Tag: statistics

BMC Med Educ. 2025 Oct 2;25(1):1300. doi: 10.1186/s12909-025-07911-3.

ABSTRACT

BACKGROUND: Simulation-based learning (SBL) is a structured educational method that enables learners to practice clinical, technical, and decision-making skills in a safe, immersive, and controlled environment. It has become a cornerstone of modern medical education.

OBJECTIVE: This study aimed to assess the effect of SBL on the academic performance of medical students at the pediatrics end of the clerkship examination.

METHODS: We analyzed the academic performance of 2,251 fifth-year medical students over 12 academic years, from September 2012 to June 2024, at the end of the pediatric clerkship. The period includes six years before and six years after the integration of simulation-based learning into the pediatric curriculum.

RESULTS: The performance of the students in the three components of the end of the clerkship examination, written, clinical, and continuous assessment, after the utilization of SBL was much better than their performance in the era before the SBL. The difference was statistically significant (p < 0.001).

CONCLUSION: The study highlights the positive impact of incorporating SBL into pediatric education for medical students in Bahrain. These findings support the wider integration of simulation as a teaching strategy across various clinical specialties in medicine and other sciences worldwide. They also highlight its potential to progressively complement and, in some cases, partially replace traditional classroom-based instruction.

PMID:41039502 | DOI:10.1186/s12909-025-07911-3

BMC Med Educ. 2025 Oct 2;25(1):1311. doi: 10.1186/s12909-025-07778-4.

ABSTRACT

INTRODUCTION: Surgical training effectiveness varies significantly worldwide. Understanding the key determinants of trainee confidence and career preference across diverse healthcare systems is crucial for optimizing educational strategies. This study examines surgical training experiences from trainees and surgeons across Kenya, Mali, and China that shape confidence and career preference identifying common associated challenges and potential solutions.

METHODS: An anonymous 38-item questionnaire incorporating multiple response formats was distributed online to surgical trainees and professionals across Kenya, China, and Mali (n = 274) between December 2023 and March 2024. The survey assessed demographics, training duration, working patterns, operative experience, assessment methods, perceived pre-operative mastery, and confidence/preference regarding surgery. Data were analysed using descriptive statistics, univariate tests, binary logistic regression (for confidence), and mixed-effects logistic regression (for preference, accounting for country). This study adheres to CHERRIES guidelines.

RESULTS: Analysis of 274 respondents revealed notable variations in professional composition and working patterns across countries. Only 28.8% reported confidence in performing gastrointestinal surgery independently after training. Multivariate analysis demonstrated that making a specialty decision (OR = 2.00, p = 0.035), experience as primary surgeon (OR = 3.07, p = 0.009), assessment during training (OR = 2.86, p = 0.011), and pre-operative mastery (OR = 3.43, p < 0.001) were key predictors of surgical confidence. Country-specific factors included professional status in Kenya, pre-operative mastery in China, and practical examinations in Mali. Regarding interest in surgery as a career, weekly participation in operations (OR = 1.94, p = 0.031), understanding procedures beforehand (OR = 2.13, p = 0.013), and effective team communication (OR = 2.15, p = 0.030) were significant factors.

CONCLUSION: This multinational survey reveals that surgical training effectiveness is primarily determined by quality factors (pre-operative preparation, hands-on experience, and formal assessment) rather than training duration. Implementation of structured learning approaches emphasizing these elements could substantially improve surgical education, regardless of resource availability or regional differences.

PMID:41039490 | DOI:10.1186/s12909-025-07778-4

JAMA Otolaryngol Head Neck Surg. 2025 Oct 2. doi: 10.1001/jamaoto.2025.2849. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with vestibular schwannoma (VS) commonly present with neurological symptoms such as hearing loss, tinnitus, and dizziness. However, factors associated with dizziness at presentation are not well understood.

OBJECTIVE: To evaluate the baseline features of adults diagnosed with VS associated with subjective dizziness using a validated instrument.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults with radiologically diagnosed VS who completed vestibular testing at Washington University (St Louis, Missouri) between June 2004 and January 2025. Baseline dizziness was measured using the Dizziness Handicap Inventory (DHI).

EXPOSURES: Anxiety associated with a VS diagnosis.

MAIN OUTCOMES AND MEASURES: The primary outcome was severity of dizziness based on DHI score.

RESULTS: A total of 109 patients were included; the mean (SD) age was 61 (14) years, 57 (52%) were female, and 52 (48%) were male. The mean (SD) DHI score was 27 (24) points. Participants with a history of anxiety had a DHI score that was 13.7 points (95% CI, 4.2-23.2 points) higher than those with no such history. For every additional point in severity of anxiety measured using the Generalized Anxiety Disorder-7 (GAD-7) scale, DHI score increased 2.6 points (95% CI, 2.0-3.3 points). After controlling for covariates, for every 1-point increase in GAD-7, DHI score increased by a mean of 1.9 points (95% CI, 1.3-2.6 points). On average, patients with a history of anxiety had a DHI score 10.6 points (95% CI, 2.4-18.7 points) higher than those with no such history.

CONCLUSIONS AND RELEVANCE: This retrospective cohort study suggests a psychological association between anxiety and dizziness might exist among patients with VS that has not previously been explored. Further studies examining this association are needed in this patient population.

PMID:41037309 | DOI:10.1001/jamaoto.2025.2849

JAMA Netw Open. 2025 Oct 1;8(10):e2534968. doi: 10.1001/jamanetworkopen.2025.34968.

ABSTRACT

IMPORTANCE: Patients with metastatic castration-resistant prostate cancer (mCRPC) harboring BRCA1/2 alterations are eligible to receive poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors as single agents or in combination with an androgen receptor pathway inhibitor after these agents showed survival improvement in their landmark clinical trials. However, data are limited regarding the uptake of PARP inhibitors in these patients.

OBJECTIVE: To investigate the use of PARP inhibitors in patients with mCRPC harboring BRCA1/2 alterations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the deidentified Flatiron-Health electronic health record-derived database of US community and academic practices to extract patient-level data. The data cutoff date was May 31, 2024. Patients with mCRPC with evidence of harboring BRCA1/2 alterations and alive after August 15, 2020 (ie, 3 months after the approval of the first PARP inhibitor, rucaparib, in mCRPC) were included. Statistical analysis was performed from September 2024 to May 2025.

EXPOSURES: Age, race and ethnicity, insurance status, and practice type at the time of mCRPC diagnosis.

MAIN OUTCOMES AND MEASURES: The receipt of PARP inhibitors. Multivariable logistic regression was conducted to assess the association between the exposures and the main outcome.

RESULTS: Of 24 105 patients with metastatic prostate cancer, 443 male patients (median [IQR] age, 72 [65-79] years) had mCRPC with BRCA1/2 alterations and were eligible and included in our analysis. Of these patients, 227 (51.2%) received a PARP inhibitor, whereas 216 (48.8%) did not. Compared with patients covered by a commercial health plan, those covered by Medicare were significantly more likely to receive a PARP inhibitor (odds ratio, 1.91; 95% CI, 1.02-3.66; P = .047). The odds of receiving a PARP inhibitor were not significantly higher in patients treated in community practice compared with those treated in academic centers (odds ratio, 1.64; 95% CI, 1.00-2.70; P = .05).

CONCLUSIONS AND RELEVANCE: This retrospective cohort study of patients with mCRPC and evidence of BRCA1/2 alterations found that approximately half of patients did not receive PARP inhibitors despite evidence of survival improvement in this population. These findings highlight the need to increase awareness of the survival data and access to life-prolonging therapies in patients with mCRPC.

PMID:41037269 | DOI:10.1001/jamanetworkopen.2025.34968

JAMA Netw Open. 2025 Oct 1;8(10):e2535004. doi: 10.1001/jamanetworkopen.2025.35004.

ABSTRACT

IMPORTANCE: Understanding secular patterns in body composition and cardiometabolic risk factors (CMRFs) is essential for identifying early-life determinants of cardiovascular health, guiding public health policies, and developing early prevention strategies.

OBJECTIVE: To examine secular patterns in the prevalence of underweight, overweight, obesity, and CMRFs among schoolchildren in Spain from 1992 to 2022.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional study analyzing data from 7 time points over a 30-year period in public primary schools from the Cuenca province in Spain. Participants were children aged 8 to 11 years (fourth to fifth grade) from 7 cohorts studied in 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Data were analyzed from April 2024 to May 2025.

MAIN OUTCOMES AND MEASURES: Prevalence of weight status (underweight, normal weight, overweight, and obesity), lipid parameters, glycemic markers, and resting systolic blood pressure (SBP) and diastolic blood pressure (DBP).

RESULTS: In a total of 4280 participants (mean [SD] age, 9.6 [0.7] years; 2137 [50.0%] girls), patterns in the prevalence of weight status show that increases in obesity appear to have slowed down and plateaued since 2018 (13.4%; 95% CI, 11.5% to 15.5% in 2010; 8.1%; 95% CI, 6.0% to 10.5% in 2018; 10.4% 95% CI, 8.1% to 13.2% in 2022; P < .001). A statistically significant decrease in mean (SD) total cholesterol (184.6 [27.4] to 160.3 [27.4] mg/dL) and low-density lipoprotein cholesterol (113.6 [24.0] to 90.1 [24.0] mg/dL) was observed, which was reflected in a reduction in non-high-density lipoprotein cholesterol (HDL-C) (125.3 [26.2] to 99.8 [26.1] mg/dL) from 1992 to 2022. Mean (SD) serum HDL-C appear to have peaked from 1998 to 2004 (66.2 [13.3] vs 66.9 [13.3] mg/dL, respectively), and its levels have decreased since then (60.5 [13.4] mg/dL in 2022; P < .001). Mean (SD) resting blood pressure showed a substantial decrease over the study period (SBP: 113.5 [9.6] to 101.0 [9.7] mm Hg and DBP: 70.4 [7.2] to 60.7 [7.3] mm Hg; P < .001). However, mean (SD) insulin levels show a significant rise from 2004 to 2022 (6.3 [5.3] to 8.7 [5.2] μIU/mL; P < .001).

CONCLUSIONS AND RELEVANCE: This repeated cross-sectional study provides a picture of the evolution of CMRFs in children over the last 30 years, showing that, in Spain, despite the concerning prevalences of excess weight, lipid parameters and blood pressure have improved over the studied period.

PMID:41037267 | DOI:10.1001/jamanetworkopen.2025.35004

Radiol Phys Technol. 2025 Oct 2. doi: 10.1007/s12194-025-00973-4. Online ahead of print.

ABSTRACT

Automatic exposure control (AEC) in digital radiography adjusts exposure time based on the chosen milliamperage (mA) and the patient’s anatomical characteristics, ensuring the delivery of an appropriate radiation dose for optimal image quality. This study aimed to evaluate the reproducibility of AEC systems in general X-ray machines under various conditions. AEC reproducibility was assessed in two general X-ray machines: the SIEMENS Multix Top and the DRGEM GXR-40S. Both systems offer three sensitivity settings (high, medium, and low). A stack of Thai ten-baht coins, consisting of one and five layers, was used as a test object and placed directly over the AEC sensor. Ten exposures were carried out for repeated measurements. Differences in mAs values and coefficients of variation (CV) were calculated, and statistical analysis was performed using the Mann-Whitney U test. Results showed that mAs values changed in response to tube voltage, sensitivity setting, object thickness, and sensor position; however, these variations remained within acceptable limits. A higher mAs value was observed at lower tube voltages (80-81 kVp), a lower sensitivity setting (D or Slow), and a five-layer coin thickness. No significant differences were observed at higher tube voltage (100 kVp) and higher sensitivity (H or Fast; p > 0.05). In conclusion, AEC reproducibility testing showed mean mAs ranges of 0.51-3.25 with a maximum CV of 2.60% for SIEMENS, and 0.37-1.62 with a maximum CV of 3.37% for DRGEM. Both systems met international standard guidelines, with a CV below 5.00%, as recommended by AAPM Report No. 150, confirming consistent mAs values under various conditions.

PMID:41037241 | DOI:10.1007/s12194-025-00973-4

Phys Eng Sci Med. 2025 Oct 2. doi: 10.1007/s13246-025-01648-5. Online ahead of print.

ABSTRACT

Accurate prediction of surface doses is crucial for clinical outcomes in radiotherapy. Surface dose distribution must be predicted accurately by calculation algorithms in the treatment planning system (TPS). This study aims to compare surface dose calculations from the Eclipse TPS with radiochromic film measurements to evaluate the reliability of these calculation algorithms. Measurements with radiochromic films were performed using 6 MV photon beams. Treatment plans for 3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and volumetric arc therapy (VMAT) were generated on the TPS and calculated using various algorithms. Treatment plans were irradiated on Gafchromic EBT3 films with a PTW head and neck phantom. EBT3 films were compared to calculation algorithms via FilmQA™ Pro (version 7.0) software with multi-channel analysis. Dosimetric evaluations were statistically analyzed. Commercial calculation algorithms underestimated the surface dose in 3DCRT, IMRT, and VMAT treatment plans. For 3DCRT, the underestimations were 8.0% with the AAA algorithm and 8.7% with AXB. In VMAT, the underestimations were 10.2% with AAA and 12.9% with AXB. For IMRT, the underestimations were 6.6% with AAA and 7.3% with AXB. The AAA algorithm closely matched surface dose measurements among calculation methods. The dosimetric results indicate that both AAA and AXB algorithms, as implemented in the Eclipse™ TPS, tend to underestimate surface dose compared to EBT3 film measurements. Accurate knowledge of the dose in the superficial region is crucial to prevent acute skin reactions or to deliver an effective dose to superficial tumors in clinically significant cases. Therefore, our surface dose measurements offer more accurate evaluations, making Gafchromic EBT3 films suitable for such cases.

PMID:41037238 | DOI:10.1007/s13246-025-01648-5

Biol Trace Elem Res. 2025 Oct 2. doi: 10.1007/s12011-025-04825-5. Online ahead of print.

ABSTRACT

Zinc is essential for testicular development, spermatogenesis, sperm protection, and male fertility maintenance. However, existing research on the relationship between zinc and sperm quality parameters shows inconsistent results. This study aimed to evaluate seminal plasma zinc levels and analyze their correlation with sperm parameters. We collected 791 male semen samples, measuring seminal plasma zinc levels via spectrophotometry and assessing the linear relationship between zinc levels and sperm parameters using RCS curves and threshold effect analysis. The results demonstrated an inverted U-shaped association between seminal plasma zinc concentration and both sperm concentration and total sperm count (p for nonlinear < 0.001). When the concentration of zinc in seminal plasma is < 156.54 mg/L, sperm concentration increases with the increase of zinc concentration in seminal plasma (β = 0.19, 95% CI: 0.12-0.26, p < 0.001), but when it is > 156.54 mg/L, although there is no statistically significant difference (β = -0.09, 95% CI: -0.20-0.02, P =0.097), sperm concentration shows a downward trend (β = -0.09, 95% CI: -0.20-0.02, p = 0.097). When the concentration of zinc in seminal plasma reaches 158.13 mg/L, the total sperm count increases significantly (β = 0.71, 95% CI: 0.45-0.96, p < 0.001), but it decreases when it exceeds this level (β = -0.31, 95% CI: -0.73 – 0.11, p = 0.152). Total zinc content demonstrated a positive linear correlation with both sperm concentration and total sperm count (p < 0.001). The findings revealed a nonlinear association between seminal plasma zinc levels and both sperm concentration and total sperm count. Total zinc content exhibited a linear relationship with these seminal parameters. These results highlight the critical need to establish a safe supplementation threshold for seminal plasma zinc.

PMID:41037237 | DOI:10.1007/s12011-025-04825-5

Curr Environ Health Rep. 2025 Oct 2;12(1):35. doi: 10.1007/s40572-025-00502-w.

ABSTRACT

BACKGROUND: In utero and childhood exposure to toxic metals is associated with poor child growth, a predictor of adverse health outcomes. Most existing research focuses on exposure to single metals; the effects of metal mixtures largely remain understudied. Further, few studies consider how diet/nutrients interact with metal mixtures.

OBJECTIVE: To synthesize research on the relationship between in utero and childhood metal mixture exposures, nutritional status-metal exposure interactions, and child anthropometric outcomes.

METHODS: PubMed and Embase were used to search literature published in 2010-2023. Included studies consisted of at least two in utero or childhood toxic metal exposures and examined anthropometric parameters as their main outcomes. Included articles underwent full-text screenings. Information on exposures, findings, nutritional variables, and statistical methods was extracted.

RESULTS: After deduplication and title and abstract screening, 95 publications were included; 70 on prenatal growth and 25 on postnatal growth. Nutritional status/diet was assessed as an effect modifier in 4.3% studies on prenatal and 12% studies on postnatal growth. Birthweight (91.4%), and height and body mass index (64%) were common indicators of prenatal and postnatal growth, respectively. Finally, 41.4% of studies on prenatal and 20% on postnatal growth included statistical models that tested for mixture effects.

CONCLUSION: Although many studies included multiple metals, their mixture effects largely remain untested. Additionally, inclusion of nutritional status/dietary intakes in statistical models is rare, highlighting the need for further research.

PMID:41037236 | DOI:10.1007/s40572-025-00502-w

Eat Weight Disord. 2025 Oct 2;30(1):79. doi: 10.1007/s40519-025-01753-0.

ABSTRACT

PURPOSE: Currently, there is a growing awareness among individuals about health and nutrition. Therefore, it is important to comprehend the factors that influence eating habits and attitudes. This study aims to investigate the potential mediation effect of eating attitudes in the relationship between social media use and well-being, as well as to explore whether the moderating effect of the level of orthorexia nervosa influences this relationship.

METHODS: The sample consisted of 599 adults (M_age = 29.82, SD = 9.39; 68% female) from Turkey and Northern Cyprus. Participants were recruited via convenience sampling through university networks, reflecting a culturally diverse context rooted in Mediterranean and Middle Eastern dietary norms. The study used the Social Media Usage Purposes, Eating Attitudes Test Short Form, Orthorexia nervosa Questionnaire-11, and the WHO-Five Well-being Index. A cross-sectional design was employed, and data were analysed using Hayes’ Process Macro (Model 58) to test for moderated mediation.

RESULTS: The study found that eating attitudes played a partial mediating role in the relationship between social media use and well-being among adults. Social media use positively predicted eating attitudes (β = .83, p < .001) and well-being (β = 1.05, p < .05), and eating attitudes significantly predicted well-being (β = .94, p < .001). Also, orthorexia nervosa moderated the mediating effect of eating attitudes in the relationship between social media use and well-being. Interestingly, the moderating effect was stronger among individuals with low levels of orthorexia nervosa, contrary to initial expectations.

CONCLUSIONS: The current study suggests that eating attitudes are a key behavioral mechanism linking social media use and well-being, and this pathway is influenced by individuals’ orthorexia nervosa tendencies. These findings could aid in the development of interventions for eating disorders at both clinical and social levels and guide individuals towards healthier lifestyles. Importantly, while orthorexia nervosa moderated the indirect relationship between social media use and well-being, the study did not find a direct association between orthorexia nervosa and social media use.

LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies.

PMID:41037224 | DOI:10.1007/s40519-025-01753-0