Category: Statistics

J Clin Psychol. 2026 Mar 30. doi: 10.1002/jclp.70133. Online ahead of print.

ABSTRACT

OBJECTIVE: Emotional labour has long been associated with personal and organizational outcomes such as burnout. However, theoretically dichotomising regulation into surface and deep acting may constrain the ecological validity of research as iterative and person-centered approaches to emotion regulation are not considered. Furthermore, recent research suggests self-compassion and experience may predict emotional labour regulation in psychologists, but specific mechanisms accounting for this relationship are unknown. We addressed these concerns by examining how self-compassion and career experience predict latent profiles of emotional labour regulation strategies in psychologists and subsequent burnout.

METHOD: We performed latent profile analysis, multinomial logistic regression, and a one-way between-groups ANOVA on data from 232 international psychologists across two time points.

RESULTS: We found a similar but not identical pattern of latent profiles when compared to previous studies in different occupations. Self-compassion and career experience significantly predicted subsequent profile membership and profiles characterized by less surface acting and more authentic and genuine emotional displays had statistically significantly lower levels of emotional exhaustion.

CONCLUSIONS: Our findings suggest that self-compassion promotes adaptive emotional labour regulation strategies in psychologists, that experienced clinicians express emotion more authentically, and that regulation that involves authentic and genuine expression is linked with lower emotional exhaustion.

PMID:41910994 | DOI:10.1002/jclp.70133

JAMA Netw Open. 2026 Mar 2;9(3):e262420. doi: 10.1001/jamanetworkopen.2026.2420.

ABSTRACT

IMPORTANCE: While the clinical benefits of timely percutaneous coronary intervention (PCI) are well established, it remains unclear whether the expansion of PCI-capable facilities enhances access to critical care or contributes to overuse.

OBJECTIVE: To assess whether new PCI-capable hospital openings are associated with changes in the overall procedural volume at the community level and the health characteristics of patients undergoing PCI.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used California all-payer data from January 1, 2011, to December 31, 2022, including 651 585 patients across 2348 communities (defined by zip code). Using a difference-in-differences framework, changes in PCI volume and patient characteristics in communities exposed to a PCI facility opening were compared with those without, stratified by baseline PCI access. Statistical analysis was completed between January and July 2025.

EXPOSURES: Opening of a PCI-capable facility within a 30-minute driving time of a zip code community.

MAIN OUTCOMES AND MEASURES: Community-level PCI volume and patient-level indicators, including primary diagnosis of stable angina, prior acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG), and procedure complexity (number of vessels treated).

RESULTS: The final sample included 651 585 patients (463 526 male [71%]; 128 469 Hispanic [20%], 370 672 White [57%]); 47 003 patients (7%) lived in rural communities. At baseline, 84 349 patients (13%) had no access to PCI within 30 minutes. Community PCI volume increased by 7.5% (95% CI, 6.4%-8.6%) after a local PCI facility opened, with a 19.9% increase (95% CI, 15.7%-24.1%) in communities without prior 30-minute access. Among patients, the proportion with stable angina increased by 2.5 percentage points (95% CI, 2.0 to 3.1 percentage points), and by 3.5 percentage points (95% CI, 1.3 to 5.7 percentage points) in communities with no PCI at baseline. In communities with prior access, there was a 0.7 percentage point increase (95% CI, 0.3 to 1.1 percentage points) in patients without prior AMI or CABG and a 0.6 percentage point increase (95% CI, 0.4 to 0.9 percentage points) in those receiving PCI on 3 or more vessels. In contrast, communities with no baseline access to PCI experienced a 2.2 percentage point increase (95% CI, 0.3 to 4.1 percentage points) in single-vessel PCI and a 2.1 percentage point decrease (95% CI, -3.0 to -1.2 percentage points) in patients receiving PCI on 3 or more vessels.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of 651 585 patients, the opening of PCI-capable hospitals was associated with increased community PCI volumes, particularly in underserved areas. Changes in patient profiles suggested potential supply-induced demand in areas that had existing access, and a release of unmet need in previously underserved areas; these findings highlighted the dual implications of service expansion.

PMID:41910975 | DOI:10.1001/jamanetworkopen.2026.2420

JAMA Netw Open. 2026 Mar 2;9(3):e263392. doi: 10.1001/jamanetworkopen.2026.3392.

ABSTRACT

IMPORTANCE: Despite the growing number of residents with disabilities, barriers to equitable access persist in medical training. Program access to accommodation has been linked to improved training and mental health outcomes, but little is known about possible resident and program characteristics associated with access to and requests for needed accommodations.

OBJECTIVE: To examine demographic, training, and disability-related factors associated with program access and accommodation requests among internal medicine (IM) residents with disabilities.

DESIGN, SETTING, AND PARTICIPANTS: This national cross-sectional study looked at accredited IM residency programs in mainland US and Puerto Rico. Participants were IM residents who took the 2023 Internal Medicine In-Training Examination and reported having at least 1 type of disability.

MAIN OUTCOMES AND MEASURES: The primary outcomes were program access, defined as receiving accommodations or not needing them, and requesting needed accommodations. Multivariable logistic regression models were conducted for each of the outcomes.

RESULTS: Of 19 205 respondents, 1824 (9.5%) reported a disability; participants were predominantly men (979 men [53.7%]), US medical graduates (1398 participants [76.6%]), and enrolled in categorical IM programs (1532 participants [84.0%]). With regard to race, 340 participants (18.6%) were Asian, 415 (22.8%) were from groups underrepresented in medicine (including self-reported Black or African American or Afro-Caribbean; Latinx or Latino or Hispanic; Native American or American Indian or Indigenous or Alaskan Native; Native Hawaiian or Pacific Islander), and 823 (45.1%) were White. Among 1052 with complete accommodation information, 811 (77.1%) had program access and 241 (22.9%) did not. In multivariable regression models, having cognitive disabilities (adjusted odds ratio [aOR], 0.27; 95% CI, 0.15-0.49) and identifying as women (aOR, 0.55; 95% CI, 0.40-0.75), Asian (aOR, 0.53; 95% CI, 0.34-0.82) and underrepresented racial or ethnic groups (aOR, 0.58; 95% CI, 0.38-0.87) were associated with lower odds of program access. Among 699 residents coded as needing disability accommodations with classifiable responses, 200 (28.6%) did not request them. Fear of stigma (164 respondents [82.0%]) and unclear institutional processes (60 respondents [30.0%]) were the most cited reasons for nonrequest for needed accommodations. Requesting accommodations was less likely among residents with cognitive disabilities (aOR, 0.16; 95% CI, 0.08-0.31) and who identify as women (aOR, 0.37; 95% CI, 0.25-0.54), genderqueer or nonbinary (aOR, 0.11; 95% CI, 0.02-0.68), Asian (aOR, 0.50; 95% CI, 0.30-0.85), or underrepresented in medicine (aOR, 0.60; 95% CI, 0.37-0.97).

CONCLUSIONS AND RELEVANCE: These findings suggest that despite growing disability representation, substantial inequities in access to and requests for accommodations persisted for IM residents with disabilities, particularly those with cognitive disabilities and marginalized identities. Institutions should implement inclusive, transparent policies to foster psychological safety and disability inclusion.

PMID:41910974 | DOI:10.1001/jamanetworkopen.2026.3392

JAMA Netw Open. 2026 Mar 2;9(3):e263885. doi: 10.1001/jamanetworkopen.2026.3885.

ABSTRACT

IMPORTANCE: The use of robotic-assisted surgery has increased rapidly despite limited evidence of superior outcomes over more established surgical approaches such as laparoscopy.

OBJECTIVE: To evaluate whether and to what extent surgeons’ financial relationships with industry are associated with the use of robotic-assisted surgery.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, fee-for-service Medicare claims (January 1, 2011, to December 31, 2021) for patients undergoing 1 of 4 common surgical operations (bariatric surgery, cholecystectomy, colectomy, or ventral hernia repair) were linked to surgeon-level Open Payments data on receipt of industry payments from a large robotic surgical device company. Data were analyzed from April to August 2025.

EXPOSURE: Receipt of a direct industry payment from a robotic-assisted surgical device company.

MAIN OUTCOME AND MEASURES: Each surgeon’s use of robotic-assisted surgery as a proportion of all surgeries performed by that surgeon. A staggered difference-in-differences (DID) approach was used to isolate the association of industry payments with the proportional use of robotic-assisted surgery among surgeons who received payment compared with control surgeons who never received a payment.

RESULTS: Among 20 313 surgeons (mean [SD] age, 50.7 [10.2] years; 86.2% male) performing 886 385 surgeries, 5933 (29.2%) received at least 1 industry payment. Receipt of an industry payment was associated with a significant increase in the proportional use of robotic-assisted surgery, with a DID estimate of 9.9 percentage points (pp) (95% CI, 9.30-10.6 pp). Results were consistent across discrete procedures (eg, DID estimate of 11.7 pp [95% CI, 9.4-13.9 pp] for bariatric surgery and 10.3 pp [95% CI, 9.4-11.4 pp] for ventral hernia repair). There was a significant dose-dependent response. For example, surgeons receiving less than $500 increased use of robotic-assisted surgery after payment from a mean of 1.5% (95% CI, 1.4%-1.6%) to 3.7% (95% CI, 3.5%-3.9%), compared with 0.4% (95% CI, 0.4%-0.5%) to 17.0% (95% CI, 16.7%-17.3%) among surgeons receiving more than $10 000.

CONCLUSIONS AND RELEVANCE: In this cohort study, receipt of industry payments by surgeons was associated with increased use of robotic-assisted surgery compared with no receipt of payment, with a significant dose-dependent response. These results suggest that surgeon-industry financial relationships may be an important contributor to greater use of robotic-assisted surgery across the US.

PMID:41910972 | DOI:10.1001/jamanetworkopen.2026.3885

JAMA Netw Open. 2026 Mar 2;9(3):e264017. doi: 10.1001/jamanetworkopen.2026.4017.

ABSTRACT

IMPORTANCE: Limited research exists on sex, racial, and ethnic disparities in required graduate medical education (GME) resident competency ratings across specialties during sensitive periods when career decision-making occurs. Rating disparities using an antideficit-based approach measured by exceptionally high ratings are underexplored in GME.

OBJECTIVE: To assess the association of exceptionally high ratings in the Accreditation Council for Graduate Medical Education (ACGME) Milestones during time-sensitive training periods across specialties with differences among residents’ characteristics, including sex, race, and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis was conducted between March 15 and December 31, 2025, using 2018 to 2021 Association of American Medical Colleges and ACGME data. Postgraduate year (PGY) 2 residents training at US ACGME-accredited emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery residency programs between 2018 and 2021 who self-reported sex, race, or ethnicity were studied.

EXPOSURE: Required Milestones ratings at the end of PGY-2 training associated with resident sex and race or ethnicity (underrepresented in medicine [URiM] and Asian), while controlling for preresidency Step 2 Clinical Knowledge examination scores.

MAIN OUTCOMES AND MEASURES: Proportion and adjusted odds ratios (AORs) for exceptionally high resident-level ratings (80th percentile level) across competencies in interpersonal and communication skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice.

RESULTS: Among 19 492 PGY-2 residents across 1754 programs, 10 384 (53.3%) were female, 28 (0.14%) American Indian or Alaskan Native, 4327 (22.2%) Asian, 1106 (5.7%) Black, 1008 (5.2%) Hispanic or Latinx, 3 (0.02%) Native Hawaiian or Pacific Islander, 12 269 (62.9%) White, 751 (3.9%) reporting 2 or more races, and 3423 (17.6%) classified as URiM. Exceptional rating differences were identified by sex, race, and ethnicity. Across all specialties, female residents had greater odds for 80th percentile ratings (AOR, 1.12; 95% CI, 1.05-1.21; P < .001); whereas when compared with White residents, URiM residents (AOR, 0.68; 95% CI, 0.62-0.76; P < .001) and Asian residents (AOR, 0.67; 95% CI, 0.60-0.74; P < .001) were less likely to have 80th percentile ratings than White residents. Within specialties, URiM residents in emergency medicine, family medicine, internal medicine, obstetrics and gynecology, and surgery were less likely to have 80th percentile ratings, whereas Asian residents in family medicine, internal medicine, pediatrics, and surgery were also less likely than White residents.

CONCLUSION AND RELEVANCE: In this cross-sectional national study of residents, exceptionally higher ratings were associated with differing resident characteristics during crucial career planning phases. These results suggest the need for more studies to explore factors of resident success during GME training.

PMID:41910971 | DOI:10.1001/jamanetworkopen.2026.4017

JAMA Netw Open. 2026 Mar 2;9(3):e264024. doi: 10.1001/jamanetworkopen.2026.4024.

ABSTRACT

IMPORTANCE: Mental health morbidity is a proximal factor in suicide. Using the research domain criteria (RDoC) framework to investigate sex and age differences in psychopathology at the time of death may provide better characterization than focusing on clinical diagnosis alone.

OBJECTIVES: To (1) evaluate whether token-based and large language model scoring of RDoC can be successfully applied to law enforcement and coroner or medical examiner death narratives in the US National Violent Death Reporting System (NVDRS), and (2) investigate sex and age differences in clinically relevant scores to illuminate underidentified dimensions of mental health dysfunction proximal to suicide.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study drew on death records in the restricted-access 2020 to 2021 NVDRS. Participants were limited to suicide decedents aged 12 years and older from all 50 states whose death record included a law enforcement and coroner or medical examiner death narrative of 20 words or more. Analyses were conducted between May 2024 and September 2025.

EXPOSURES: Sex and age of decedents.

MAIN OUTCOMES AND MEASURES: RDoC symptom scores; mental health status measures in death records (mental health diagnosis, current depressed mood, and alcohol or drug misuse).

RESULTS: Using both a token-based system and a large language model approach, law enforcement and coroner or medical examiner narratives of 72 585 suicide decedents were scored (mean [SD] age, 46.3 [19.3] years; 57 770 [80.6%] male). Both methods were previously validated with psychiatric electronic health records. To validate this approach, token density and large language model scores were compared with current NVDRS mental health status measures. Both scoring methods correlated with precoded measures and demonstrated levels of neurobehavioral dysfunction at the time of death similar to psychiatric inpatients on admission. Sex- and age-related differences in clinically relevant dysfunction showed the highest levels among female vs male and younger vs older decedents after adjusting for demographic confounding.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of suicide decedents found that information relevant to RDoC domains is encoded in NVDRS death narratives and can be extracted using large language models. The approach used here observed more pervasive neurobehavioral dysfunction among suicide decedents than that captured by currently employed NVDRS measures of mental health.

PMID:41910970 | DOI:10.1001/jamanetworkopen.2026.4024

JAMA Netw Open. 2026 Mar 2;9(3):e264171. doi: 10.1001/jamanetworkopen.2026.4171.

ABSTRACT

IMPORTANCE: A sense of belonging is a fundamental need that predicts mental, physical, social, economic, and behavioral outcomes. Experiencing a sense of belonging at work may be influenced by organizational culture and whether a person feels supported by teammates. There is little evidence of what proportion of physicians feel a strong sense of belonging and teammate support. There exists a gap in literature showing whether these factors are associated with burnout or work intentions, which leaves health care leaders without a valuable tool to improve professional well-being and workforce retention.

OBJECTIVE: To provide health care leaders with a better understanding of how fostering belonging and teammate support can decrease burnout and potentially prevent costly turnover.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from a survey administered to physicians by their organization leaders as part of the organization’s quality improvement efforts through participation in the American Medical Association Organizational Biopsy program. The survey was administered within health care organizations and health systems across the US with more than 50 physicians. The study population comprised physicians working in US-based health care organizations and health systems. Survey responses were collected between November 7, 2023, and November 12, 2024. Analysis was performed from June to August 2025.

MAIN OUTCOMES AND MEASURES: Belonging and teammate support perceptions were measured by asking participants to indicate how much they agree with 2 statements. Burnout was assessed using the single-item Mini Z assessment, and work intentions were indicated by likeliness to reduce clinical hours in the next 12 months or leave practice within the next 2 years. Odds ratios (ORs) and 95% CIs were used.

RESULTS: Of 14 051 physicians, 7315 were male (52.1%), 1978 were Asian (14.1%), 406 were Black or African American (2.9%), 425 were Latinx or Hispanic (3.0%), and 8681 were White (61.8%). Additionally, 4733 (33.7%) had 20 or more posttraining years of clinical practice and 4475 (31.8%) practiced in primary care. A strong sense of belonging was endorsed by 8425 (60.0%) and 11 293 (80.4%) perceived teammate support. Females (odds ratio [OR], 0.91, 95% CI, 0.84-0.98) and physicians with more than 5 years of clinical practice (eg, 6-10 years: OR, 0.76; 95% CI, 0.67-0.85; ≥20 years: OR, 0.87; 95% CI, 0.78-0.96) had lower odds of having strong sense of belonging. A strong sense of belonging was associated with lower odds of burnout (OR, 0.22; 95% CI, 0.21-0.24), lower odds of intent to reduce clinical hours (OR, 0.48; 95% CI, 0.44-0.53), and lower odds of intent to leave the organization (OR, 0.23; 95% CI, 0.21-0.26). Similar patterns were observed for factors associated with teammate support and for the association of teammate support with burnout, intent to reduce hours, and intent to leave the organization.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of physicians in the US, a strong sense of belonging was associated with lower odds of burnout, intent to reduce clinical hours, and intent to leave the organization. These findings suggest that fostering belonging and teammate support can benefit physicians, care teams, patients, and organizations by potentially avoiding physician turnover. Organizations should prioritize belonging and teammate support in their efforts to improve culture, work environment, and physician well-being.

PMID:41910969 | DOI:10.1001/jamanetworkopen.2026.4171

J Autism Dev Disord. 2026 Mar 30. doi: 10.1007/s10803-026-07318-z. Online ahead of print.

NO ABSTRACT

PMID:41910941 | DOI:10.1007/s10803-026-07318-z

Clin Drug Investig. 2026 Mar 30. doi: 10.1007/s40261-026-01547-x. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Carboprost tromethamine is commonly used to prevent or treat postpartum hemorrhage during cesarean section but causes frequent side effects. This study aimed to compare dexmedetomidine and sufentanil for preventing these side effects and assess hemodynamic stability.

METHODS: This is a single-center randomized controlled trial. Parturients undergoing elective cesarean section were randomized to Group D (dexmedetomidine intravenously), Group S (sufentanil intravenously), and Group C (saline intravenously). Carboprost tromethamine 250 µg was intrauterine injected after delivery. The incidence of complications, Ramsay sedation scores, and noninvasive cardiac system-derived hemodynamic parameters were analyzed. The primary endpoint is dexmedetomidine or sufentanil could relieve the nausea and vomiting caused by carboprost tromethamine.

RESULTS: A total of 152 subjects were included in the analysis. Both Groups D and S had significantly fewer intraoperative nausea and vomiting episodes (Group D 16% vs Group S 19.2% vs Group C 76%, P < 0.001) and higher Ramsay scores (P < 0.001) compared with Group C. Group C showed significant increases in mean arterial pressure and respiratory rate (P < 0.05). Heart rate in Group D was significantly lower than in Group C (P < 0.05). The total peripheral resistance was significantly lower in Group S at T2-T5 (from 2 minutes post-carboprost tromethamine until the end of surgery) and in Group D at T2-T4 (2, 5, and 10 minutes post-carboprost tromethamine) compared with Group C (P < 0.05). Cardiac output in Group S was higher at T2-T4 (2, 5, and 10 minutes post-carboprost tromethamine) than in Group C, and at T2-T3 (2 and 5 minutes post-carboprost tromethamine), it was even higher than in Group D (P < 0.05).

CONCLUSIONS: Both dexmedetomidine and sufentanil alleviated carboprost tromethamine-induced side effects while maintaining stable hemodynamics. Sufentanil showed greater efficacy in reducing peripheral vascular resistance.

CLINICAL TRIAL REGISTRATION: ChiCTR2000038350.

PMID:41910933 | DOI:10.1007/s40261-026-01547-x

Int J Implant Dent. 2026 Mar 30. doi: 10.1186/s40729-026-00673-7. Online ahead of print.

ABSTRACT

AIM: To evaluate the efficacy of injectable bone fillers for alveolar ridge preservation (ARP).

MATERIALS AND METHODS: Mandibular premolars (P2, P3, P4) were bilaterally extracted in nine beagle dogs. Each tooth underwent hemisection, with the mesial root devitalized and filled with calcium hydroxide, while the distal roots were extracted. This resulted in six sockets per dog, which were randomly assigned to four injectable test materials (T1-T4), one control (C), and one negative control group (N). Primary wound closure was achieved in all groups except for N. After 12 weeks, tissue blocks were analyzed using micro-computed tomography (micro-CT). The primary outcome was bone volume fraction (BV/TV, %). Secondary outcomes included trabecular thickness (Tb.Th, mm), trabecular separation (Tb.Sp, mm), bone surface to bone volume ratio (BS/BV, mm²/mm³), buccal bone defect volume (BBD, mm³), vertical bone height (VBH, mm), buccal wall thickness (BBW, mm) and lingual wall thickness (LBW, mm). Data were analyzed using the Kruskal-Wallis test.

RESULTS: After 12 weeks of healing, all groups were associated with a similar BC/TV values (64.6%, 68.2%, 69.0%, 66.5%, 76.5% and 79.8% in the T1, T2, T3, T4, C and N groups, respectively; p > 0.05 for all between group comparisons). No statistically significant differences were found among groups for Tb.Th, Tb.Sp, BS/BV, BBD, VBH, BBW and LBW.

CONCLUSIONS: Within its limitations, the present study showed comparable efficacy of injectable bone fillers in maintaining alveolar ridge dimensions compared with the C and N groups.

CLINICAL RELEVANCE: Injectable bone fillers represent a convenient and potentially effective alternative for alveolar ridge preservation procedures.

PMID:41910925 | DOI:10.1186/s40729-026-00673-7