Nevin Manimala

Rev Bras Enferm. 2026 Mar 20;78(6):e20240576. doi: 10.1590/0034-7167-2024-0576. eCollection 2026.

ABSTRACT

OBJECTIVES: to analyze the sexual behavior of individuals who tested positive for HIV and were treated at Testing and Counseling Centers, according to sociodemographic characteristics.

METHODS: this was a cross-sectional study conducted in Ribeirão Preto, São Paulo, Brazil, between 2018 and 2021. Data were collected from patient records, including sociodemographic and sexual behavior variables, which were dichotomized as high vs. low/moderate risk.

RESULTS: a total of 214 individuals were included, of whom 111 (51.9%) exhibited high-risk sexual behavior: having a steady or casual partner, having six or more partners, having relationships with both men and women, sometimes/never using condoms and lubricants, and having anal sex. No association was identified between high-risk sexual behavior and sociodemographic variables.

CONCLUSIONS: high-risk sexual behavior was observed among individuals living with HIV without a specific profile, requiring public policies that encourage the adoption of safe sex practices and reduce virus transmission.

PMID:41880454 | DOI:10.1590/0034-7167-2024-0576

Chem Res Toxicol. 2026 Mar 25. doi: 10.1021/acs.chemrestox.5c00459. Online ahead of print.

ABSTRACT

In recent years, the rapid increase in the production and environmental release of synthetic organic chemicals has raised serious concerns about their potential adverse effects on human health and the environment. Repeated exposure to such substances can lead to significant toxicological effects, underscoring the importance of early and reliable hazard assessment. However, experimental determination of repeated-dose toxicity (RDT) is costly, time-consuming, and constrained by ethical considerations. In this study, we developed various classification-based predictive models to evaluate the subchronic RDT potential of chemicals after oral exposure. We compiled data from eChemPortal and J-CHECK databases. The data set contains two study-derived effect levels: NOAEL (no observed adverse effect level) and LOAEL (lowest observed adverse effect level), for which separate models have been developed. A key strength of this data set is that all studies followed standardized OECD test guidelines (407, 408, and 422) and were conducted under good laboratory practice (GLP) conditions, ensuring regulatory relevance and high data reliability. Multiple machine learning algorithms were systematically evaluated, and the best models were selected using a multicriteria analysis based on the sum of ranking differences (SRD) technique. The final selected models achieved accuracies on the training sets ranging from 0.665 to 0.902, while the test sets showed accuracies ranging from 0.642 to 0.682. We also conducted a substructure analysis to identify the key substructures involved in the toxicity. This analysis revealed eight structural motifs, with chlorine- and amine-group-containing aromatic systems being particularly significant. The final developed models were experimentally validated using chemical substances provided by Global Product Compliance (GPC) Europe AB. Additionally, the models were applied to the Pesticides Properties DataBase (PPDB) to screen for pesticides with potential toxicity upon repeated exposure. To facilitate accessibility and regulatory application, the final models have been implemented in both a Python-based tool and a web application. Scientific contribution: this study presents predictive models as alternatives to traditional animal testing for assessing the subchronic oral repeated-dose toxicity (RDT) of chemicals. Our models demonstrate strong statistical performance, indicating their suitability for further application, as supported by experimental validation. These models could be used for preliminary hazard screening or weight-of-evidence evaluations. An additional advantage is that these models were developed using data that were tested in accordance with internationally harmonized test protocols, thereby enhancing their acceptance for regulatory decision-making.

PMID:41880451 | DOI:10.1021/acs.chemrestox.5c00459

Braz Oral Res. 2026 Mar 20;40:e010. doi: 10.1590/1807-3107bor-2026.vol40.010. eCollection 2026.

ABSTRACT

The aims of this retrospective radiographic study were to assess the occurrence of dental anomalies in children and patients with disabilities and to investigate the association of these anomalies with pre-, peri-, and post-natal medical history. A total of 289 panoramic radiographs of children (0-14 years) and patients with disabilities (including all age groups) were used to identify developmental dental anomalies, and information was collected from medical records for statistical analysis. Data were expressed as relative frequency (percentage). The chi-square test, Fisher’s exact test, relative risk calculation, and the Mann-Whitney test were used for statistical comparisons with a significance level of 5%. Occurrence of dental alterations was 50.34% in children and 37.50% in patients with disabilities. Agenesis was the most common alteration (24.14% in children and 30.55% in patients with disabilities). The study found a relative risk of 2.6 for agenesis in children with a history of prematurity (p = 0.02). The variable “performing medical treatment” was a risk factor for the presence of dental alterations in children. The age and the medical conditions of the patients with disabilities varied greatly, with neurological diseases being the most prevalent disability. However, the health history of mothers during pregnancy was not associated with dental alterations in patients with disabilities (p > 0.05). Developmental dental anomalies were frequently observed in both groups, with agenesis being the most common condition. Prematurity was identified as a predictive factor for agenesis.

PMID:41880449 | DOI:10.1590/1807-3107bor-2026.vol40.010

J Med Internet Res. 2026 Mar 25;28:e79363. doi: 10.2196/79363.

ABSTRACT

BACKGROUND: Stroke is a leading cause of long-term upper limb disability, severely impacting patients’ independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions.

OBJECTIVE: This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research.

METHODS: This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies.

RESULTS: This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type.

CONCLUSIONS: RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations.

TRIAL REGISTRATION: PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183.

PMID:41879816 | DOI:10.2196/79363

Am J Clin Oncol. 2026 Mar 25. doi: 10.1097/COC.0000000000001321. Online ahead of print.

ABSTRACT

OBJECTIVES: Solitary plasmacytoma is a rare plasma cell neoplasm with varying outcomes. This large IRB-approved retrospective analysis used the National Cancer Database (NCDB) to assess prognostic factors, treatment patterns, and overall survival (OS) among patients treated at Commission on Cancer-accredited facilities in the United States.

METHODS: Plasmacytoma patients (N=9427) from 2004 to 2020 were identified using the NCDB, excluding multiple myeloma. Descriptive statistics, Kaplan-Meier curves, and multivariate Cox regression analysis were used to evaluate survival outcomes by primary site, radiation dosage, and treatment modality. SAS version 9.4 was used to analyze the data.

RESULTS: Among 9427 patients, solitary plasmacytoma of bone (P-Bone) comprised 73% and extramedullary plasmacytoma (P-EM) 27%. Median OS was 106 months for P-Bone versus 146 months for P-EM (P<0.0001). Combined radiation therapy and surgery achieved the longest median OS (181 mo) versus surgery alone (137 mo) and radiation alone (116 mo; P<0.0001). OS increased with higher radiation dose: <35 Gy (46.6 mo) to ≥50 Gy (176.4 mo; P<0.0001). Among P-Bone sites, skull/mandible lesions showed the best outcomes (122.3 mo). Radiation doses of 45 to 49.9 Gy predominated across most sites.

CONCLUSIONS: This real-world study analyzes treatment patterns and overall survival in the largest plasmacytoma database to date. Combined surgery and radiation therapy show improved survival outcomes, emphasizing the need for personalized treatment approaches and the strength of combined modality therapy. Considering the primary bone site and radiation dosage aids prognostic assessment and treatment decision-making, contributing to plasmacytoma management and personalized care.

PMID:41879814 | DOI:10.1097/COC.0000000000001321

Glob Health Action. 2026 Dec;19(1):2647528. doi: 10.1080/16549716.2026.2647528. Epub 2026 Mar 25.

ABSTRACT

All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen’s Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage.

PMID:41879796 | DOI:10.1080/16549716.2026.2647528

JAMA Netw Open. 2026 Mar 2;9(3):e262103. doi: 10.1001/jamanetworkopen.2026.2103.

ABSTRACT

IMPORTANCE: Patients with cancer face an increased risk of Clostridioides difficile infection (CDI) due to several factors, including chemotherapy and repeated health care exposures. However, recent national-level data characterizing the prevalence of CDI, associated clinical outcomes, and resource utilization in this population remain limited.

OBJECTIVE: To characterize the hospitalization-level prevalence, clinical outcomes, and health care resource utilization associated with CDI among hospitalized patients with cancer in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Inpatient Sample, a nationally representative database, to identify hospitalizations among adults with a diagnosis of cancer between January 1, 2016, and December 31, 2022. Hospitalizations with CDI were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Data were analyzed from May to June 2025.

EXPOSURES: Presence of CDI as a primary or secondary diagnosis during the index hospitalization.

MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included need for kidney replacement therapy, mechanical ventilation, vasopressor support, and colonoscopy. Multivariable logistic regression was used to adjust for demographics, comorbidities, cancer type, and hospital characteristics.

RESULTS: Of 32 083 671 cancer-related hospitalizations (overall study population mean [SD] patient age, 69.4 [13.9] years; 16 050 025 [50.0%] male), 450 360 (1.4%) involved a diagnosis of CDI. Compared with hospitalizations without CDI, those with CDI involved older patients, a higher proportion of women, and higher prevalence of hematologic cancers, cirrhosis, solid organ transplant, bone marrow transplant, chronic kidney disease, and inflammatory bowel disease. Patients with CDI infection had higher in-hospital mortality (7.3% vs 4.5%; adjusted odds ratio [aOR], 1.62; 95% CI, 1.58-1.67) and greater use of critical care interventions. CDI was associated with higher rates of critical care interventions, including kidey replacement therapy (44.3 vs 20.4 per 1000 hospitalizations; aOR, 2.00; 95% CI, 1.92-2.08; P < .001), mechanical ventilation (68.1 vs 35.6 per 1000 hospitalizations; aOR, 1.89; 95% CI, 1.84-1.95; P < .001), and vasopressor use (25.6 vs 11.5 per 1000 hospitalizations; aOR, 2.11; 95% CI, 2.00-2.24; P < .001). Mortality among patients with CDI varied geographically, ranging from 6.4% (95% CI, 6.2%-6.5%) in the Midwest to 8.5% (95% CI, 8.3%-8.7%) in the Northeast.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US oncologic hospitalizations, CDI occurred in 1 in 70 cancer-related hospitalizations and was associated with significantly increased mortality and resource utilization. These findings underscore the need for targeted prevention and early intervention strategies in this vulnerable population.

PMID:41879784 | DOI:10.1001/jamanetworkopen.2026.2103

JAMA Netw Open. 2026 Mar 2;9(3):e262443. doi: 10.1001/jamanetworkopen.2026.2443.

ABSTRACT

IMPORTANCE: Large language models (LLMs) are increasingly being applied to analyze clinical data, primarily clinical text, with an increasing emphasis on integration in health care. However, the use of LLMs in pediatric care remains underexplored.

OBJECTIVE: To map the emerging literature on LLM use in pediatrics involving clinical text and identify evidence gaps and future directions for implementation and evaluation.

EVIDENCE REVIEW: PubMed/MEDLINE, Embase, Web of Science, Scopus, and preprint servers were searched for English-language original research published from January 1, 2020, to July 1, 2025. Included studies used modern transformer-based LLMs with pediatric clinical text as input. Two reviewers independently screened studies using predefined criteria. Data were extracted by one reviewer and verified by another. Findings were descriptively synthesized, and adherence to the Minimum Information for Medical AI Reporting (MINIMAR) standards was assessed.

FINDINGS: The review included 40 studies published between 2023 and 2025. Twenty-three studies were conducted in the US, and all were retrospective observational studies using clinical data from sources such as electronic health records. Participant sample sizes ranged from 10 to 172 683. Although all pediatric age subgroups were represented, early childhood populations (aged 0-5 years) were underrepresented. The most common LLM clinical applications were diagnostic decision support in 24 studies (60.0%) and treatment planning in 7 studies (17.5%). Although all 40 studies conducted clinical evaluation of LLMs and 30 included discussions of ethics or data privacy, 39 studies (97.5%) did not meet full MINIMAR standards, 34 (85.0%) did not report use of Health Insurance Portability and Accountability Act-compliant models, and 30 (75.0%) lacked fine-tuning for pediatric-specific data. Among 33 studies assessing model performance against human annotations, 10 (30.3%) did not include clinicians as annotators; among 26 studies with multiple annotators, only 9 (34.6%) reported interannotator agreement statistics.

CONCLUSIONS AND RELEVANCE: This scoping review found that diagnostic decision support and treatment planning were commonly proposed applications of LLMs in pediatrics. However, gaps in scientific rigor and limited use of pediatric-specific data may hinder their safe and effective implementation in pediatrics. Future studies should use standardized evaluation and reporting methods, increase clinician involvement, and expand research to underrepresented ages and clinical applications.

PMID:41879783 | DOI:10.1001/jamanetworkopen.2026.2443

JAMA Netw Open. 2026 Mar 2;9(3):e263050. doi: 10.1001/jamanetworkopen.2026.3050.

ABSTRACT

IMPORTANCE: Although buprenorphine is highly effective at preventing overdose, access is limited in rural areas. Rural primary care is a critical site to expand access; prescribing support tailored for this setting is urgently needed.

OBJECTIVE: To test the feasibility and preliminary effectiveness of a brief buprenorphine prescribing support program (BPSP) tailored for rural primary care professionals (PCPs).

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized pilot clinical trial compared 27 Ohio community health centers with 63 PCPs (10 physicians, 50 nurse practitioners, and 3 physician assistants) receiving the support program at baseline and immediately after the intervention with those receiving only copies of the American Society of Addiction Medicine’s buprenorphine prescribing guidelines. Data were collected from July 25, 2024, to February 28, 2025.

INTERVENTIONS: The BPSP is a brief, hour-long, asynchronous and online training program, followed by an optional, live booster session, that provides clinical skills on buprenorphine prescribing, addresses misinformation on the safety of buprenorphine, and addresses stigma toward buprenorphine. Health centers were randomized with 2 centers allocated to the intervention for every 1 allocated to the control condition.

MAIN OUTCOMES AND MEASURES: Primary implementation outcomes were feasibility (measured via the 4-item Feasibility of Intervention Measure [scale of 1 to 5, with higher scores indicating greater feasibility]), acceptability (measured via the 4-item Acceptability of Intervention Measure [scale of 1 to 5, with lhigher scores indicating greater acceptability]), and appropriateness (measured via the 4-item Intervention Appropriateness Measure [scale of 1 to 5, with higher scores indicating greater appropriateness]) of the BPSP; willingness to treat opioid use disorder (OUD) in primary care (using a measure developed and tested with a different sample of PCPs); and likelihood of prescribing buprenorphine in the next 6 months (measured via a 5-point Likert scale ranging from 1.00 [extremely unlikely] to 5.00 [extremely likely]).

RESULTS: Of the 63 participating PCPs, 48 participants were allocated to the intervention condition and 15 to the control condition (49 female [78%]; mean [SD] age, 45.5 [11.4] years). Forty-nine participants (78%) practiced in rural areas and 10 (16%) had ever prescribed buprenorphine. Participants receiving the BPSP rated it as highly feasible (median score, 4.25 [IQR, 4.00-5.00]), acceptable (median score, 4.88 of 5.00 [IQR, 4.00-5.00]), and appropriate (median score, 5.00 of 5.00 [IQR, 4.00-5.00]). Participants receiving the BPSP had significantly higher willingness to treat OUD; 86% of rank comparisons improved post intervention. Intention to prescribe buprenorphine in the next 6 months also significantly increased; 98% of rank comparisons improved post intervention. Participants who completed the BPSP showed significant improvements in having correct information about buprenorphine, had greater confidence treating addiction and prescribing buprenorphine, and had lower stigma and greater empathy toward patients with OUD.

CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial of the BPSF, brief prescribing support was feasible, acceptable, and appropriate for implementation in rural primary care, and intentions to prescribe buprenorphine increased. A larger trial is needed to confirm preliminary findings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05505227.

PMID:41879782 | DOI:10.1001/jamanetworkopen.2026.3050

JAMA Netw Open. 2026 Mar 2;9(3):e263410. doi: 10.1001/jamanetworkopen.2026.3410.

ABSTRACT

IMPORTANCE: Despite safety warnings, antipsychotics remain commonly prescribed to older adults, particularly those with dementia, and for off-label indications. However, little is known about how prescribing patterns vary by clinician type over time.

OBJECTIVE: To examine trends in antipsychotic prescribing by clinician type among Medicare beneficiaries from 2013 to 2023.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used the Medicare Part D Prescribers by Provider and Drug dataset from 2013 to 2023. Participants included Medicare beneficiaries enrolled in Medicare Part D. Analyses were performed between November 2024 and June 2025.

EXPOSURE: Prescribing clinician type, categorized as psychiatrist, primary care physician (PCP), advanced practice registered nurse (APRN) or physician assistant (PA), or other physician.

MAIN OUTCOMES AND MEASURES: Annual antipsychotic prescription claims, the proportion of claims by clinician type, the number of prescribing clinicians, and the mean number of claims per clinician.

RESULTS: From 2013 to 2023, annual antipsychotic prescription claims decreased from 10.8 million to 7.8 million for psychiatrists (average annual percentage change [AAPC], -3.2% [95% CI, -3.7% to -2.7%]; P < .001) and from 7.4 million to 5.7 million for PCPs (AAPC, -2.6% [95% CI, -3.2% to -2.3%]; P < .001). In contrast, claims prescribed by APRNs or PAs more than tripled from 2013 to 2023, increasing from 3.1 million to 9.5 million (AAPC, 11.8% [95% CI, 10.9%-12.7%]; P < .001). The proportion of prescriptions decreased for psychiatrists (48.4% to 32.4%) and PCPs (33.0% to 23.8%) but increased for APRNs and PAs (13.8% to 39.6%) from 2013 to 2023. These shifts were associated primarily with the expanding number of prescribing APRNs and PAs rather than an increase in the mean number of claims per clinician. Although trends were observed in both rural and urban areas, rural areas experienced larger shifts from PCPs to APRNs and PAs, whereas urban areas experienced larger shifts from psychiatrists to APRNs and PAs.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicare Part D data from 2013 to 2023, antipsychotic prescribing shifted from psychiatrists and PCPs to APRNs and PAs, reflecting growth in nonphysician prescribers. These findings suggest evolving roles in antipsychotic medication management and highlight the need for appropriate training for the full range of clinician types who prescribe these medications to Medicare enrollees.

PMID:41879781 | DOI:10.1001/jamanetworkopen.2026.3410