Category: Statistics

JMIR Form Res. 2026 Jul 3;10:e95867. doi: 10.2196/95867.

ABSTRACT

BACKGROUND: In recent years, artificial intelligence (AI) has ushered in a promising era in medicine, particularly in medical education. However, studies assessing the knowledge, attitudes, and practices related to AI among medical students in Vietnam remain limited.

OBJECTIVE: This study aimed to evaluate AI knowledge, attitudes, and practices among Vietnamese medical students in learning and research, and to identify factors associated with their AI practices.

METHODS: A cross-sectional study was conducted among medical students at Thai Binh University of Medicine and Pharmacy from November to December 2025. Data were collected using an online structured questionnaire covering demographic characteristics and AI knowledge, attitudes, and practices. The main outcome of interest was AI practices in learning and research. Descriptive statistics and multivariable linear regression were used to examine associated factors. Regression coefficients (β), 95% CIs, and P values are reported.

RESULTS: A total of 1002 medical students (mean age 21.00, IQR 19.00-23.00 years; n=596, 59.5% female) were included. The median percentage of maximum possible (POMP) score of AI knowledge was 66.67 (IQR 33.33-83.33), with a high level of familiarity with common tools (n=798, 79.6%). AI attitudes were generally positive (median POMP score 70.00, IQR 53.33-76.67). AI-related practices were lower (median POMP score 50.00, IQR 46.88-71.88), with AI being used primarily for information retrieval and literature research support. In the multivariable analysis, knowledge POMP score (β=0.12, 95% CI 0.08-0.16) and attitudes POMP score (β=0.42, 95% CI 0.34-0.51) were significantly associated with AI practices POMP score (P<.001). Age, gender, major, grade point average classification, and having participated in an AI seminar or training were not associated with AI practices.

CONCLUSIONS: Medical students showed favorable knowledge and positive attitudes, but their AI practices remained limited. Integrating AI into medical curricula, including fundamentals, applications, and ethical aspects, is essential to prepare future physicians for AI-driven health care.

PMID:42397674 | DOI:10.2196/95867

Curr Psychiatry Rep. 2026 Jul 3;28(1):46. doi: 10.1007/s11920-026-01697-x.

ABSTRACT

PURPOSE OF REVIEW: The Far East is highly vulnerable to natural disasters and mass trauma, underscoring the critical need for child and adolescent psychiatrists (CAPs) equipped to deliver disaster mental health care. To understand regional capacity and preparedness, we conducted the third wave of a 12-year longitudinal survey tracking CAP postgraduate training systems and workforce trends in the Far East.

RECENT FINDINGS: In 2024, representatives from 16 of 17 countries and functionally self-governing areas completed a standardized online questionnaire. Data regarding CAP training structures, specialty recognition, and workforce size were descriptively compared with previous survey waves (2012 and 2017). The CAP workforce has steadily increased, with new specialists emerging in Cambodia, Mongolia, and Myanmar. By 2024, 75% (12/16) of regions offered postgraduate CAP training-up from 59% in 2017-and recognition of CAP as a distinct specialty increased to 75%. Curricula have diversified, frequently integrating school consultation (83%) and forensic psychiatry (58%). However, national guidelines, board certification (44%), and institutional support remain highly uneven across the region. While CAP training in the Far East has significantly expanded, persistent workforce disparities limit the region’s ability to deploy skilled specialists during humanitarian emergencies. Strengthening CAP training systems is an essential public health measure to fortify regional resilience and address child and family disaster psychiatry needs.

PMID:42397655 | DOI:10.1007/s11920-026-01697-x

Int J Implant Dent. 2026 Jul 3. doi: 10.1186/s40729-026-00700-7. Online ahead of print.

ABSTRACT

PURPOSE: Zygomatic implants (ZIs) are indicated for severely atrophic maxillae where conventional implant (CI) placement is difficult. Although ZIs show favourable outcomes, factors influencing their survival remain unclear. This retrospective study evaluated implant- and patient-related factors associated with ZI survival in full-arch immediate-loading rehabilitation using the all-on-four concept combining ZIs and CIs.

METHODS: A total of 923 implants (323 ZIs and 600 CIs) placed in 203 patients between 2010 and 2021 were analysed. Cumulative survival rates were estimated using the Kaplan-Meier method, and intergroup comparisons were performed using the log-rank test. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs). Statistical significance was set at p < 0.05.

RESULTS: Cumulative survival rates at 3-13 years were 94.5% and 95.9% at the patient and implant levels, respectively, for ZIs, and 97.9% and 98.7%, respectively, for CIs. ZIs showed significantly lower implant-level survival than CIs (p = 0.0178). Palatal positioning of the ZI platform was significantly associated with reduced implant-level survival (HR = 18.177, 95% CI: 1.418-233.053, p = 0.026). Systemic disease was significantly associated with reduced patient-level ZI survival after adjustment for sex and smoking status (HR = 14.872, 95% CI: 1.812-122.077, p = 0.012).

CONCLUSIONS: Immediate full-arch rehabilitation combining ZIs and CIs achieved high long-term survival; however, palatal platform positioning and systemic disease were associated with ZI failure.

PMID:42397653 | DOI:10.1186/s40729-026-00700-7

Discov Oncol. 2026 Jul 3. doi: 10.1007/s12672-026-05485-0. Online ahead of print.

ABSTRACT

OBJECTIVE: Uric acid (UA) is the end product of purine metabolism. Numerous studies have reported an association between serum UA levels and the risk of several solid tumors, but its association with gastric cancer (GC) remains controversial. This study aims to explore the relationship between serum uric acid (SUA) and GC, to inform GC prevention and treatment strategies.

METHOD: Literature searches were conducted in PubMed, Embase, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI). Mean differences (MD) with 95% confidence intervals (95% CI) were calculated using fixed or random effects models. Subgroup analysis was performed to explore heterogeneity sources. Additionally, bioinformatics analyses were carried out using publicly available datasets from the Gene Expression Omnibus (GEO), STRING, and DAVID databases to identify shared molecular pathways.

OUTCOME: Six studies met the inclusion criteria. Meta-analysis revealed significantly higher SUA levels in GC patients compared to controls (pooled MD: 48.74; 95% CI 35.23-62.25; P < 0.00001; pooled SMD: 1.52, 95% CI 0.69-2.34), with extreme high heterogeneity was observed (I² = 89%, P < 0.00001; I² = 98%, P < 0.00001). Subgroup analysis based on control types presented numerical differences in pooled MD values between healthy control group (MD: 55.73; 95% CI 51.29-60.17; P = 0.33) and non-healthy control group (MD: 27.82; 95% CI – 7.87-63.51; P = 0.0006), while no statistically significant difference was detected in the healthy control subgroup. No publication bias was detected (P = 0.175). Bioinformatics analysis identified 188 overlapping differentially expressed genes (DEGs) between hyperuricemia and GC. Protein-protein interaction (PPI) network analysis highlighted IL6, TNF, and CXCL8 as central hub genes. Functional enrichment analysis showed enrichment trends in inflammatory pathways such as the IL-17 signaling axis, as well as interactions between viral proteins and cytokine receptors. These enrichment results provide preliminary bioinformatic clues that the correlation between SUA and GC may be associated with inflammatory response, immune microenvironment alteration and gastric mucosal barrier-related biological processes.

CONCLUSION: Our findings suggest a possible correlation between elevated SUA levels and GC, with a more obvious numerical trend in studies adopting healthy population controls. Elevated SUA may correlate with GC, especially in studies using healthy controls. Inflammation and immune dysregulation pathways likely underlie this association. SUA shows preliminary potential as a GC-related biomarker, though clinical use is unconfirmed. Large-sample prospective studies and basic experiments are needed to verify the correlation and mechanisms.

PMID:42397651 | DOI:10.1007/s12672-026-05485-0

Psychiatr Q. 2026 Jul 3. doi: 10.1007/s11126-026-10297-0. Online ahead of print.

ABSTRACT

The February 2023 earthquakes in Turkey exposed frontline resident physicians to personal trauma, occupational stress, and the psychological burden of caring for traumatized survivors. This study aimed to evaluate post-traumatic stress disorder (PTSD) symptoms, post-traumatic growth (PTG), and associated factors among resident physicians in Turkey after the earthquakes. A cross-sectional study was conducted using an online survey administered to resident physicians at the Faculty of Medicine of XXX University between October and November 2023. The survey consisted of sociodemographic characteristics, earthquake-related exposure variables, the PTSD Checklist for DSM-5 (PCL-5), and the PTG Inventory. A total of 157 physicians participated, with a mean age of 29.6 ± 4.25 years and 7.6% reported receiving psychological treatment after the disaster. The mean PCL-5 score was 33.8 ± 18.4, with 23.6% meeting criteria for probable PTSD. The mean PTG score was 46.2 ± 26.9. A moderate positive correlation was observed between PTSD and PTG (r = 0.439, p < 0.001). In bivariate analysis, only religiosity showed a statistically significant association with PTSD (χ²(2) = 6.547, p = 0.038), with the highest prevalence among moderately religious physicians (31.0%). In the multivariable model, no independent predictor was significantly associated with PTSD symptoms. Higher PTG scores were independently associated with male gender (B = 8.55, 95% CI: 0.27-16.82, p = 0.043), greater religiosity (B = 7.90, 95% CI: 1.70-14.10, p = 0.013), and previous trauma experience (B = 10.48, 95% CI: 1.43-19.53, p = 0.024). After the earthquakes, physicians demonstrated moderate levels of PTG, and approximately one-quarter exhibited PTSD symptoms, highlighting the need for ongoing mental health monitoring and accessible psychological support.

PMID:42397616 | DOI:10.1007/s11126-026-10297-0

Environ Monit Assess. 2026 Jul 3;198(8):805. doi: 10.1007/s10661-026-15634-1.

ABSTRACT

This study employed a greenhouse gas flux monitoring system equipped with LI-COR 7810/7820 portable trace gas analyzers to measure daily fluxes of CO₂, CH₄, and N₂O across asphalt pavement sections during three time periods (8:00-9:00 AM, 1:00-2:00 PM, 6:00-7:00 PM). Using high-frequency data obtained from the analyzers, precise fluxes were calculated via an exponential fitting model in SoilFluxPro software. A comprehensive assessment, integrating spatiotemporal statistical analysis and global warming potential (GWP), was conducted. The results revealed the following: (i) Spatial distribution: Asphalt road surfaces act as carbon sources along both sides, with an average GWP of 920.762 nmol·m⁻²·s⁻¹ per day, while the central section serves as a weak carbon sink, with an average GWP of -73.685 nmol·m⁻²·s⁻¹ per day. (ii) Temporal distribution: Greenhouse gas emissions from asphalt pavements are higher during the daytime and lower at night. (iii) Gas composition: CO₂ is the dominant contributor to greenhouse gas fluxes from asphalt pavements, accounting for over 98% of total emissions. (iv) Primary drivers: The primary source of greenhouse gas emissions from asphalt pavements is the organic debris covering the soil and vegetation along roadside areas.

PMID:42397608 | DOI:10.1007/s10661-026-15634-1

Arch Orthop Trauma Surg. 2026 Jul 3;146(1):244. doi: 10.1007/s00402-026-06406-0.

ABSTRACT

INTRODUCTION: Tranexamic acid (TXA) effectively reduces blood loss and transfusion requirements in shoulder arthroplasty. However, concerns regarding thromboembolic, neurologic, cardiac, and renal complications have limited its use in medically high-risk patients. This study evaluated temporal trends and the safety of TXA in high-risk patients undergoing total shoulder arthroplasty (TSA).

METHODS: A retrospective cohort study was conducted using TriNetX, identifying patients who underwent shoulder arthroplasty (2012-2025). Patients were stratified by preexisting high-risk conditions, including prior thromboembolism, renal failure, atrial fibrillation, seizure disorders, and visual disturbances. Within each subgroup, patients receiving TXA were propensity score-matched to those who did not. Perioperative TXA utilization trends were assessed. Ninety-day postoperative outcomes were compared, including transfusion requirements, thromboembolic events, cardiac complications, renal failure, neurologic events, infections, readmissions, emergency department visits, and mortality. Outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: Reported perioperative TXA use began in 2012 and increased through 2025, with over 70% of patients in both standard- and high-risk cohorts receiving TXA. TXA use was associated with significantly lower transfusion rates (OR range 0.53-0.62) and readmissions (OR range 0.63-0.75) across all high-risk cohorts (all p ≤ 0.01). TXA use was not associated with increased risk of deep vein thrombosis, pulmonary embolism, stroke, or postoperative seizures in any subgroup. Notably, TXA demonstrated a protective association against myocardial infarction, cardiac ischemia, acute renal failure, and mortality in select high-risk populations. No increase in infection-related complications was observed.

CONCLUSIONS: In patients undergoing shoulder arthroplasty, TXA use was safe across multiple high-risk medical populations and was consistently associated with lower transfusion and readmission rates, with reduced mortality in select cohorts. These findings support the broader use of TXA for blood conservation in shoulder arthroplasty, even among patients with traditionally high-risk comorbidities, while underscoring the need for future prospective, shoulder-specific safety studies.

LEVEL OF EVIDENCE: III, Retrospective Cohort Study.

PMID:42397605 | DOI:10.1007/s00402-026-06406-0

HNO. 2026 Jul 3. doi: 10.1007/s00106-026-01784-8. Online ahead of print.

ABSTRACT

BACKGROUND: A wide range of methods for speech audiometry to evaluate the outcome after cochlear implant (CI) fitting exist in German-speaking countries. Various procedures are used to determine the speech recognition threshold in noise (SRT). As an adaptive test with a simple lexical structure, the digits-in-noise (DiN) test offers an alternative to list-based speech tests or matrix tests. The aim of this study was to evaluate the clinical relevance of DiN in postoperative follow-up, particularly in comparison to the Freiburg speech test (FBS) and the Oldenburg sentence test (OlSa), as well as for supporting individualized CI settings.

MATERIALS AND METHODS: In a prospective study, 73 adult CI users were examined. Speech comprehension was assessed monaurally in a free field using the FBS, OlSa, and DiN. The participants were divided into three groups based on their hearing loss for numbers (HVZ). The OlSa in noise was only performed if speech comprehension was sufficient. The evaluation was carried out using descriptive statistics, the Kruskal-Wallis test, and Bland-Altman analysis.

RESULTS: The test-retest reliability of the DiN was high and independent of the time of measurement. The SRTs differed significantly between groups, with better audibility showing lower thresholds. Speech tests in quiet and noise confirmed these differences. The DiN could be performed in all participants.

CONCLUSION: The DiN can be used in all phases of audiological CI follow-up care and enables early differentiation and progress monitoring, provides information on audibility, complements the FBS, and may be used in future studies on optimal fitting of CI systems.

PMID:42397601 | DOI:10.1007/s00106-026-01784-8

Fish Physiol Biochem. 2026 Jul 3;52(4):109. doi: 10.1007/s10695-026-01728-7.

ABSTRACT

Inland heatwaves (HW) are increasingly recognised as potent environmental stressors affecting aquatic ecosystems. This study investigated the physiological, biochemical, and molecular stress responses in juvenile GIFT (Oreochromis niloticus) exposed to simulated short-term (STHW) and long-term (LTHW) heatwave conditions. A total of 144 fish (15.79 ± 0.21 g) were randomly assigned to three treatment groups-control, STHW, and LTHW-with four replicates each. At the end of each experimental heatwave exposure, parameters such as survival, physio-biochemical responses from different organs, serum, and whole-body proximate and fatty acid profiles were assessed. Despite no statistically significant differences in survival rates, HW exposure induced marked alterations in serum biochemical parameters, including elevated glucose and decreased hormone profiles (T3, T4, cortisol). HW significantly impacted serum lipid profiles, with notable reductions in LDL, HDL, and cholesterol, particularly in the LTHW group. Oxidative stress enzyme activities revealed organ-specific responses: liver SOD decreased while CAT and GPX increased under LTHW, indicating heightened oxidative stress. The CAT and GST activities of the gill were suppressed, whereas GPX surged in LTHW-exposed fish. Upregulation of hsp-70 and nka-1α mRNA in STHW, and a decline in LTHW, indicate changes in the cellular stress protein markers and ion transport. Whole-body composition analysis revealed reduced crude protein and ash, increased lipid content, and depleted muscle glycogen under heatwave exposure. Fatty acid profiling and PCA analysis demonstrated significant shifts in fatty acid metabolism, with increased levels of palmitic acid, ARA, and DPA under LTHW, alongside reduced MUFA and SFA/PUFA ratios. Overall, these findings underscore the multifaceted physiological disruptions caused by inland heatwaves in GIFT juveniles, with LTHW eliciting more pronounced stress responses.

PMID:42397600 | DOI:10.1007/s10695-026-01728-7

Arch Orthop Trauma Surg. 2026 Jul 3;146(1):242. doi: 10.1007/s00402-026-06401-5.

ABSTRACT

INTRODUCTION: Hip fractures are a major complication of osteoporosis and are associated with high morbidity, mortality, and costs. Despite clear guideline recommendations, pharmacological osteoporosis treatment remains underutilized. In addition, medications that increase fall and fracture risk further contribute to fracture occurrence. The aim of this study was to assess guideline concordance of osteoporosis therapy and to quantify the prevalence of medications associated with increased fall and fracture risk prior to the fracture in patients admitted with femoral fractures.

MATERIALS AND METHODS: In this prospective observational study, 145 patients aged ≥ 55 years admitted with femoral neck, per- and subtrochanteric, femoral shaft and distal femur fractures to a tertiary academic trauma center between April and June 2025 were included. Pre-admission medication was assessed using structured medication reconciliation. Guideline concordance of pre-fracture osteoporosis therapy was evaluated according to the current Austrian osteoporosis guideline (Dimai et al., 2024). Fall-risk-increasing drugs (FRIDs) were identified using the STOPPFall criteria, and fracture-associated medications were recorded based on Austrian osteoporosis guideline-defined drug classes.

RESULTS: Among 145 included patients (mean age 80.4 years; 71% female), 117 (81%) met criteria for pharmacological osteoporosis treatment prior to the fracture, defined by a preexisting osteoporosis diagnosis or a 10-year fracture risk above the treatment intervention threshold using the FRAX^® calculator. Only 9 (7.7%) of these patients were treated in accordance with guideline recommendations. A treatment gap was observed in 78.6% of therapy-eligible patients. At least one FRID was prescribed in 70% of patients, and 57% received at least one medication associated with increased fracture risk.

CONCLUSIONS: Patients presenting with femoral fractures demonstrate a substantial gap in guideline-concordant osteoporosis therapy and a high prevalence of medications associated with increased fall and fracture risk. These findings highlight important opportunities for systematic primary and secondary fracture prevention and structured medication review.

PMID:42397594 | DOI:10.1007/s00402-026-06401-5