Tag: statistics

BMC Psychol. 2025 Aug 30;13(1):989. doi: 10.1186/s40359-025-03223-9.

ABSTRACT

OBJECTIVE: Impaired Activities of Daily Living (ADL) can have a negative impact on the psychological well-being of older adults. This study categorises ADL into Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). By utilising nationally representative cross-sectional data, we explore the association between ADL and BADL limitations and depressive symptoms among the elderly population in China. In addition, this study explored the relationships between BADL, IADL and depression risk in elderly people at the individual and provincial levels and in rural and urban subgroups.

METHODS: The China Health and Retirement Longitudinal Study(CHARLS) survey used a multistage probability‒proportional‒to-size (PPS) sampling technique. Province-level socioeconomic characteristics were merged with microdata for respondents over 60 years of age from the 2020 China Health and Retirement Longitudinal Study (CHARLS 2020) Wave 5 (n = 10,036) by the author. The respondents were asked whether their BADL and IADL were limited. The risk of depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D 10). The chi-squared test was used to explore whether having a disability that limits BADL and IADL was associated with mental health status. A binary logistic regression model was used to evaluate this association further after controlling for confounding factors.

RESULTS: Overall, 27.5% (2759/10036) and 25.7% (2776/10036) of the participants over 60 years of age were limited in their BADL and IADL, respectively. Regression analyses revealed that older adults whose BADL were not limited (OR = 1.942, 95% CI: 1.638-2.303, P <.001) and whose IADL were not limited (OR = 1.775, 95% CI: 1.485-2.122, P <.001) had a lower risk of depression than older adults whose BADL and IADL were limited. In addition, older adults who were female (P <.001), were 60-69 years (P <.005), had a partner (P <.001), were literate (P <.001), lived in a rural area (P <.001), had a retirement pension (P <.001), had three or more children (P <.001), did not have any chronic diseases (P <.001), had a fair SRH score (P <.001), drank alcohol (P <.001), exercised (P <.005), did not participate in social activities (P <.001), or had an above average per capita household consumption (P <.001) lived in provinces with the first quartile of GDP per capita (P <.001) and lived in provinces with the second quartile of the number of beds in medical institutions per 10,000 persons (P <.001) were more likely to experience depressive symptoms, while smoking had no effect. In a binary logistic regression, older adults who were single (OR = 0.669, 95% CI = 0.551, 0.812), illiterate (OR = 0.646, 95% CI = 0.504, 0.828), living in rural areas (OR = 1.485, 95% CI = 1.270, 1.735), without retirement pensions (OR = 0.671, 95% CI = 0.582, 0.819) and with very bad SRH scores (OR = 0.411, 95% CI = 0.311, 0.544) had a greater risk of depressive symptoms. In the binary logistic regression analysis of the urban and rural subgroups separately, the results indicated that old people whose BADL or IADL were not limited were associated with a risk of depression, especially rural (P <.001) and urban (P <.001) participants.

CONCLUSIONS: The present study provides evidence of an association between BADL, IADL and depression in older Chinese adults. This study revealed that individuals with limited BADL and limited IADL were predominantly depressed older adults. Binary logistic regression models suggested that disabilities limiting BADL and IADL were more likely to be associated with depressive symptoms in rural Chinese older adults. Findings underscore the need for targeted rural interventions (e.g., subsidised mobility aids and caregiver training) to mitigate depression risk.

PMID:40885987 | DOI:10.1186/s40359-025-03223-9

BMC Public Health. 2025 Aug 30;25(1):2977. doi: 10.1186/s12889-025-24097-x.

ABSTRACT

BACKGROUND: Given the growing global burden of Alzheimer’s Disease and Other Dementias (ADODs) and inequalities in its distribution, it is of great necessity to analyze the trends and cross-country inequalities in the burden of ADODs globally and in China from 1990 to 2021.

METHODS: Estimates and 95% uncertainty intervals (UIs) for incidence, prevalence, and disability-adjusted life years (DALYs) of ADODs were obtained from the Global Burden of Diseases Study (GBD) 2021. We described the epidemiology of ADODs at global, regional, and national levels, conducting temporal trend analyses using estimated annual percentage change, joinpoint regression, and age-period-cohort model. Additionally, we performed spatial autocorrelation, decomposition, and cross-country inequality analyses, comparing the burden in China to global trends.

RESULTS: The global burden of ADODs increased overall from 1990 to 2021. GBD 2021 estimated 9,837,056 incident cases, 56,856,688 prevalent cases, and 36,332,687 DALYs for ADODs worldwide in 2021, with the highest case number in East Asia and highest age-standardized rate of DALYs in central sub-Saharan Africa. Spatial trends analyses showed hot spots in sub-Saharan Africa, the Middle East and North Africa, Europe, and High-income North America. Decomposition analysis revealed that changes in DALYs were primarily driven by population growth and aging, followed by prevalence, case fatality, and disease severity. Significant increases in absolute and relative sociodemographic index (SDI)-related inequalities in DALYs were observed from 1990 to 2021, with 318.19 to 759.97, and 0.43 to 0.49, respectively.

CONCLUSION: The burden of ADODs globally and in China showed overall increasing trends from 1990 to 2021. This increase was primarily driven by population growth and aging. Countries with high SDI values faced a disproportionately large burden of dementia, and SDI-related inequalities among countries exacerbated over time. These findings highlight significant challenges for the prevention and control of ADODs globally and in China.

PMID:40885984 | DOI:10.1186/s12889-025-24097-x

BMC Public Health. 2025 Aug 30;25(1):2973. doi: 10.1186/s12889-025-24476-4.

ABSTRACT

BACKGROUND: One of the core features of mental health is psychological well-being, which includes enjoyment, pleasure, happiness, fulfillment, and resilience. Assessing psychological well-being might be a useful indicator in determining the effectiveness of a research study or the appropriateness of a clinical intervention. The gender and sexually diverse people (GSDP), including men who have sex with men (MSM), male sex workers (MSW), and transgender women (hijra), are subject to widespread stigma and discrimination in Bangladesh that imposes a great mental health burden by compromising their mental health and well-being. The Bangla WHO-5 Well-being Index may be considered a promising and useful instrument for assessing the well-being of GSDP. However, the psychometric properties of the Bangla WHO-5 Well-being Index on GSDP have never been explored in Bangladesh.

METHODS: Data were collected from 229 GSDP, including self-identified gay men, during their screening for enrollment in a Pre-exposure prophylaxis (PrEP) pilot intervention. The WHO-5 Well-being Index (WHO-5) was administered between February 2022 and August 2022. Confirmatory factor analysis, along with reliability and validity assessments of the WHO-5, were conducted using IBM SPSS software version 24 and AMOS 18.

RESULTS: The scale showed very good results with regard to internal consistency, where Cronbach’s alpha value was found to be 0.856. With regard to divergent validity, the scale manifested a significant negative correlation with depression (r= -0.753, p < 0.01), anxiety (r= -0.614, p < 0.01), and stress (r= -0.702, p < 0.01) subscales of the Bangla Depression Anxiety and Stress (DASS-21) scale. Convergent validity was supported by Average Variance Extracted (0.64) and Composite Reliability (0.89) values. The single-factor structure of the scale was confirmed by the confirmatory factor analysis (χ² = 8.244, χ²/df = 1.648, GFI = 0.989, RMSEA = 0.053, TLI = 0.986, CFI = 0.993, and SRMR = 0.0218).

CONCLUSIONS: Findings of the present analysis indicate that the Bangla WHO-5 Well-being Index is a valid and reliable instrument to assess psychological well-being among GSDP in Bangladesh and is comparable with the original version of the scale in terms of psychometric properties.

PMID:40885982 | DOI:10.1186/s12889-025-24476-4

Int J Behav Nutr Phys Act. 2025 Aug 30;22(1):116. doi: 10.1186/s12966-025-01808-6.

ABSTRACT

BACKGROUND: To ensure the large number of school-based physical activity and nutrition programs have a lasting positive impact on the health and wellbeing of students, it is essential that such programs are sustained long-term. However, there is limited research assessing the duration of such programs and the determinants that are related to their sustainment. This study investigates the duration of, and determinants to the sustainment of physical activity and nutrition programs in Australian primary schools.

METHODS: A cross-sectional study with 207 Principals (one from each school) from a nationally representative sample of randomly selected Australian primary schools. Principals completed a survey online or via telephone, which included items assessing the determinants of program sustainment categorised based on the domains of the Integrated Sustainability Framework (inner contextual factors; outer contextual factors; characteristics of the intervention; and processes). Schools were randomised to answer survey items relating to either physical activity or nutrition programs. We collected data on the number and type of programs, their duration, and factors influencing the sustainment of one selected program. Descriptive statistics were used to assess the duration and prevalence of programs. Regression analysis was used to assess the association between sustainment determinants and the duration of program delivery.

RESULTS: Schools randomised to physical activity programs implemented on average, 5.4 of the nine physical activity programs assessed. Schools randomised to nutrition implemented on average, 2.8 of the seven nutrition programs assessed. Physical activity programs had a mean duration of 6.9 years and nutrition programs had 7.4 years. Nutrition programs had 3.27 times the odds of being sustained longer than physical activity programs (95% CI: 1.57, 6.83; p = 0.002). The only domain from the Integrated Sustainability Framework that was statistically significantly associated with the sustainment for both physical activity and nutrition programs was outer contextual factors. This domain includes the alignment of the program with the priorities of the school, partnerships between the school and external organisations, and the existence of a governing body policy or guideline related to the program. The highest ranked determinant from this domain for both physical activity and nutrition programs was the alignment of the program with the priorities of the school.

CONCLUSION: This study highlights the need for targeted strategies to support the sustainment of health programs in schools, particularly focusing on outer contextual factors. Specifically, the alignment of the program with the priorities of the school. Policymakers and practitioners should prioritise targeting these outer contextual determinants to enhance the sustainment of physical activity and nutrition programs, ultimately promoting better long-term population health outcomes.

PMID:40885977 | DOI:10.1186/s12966-025-01808-6

BMC Pulm Med. 2025 Aug 30;25(1):414. doi: 10.1186/s12890-025-03883-8.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and related public health restrictions have substantially altered healthcare access and delivery, particularly for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the impact of the COVID-19 pandemic and lockdown measures on COPD-related symptoms and hospital admissions, and to compare these outcomes with the pre-pandemic period.

METHODS: This multicenter cross-sectional study was conducted between July 2021 and February 2022 across ten tertiary pulmonary outpatient clinics in Turkey. A total of 347 COPD patients were included. Data on demographics, spirometry, symptom progression, medication access, COVID-19 history, and hospital admissions were collected via structured questionnaire and medical records. Pandemic-related outcomes were compared with data from the pre-pandemic year (March 2019-March 2020). Additional multivariable regression analyses were performed to identify predictors of hospital admission and COVID-19-related hospitalization.

RESULTS: The mean number of hospital admissions significantly decreased during the pandemic compared to the pre-pandemic period (p < 0.001), while patient-reported respiratory symptoms increased over time. Hospital admissions were lowest during the first pandemic period, when restrictions were most intense. Regression analyses showed that lower FEV₁, advanced GOLD stage, and inhaled corticosteroid (ICS) use were independently associated with increased hospital admissions. COVID-19 was diagnosed in 21.1% of patients. Lower FEV₁, GOLD stage, and smoking were significantly associated with COVID-19-related hospitalization.

CONCLUSION: Although COPD-related hospital admissions decreased during the pandemic, respiratory symptoms progressively worsened. These findings reflect the complex interplay between public health measures, healthcare accessibility, and chronic disease management. Disease severity and airflow limitation were key determinants of adverse outcomes. Maintaining access to routine care and adopting personalized approaches in COPD management are essential during public health emergencies.

PMID:40885974 | DOI:10.1186/s12890-025-03883-8

BMC Public Health. 2025 Aug 30;25(1):2975. doi: 10.1186/s12889-025-24273-z.

ABSTRACT

BACKGROUND: In South Korea, the prognosis of avoidable hospitalization in diabetes has not been evaluated, even though the incidence rate is considerably high compared to the Organization for Economic Co-operation and Development average. This study investigated the association between diabetic avoidable hospitalization after the diagnosis of type 2 diabetes mellitus and short- and long-term all-cause mortality.

METHODS: Participants were type 2 diabetes mellitus patients aged 60 years and older and gathered through the National Health Insurance Services Senior cohort data from 2008 to 2019. The outcome measures included five-year and overall period all-cause mortality. The main independent variable was the first-year experience of diabetic avoidable hospitalization after type 2 diabetes mellitus diagnosis. Regression analysis was performed using the Cox proportional hazard model. To enhance the robustness of the study results, a sensitivity analysis and inverse probability of treatment weighting method were conducted.

RESULTS: Among 27 005 participants, 2099 (7.8%) died within five-year of type 2 diabetes mellitus diagnosis and 4693 (17.4%) died in the overall study period after type 2 diabetes mellitus diagnosis. Participants who experienced diabetic avoidable hospitalization one year after being diagnosed with type 2 diabetes mellitus had a higher risk of all-cause mortality compared to those who did not (inverse probability of treatment weighted, Five-year: hazard ratio 1.24, 95% confidence interval 1.14-1.36; Overall period: hazard ratio 1.41, 95% confidence interval 1.33-1.50).

CONCLUSIONS: Enhancing accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary.

PMID:40885973 | DOI:10.1186/s12889-025-24273-z

BMC Public Health. 2025 Aug 30;25(1):2974. doi: 10.1186/s12889-025-24365-w.

ABSTRACT

OBJECTIVE: To synthesize and determine the relative effectiveness of diverse opioid agonist treatment (OAT) medications, including injectables, for opioid use disorder (OUD).

METHODS: We searched EMBASE, PubMed, and CENTRAL for Randomised Controlled Trials (RCTs) (CRD42018109469) and previously published systematic reviews of head-to-head trials of OAT medications. The primary outcome was treatment retention, and secondary outcomes included days of opioid use, days of cocaine use, and proportion of participants involved in criminalized activities. We calculated odds ratios (ORs) and mean differences (MDs) and corresponding 95% credible intervals (CrI) using Bayesian network meta-analyses (NMAs) to indirectly compare treatments at varying lengths of follow-up (3 to 12 months). Sensitivity analyses examined influence of follow-up duration and other trial factors.

RESULTS: Twenty-four RCTs were included. Diacetylmorphine plus oral methadone and injectable hydromorphone plus oral methadone had similar retention compared to one another (OR: 1.05; 95%CrI: 0.27, 4.10). Diacetylmorphine plus oral methadone had similar or statistically favourable retention versus low, medium, and high doses of conventional OATs: buprenorphine (OR: 13.55; 95%CrI: 4.51, 42.52; OR: 5.07; 95%CrI: 2.03, 12.47; OR: 2.21; 95%CrI: 0.18, 21.54) and methadone (OR: 5.88; 95%CrI: 2.34, 16.33; OR: 3.66; 95%CrI: 1.57, 8.82; OR: 3.67; 95%CrI: 1.83, 8.35). Similarly, injectable hydromorphone plus oral methadone also showed favourable or similar retention relative to conventional OATs. Limiting analyses to trials that included only OAT-experienced patients, that offered no extra participation incentive, and/or with 6 months (± 0.5) of follow-up generally did not change the direction of the findings. Injectable hydromorphone plus oral methadone was also statistically favoured in terms of reduced days of opioid use relative to methadone, but mean differences in days of cocaine use were similar. Diacetylmorphine plus oral methadone was associated with a smaller proportion of participation in criminalized activities relative to methadone alone.

CONCLUSION: Both diacetylmorphine and injectable hydromorphone supplemented with methadone showed favourable retention compared to methadone and buprenorphine, depending on the strength of the OAT being co-prescribed or being compared to. These results provide further support for alternatives to conventional OATs such as diacetylmorphine or injectable hydromorphone for treatment retention.

PMID:40885969 | DOI:10.1186/s12889-025-24365-w

BMC Womens Health. 2025 Aug 30;25(1):415. doi: 10.1186/s12905-025-03965-z.

ABSTRACT

BACKGROUND: Globally, female genital mutilation (FGM) remains a significant public health concern. The practice is disproportionately high in African countries. In Tanzania, FGM poses serious health risks to both women, girls and children. However, there is limited empirical literature on the factors associated with FGM in Tanzania. This study intended to fill the gap.

METHODS: In this study, we analysed secondary data from a cross-sectional survey, involving a weighted sample of 7,678 women aged 15-49 from the 2022 Tanzania Demographic and Health Survey (TDHS). In this study, the binary dependent variable indicates whether the respondent is mutilated or not mutilated while the independent variables include various demographic characteristics of women, such as age, education level, socioeconomic status, and region of residence. Bivariate and multivariable logistic regression analyses were conducted. A threshold of p-value < 0.05 at 95% Confidence Interval (CI) was used to determine a statistically significant association.

RESULTS: The prevalence of FGM in Tanzania is 8.2% and types I and II (a cut with or without removal of flesh) were the dominant types of FGM practice by 89.2%. After controlling for other variables, higher odds of being mutilated was reported in; older ages 45-49 years (adjusted Odds Ratio(aOR));3.09, 95%CI: 1.72, 5.54), in rural areas (aOR;2.30, 95%CI:1.4,3.6), in women in unions (aOR;1.60, 95%CI:1.20,2.10), in Northern zone (aOR;9.10, 95%CI: 4.60, 17.80), those who ever heard about FGM had 2.27 times (aOR; 2.27, 95%CI: 0.82, 6.29), those who said FGM required by religion had 8.3 times (aOR; 8.30, 95%CI: 4.30,16.03), those who supported FGM had 5.29 times (aOR; 5.29, 95%CI: 2.69, 10.40) higher odds of reporting having undergone FGM compared to those who said the practice should be stopped. Conversely, lower odds of experiencing FGM was reported in; women with at least secondary education (aOR;0.40, 95%CI:0.20,0.60), those from richest households (aOR;0.40, 95%CI: 0.20, 0.60) and those who said distance to a health facility was not a big problem (aOR;0.70, 95%CI: 0.50, 0.90).

CONCLUSION: Our study found that prevalence of FGM in Tanzania is 8.2%. The factors associated with experiencing FGM included woman’s socio-demographic factors like older age, rural residency, lower or no education, poorest wealth quintile, supporting FGM to continue and being in unions. This calls for collaborative efforts between the government and other stakeholders to design targeted interventions as ending FGM require a multisectoral approach addressing aforementioned determinants across multiple levels including education and wealth creation programs particularly to uneducated and poorest women from rural areas.

PMID:40885968 | DOI:10.1186/s12905-025-03965-z

World J Emerg Surg. 2025 Aug 30;20(1):72. doi: 10.1186/s13017-025-00645-z.

ABSTRACT

BACKGROUND: Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions.

METHODS: This retrospective, multicenter study used 2014-2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7).

PRIMARY OUTCOMES: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events.

RESULTS: Among 9,330 patients (median age 37 (26-54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42-0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62-0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings.

CONCLUSIONS: In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.

PMID:40885959 | DOI:10.1186/s13017-025-00645-z

BMC Public Health. 2025 Aug 30;25(1):2983. doi: 10.1186/s12889-025-24466-6.

ABSTRACT

BACKGROUND: We aimed to comprehensively analyze the impact of both maternal age and birth spacing on adverse maternal and neonatal outcomes.

METHODS: A total of 151,301 pregnancies in China from January 1, 2010, to December 31, 2021 were included, and 8,222 subjects matched their primary and second pregnancy information. Join point regression was used to analyze the temporal trends of adverse outcomes with maternal age and birth spacing.

RESULTS: The mean maternal age at delivery rose from 27.1 years to 28.5 between 2010 and 2021, and the average annual percentage change in advanced maternal age (≥ 35 years) was 1.2%. The optimal childbearing age (with the fewest adverse outcomes) appears to be 27 years. Compared with women aged 27 years, both those aged < 27 years and those aged > 27 years exhibited a significantly higher risk of anemia, low birth weight (LBW), preeclampsia, and preterm birth. In addition, we found that the optimal primiparous childbearing age was 26 years old and birth spacing was 3 years, < 3 years increased the risk of FGR, oligohydramnios, placenta previa, preeclampsia, LBW, preterm birth and premature rupture of membranes (PROM). While birth spacing > 3 years significantly increased the risks of anemia, gestational diabetes mellitus (GDM), placenta previa, preeclampsia, thyroid dysfunction (TD), preterm birth and PROM. The subgroup analysis revealed that the common adverse outcomes increased with longer birth spacing in pregnant women < 26 years, while these adverse outcomes showed lowest prevalence rates at 3-year birth spacing in pregnant women > 26 years.

CONCLUSIONS: The age of childbearing continues to be delayed, and we are in favor of having children at relatively optimal ages and spacing.

PMID:40885958 | DOI:10.1186/s12889-025-24466-6