Category: Nevin Manimala

Acad Med. 2026 Feb 18:wvag045. doi: 10.1093/acamed/wvag045. Online ahead of print.

ABSTRACT

PURPOSE: The gender composition of the physician workforce in the United States (US) is constantly evolving. This study aimed to determine how female physician representation has changed from 2014-2024 with attention to geographic and temporal trends.

METHOD: Data were obtained on US physicians from the Centers for Medicare and Medicaid Services (CMS) Doctors and Clinicians national downloadable file (2014-2024). Pediatricians were excluded due to Medicare data limitations. Gender diversity was quantified using the Gender Diversity Index (GDI), a metric that relates to the likelihood that two randomly selected providers in a given area are of different genders. Local Indicators of Spatial Association (LISA) mapping of counties identified statistically significant areas with higher and lower GDIs than average.

RESULTS: Female physician representation across the US rose in 2014 from 159,850 (28.7%) to 224,377 (34.9%) in 2024, and the mean GDI per state rose from 79.4 in 2014 to 88.7 in 2024 (P <.001). Female physician representation increased from 2014 to 2024 in urban areas from 142,354 (29.7%) to 198,667 (36.3%) and in rural areas from 17,496 (22.5%) to 25,710 (26.7%). Clustering revealed GDI “hotspots” primarily in the Northeast, West Coast, and other urban hubs, with “coldspots” concentrated in the Midwest and South.

CONCLUSIONS: Although there have been broad increases in female representation in many regions throughout the US, variations persist across specialties, geographic regions, and degrees of rurality that underscore the complexity of achieving gender balanced representation. Initiatives focused on recruiting and retaining female physicians should target the regions highlighted by this analysis.

PMID:41707238 | DOI:10.1093/acamed/wvag045

Acad Med. 2026 Feb 18:wvag034. doi: 10.1093/acamed/wvag034. Online ahead of print.

ABSTRACT

PROBLEM: Development of foundational scholarship and research skills is a core competency that resident physicians must achieve. Evaluating trainee progress in scholarly activities is challenging due to a lack of evidence-informed assessment tools, and residency programs struggle to engage learners in these activities. In 2019, the University of Alberta (UofA) Physical Medicine and Rehabilitation residency program developed a new Research In Training Evaluation Report (R-ITER) to improve resident engagement in scholarly work and assessment of scholarly competencies. The development, implementation and utility of this innovative tool is described.

APPROACH: A sequential mixed methods approach was employed beginning with a qualitative analysis of program documents outlining the context and need for R-ITER creation, followed by a survey of R-ITER users to evaluate the tool’s utility. Thematic analysis of documents and survey comments identified the impetus for the innovation and interest-holder experiences using the new tool. Descriptive statistics summarized user experiences. Thematic analysis generated insights driving the development and implementation of the R-ITER: inadequate support and direction for research projects, limited research time, residents’ research knowledge gaps, and unclear research opportunities.

OUTCOMES: Survey respondents included 9/22 residents (40.9%) and 2/11 supervisors (18.2%). Participants found the R-ITER easy to access, well-organized, and effective for tracking progress. However, participants were unclear regarding the frequency at which the R-ITER should be used to assess progress. Following R-ITER implementation, 10/16 (62.5%) resident physicians who graduated between 2021-2025 have published 12 peer-reviewed papers representing projects initiated and completed during residency training. The R-ITER provides an effective, accessible, and well-structured innovation for assessing resident research performance.

NEXT STEPS: Future steps include gathering more research supervisor feedback, including explicit expectations pertaining to its use and completion, utilizing the R-ITER to implement additional research programs, and exploring the use of the R-ITER in other residency programs nationally or internationally.

PMID:41707228 | DOI:10.1093/acamed/wvag034

Traffic Inj Prev. 2026 Feb 18:1-10. doi: 10.1080/15389588.2026.2617455. Online ahead of print.

ABSTRACT

OBJECTIVE: The proportion of older drivers has increased with the aging population. In order to solve the problem of high accident tendency at unsignalized intersections caused by improper driving behavior of older drivers (OD-ER), this study analyzed turning behavior differences between OD-ERs and young and middle-aged drivers (YM-ERs), and then a petri net was used to describe the change in the behavior characteristics of two driver groups. The shortcoming of OD-ER’s behavior can be found through the information transfer model, thereby improving driving safety.

METHODS: Virtual scenarios of unsignalized intersections were built for drivers who were recruited from the general population for the study. Data on vehicle operation, driver visual behavior and physiological information were collected and analyzed. A petri net was applied to construct an information transfer model of turning behavior for two driver groups.

RESULTS: YM-ERs performed better than OD-ERs in three types of data. The most significant difference was observed in the vehicle operation data, for which all examined metrics showed statistically significant differences (p < 0.05). The information transfer model indicated that the primary limitation for OD-ERs is saccade behavior, which introduced additional transmission delays and constrained information flow compared with YM-ERs, particularly during left turning scenarios.

CONCLUSION: OD-ERs exhibit weaker turning ability than YM-ERs in terms of vehicle operation, information processing and judgment. Driver’s turning behavior characteristic can be described from the turning information transfer model and then evaluate the driving quality, OD-ERs can identify their areas of focus from the graph for training and improvement of driving safety. It can be used for the application of improvement face to the older driver when they enter into the unsignalized intersection.

PMID:41707221 | DOI:10.1080/15389588.2026.2617455

Traffic Inj Prev. 2026 Feb 18:1-11. doi: 10.1080/15389588.2026.2616385. Online ahead of print.

ABSTRACT

OBJECTIVE: On April 1, 2024, cannabis was partially legalized in Germany, accompanied by an increase in the statutory Δ9-tetrahydrocannabinol (THC) threshold for administrative traffic offenses from 1.0 to 3.5 ng THC/mL serum in August 2024. A key legislative objective was to protect frequent cannabis users who separate consumption from driving but still display THC levels exceeding 1.0 ng/mL from disproportionate sanctions. The law mandates a statistical evaluation of its impact after three years. Since no national statistics differentiate substance-impaired driving offenses by a specific drug class, we analyzed all traffic-related blood samples containing THC or THC-carboxylic acid detected in our laboratory over four years.

METHODS: Included were cases from three federal states between April 1, 2021, and March 31, 2025, submitted for toxicological analysis with the legal context of administrative (§24 German Road Traffic Act) or criminal offenses (§316/§315c German Criminal Code). We examined case frequencies, age distributions, co-use of other substances, time intervals between incident and blood collection, consumption patterns, THC and THC-carboxylic acid concentrations, and frequencies of sanctions and driving errors.

RESULTS: Among 48,058 total cases, 83% were administrative and 17% criminal offenses. 46% of drivers were aged 21-30 years; the proportion of those below 21 years decreased from 18.2% to 13.3%. In administrative offenses, THC alone was detected in 74% of cases, compared to only 30% in criminal cases. The time from incident to blood sampling was under 1.5 h in 82% of cases. Based on THC-carboxylic acid concentrations, four consumption categories were established: occasional, regular, repeated and chronic. The distribution across these groups was 47%, 22%, 19%, and 11%, respectively and median THC concentrations were 1.3, 4.5, 8.4, and 14.9 ng/mL serum. Remarkably, median THC levels in administrative and criminal offenses were identical: 3.44 ng/mL serum. Across individual years, the highest THC medians in serum occurred in the year following legalization (3.95 and 3.97 ng/mL). Applying the new 3.5 ng/mL limit to our case cohort would exempt 899 frequent and 11,855 occasional users with serum THC levels between 1.0 and < 3.5 ng/mL from sanctions.

CONCLUSION: Our data indicate a modest upward shift in THC concentrations, continuing beyond April 2024, alongside a demographic shift toward older drivers. The nearly identical THC medians between drivers with and without conspicuous driving performance challenge the validity of the new threshold. Notably, almost half of the unimpaired drivers exceeded 3.5 ng/mL, whereas half of the impaired drivers remained below it. 7.4% of the frequent users benefited from the raised threshold, while at the same time 58.3% of occasional users-whose driving ability at THC concentrations between 1 and <3.5 ng/mL may be compromised-fell out of legal sanction. While substantial doubt remains if the initial goal was achieved, the question of an appropriate THC threshold remains unresolved and calls for alternative legal approaches.

PMID:41707218 | DOI:10.1080/15389588.2026.2616385

Surg Laparosc Endosc Percutan Tech. 2026 Feb 4. doi: 10.1097/SLE.0000000000001447. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of preoperative nasopancreatic duct stent placement on local resection of benign pancreatic tumors, particularly its efficacy in reducing secondary surgeries due to postoperative pancreatic fistula.

METHODS: The clinical data of 306 patients with benign pancreatic tumors larger than 2 cm who underwent local resection at the Department of Pancreatic Surgery, Hubei Provincial People’s Hospital, over the past 6 years were retrospectively analyzed. Propensity score matching was used to minimize the selection bias.

RESULTS: The incidence of grade C pancreatic fistula in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 20% (32/160) observed in the non-nasopancreatic duct placement group, with a statistically significant difference (Fisher exact test, P=0.02). In addition, the rate of secondary surgery in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 16% (29/160) in the non-nasopancreatic duct placement group (Fisher exact test, P=0.04). However, there was no significant difference in the incidence of postoperative complications such as septic shock, overall pancreatic fistula, and postoperative mortality between the 2 groups.

CONCLUSION: Preoperative nasopancreatic duct stent placement is a safe and effective procedure that significantly reduces the incidence of grade C pancreatic fistula following surgery for benign pancreatic tumors. Consequently, this decreases the necessity for secondary interventions related to grade C pancreatic fistula, ultimately enhancing patient prognosis and quality of life.

PMID:41707215 | DOI:10.1097/SLE.0000000000001447

JMIR Public Health Surveill. 2026 Feb 18;12:e79720. doi: 10.2196/79720.

ABSTRACT

BACKGROUND: The growing use of artificial intelligence (AI) chatbots for seeking health-related information is concerning, as they were not originally developed for delivering medical guidance. The quality of AI chatbots’ responses relies heavily on their training data and is often limited in medical contexts due to their lack of specific training data in medical literature. Findings on the quality of AI chatbot responses related to health are mixed. Some studies showed the quality surpassed physicians’ responses, while others revealed occasional major errors and low readability. This study addresses a critical gap by examining the performance of various AI chatbots in a complex, misinformation-rich environment.

OBJECTIVE: This study examined AI chatbots’ responses to human papillomavirus (HPV)-related questions by analyzing structure, linguistic features, information accuracy and currency, and vaccination stance.

METHODS: We conducted a qualitative content analysis following the approach outlined by Schreier to examine 4 selected AI chatbots’ (ChatGPT 4, Claude 3.7 Sonnet, DeepSeek V3, and Docus [General AI Doctor]) responses to HPV vaccine questions. These questions, simulated by young adults, were adapted from items on the Vaccine Conspiracy Beliefs Scale and Google Trends. The selection criteria for AI chatbots included popularity, accessibility, countries of origin, response update methods, and intended use. Two researchers, simulating a 22-year-old man or woman, collected 8 conversations between February 22 and 28, 2025. We used a deductive approach to develop initial code groups, then an inductive approach to generate codes. The responses were analyzed based on a comprehensive codebook, with codes examining response structure, linguistic features, information accuracy and currency, and vaccination stance. We also assessed readability using the Flesch-Kincaid Grade Level and Reading Ease Score.

RESULTS: All AI chatbots cited evidence-based sources from reputable health organizations. We found no fabricated information or inaccuracies in numerical data. For complex questions, all AI chatbots appropriately deferred to health care professionals’ suggestions. All AI chatbots maintained a neutral or provaccine stance, corresponding with scientific consensus. The mean and range of response lengths varied [word count; ChatGPT: 436.4 (218-954); Claude: 188.0 (138-255); DeepSeek: 510.0 (325-735); and Docus: 159.4 (61-200)], as did readability [Flesch-Kincaid Grade Level; ChatGPT: 10.7 (6.0-14.9); Claude: 13.2 (7.7-17.8); DeepSeek: 11.3 (7.0-14.7); and Docus: 12.2 (8.9-15.5); and Flesch-Kincaid Reading Ease Score; ChatGPT: 46.8 (25.4-72.2); Claude: 32.5 (6.3-67.3); DeepSeek: 43.7 (22.8-67.4); and Docus: 40.5 (19.6-58.2)]. ChatGPT and Claude offered personalized responses, while DeepSeek and Docus lacked this. Occasionally, some responses included broken or irrelevant links and medical jargon.

CONCLUSIONS: Amidst an online environment saturated with misinformation, AI chatbots have the potential to serve as an alternative source of accurate HPV-related information to conventional online platforms (websites and social media). Improvements in readability, personalization, and link accuracy are still needed. Furthermore, we recommend that users treat AI chatbots as complements, not replacements, to health care professionals’ guidance on clinical settings.

PMID:41707197 | DOI:10.2196/79720

JMIR Mhealth Uhealth. 2026 Feb 18;14:e81779. doi: 10.2196/81779.

ABSTRACT

BACKGROUND: Goal personalization features integrated into mobile health apps have the potential to enhance physical activity, as some evidence shows that the personalized goals generated by algorithms are more effective than default or fixed goals. However, it remains unclear whether goals set by users are more effective than fixed goals and which personalization strategy is more effective for different user segments.

OBJECTIVE: This field study aimed to evaluate (1) the efficacy of 2 step goal personalization strategies-personalized-by-you and personalized-by-the-algorithm-and (2) which strategy is more effective among users with different activity levels.

METHODS: All users of SamenGezond, a Dutch mobile health app, have a default goal of 2000 steps per day, 5 days a week. For this study, 2 random groups were selected, totaling 5800 users. Subsequently, an email was sent to 3800 users in group 1, asking whether they were satisfied with their current goal. Those who were not satisfied were offered 2 personalization options: to set a goal themselves or to have the algorithm integrated in the app set goals for them. In total, 1399 users responded: 230 chose to set their own goals (personalized-by-you group), 236 opted for setting the goal by the algorithm (personalized-by-the-algorithm group), and 933 chose to keep the default goal (not-changed group). The algorithm used a moving-window percentile rank method based on step data from the previous 4 weeks. Users who did not personalize retained the default goal. The remaining 2000 users in group 2 did not receive the email and also retained the default goal. To evaluate the effectiveness of step goal personalization strategies, we used propensity score matching and difference-in-difference analysis.

RESULTS: Users in the personalized-by-you group increased weekly step count by 3793 a week, while those in the personalized-by-the-algorithm group increased by 4315 steps a week, compared with the not-changed group (users with default goals). The 2 strategies appear to have a similar effect. Interestingly, users in the not-changed group also increased their weekly steps by 1759. Furthermore, the effectiveness of each strategy varied by baseline activity level. The personalized-by-you strategy was effective for medium- (increase of 5842 steps) and high-active users (increase of 4266 steps) but not for low-active users (increase of 384 steps; P=.82). Conversely, the personalized-by-the-algorithm strategy was effective for low- (increase of 5095 steps) and medium-active users (increase of 5278 steps) but not for high-active users (increase of 1446 steps; P=.51).

CONCLUSIONS: Step goal personalization demonstrates short-term effectiveness. However, their impact varies by users’ baseline activity levels, indicating the need for a tailored approach for different user segments. Future studies should examine the long-term effects of such interventions to design sustainable health behavior change strategies.

PMID:41707195 | DOI:10.2196/81779

JMIR Res Protoc. 2026 Feb 18;15:e84610. doi: 10.2196/84610.

ABSTRACT

BACKGROUND: HIV/AIDS is a disease associated with stigma and discrimination. This can hinder the adoption of preventive and treatment methods, especially in vulnerable populations, such as the transgender community.

OBJECTIVE: The primary objectives of this study are to explore awareness barriers related to HIV/AIDS, develop and pilot a mobile-based HIV awareness app, and evaluate its acceptability and usability within the transgender community.

METHODS: The research will employ a quasi-experimental design, utilizing a pre- and posttest comparison between an intervention group that will use the mobile app and a comparison group that will not. Phase 1 involves a situational analysis, including key informant interviews, focus group discussions, and a cross-sectional survey. An app will be designed and developed in Phase 2. Phase 3 will comprise a preintervention assessment recruiting 150 transgender people, implementation of the app on the cell phones of 75 transgender people, and a postapp assessment. Statistical techniques will be employed to analyze the captured data and assess the effectiveness of the app.

RESULTS: The recruitment began on August 25, 2025, for the first phase, with the subsequent phases to follow. The data collection and analysis will be completed and finalized by August 31, 2026, following the intervention deployment. No funding was received from any external source for this study.

CONCLUSIONS: The results of this study will reveal the effectiveness of a mobile app for the transgender community. These results will determine the continuation and further scale-up of this intervention. The findings will create evidence to inform favorable strategies for vulnerable populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/84610.

PMID:41707188 | DOI:10.2196/84610

JMIR Hum Factors. 2026 Feb 18;13:e85412. doi: 10.2196/85412.

ABSTRACT

BACKGROUND: Although fitness apps could promote healthier lifestyles, evidence on the effectiveness of app-based interventions remains inconsistent. Previous studies have used affordance theory to identify the factors that generate exercise-related value for users. However, many fitness app affordance studies have examined multiple fitness apps collectively, assuming similar design intentions across platforms. Moreover, most have relied on predefined affordances rather than investigating emergent or novel ones that may reveal unique user-fitness app interactions.

OBJECTIVE: This study aimed to identify the common affordances actualized by Fitbit users and uncover novel affordances that emerge from their interactions with this specific app, thereby extending the understanding of how affordances contribute to user engagement and health outcomes.

METHODS: We used a 2-stage mixed methods design. First, a cross-sectional web-based survey was conducted with 442 US-based Fitbit users engaging in regular exercise. The participants selected affordances from a list identified in prior literature and could report additional affordances in open-text responses. To corroborate and extend the survey findings, 15,000 user reviews were collected from the Google Play Store, of which 2674 (17.8%) comments were automatically categorized into affordance themes and 1182 (7.9%) were manually validated as relevant. Reviews were thematically classified into affordance categories via a generative pretrained transformer-based approach guided by survey-identified affordances.

RESULTS: The survey revealed that the most frequently actualized affordances were updating (351 participants and 749 review mentions; total=1100) and reminding (319 participants and 143 mentions; total=462), underscoring Fitbit’s role in tracking progress and sustaining routines. Competing (99 participants and 88 mentions; total=187) and rewards (133 participants and 32 mentions; total=165) highlighted gamification, whereas comparing (151 participants and 8 mentions; total=159) and guidance (118 participants and 25 mentions; total=143) reflected benchmarking and instructional support. Other affordances such as searching (135 participants and 2 mentions; total=137), encouraging (75 participants and 19 mentions; total=94), and watching others (68 participants and 3 mentions; total=71) were less common, whereas recognizing (58 participants and 0 mentions; total=58) and self-presentation (47 participants and 1 mention; total=50) were the least common. The novel affordances included encouraging others (14 participants and 1 mention; total=15), accountability (3 participants and 9 mentions; total=12), and self-comparison (3 participants and 5 mentions; total=8).

CONCLUSIONS: Most Fitbit users actualized updating and reminding affordances, whereas a limited number of users actualized the other affordances. Moreover, few Fitbit users actualized novel affordances that reflect self-regulation, an extension of social connection, and personal meaning. This study emphasizes that Fitbit should focus on core tracking and reminding for most users while providing optional features that foster guidance, community, accountability, and personal relevance. Designing features that facilitate the actualization of common and novel affordances may improve app effectiveness and, ultimately, the health benefits of fitness technologies.

PMID:41707184 | DOI:10.2196/85412

JMIR Hum Factors. 2026 Feb 18;13:e70370. doi: 10.2196/70370.

ABSTRACT

BACKGROUND: Antenatal care has been crucial in reducing maternal mortality. Currently, screening programs of pregnant women include blood pressure (BP) measurements, urine protein tests, and the identification of risk factors. Home monitoring can enhance the early detection and management of pregnancy-related hypertension, while also empowering women to take an active role in their own health care.

OBJECTIVE: This study aimed to evaluate the reliability and accuracy of contactless BP monitoring using the Anura smartphone app and to compare it to conventional manual cuff measurements. This was done in normotensive and high-risk pregnancies, as well as in women diagnosed with preeclampsia. A secondary objective was to assess women’s experience using the Anura app.

METHODS: Pregnant women with normotensive or high-risk pregnancies were enrolled from pregnancy weeks 8-14, and women with preeclampsia were enrolled at the time of diagnosis. The 3 study groups consisted of 132 women with normotensive pregnancies, 40 women with high-risk pregnancies, and 87 women with preeclampsia. They were instructed to use the Anura smartphone app and perform a 30-second facial scan, alongside manual BP measurements, throughout pregnancy. Differences between the 2 methods were analyzed with linear mixed models accounting for repeated measures, reporting beta coefficients with 95% CIs, stratified by patient group and trimester. Outliers were detected visually in the Bland-Altman plots. A digital survey was answered in the Anura app at gestational weeks 37-39, about their experiences using the Anura app.

RESULTS: A total of 4932 BP measurements were recorded with Anura, of which 539 had corresponding manual measurements. In normotensive pregnancies, Anura consistently showed slightly higher diastolic values (approximately 5-7 mm Hg) and lower systolic values, with significant differences in the second and third trimesters. In high-risk pregnancies, both the systolic and diastolic BP were generally lower with Anura, especially in the second and third trimesters, while women with preeclampsia showed the largest differences, with Anura clearly showing lower systolic and diastolic values. Bland-Altman analyses confirmed these patterns and showed increasing variability and wider limits of agreement in the high-risk pregnancies with preeclampsia. Of 172 women with normotensive and high-risk pregnancies, 56 (32.5%) evaluated their experiences that were predominantly positive, with high perceived safety, better control, and a feeling of increased responsibility for their own health. Some experienced the measurement as somewhat uncomfortable.

CONCLUSIONS: The Anura app is well accepted by pregnant women and supported them to take an active role in their own health care. Agreement with manual BP measurements was acceptable in normotensive pregnancies but lower in high-risk and preeclamptic pregnancies. These findings indicate potential for Anura as a complementary self-monitoring tool. Further development is needed to improve the app’s accuracy in high-risk groups before broader implementation can be recommended.

PMID:41707183 | DOI:10.2196/70370