and mortality rates were recorded. Postoperative follow-ups occurred at 2, 6, and 12 weeks, 6 months, 1 year, and annually. Various statistical methods investigated the impact of preoperative waiting time on mortality and mobility.

RESULTS: A total of 289 hip fracture surgeries were followed for an average of 5.1 years (range: 0-8.5 years). The mean age was 79 (range: 65-100), with 174 females (60.2%) and 115 males (39.8%). The average preoperative waiting time was 14 days (range: 0-49 days). ROC analysis indicated the critical mortality threshold was 12 days. The one-month cumulative mortality rate was 6% for patients operated on within the first 12 days and 11% for those operated on after 12 days. One-year cumulative mortality rates were 21% for patients operated on within 12 days and 39% for those operated on after 12 days.

CONCLUSION: This study confirms the relationship between surgical delay and increased mortality rates in hip fracture patients, with a 12-day threshold for high mortality risk exceeding typical reports. While no statistically significant relationship was found between preoperative waiting time and ambulation, one-third of postoperative patients could walk without support and nearly half could not walk at all. Despite being retrospective, this study with a large patient population demonstrates the significant impact of surgical delay on mortality and morbidity rates in hip fracture patients.

PMID:40819048 | DOI:10.1186/s12891-025-09062-4

World J Surg Oncol. 2025 Aug 16;23(1):313. doi: 10.1186/s12957-025-03736-y.

ABSTRACT

BACKGROUND: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated improved overall survival (OS) and disease-free survival (DFS) in carefully selected patients with peritoneal metastases from colorectal cancer (CRC-PM). The primary aim of this retrospective study was to identify patients treated with CRS + HIPEC who achieved long-term survival and to analyze the factors most strongly associated with prolonged survival.

METHODS: Among those eligible for CRS + HIPEC, a group of patients with adequate follow-up was evaluated and divided into two groups: the long-term survival group (OS > 48 months) and the average-term survival group (OS < 48 months). A comparative analysis was performed between the two groups to evaluate which factors might be associated with an increased likelihood of long-term survival. Propensity score matching (PSM) was employed to homogenize patients based on peritoneal cancer index (PCI) and extensive small bowel involvement. A further analysis was conducted to assess the differences in recurrence behavior between the two groups.

RESULTS: During the study period, 116 patients underwent CRS + HIPEC. The median OS for the entire sample was 52 months. Among the 63 patients with at least 4 years of follow-up, 32 were identified as part of the average survival group (AS-G), while 31 were classified in the long-survival group (LS-G). DFS and survival after recurrence were statistically higher in the LS-G compared to the AS-G. Higher PCI, BRAF V600E mutation, right-sided primary tumor location, small bowel involvement, and mucinous histology were statistically more frequent in the AS-G compared to the LS-G. After PSM analysis, the absence of BRAF V600E mutation and the non-mucinous histology were significantly associated with long-term survival.

CONCLUSIONS: Long-term survival can potentially be achieved in patients with peritoneal metastasis from colorectal cancer (CRC) treated with CRS and HIPEC, often resulting in prolonged disease-free periods and less aggressive disease progression if recurrence occurs.

PMID:40819044 | DOI:10.1186/s12957-025-03736-y

BMC Public Health. 2025 Aug 16;25(1):2800. doi: 10.1186/s12889-025-24022-2.

ABSTRACT

OBJECTIVE: Grounded in the Health Belief Model (HBM) and Media System Dependency Theory (MSDT), this study examines the relationship between media literacy and health literacy in the Turkish context, where digital media plays an increasingly dominant role in disseminating health-related information. It focuses on how individuals access, evaluate, and utilize health information, analyzing the effects of media literacy sub-dimensions-access, analysis, evaluation, and communication-on health literacy levels. The study aims to determine how media-based health information influences individuals’ decision-making processes and their ability to make informed health choices.

METHODS: A survey-based quantitative research approach was employed with 485 participants from Turkey, of which 477 valid responses were analyzed. The Turkish Health Literacy Scale (TSOY-32) measured health literacy, while the Media Literacy Skills Scale assessed media literacy. The Generalized Ordered Logit Model (GOLM) was applied to examine the effects of media literacy on health literacy.

RESULTS: Descriptive statistics, correlation analysis, and hypothesis testing were conducted. Media literacy levels significantly influence health literacy levels (p < 0.05). The access sub-dimension increased the likelihood of improving health literacy by 1.90 times (p < 0.05). The analysis sub-dimension significantly enhanced health literacy by 2.23 times (p < 0.05). The evaluation sub-dimension had a statistically significant effect on health literacy (p < 0.05). The communication sub-dimension supports individuals in sharing health information and making informed decisions (p < 0.05). Health recommendations disseminated through media significantly impact health literacy levels (p < 0.05). Trust in media-based health information had a weak but positive correlation with health literacy (r = 0.2097, p < 0.05). Education level was positively correlated with health literacy, while income level showed no significant effect. These findings suggest that enhancing media literacy skills, particularly in access and analysis, can meaningfully improve individuals’ capacity to navigate complex health information landscapes and foster more informed health behaviors.

CONCLUSION: The study highlights the crucial role of media literacy in improving health literacy and preventing misinformation. Access and analysis skills are particularly vital in enabling individuals to obtain accurate health information and avoid misleading content. Conducted within the Turkish sociocultural context, where digital media usage is high and misinformation about health is prevalent, the findings offer valuable insights for national health promotion strategies. Policymakers and educators should integrate media literacy into educational curricula, launch public awareness campaigns to combat misinformation, and develop strategies to enhance individuals’ critical thinking skills regarding health information. This study is limited by its cross-sectional design and reliance on self-reported data. Future research should employ longitudinal methods and explore the long-term impact of media and health literacy across different demographic groups and contexts.

PMID:40819030 | DOI:10.1186/s12889-025-24022-2

BMC Prim Care. 2025 Aug 16;26(1):254. doi: 10.1186/s12875-025-02956-1.

ABSTRACT

BACKGROUND: There is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines.

METHODS: We used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. Linked data included deprivation information and hospital episode statistics admitted patient care data to improve completeness of ethnicity information. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, for how long. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse.

RESULTS: There were 4,355,694 people included in the study population. Of these, 304,029 (7.0%) had an opioid and antidepressant co-prescribed at least once during the study period. The prevalence of co-prescribing increased from 35.8 per 1000 person-years in 2010 to 44.1 in 2015 and then decreased to 39.2 in 2019. Co-prescribing rates were higher in females, older age groups, people living in more deprived areas and the White ethnic group. The overall median length of the opioid and antidepressant co-prescriptions was 29 days (interquartile range: 17 to 51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 235,017 times to 87,274 people. The second most commonly co-prescribed combination was codeine and citalopram, co-prescribed 55,792 times to 158,812 people. Combinations of opioids and antidepressants both metabolised by CYP2D6 were also common.

CONCLUSIONS: There is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups.

PMID:40819028 | DOI:10.1186/s12875-025-02956-1

BMC Public Health. 2025 Aug 16;25(1):2812. doi: 10.1186/s12889-025-23721-0.

ABSTRACT

This research investigates how loneliness influences alexithymia among Chinese adolescents, drawing on Internet Compensation Theory and the Social Compensation Hypothesis. The study highlights the mediating role of problematic smartphone use (PSU) and the moderating effect of fear of negative evaluation (FNE). Using a cross-sectional design, data were collected from 688 secondary school students via the online Questionnaire Star platform. The results indicate that loneliness is positively associated with both PSU and alexithymia. PSU partially mediates the relationship between loneliness and alexithymia (based on statistical models). Additionally, FNE plays a moderating role in the relationship between loneliness and PSU or alexithymia. Subgroup analysis revealed that male students reported significantly higher levels of alexithymia than females. Among individuals with higher levels of FNE, the positive correlation between loneliness and alexithymia was significantly stronger. This study proposes a mechanism involving internal emotion (loneliness), external behavior (PSU), and cognitive evaluation (FNE), offering a systematic theoretical basis for adolescent mental health interventions.

PMID:40819026 | DOI:10.1186/s12889-025-23721-0

NPJ Digit Med. 2025 Aug 16;8(1):526. doi: 10.1038/s41746-025-01935-1.

ABSTRACT

The sensitive nature of electronic health records (EHR) and wearable data presents challenges in sharing biomedical resources while minimizing re-identification risks. This article introduces an end-to-end, titratable pipeline that generates privacy-preserving “digital twin” datasets from complex EHR and wearable-device records (Apple Watch data from 3029 participants) using DataSifter and Synthetic Data Vault (SDV) methods. Various obfuscation levels were applied (DataSifter: small, medium, large; SDV: CTGAN, Gaussian Copula) and benchmarked using utility (statistical fidelity, machine learning performance) and privacy (re-identification risk, detection likelihood) metrics. The highest-obfuscation DataSifter twin delivered the strongest privacy protection (0.83) while preserving key statistical and predictive signals (83.1% confidence interval overlap in regression models), outperforming SDV, particularly for longitudinal data. Despite declining performance in machine learning tasks with higher obfuscation, utility was generally preserved. The study underscores the importance of digital twin datasets and highlights DataSifter’s adaptability in privacy-utility trade-offs, advocating its utility for secure data sharing.

PMID:40818998 | DOI:10.1038/s41746-025-01935-1

BMC Public Health. 2025 Aug 16;25(1):2798. doi: 10.1186/s12889-025-24164-3.

ABSTRACT

OBJECTIVE: To understand the implementation of leprosy symptom surveillance in Guangdong Province, explore its role in early detection of leprosy, and provide a theoretical basis for leprosy prevention and control.

METHODS: Data from the National Leprosy Prevention and Management Information System (LEPMIS) and Guangdong Suspected Leprosy Symptom Surveillance System were collected, including symptom surveillance data (2018-2023) and newly diagnosed leprosy case records (2012-2023). The newly diagnosed leprosy case records were divided into pre-implementation (2012-2017) and post-implementation (2018-2023) of symptom surveillance. The effectiveness of the symptom surveillance program was evaluated by assessing the surveillance coverage and clinical outcomes, including but not limited to coverage rate, delayed discovery time, and early diagnosis. Database was established and checked for logical errors, followed by descriptive statistical analysis, chi-square test using SPSS 24.0.

RESULTS: By the end of 2023, the number of participating medical institutions was 2,891, increased by 92.3% compared to 2018 when the symptom surveillance was first initiated, and the county-level coverage rate increased from 11.3 to 97.6%. After implementation of symptom surveillance, the proportions of resident patients, Han ethnicity, and farmers or herders decreased significantly (p < 0.05). The delayed discovery time decreased from (36.2 ± 2.0) months to (31.8 ± 3.1) months, and the patients delayed discovery time decreased from (27.7 ± 1.8) months to (20.8 ± 2.5) months, both showing a statistically significant difference (p < 0.05).

DISCUSSION: Our findings indicate that the leprosy symptom surveillance program in Guangdong Province has effectively reduced delayed discovery time, particularly patients delayed discovery time in seeking medical care, thereby facilitating early detection of leprosy cases.

PMID:40818964 | DOI:10.1186/s12889-025-24164-3

Injury. 2025 Jul 19;56(10):112620. doi: 10.1016/j.injury.2025.112620. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The best treatment of comminuted, proximal humeral fractures in the elderly population is an unresolved clinical problem. This study aimed to compare the outcome of hemiarthroplasty (HA) and nonoperative treatment in the elderly population patients with a comminuted proximal humeral fracture.

METHOD: From October 6, 2009 to April 26, 2017, 57 elderly patients with a comminuted proximal humeral fracture were enrolled in the multicenter randomized controlled trial (RCT). Patients were randomized to HA or nonoperative treatment. Outcome measures were the Constant-Murley score (primary outcome), Disabilities of the Arm, Shoulder, and Hand, pain (Visual Analog Score), quality of life (Short Form-36 and EuroQoL-5D-3 L), complications, revision operation, health care consumption, and costs. Patients were followed for two years.

RESULT: Of the 57 patients included, 30 underwent treatment with HA and 27 were treated nonoperatively. Patients had a median age of 77 years, and 89 % was female. According to the Hertel classification, most fractures were type 7 (47 %) or type 12 (42 %). The median Constant-Murley score increased from 23 (95 % CI 17-29) at six weeks to 48 (95 % CI 41-53) at 24 months in the HA group, and from 24 (95 % CI 17-31) to 59 (95 % CI 52-65) in the nonoperative group. Throughout follow-up, scores were similar in both groups. The DASH score consistently decreased over time in both groups. At 24 months, median DASH scores were 24.0 (95 % CI 17.4-30.8) and 23.4 (95 % CI 16.5-30.4) in the HA and nonoperative group, respectively. Pain levels, SF-36, and EQ-5D were similar in both groups throughout follow-up. Eleven patients, of which seven in the HA group, developed one or more complications, of which six patients required surgical interventions. Total costs were higher for HA, although not statistically significant.

CONCLUSION: Based on results of this RCT, primary hemiarthroplasty cannot be considered superior to nonoperative treatment for comminuted proximal humeral fractures in the elderly population. A trend favoring nonoperative treatment is observed in outcomes and in costs.

PMID:40818163 | DOI:10.1016/j.injury.2025.112620