Nevin Manimala

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012696. Online ahead of print.

ABSTRACT

OBJECTIVE: The lingula and antilingula are important anatomic references in oral and maxillofacial procedures. This study aims to characterize morphologic variations of the lingula and antilingula in unilateral craniofacial microsomia (CFM) and evaluate their associations.

METHODS: Cranial CT scans of 98 unilateral CFM patients (Pruzansky-Kaban types I, IIA, and IIB) were retrospectively analyzed. Lingula morphology was classified as nodular, triangular, truncated, or assimilated (absent); antilingula was recorded as present/absent. Statistical analyses included χ2 tests, Cochran-Armitage trend tests, and Cohen κ for concordance.

RESULTS: Among 196 mandibular sides, lingula absence occurred in 19.4%, with higher prevalence on affected sides (35.7% versus 3.1%, P<0.001). Antilingula absence increased significantly with Pruzansky-Kaban severity on affected sides (type IIB: 62.1% versus type I: 9.1%, P=0.003). Lingula-antilingula concordance was weak (κ=0.157, P=0.020).

CONCLUSIONS: CFM patients exhibit high variability in lingula and antilingula anatomy, particularly on the affected side. Preoperative 3‑dimensional CT evaluation is therefore crucial for safe osteotomy planning.

PMID:41911566 | DOI:10.1097/SCS.0000000000012696

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012686. Online ahead of print.

ABSTRACT

BACKGROUND: Epilepsy is rarely observed in patients with craniofacial syndromes, with few reports in the literature devoted to identifying epilepsy predictors for this patient population. This study aims to determine potential predictors of epilepsy in syndromic craniosynostosis.

METHODS: This retrospective study analyzed data from 476 patients with Apert, Crouzon, or Pfeiffer syndromes treated at 2 craniofacial centers between 2007 and 2022. Patients were divided into 2 groups: those diagnosed with epilepsy (group A) and those without (group B). Independent variables included age, number of surgeries, previous surgery performed elsewhere, neurosurgical complication during craniofacial surgery, Chiari malformation type I, meningitis, systemic complication, encephalomalacia, hydrocephalus, placement of a ventriculoperitoneal shunt, and family history of epilepsy. These variables were compared between groups. Statistical analyses were conducted using logistic regression models to identify significant epilepsy predictors.

RESULTS: Epilepsy was diagnosed in 24 patients, resulting in a prevalence of 5%. Significant predictors of epilepsy included previous surgeries performed elsewhere and neurosurgical complications during craniofacial surgery, with odds ratios of 853 and 902, respectively. These factors suggest that epilepsy in this population is primarily acquired rather than congenital.

CONCLUSION: The study identified a higher prevalence of epilepsy among children with syndromic craniosynostosis compared with the general population. Intracranial complications, particularly those associated with surgeries performed outside specialized centers, are key predictors of epilepsy. These findings emphasize the importance of specialized surgical care to mitigate epilepsy risk in this patient population.

PMID:41911563 | DOI:10.1097/SCS.0000000000012686

JMIR Form Res. 2026 Mar 30;10:e76755. doi: 10.2196/76755.

ABSTRACT

BACKGROUND: Gait assessment is an important tool for evaluating health risks in older adults but remains underused in low-resource settings. We explored the feasibility of using a low-cost, simple walking protocol with smartphone video capture to extract health-related gait signals by classifying sex and age. Sex and age are fundamental biological factors linked to most health- and aging-related outcomes. Establishing baseline classification performance provides justification for future exploration of more complex health-related conditions using this protocol.

OBJECTIVE: This study aimed to assess whether pose parameters derived from smartphone-based gait videos can be used by machine learning models to classify age and sex.

METHODS: A cross-sectional study was conducted with 155 participants (Thailand: n=59, 38.1%; India: n=96, 61.9%). Participants performed a simple walking protocol while being recorded using smartphones. Pose estimation was conducted using the MediaPipe algorithm to extract 109 features related to joint distances, angles, and walking speed. For feasibility assessment, we calculated the proportion of recordings for which pose estimation could be extracted. Elastic-net logistic regression and histogram-based gradient boosting classifiers were used for analysis. Model performance was evaluated using 5-fold cross-validation. Outcomes were sex (male vs female) and age group (aged<65 vs ≥65 y).

RESULTS: Pose parameters were successfully extracted from 145 (93.5%) of the 155 video recordings. Among the 145 participants, 94 (64.8%) were female, and 55 (37.9%) were aged 65 years or older. The 2 analytic models demonstrated comparable performance. Sex classification achieved a maximum mean area under the receiver operating characteristic curve of approximately 0.90 (SD 0.06), whereas age classification achieved a maximum mean area under the receiver operating characteristic curve of approximately 0.70 (SD 0.09). Classification performance was primarily influenced by the number of features used, clothing characteristics, and the quality of pose estimation.

CONCLUSIONS: This simple smartphone-based gait assessment protocol was able to extract meaningful pose parameters and classify biological features (age and sex). Further studies are warranted to evaluate its potential utility for disease screening, risk stratification, and longitudinal health monitoring.

PMID:41911547 | DOI:10.2196/76755

JMIR Form Res. 2026 Mar 30;10:e80852. doi: 10.2196/80852.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer/questioning, plus (LGBTQ+) youth experience significant health challenges relative to their peers, including higher rates of HIV, sexually transmitted infections, and mental health symptoms, partly due to minority stressors. Digital health interventions hold promise for addressing these issues, but their effectiveness hinges on human-centered co-design that ensures relevance and engagement.

OBJECTIVE: This study aimed to examine the use of Discord as a platform for conducting human-centered design (HCD) activities to adapt a digital text-based intervention designed to improve HIV testing rates among LGBTQ+ youth.

METHODS: We recruited 21 LGBTQ+ youth (aged 13-18 years) in the United States via social media and participant registries, oversampling minoritized gender, racial, and ethnic identities to ensure diverse representation. Over 9 months, participants engaged in structured HCD activities on a private Discord server, including polls, open-ended discussions, and interactive feedback tasks. Design insights were collected iteratively and used to refine the intervention in real time. We also surveyed participants to examine the acceptability of Discord as a tool for hosting the HCD process.

RESULTS: We identified best practices for integrating HCD methods within Discord, including cocreating the server environment with participants and enabling real-time iteration of intervention components based on youth input. The privacy of the Discord server supported psychological safety; facilitated open and effective communication between participants and the research team; and fostered an informal, familiar atmosphere.

CONCLUSIONS: Discord provides an effective and acceptable environment for conducting HCD processes in the design of digital health interventions. Its structural features, including anonymity, accessibility, and community-driven interaction, facilitated meaningful youth engagement in co-design activities. These insights offer a model for leveraging social media platforms to support participatory intervention development for LGBTQ+ populations.

PMID:41911545 | DOI:10.2196/80852

JMIR Aging. 2026 Mar 30;9:e84956. doi: 10.2196/84956.

ABSTRACT

BACKGROUND: Digital eldercare services are promoted to address gaps in traditional care provision, yet actual uptake among older adults remains limited. Prior research has largely focused on technological attributes, with less attention to older adults’ context-specific behavioral attitudes toward digital services.

OBJECTIVE: This study aimed to identify the multidimensional structure of older adults’ behavioral attitudes toward digital meal assistance services and to examine their associations with usage intention and actual use.

METHODS: A mixed-mode survey was conducted in 2020 among adults aged 60 years or older in a large metropolitan city in China. A total of 1019 valid questionnaires were collected (n=405 online and n=614 offline). Exploratory factor analysis was used to identify attitudinal dimensions, followed by binary logistic regression analyses conducted separately for online and offline samples, controlling for sociodemographic characteristics.

RESULTS: Five attitudinal dimensions were identified, explaining 60.38% of the variance. Regression analyses showed that associations between attitudinal dimensions and service use differed by usage stage and sample type. Digital trust was the most consistent predictor, significantly associated with intention to use in both samples-particularly online (odds ratio [OR] 1.351, 95% CI 1.054-1.732; P=.02)-and with actual use in the offline sample (OR 1.068, 95% CI 1.011-1.128; P=.02), with a marginal association online (OR 1.347, 95% CI 0.986-1.840; P=.06).

CONCLUSIONS: Older adults’ adoption of digital meal assistance services is shaped by multidimensional and context-dependent attitudes that extend beyond technological considerations. Policy efforts should therefore emphasize trust-building, affordability, and differentiated strategies tailored to diverse groups of older adults.

PMID:41911544 | DOI:10.2196/84956

JMIR Res Protoc. 2026 Mar 30;15:e73496. doi: 10.2196/73496.

ABSTRACT

BACKGROUND: The Mothers’ Absolute Affection (MAA) program is a national initiative launched by the Ministry of Health and Family Welfare, Government of India, on August 5, 2016, to promote, support, and protect breastfeeding across the country. The program aims to provide focused breastfeeding promotion and counseling services through the health system. It targets approximately 39 million pregnant and nursing mothers, 880,000 Accredited Social Health Activists, 150,000 subcenters, and 17,000 delivery points across all states and union territories. Despite its wide reach, there remains a lack of valid and reliable tools to assess mothers’ knowledge and practices related to breastfeeding and the MAA program.

OBJECTIVE: The aims of this study are to assess the existing knowledge and practice regarding the MAA program among postnatal mothers, to evaluate the effectiveness of an awareness program on knowledge and practice regarding the MAA program, to correlate knowledge and practice regarding the MAA program among postnatal mothers, and to associate knowledge and practice with selected demographic variables.

METHODS: A quasi-experimental one-group pretest and posttest design was used to evaluate the effectiveness of an awareness program for the MAA program among postnatal mothers. The study was conducted at a selected hospital with a sample of 80 postnatal mothers selected through inclusion and exclusion criteria. On Day 1, participants underwent a pretest followed by an awareness session on the MAA program. A posttest was administered on Day 2. Knowledge was assessed using a structured questionnaire consisting of 15 items, while practice was evaluated using a 5-point Likert scale. Data were analyzed using descriptive and inferential statistics, including paired t tests and χ2 tests.

RESULTS: Knowledge scores were classified into three levels-poor (0%-33.33%), fair (33.34%-66.66%), and good (66.67%-100%)-based on the number of correct responses out of 15. Practice was categorized as poor (0%-50%) or good (51%-100%) based on the 5-point scale score. The study revealed significant improvements in both knowledge and practice following the awareness intervention, indicating that the program was effective. The scoring procedure provided a comprehensive understanding of the awareness and practical implementation of the MAA program among postnatal mothers.

CONCLUSIONS: The awareness program significantly improved the knowledge and practices of postnatal mothers regarding the MAA program, emphasizing the value of educational interventions in promoting breastfeeding.

PMID:41911538 | DOI:10.2196/73496

J Can Dent Assoc. 2025 Jul;91:p15.

ABSTRACT

INTRODUCTION: The recently launched income-based Canadian Dental Care Plan (CDCP) may help to reduce oral health inequities and financial barriers for almost 9 million uninsured residents of Canada. The objective of this study was to critically appraise early CDCP data in terms of patient eligibility and provider enrolment and participation in the program.

METHODS: This study was based on cross-sectional and retrospective publicly available data from the CDCP and from the Survey of Oral Health Care Providers (SOHCP) released by the Government of Canada, Health Canada and Statistics Canada in 2024 and 2025. The results of descriptive statistical analyses are reported as means, percentages and averages.

RESULTS: The number of approved applicants (where eligibility was based on annual income tax records), the number of those receiving care and the number of oral health care providers (e.g., dentists, dental therapists, independent practising hygienists) participating in the CDCP increased by 77.2%, 344.6% and 34.0%, respectively, between August 2024 and May 2025. According to the providers participating in the SOHCP, more than 60% of practices would be able to accommodate the forecasted additional patient visit load associated with introduction of the CDCP. As wait times for existing patients increased, the likelihood of accommodating more patients decreased. At the time this study was conducted, no claims data on types of treatment provided or patients’ perspectives about the program were available.

CONCLUSION: The CDCP is a form of policy offering publicly funded oral health care, but potential enrolment is restricted to those who file their income tax returns. Most practices seem able to cope with the foreseen increase in patients seeking oral health care. Service utilization and oral health indicators are still emerging; comprehensive claims data and further research on patients’ perspectives are needed to explore the extent to which the CDCP is addressing oral health inequities.

PMID:41911527

J Can Dent Assoc. 2025 Aug;91:p8.

ABSTRACT

INTRODUCTION: Although condylar fractures are common in the field of oral and maxillofacial surgery, the approach to their treatment is not straightforward. Multiple soft-tissue approaches are available, but it is unclear which yields the best outcomes. In this retrospective study, we aimed to determine whether a transparotid or submandibular soft-tissue approach to treating condylar fractures yields better outcomes.

METHODS: This study consisted of a retrospective chart audit and an in-person assessment. The chart audit involved all patients who presented to the Queen Elizabeth II Health Sciences Centre (Halifax) between 2012 and 2022 with condylar fracture treated with open reduction and internal fixation. The chart review assessed each patient’s maximum interincisal opening, paresthesia, nerve function, infection and occlusion. The in-person assessment further assessed scar satisfaction, overall patient satisfaction with the treatment process and cosmetic results, and the incidence of Frey syndrome. Outcomes with the transparotid and submandibular approaches were compared using the Mann-Whitney U test for continuous variables and the χ² or Fisher exact test for categorical variables, with significance level set at p < 0.05 (2-tailed).

RESULTS: Data were collected from the charts of 32 patients who met the eligibility criteria during the study period; 14 of these patients also underwent an in-person assessment (at 1 to 7 years after the surgery). Statistical analysis of data from the chart audit and in-person assessment suggested no difference between the 2 approaches in terms of surgical outcomes after condylar fractures.

CONCLUSION: The optimal approach for treatment of condylar fractures should be determined individually, based on the surgeon’s preference, fracture location and extent of the fracture.

PMID:41911523

PLoS One. 2026 Mar 30;21(3):e0345301. doi: 10.1371/journal.pone.0345301. eCollection 2026.

ABSTRACT

Having enough doctors to provide healthcare services is a concern internationally. In the UK, significant resources for education and training have been devoted to medical workforce management. Nevertheless, some areas of the country still struggle to recruit and retain staff compared with others. Solutions to this problem have focused on attracting students from backgrounds not traditionally represented in medicine to choose it as a career, and opening new medical schools in different areas of the country. The main objective of this paper is to examine medical student and doctor distribution in order to contribute to understanding the distribution of health and health service inequalities. We used a modelling approach to understand characteristics of medical students, medical schools and foundation schools to interpret and identify the relationship between geographic distribution and socio-economic deprivation. This geographical and statistical analysis aims to identify patterns in workforce distribution, layering these with data on deprivation and inequality. Analysis shows that there are fewer students who come from from more deprived areas, and that different patterns can be observed in geographic locations of training when considering gender and ethnicity. While there is greater diversity of the future workforce in terms of gender and ethnicity, there is evidence that fewer students from more deprived backgrounds are attending medical schools. This has implications for the future workforce, and medical schools may need to play a greater role in increasing access to medical education to overcome observed inequalities.

PMID:41911518 | DOI:10.1371/journal.pone.0345301

JCO Precis Oncol. 2026 Mar;10(3):e2500772. doi: 10.1200/PO-25-00772. Epub 2026 Mar 30.

ABSTRACT

PURPOSE: Deficient DNA mismatch repair (dMMR) and microsatellite instability-high (MSI-H) status, which sensitizes tumors to immune checkpoint inhibitors (ICIs), is three times more common with upper tract urothelial carcinoma (UTUC) than with bladder cancer. However, data on ICI efficacy against dMMR/MSI-H advanced UTUC remain limited.

MATERIALS AND METHODS: We retrospectively reviewed records of 24 patients with dMMR/MSI-H advanced UTUC treated with single-agent ICIs at a single institution (2015-2024). Descriptive statistics and the Kaplan-Meier method for survival outcomes were used.

RESULTS: Immunohistochemistry confirmed dMMR in 22 (92%) patients, with loss of MSH2 or MSH6 in 15 (68.2%) patients and loss of PMS2 or MLH1 in seven patients (31.8%). Germline mutation testing confirmed Lynch syndrome in 16 (67%) patients. ICI monotherapy was associated with a median progression-free survival (PFS) time of 65.9 months (95% CI, 31.6 months to nonevaluable [NE]). The PFS rates at 12 and 24 months were 95.2% (95% CI, 86.1% to 100.0%) and 78.8% (95% CI, 60.1% to 97.5%), respectively. At a median follow-up duration of 56.9 months (95% CI, 42.2 to 92.2 months), the median overall survival time was not reached (95% CI, 65.9 months to NE). The confirmed overall response rate was 83%, including 16 complete responses. Four (17%) patients were offered surgical consolidation with these pathologic outcomes: ypTaN0, ypT0N0, and ypT1N0 (two patients). Eight patients (33%) experienced grade ≥3 immune-related adverse events, including bullous pemphigoid (n = 3), hepatitis (n = 1), pancytopenia (n = 1), colitis (n = 1), polyendocrinopathy (n = 1), and polyarthritis with sarcoid-like reaction (n = 1).

CONCLUSION: Our hypothesis-generating findings suggest that dMMR/MSI-H may serve as a biomarker of sensitivity to single-agent ICIs in advanced UTUC. External validation in larger, ideally prospective, studies is needed to confirm the effectiveness and durability of immune checkpoint blockade in this molecular subgroup.

PMID:41911516 | DOI:10.1200/PO-25-00772