Tag: statistics

Worldviews Evid Based Nurs. 2025 Dec;22(6):e70082. doi: 10.1111/wvn.70082.

ABSTRACT

INTRODUCTION: Evidence-based practice (EBP) is essential for improving the quality of care and health outcomes in healthcare organizations. This study aimed to analyze the association between the nursing work environment and EBP elements, including attitude, training, implementation and quality of care.

METHODS: A multicenter, cross-sectional study was conducted with 1022 registered nurses from 57 primary care centers and four public hospitals in northern Spain. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess the nursing work environment. Data collection also included the Health Sciences Evidence-Based Practice (HS-EBP) questionnaire to evaluate attitudes toward EBP, and self-reported measures of EBP training, EBP implementation, and overall quality of care. Odds ratios (OR) and 95% confidence intervals for the association between the nursing work environment and EBP elements were calculated using logistic regression adjusted for sociodemographic and occupational characteristics.

RESULTS: Compared to nurses who reported working in unfavorable environments (n = 220; 21.5%), those working in favorable environments (n = 437; 42.8%) exhibited a positive attitude toward EBP (OR = 2.89; 95% CI [2.00, 4.18]), EBP implementation (OR = 2.30; 95% CI [1.52, 3.39]) and higher quality of care (OR = 2.35; 95% CI [1.61, 3.44]). Using a composite measure that considered all EBP elements, favorable environments were associated with overall EBP engagement (OR = 3.47; 95% CI [2.38, 5.07]). The most influential environmental dimensions were adequate staffing and strong nursing foundations.

LINKING EVIDENCE TO ACTION: A favorable nursing work environment was strongly associated with a positive attitude toward EBP, the implementation of EBP, and a commitment to providing high-quality care. Key strategies to promote EBP should involve healthcare and academic institutions working together to establish a healthy work environment with appropriate staffing and care foundations rooted in nursing theory.

PMID:41204679 | DOI:10.1111/wvn.70082

Environ Microbiol Rep. 2025 Dec;17(6):e70232. doi: 10.1111/1758-2229.70232.

ABSTRACT

Our study aims to identify electrogenic bacteria and optimise culture conditions using different commercial and agro-industrial wastes as a sole carbon source. Potential candidates of electrogenic bacteria isolates (EBIs) were screened from anode-developed biofilm in a double-chambered microbial fuel cell (MFC) bioreactor system. Characterisation using cyclic voltammetry (CV) showed that the isolated bacteria had a potential bio-electrochemical property. Statistical techniques were used, including response surface methodology (RSM) with a central composite design (CCD). The highest cell growth, measured by optical density at 600 nm (OD_600nm) (1.1407 ± 0.00316) and cell dry weight (CDW) (0.02135 ± 0.00152 g/L), was obtained when commercial carbon glucose was used. Cost-effective, barley bran formulated media resulted in maximum growth, OD_600nm 1.52167 ± 0.03476 and CDW with 0.01541 ± 0.000071 g/L. The RSM optimised condition achieved a 32.3% fold increase of cell growth yield (OD_600nm) compared to unoptimised conditions. This is the first study to use 16S rRNA gene sequencing from anode biofilm to identify native Enterobacter species. In conclusion, the recently discovered isolate exhibited growth conditions between 18°C and 52°C, pH 3 and pH 11, and resistance to high salt concentrations (0.332 M NaCl). It might therefore be considered a potentially versatile biocatalyst candidate for MFC applications.

PMID:41204673 | DOI:10.1111/1758-2229.70232

Int J Inj Contr Saf Promot. 2025 Nov 7:1-9. doi: 10.1080/17457300.2025.2578794. Online ahead of print.

ABSTRACT

Disproportionately more of the world’s fatalities and injuries on the roads occur in low- and middle-income countries, despite these countries having approximately only 60% of the world’s vehicles. Injury rates due to motor-vehicles are related to a complex multidimensional array of risk factors, embedded in the social and economic infrastructure of a country or region. Whether environmental infrastructure factors differ in determining the risk of an injury for motor vehicle occupants compared to pedestrians and other vulnerable road users has not been extensively studied. We explored the role of environmental infrastructure factors on motor-vehicle-related non-fatal injury using the Prospective Urban and Rural Epidemiology (PURE) cohort study of 162,793 adults from 23 high-, middle- and low-income countries. As expected, low-income countries had slightly higher motor vehicle injury rates, with pedestrians tending to have higher injury rates in these countries. There was considerable variation in motor vehicle injury rates within country-income-categories, while there were similarities in motor vehicle injury rates despite large differences in motorization of countries. There was a meaningful community effect on motor vehicle injury rates. We found that community-level infrastructure risk factors for motor vehicle injuries differed for car occupants and for pedestrians, with road quality and alcohol use being the main factors associated with an injury for car occupants, while poor roadside infrastructure (streetlights, sidewalks) and alcohol use were the main risk factors for an injury as a pedestrian.

Active transport, such as walking and bicycling, are being promoted as leading to healthy lifestyle habits and reduced pollution. These require improved walkability for pedestrians, but also separation from motorized vehicles, which leads to recommending that low-and middle-income countries devote more funds for roadway quality and streetlight infrastructure. Policies to reduce motor vehicle injuries should be supported at the national level, but should be specific at the community level, since they must be focused on the specific local infrastructure. Countermeasures for reducing road transport injuries for pedestrians have different risk factors than for reducing injuries for car occupants.

PMID:41204631 | DOI:10.1080/17457300.2025.2578794

Medicine (Baltimore). 2025 Nov 7;104(45):e45597. doi: 10.1097/MD.0000000000045597.

ABSTRACT

The impact of the coronavirus disease 2019 (COVID-19) pandemic extended beyond direct infection-associated complications to wide-reaching impacts on health system including workflow disruption, enhanced telehealth utilization, labor force changes, and access to procedures. Whilst it is clear that COVID-19 can affect histopathological findings on kidney biopsy, the impact of COVID-19 pandemic on non-COVID-19 kidney disease research remains unclear. This study reviewed kidney biopsy research activity (i.e., patient consent and bio-sample collection), kidney biopsy practice and histopathological findings over the COVID-19 pandemic in an Australian metropolitan health service network of 4 hospitals between 2018 and 2023. All kidney biopsies performed at the Metro North Kidney Health Service between 2018 and 2023 were divided into pre-pandemic (2018-2019), pandemic (2020-2021) and post-pandemic (2022-2023) eras. Demographic data, consent rates, bio-sample collection rates, and procedural complications were retrospectively compared between the 3 eras. Two hundred twenty-nine kidney biopsies were performed in 2018 to 2019, 223 in 2020 to2021 and 213 in 2022 to 2023. Participant consent for research reduced from 70% to 63% between pre-pandemic to pandemic eras but quickly recovered in the post-pandemic era (68%). Bio-sample collection decreased (pre-pandemic: 50%, pandemic: 47%, post-pandemic: 38%) and did not recover in the post-pandemic era indicating the long tail effect on research activities. Although there were changes in service provision (e.g., delay in elective procedures, lockdowns), these measures were not associated with changes in biopsy number, setting, and department over the course of the pandemic. Kidney disease biomarker research activities decreased during the COVID-19 pandemic as demonstrated by reductions in biomarker study consent and sample collection. Strategies to maintain non-pandemic research need to be built into pandemic preparedness plans to preserve the momentum of discoveries which improve clinical outcomes for non-pandemic diseases; discoveries which may well end up being repurposed for pandemic-related conditions (e.g., remdesivir from Ebola research).

PMID:41204614 | DOI:10.1097/MD.0000000000045597

Medicine (Baltimore). 2025 Nov 7;104(45):e45644. doi: 10.1097/MD.0000000000045644.

ABSTRACT

BACKGROUND: At present, laparoscopic cholecystectomy (LC) is the primary treatment for gallstone. Although the application of LC has been widespread in developed countries, the cost-effectiveness of LC in high-altitude, low-resource regions remains unclear.

METHODS: We aimed to determine the cost-effectiveness of LC in the Qinghai Province and to provide a reference for other high-altitude area. We included 124 patients treated from 2018 to 2022 in Qinghai Traffic Hospital. We collected their demographic and clinical information and used the EuroQol Five Dimensions questionnaire to assess their quality of life. We performed cost-effectiveness analysis to evaluate LC and open cholecystectomy (OC). We also performed sensitivity and threshold analyses to determine the robustness of the results.

RESULTS: The OC and LC group demonstrated no significant differences in demographic characteristics. However, the hospital costs, the length of stay and quality-adjusted life years were significantly different between 2 groups (P < .05). The average cost was $1293 for LC and $2480 for OC. When the willingness to pay value is $2328 per quality-adjusted life year, the probability is >0.9, while when the willingness to pay value is $2793 per length of stay, the probability is >0.8.

CONCLUSION: LC is less expensive and more effective than OC from the patient and society perspectives. Although there are some obstacles, it is feasible to promote LC in high-altitude, low-resource areas.

PMID:41204610 | DOI:10.1097/MD.0000000000045644

Medicine (Baltimore). 2025 Nov 7;104(45):e45392. doi: 10.1097/MD.0000000000045392.

ABSTRACT

To evaluate the efficacy and safety of intraoperative optical coherence tomography (iOCT)-guided partial internal limiting membrane (ILM) peeling combined with inferior flap coverage for the treatment of idiopathic macular holes (IMH). This prospective, randomized, controlled clinical trial included patients with Gass stage 4 IMH, aged 50 or older, who had not undergone prior vitreoretinal surgery. Patients were randomized into 2 groups: the experimental group received iOCT-guided partial ILM peeling with inferior flap coverage, and the control group underwent standard ILM peeling. Outcome measures included best-corrected visual acuity, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), multifocal electroretinography, and microperimetry at 2 weeks and 6 months postoperatively. A total of 34 eyes were enrolled, with 18 in the experimental group and 16 in the control group. There was a significant improvement in best-corrected visual acuity and reduction in central foveal thickness in both groups, with no statistically significant differences between groups at any time point. The hole closure rate was also comparable, with 83.3% in the experimental group and 75.0% in the control group at 2 weeks, and 94.4% and 87.5% at 6 months, respectively. Functional outcomes, as measured by OCTA, microperimetry, and multifocal electroretinography, showed significant improvements in both groups without significant intergroup differences. iOCT-guided partial ILM peeling with inferior flap coverage is a feasible and safe surgical approach for IMH, with outcomes not statistically different from the standard ILM peeling technique. The novel technique may offer subtle benefits in preserving retinal structure and function, warranting further investigation.

PMID:41204608 | DOI:10.1097/MD.0000000000045392

Medicine (Baltimore). 2025 Nov 7;104(45):e45157. doi: 10.1097/MD.0000000000045157.

ABSTRACT

BACKGROUND: To evaluate the impact of extracorporeal diaphragm pacing (EDP) therapy on diaphragm function in critically ill patients reliant on mechanical ventilation.

METHODS: Patients were randomly divided into an observation group (39 cases) and a control group (40 cases) using a random number table. Both groups received bedside rehabilitation interventions. Additionally, the observation group underwent EDP therapy 6 times weekly for 2 weeks. Diaphragm activity, diaphragm thickness, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), and Oxygenation Index (OI) were measured at baseline and 2 weeks postenrollment or upon extubation.

RESULTS: Both groups showed significant improvements in diaphragm activity, PaO2, PaCO2, and OI compared to baseline (P <.05). The observation group had significantly better outcomes in diaphragm thickness (0.22 ± 0.03), diaphragm activity (13.96 ± 0.73), PaCO2 (37.59 ± 5.66), and OI (271.10 ± 17.25) compared to the control group (0.20 ± 0.02, 12.24 ± 0.99, 47.25 ± 5.64, 248.60 ± 15.26), with statistical significance (P <.05).

CONCLUSION: EDP therapy offers benefits in improving diaphragm function in critically ill patients on mechanical ventilation. It enhances diaphragm strength and endurance, increases diaphragm activity, improves pulmonary ventilation, and reduces mechanical ventilation duration.

PMID:41204603 | DOI:10.1097/MD.0000000000045157

Medicine (Baltimore). 2025 Nov 7;104(45):e45468. doi: 10.1097/MD.0000000000045468.

ABSTRACT

Diet is an important factor influencing chronic constipation and diarrhea. This investigation proposes to examine the correlation between the Planetary Health Diet Index (PHDI), a new dietary scoring system, and the risk of chronic constipation and diarrhea in the general population. Data on 13,669 adults (≥20 years) were extracted from the 2005 to 2010 National Health and Nutrition Examination Survey. The PHDI was calculated by two 24-hour dietary recall interviews and consisted of scores from 15 food groups with a total score range of 0 to 140. Multivariable logistical regression analyses were employed to examine the correlation between PHDI and chronic constipation/diarrhea, and presented as odds (OR) and 95% confidence interval. Subgroup evaluations were carried out according to population and disease characteristics. The weighted quantile sum analysis was applied to evaluate the effect of total PHDI and its components on chronic constipation. Among these 13,669 participants, 1027 reported chronic constipation, 1061 had chronic diarrhea, and 11,581 maintained normal bowels. The second (63.69-66.67) (OR = 0.73 [0.57-0.92]) and third (>66.67) tertiles (OR = 0.68 [0.54-0.85]) of PHDI were connected to lower odds of chronic constipation versus the first tertile of PHDI (<63.69). No significant correlation was identified between PHDI and chronic diarrhea (P > .05). There was a nonlinear link of PHDI with chronic constipation (Poverall < .001, Pnonlinear < .001), and the risk of chronic constipation in individuals decreased with the increase in PHDI. Subgroup analysis indicated that the connection between PHDI and chronic constipation risk was more obvious in populations aged <65 years, those without diabetes, and those with dyslipidemia (P < .05). The weighted quantile sum analysis demonstrated that the overall mixed exposure effect of PHDI on the risk of chronic constipation was 0.96 (95% confidence interval: 0.94-0.97) (P < .001). Among the contributions of each component to PHDI, “added sugar and fruit juices” contributed the most to the effect of PHDI, followed by “saturated oils and transfat,” while “legumes” and “nuts and seeds” contributed the least. A high PHDI is correlated with a lower risk of chronic constipation in the general population, which may suggest the potential benefits of dietary modification.

PMID:41204594 | DOI:10.1097/MD.0000000000045468

Medicine (Baltimore). 2025 Nov 7;104(45):e45711. doi: 10.1097/MD.0000000000045711.

ABSTRACT

Maternal smoking around birth (MSAB) has been associated with various adverse health outcomes in offspring, including an increased risk of kidney diseases. This study aims to investigate the potential causal relationship between MSAB and the risk of kidney diseases in descendants using Mendelian randomization (MR) methods, providing insights into the epidemiological background of kidney diseases and the application of MR in this context. We conducted a 2-sample MR analysis utilizing publicly available data from large-scale genome-wide association studies on MSAB (n = 397,732), breastfeeding (n = 352,094), and various kidney diseases, including acute kidney injury (AKI) (n = 482,266), chronic kidney injury (n = 482,858), glomerulonephritis (n = 500,348), renal malignancies (n = 463,010), and chronic kidney disease (n = 493,235). We employed multiple MR methods, including inverse variance weighted (IVW), weighted median, weighted mode, and MR Egger regression, to assess the causal effects. We used the odds ratio (OR) as our measure and conducted multivariable MR analysis to account for the confounding effect of breastfeeding. To ensure the reliability and stability of our results, we conducted sensitivity analyses, which included Cochran Q test, MR Egger, and leave-one-out analysis. The MR-IVW results indicated a strong positive causal association between MSAB and the risk of AKI (OR = 11.47, 95% confidence interval [CI]: 2.58-51.02, P-fdr = .008) and renal malignancies (OR = 1.02, 95% CI: 1.01-1.04, P-fdr = .01) in offspring. A potential causal relationship with glomerulonephritis was also observed (OR = 8.63, 95% CI: 1.13-65.88, P-fdr = .08). After adjusting for breastfeeding using multivariable MR, the associations between MSAB and AKI (OR: 13.43, 95% CI: 2.72-66.25, PIVW = .001) as well as renal malignancies (OR: 1.02, 95% CI: 1.01-1.04, PIVW = .005) remained statistically significant. This suggests that maternal smoking during pregnancy significantly increases the risk of AKI and renal malignancies in their children. Our study provides compelling evidence for a causal link between maternal smoking and an increased risk of kidney diseases in offspring, emphasizing the importance of addressing maternal smoking as a modifiable risk factor. Future research should focus on elucidating the underlying biological mechanisms and exploring interventions to mitigate the impact of maternal smoking on offspring health.

PMID:41204590 | DOI:10.1097/MD.0000000000045711

BMC Public Health. 2025 Nov 7;25(1):3834. doi: 10.1186/s12889-025-25111-y.

ABSTRACT

BACKGROUND: Reproductive tract infections (RTIs) remain a major public health concern among women of reproductive age, but limited evidence exists on their association with knowledge, attitudes, and practices (KAP) in university settings. This study examined the prevalence of RTIs and their relationship with KAP and sociodemographic factors among university-affiliated women.

METHODS: A cross-sectional survey was conducted from October 2023 to March 2024 among 457 women aged 18-48 years at a large comprehensive university in Tianjin, China, including students, faculty, administrative staff, and contracted workers. Participants were recruited through stratified convenience sampling and completed a validated 23-item KAP questionnaire, followed by standardized clinical examination and standardized clinical assessment with targeted laboratory testing. Associations between KAP, sociodemographic characteristics, and RTI prevalence were assessed using descriptive statistics and chi-square tests.

RESULTS: The mean KAP score was 50 (SD 14); 34.5% of participants were categorized as low, 46.3% as medium, and 19.0% as high. Overall RTI prevalence was 37.6%, with endometritis (17.7%) and salpingitis (17.2%) most common. Higher KAP levels were inversely associated with RTI prevalence (p < 0.001). Marked gradients were observed by education and expenditure: prevalence was 24.5% among women with a master’s degree or above versus 50.8% among college students, and 70.7% among those with monthly expenditure < 2,000 RMB.

CONCLUSIONS: Institutional affiliation alone did not confer adequate sexual health; persistent occupational and socioeconomic gradients indicate that structural socioeconomic and cultural barriers-rather than educational access per se-drive disparities. Equity-oriented, culturally appropriate, KAP-based interventions and longitudinal evaluation are warranted.

PMID:41204406 | DOI:10.1186/s12889-025-25111-y