Tag: pubmed

BMJ Open. 2026 Apr 15;16(4):e110853. doi: 10.1136/bmjopen-2025-110853.

ABSTRACT

OBJECTIVE: Ethnic communities provide an appropriate setting for examining patterns of pregnancy and childbirth. Policy-making aimed at improving maternal health will be rendered ineffective in the absence of knowledge and comprehension of the traditions and beliefs associated with childbirth. The objective of this study was to cross-ethnically compare childbirth experiences.

DESIGN: This research used a cross-sectional methodology and was conducted in 2023. The sampling in the cities of Tabriz (Azeri), Sanandaj (Kurdish), Babol (Mazani), Khorramabad (Lur), Ahvaz (Arab) and Tehran (Fars) was conducted using the cluster random approach. The data collection instruments included questionnaires of sociodemographic and obstetric characteristics and childbirth experience (Childbirth Experience Questionnaire 2.0). In bivariate analysis, a one-way analysis of variance test was employed. In contrast, a general linear model (GLM) was used in multivariate analysis to adjust for the influence of sociodemographic and obstetric characteristics. The data were analysed using SPSS V.24 software. The p value less than 0.05 was considered significant.

SETTING: Health centres in cities with different ethnic groups all over Iran.

PARTICIPANTS: For this purpose, 1331 women from six ethnic groups who were referred to health centres were selected 4 to 6 weeks after giving vaginal birth.

RESULTS: The following are the mean (SD) scores (scoring range: 1-4) for the childbirth experiences of the participating women: Azeri 2.31 (0.32), Kurdish 2.14 (0.31), Fars 2.26 (0.42), Mazani 1.93 (0.38), Lur 2.14 (0.4) and Arab 2.06 (0.18). Results from GLM multivariate analysis showed that while Azeri (B: 0.25; 95% CI 0.16 to 0.35; p<0.001), Kurdish (B: 0.10; 95% CI 0.03 to 0.18; p=0.007) and Fars (B: 0.18; 95% CI 0.03 to 0.27; p=0.014) women had significantly higher mean scores for childbirth experience than Arabs (the reference group), women of Mazani ethnicity had significantly lower scores (B: -0.10; 95% CI -0.18 to -0.04; p=0.002).

CONCLUSIONS: Women of different Iranian ethnicities have varying childbirth experiences. Women of Azeri and Fars ethnic groups report higher satisfaction with childbirth than those of others. Mazeni women had the lowest mean scores for having a positive birth experience. To offer compassionate and effective treatment for their patients, healthcare providers must have a deep understanding of cultural diversity.

PMID:41985963 | DOI:10.1136/bmjopen-2025-110853

BMJ Open. 2026 Apr 15;16(4):e113798. doi: 10.1136/bmjopen-2025-113798.

ABSTRACT

OBJECTIVES: To assess access to child-appropriate medicines in Albanian community pharmacies by applying a child-adapted version of sustainable development goal (SDG) indicator 3.b.3.

DESIGN: Cross-sectional survey.

SETTING: Community pharmacies providing primary care medicines in six urban areas in Albania.

PARTICIPANTS: Thirty community pharmacies were surveyed. Two predefined baskets of child-appropriate essential medicines were assessed: 24 medicines for children aged 1-59 months and 25 medicines for children aged 5-12 years. Medicines were selected from these child-adapted SDG 3.b.3 medicine baskets proposed at an international level and then matched to paediatric formulations registered nationally for application to Albania.

OUTCOMES: Individual facility scores by age group and medicine type (originator brands (OBs) vs lowest-priced generics (LPGs)), as well as sensitivity analyses using alternative affordability thresholds.

RESULTS: The SDG 3.b.3 indicator score was 0%, as no surveyed facility reached the 80% access threshold. Mean facility scores were 42.6% for medicines intended for children aged 1-59 months and 29.6% for those aged 5-12 years, indicating poorer access for older children. Scores for OBs were particularly low (11.8% and 13.6%, respectively), reflecting reliance on LPGs. In younger children, ibuprofen and hydroxycobalamin showed 0% availability, while in school-aged children, paracetamol, propranolol and budesonide were absent across surveyed facilities; benzylpenicillin was absent in both age groups, whereas ceftriaxone was consistently available in both. Although all surveyed medicines were affordable, limited availability remained the primary barrier to access.

CONCLUSIONS: Application of the child-adapted SDG indicator 3.b.3 in Albania highlights substantial gaps in access to essential paediatric medicines in private community pharmacies, driven primarily by poor availability rather than affordability. The findings underscore the need for targeted supply-side policies. This study demonstrates the complementary value of composite SDG indicators and medicine-specific availability measures in monitoring progress toward universal health coverage for children.

PMID:41985961 | DOI:10.1136/bmjopen-2025-113798

J Dent. 2026 Apr 13:106698. doi: 10.1016/j.jdent.2026.106698. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective study aimed to evaluate the impact of artificial intelligence (AI)-based automated segmentation (AS) on the accuracy of robotic computer-aided implant surgery (r-CAIS).

METHODS: Patients who underwent r-CAIS were enrolled. Preoperative CBCT images were segmented using either threshold-based SS approach (SS group) or the AI-based AS approach (AS group). Osteotomy preparation and implant placement were performed using a semi-active robot. Registration errors and deviations between planned and postoperatively placed implant positions were calculated. Intergroup comparisons were performed using Wilcoxon Mann-Whitney U tests, with P < 0.05 considered significant.

RESULTS: A total of 140 patients (79 females, 61 males) receiving 224 implants were included (SS group: 69 patients, 107 implants; AS group: 71 patients, 117 implants). The registration error in the AS group (0.10 ± 0.04 mm) was significantly lower than that in the SS group (0.12 ± 0.04 mm) (P < 0.05). The AS group demonstrated lower deviations at the platform (0.51 ± 0.16 vs.0.56 ± 0.18 mm), apex (0.60 ± 0.23 vs. 0.66 ± 0.23 mm), and angulation (1.13 ± 0.59° vs. 1.19 ± 0.53°), with a statistically significant difference observed in global platform deviation (P < 0.05).

CONCLUSIONS: r-CAIS demonstrated consistently high accuracy, which was further improved by AI-based AS. This improvement may be associated with enhanced registration precision achieved through AI-based AS.

CLINICAL SIGNIFICANCE: These findings support the potential clinical application of AI-based AS in r-CAIS.

PMID:41985737 | DOI:10.1016/j.jdent.2026.106698

J Oral Maxillofac Surg. 2026 Mar 31:S0278-2391(26)00257-0. doi: 10.1016/j.joms.2026.03.015. Online ahead of print.

ABSTRACT

BACKGROUND: There is a critical trade-off in ameloblastoma management: balancing the significant tissue-preserving benefits of decompression treatment against its potential for higher recurrence compared to radical resection.

PURPOSE: The study purpose was to evaluate the therapeutic effects of decompression treatment for managing ameloblastoma.

STUDY SELECTION: A systematic search was conducted across multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of proportions was performed using a random-effects model in RStudio to pool data on size reduction and time to recurrence rates. Heterogeneity was assessed using I² and Tau statistics.

RESULTS: Nine studies met the inclusion criteria. The analysis included 555 ameloblastomas (381 unicystic ameloblastoma, 174 multicystic ameloblastoma). Decompression treatment yielded a significant mean size reduction of 55.3% (range: 7.5 to 93.02%). Recurrence outcomes were evaluated using time-to-event analysis where individual patient data were available (n = 287). The overall recurrence rate was 3.8 per 100 person-years (95% CI: 2.4 to 6.1). A stark difference was observed between histological subtypes: unicystic ameloblastoma demonstrated a recurrence rate of 2.1 per 100 person-years (95% CI: 1.1 to 4.0) compared to 8.9 per 100 person-years (95% CI: 5.4 to 14.6) for multicystic ameloblastoma (hazard ratio [HR] = 3.2; 95% CI: 1.8 to 5.7; P = .008). Longer decompression duration (>12 months) was associated with a significantly reduced recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012). Prolonged decompression (>12 months) was associated with a 48% reduction in recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012).

CONCLUSIONS AND RELEVANCE: Decompression treatment is effective for reducing ameloblastoma size, facilitating minimally invasive treatment. However, recurrence risk is significantly higher in multicystic and mural subtypes, with multicystic variants demonstrating a 3.2-fold increased hazard of recurrence compared to unicystic variants. These findings support a tailored surgical approach based on histology and clinical presentation, though they should be interpreted with caution due to the high heterogeneity among the included studies.

PMID:41985552 | DOI:10.1016/j.joms.2026.03.015

J Surg Educ. 2026 Apr 14;83(6):103958. doi: 10.1016/j.jsurg.2026.103958. Online ahead of print.

ABSTRACT

INTRODUCTION: Acquisition of technical skills in surgery requires both precise motor coordination and efficient cognitive control. While simulation platforms and benchtop dexterity tests have demonstrated utility in differentiating performance levels, their predictive validity remains variable. Concurrently, physiologic metrics of cognitive load have emerged as promising tools for quantifying mental effort during surgical tasks. Pupillometry, in particular, offers high temporal resolution, noninvasiveness, and task-synchronized measurement capabilities. However, few studies have integrated objective dexterity metrics with real-time physiologic workload assessment in a unified, scalable framework. To address this gap, we developed a benchtop testing protocol combining standardized fine-motor tasks with pupillometry to evaluate technical performance and cognitive load at different levels of surgical training.

METHODS: In a pilot cross-sectional observational study, 79 participants, including 49 medical students, 17 nonmedical controls, and 13 experts, completed 2 standardized dexterity tasks: the O’Connor Finger Dexterity and O’Connor Tweezer Dexterity Tests, followed by a knot-tying task. Performance metrics included completion time for each task. Cognitive load was indexed by baseline-corrected pupil diameter (Δ-BCPD), continuously captured and rescaled to normalized task time. Cognitive-load dynamics were compared across groups and performance tiers.

RESULTS: Finger dexterity scores differed significantly by role (p = 0.048) and correlated with knot-tying time (R² = 0.472), supporting their construct-specific validity. Tweezer-task scores showed no significant relationship with procedural performance (R² = 0.004). Pupillometry showed directionally consistent group-level gradients in Δ-BCPD, with experts exhibiting lower mean task-evoked dilation. High-performing participants demonstrated reduced cognitive load, particularly during the finger task, indicative of greater automation. Trends in Δ-BCPD were directionally consistent across groups but did not reach statistical significance.

CONCLUSIONS: Brief dexterity tasks paired with time-normalized pupillometry may provide complementary information about motor performance and cognitive workload. This exploratory, rater-independent framework showed promise for distinguishing performance differences and characterizing task demands, supporting further validation in larger cohorts.

PMID:41985317 | DOI:10.1016/j.jsurg.2026.103958

Nutrition. 2026 Mar 12;148:113202. doi: 10.1016/j.nut.2026.113202. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) is a leading global cause of mortality, strongly influenced by diet. Research in this field has evolved from the analysis of nutrients to the evaluation of dietary patterns (DP), with the aim of more accurately reflecting real eating behaviors. A variety of statistical methods are employed to identify DP, leading to heterogeneous results. This variability highlights the need for methodological standardization to improve comparability and evidence synthesis.

OBJECTIVE: The aim of this study was to evaluate the statistical methodologies used to identify a posteriori DP and determine their relationship with CVD.

METHODS & PROCEDURES: A systematic search of the PubMed, Scopus and Web of Science databases was carried out, including observational studies conducted on adults aged 18 years and over. The review protocol was registered in PROSPERO (CRD4202525642904). The analysis of 18 studies that identified a posteriori DP related to CVD was conducted.

RESULTS: Across the included studies, DP were mainly derived using principal component analyses (PCA), although variability existed in component selection and factor loading thresholds. Most studies assessed sampling adequacy, applied Varimax orthogonal rotation, and selected components based on eigenvalue thresholds >1, although cut-offs varied. A small number of studies combined PCA with other multivariate approaches. Despite heterogeneity in identified patterns, Western, traditional, animal-based, and Mediterranean DP were most frequently reported. Western patterns were associated with increased CVD, whereas Mediterranean patterns showed a protective effect.

CONCLUSIONS: CVD-related DP are highly variable, depending on factors such as sex, culture and socio-economic status. This underlines the importance of standardizing dietary collection and assessment methods.

PMID:41985214 | DOI:10.1016/j.nut.2026.113202

J Plast Reconstr Aesthet Surg. 2026 Mar 16;116:215-222. doi: 10.1016/j.bjps.2026.03.009. Online ahead of print.

ABSTRACT

INTRODUCTION: Assessing the ability of AI chatbots to provide information consistent with clinical guidelines is essential for evaluating the accuracy of the information that patients may receive. We evaluated the ability of three widely used chatbots to reference and respond to clinical questions in alignment with the American Society of Plastic Surgeons’ (ASPS) clinical guidelines.

METHODS: Evidence-based clinical practice guidelines from ASPS and the American Association of Plastic Surgeons (AAPS) were used to develop prompts for ChatGPT-4, Meta Llama 3.1, and Microsoft Copilot. Reviewers determined if the chatbots’ answer aligned with the ASPS guidelines. Any reference to ASPS by the chatbots was recorded. Descriptive statistics were used for data analysis.

RESULTS: Forty-nine total recommendations from five clinical guidelines were included: reduction mammoplasty, autologous breast reconstruction, breast-implant associated anaplastic large cell lymphoma, eyelid surgery, and reconstruction after skin cancer. Copilot cited ASPS recommendations most frequently (Copilot: 67.3%, Llama: 34.7%, ChatGPT: 16.3%; p<0.0001) and had the highest rate of ASPS- and AAPS-aligned responses (Copilot: 79.6%, Llama: 73.5%, ChatGPT: 69.4%; p>0.05). Among the misaligned responses, neutral responses were most common with no significant differences among the chatbots (Copilot: 60%, Llama: 69.2%, ChatGPT: 40%; p=0.62).

CONCLUSION: In our study, up to 30% of chatbot responses did not align with ASPS and AAPS guidance. These results indicate a need for advocacy from plastic surgery societies regarding patient reliance on AI chatbots and training AI models specific to the specialty.

PMID:41985209 | DOI:10.1016/j.bjps.2026.03.009

Epilepsy Behav. 2026 Apr 14;180:111044. doi: 10.1016/j.yebeh.2026.111044. Online ahead of print.

ABSTRACT

BACKGROUND: Intractable epilepsy with partial-onset seizures (POS), affecting more than 20% of individuals with epilepsy, is one of the most common neurological conditions worldwide. Perampanel (PER), an antiepileptic drug (AED), is widely used in the treatment of refractory POS. However, the optimal dose of PER remains undetermined. This network meta-analysis (NMA) aims to determine the optimal dose of PER by comparing and ranking the outcomes acquired from eligible randomized, double-blind, placebo-controlled trials, quantitatively analyzing the data.

METHODS: Electronic databases such as Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched from database inception through May 30, 2024. This NMA includes and synthesizes data from four eligible randomized controlled trials and compares outcomes from four fixed doses of PER (i.e. 12 mg, 8 mg, 4 mg, and 2 mg) along with placebo (PBO). The outcomes assessed include the 50% responder rate, seizure-free rate, dropout rate due to treatment-emergent adverse events (TEAEs), retention rate, and the incidence of TEAEs and serious TEAEs (sTEAEs), using a modified intention-to-treat (MITT) approach. Two reviewers independently screened studies, extracted data from eligible studies and assessed the risk of bias (ROB) using the Cochrane ROB tool 2.0. Pairwise meta-analysis (PMA) and NMA were conducted using a random-effects model with ADDIS v1.16.8 software. The odds ratio (OR) and 95% confidence interval (CI) were calculated for PMA, and OR and 95% credible intervals (CrI) for NMA for dichotomous outcomes. Statistical heterogeneity and sensitivity analyses were performed, and inconsistencies were assessed using the node-split and inconsistency models. We evaluated the quality of evidence and strength of recommendations for clinical practice using the GRADE approach. This prospective study protocol is registered with PROSPERO (registration number: CRD42021247514).

FINDINGS: A total of 281 citations were initially identified from the databases and manual searches, with 4 studies involving 2187 participants ultimately included in the systematic review and NMA. All included trials were assessed as having a low ROB according to the revised Cochrane ROB tool 2.0. The ORs and CrIs for the 50% responder rate showed that PER 12 mg compared to PER 4 mg, PER 2 mg, and PBO ranged from 1.96 (1.12 to 3.21) to 2.78 (1.74 to 4.08). For PER 8 mg, the ORs and CrIs compared to PER 4 mg, PER 2 mg, and PBO ranged from 1.66 (1.01 to 2.67) to 2.33 (1.57 to 3.39). For the seizure-free rate, the ORs and CrIs of PER 4 mg, PER 8 mg, and PER 12 mg compared to PBO ranged from 4.21 (1.18 to 15.35) to 5.90 (1.88 to 22.06), respectively. For TEAEs, the ORs and CrIs for PER 12 mg compared to PER 4 mg, PER 2 mg, and PBO ranged from 2.26 (1.30 to 4.00) to 3.07 (1.86 to 4.82). No significant differences were found in the incidence of sTEAEs across all intervention groups. The ORs and CrIs for the dropout rate showed that PER 12 mg compared to PER 8 mg, PBO, and PER 4 mg ranged from 2.16 (1.22 to 4.06) to 5.00 (2.26 to 14.19), and for PER 8 mg compared to PBO and PER 4 mg, the ORs and CrIs ranged from 2.31 (1.24 to 4.58) to 2.38 (1.06 to 6.22). For the retention rate, the ORs and CrIs of PER 12 mg compared to PER 4 mg, PBO, and PER 8 mg ranged from 0.43 (0.24 to 0.69) to 0.65 (0.43 to 0.97). The overall quality of evidence was deemed high. A strong recommendation is made to prioritize PER 8 mg as the first-line treatment, with PER 12 mg as a secondary option for refractory epilepsy with POS.

INTERPRETATION: PER is safe and effective for the treatment of intractable epilepsy with POS. This NMA, which provides high-quality evidence, strongly recommends PER 8 mg as the first-line treatment option, with PER 12 mg as the second choice when necessary. These recommendations are likely applicable to the majority of patients with intractable epilepsy with POS; however, they may not apply to all patients, particularly those with unique clinical characteristics or in specific clinical circumstances.

PMID:41985208 | DOI:10.1016/j.yebeh.2026.111044

Epilepsy Behav. 2026 Apr 14;180:111051. doi: 10.1016/j.yebeh.2026.111051. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to assess feasibility of a remotely delivered physical activity intervention in adults with epilepsy.

METHODS: Adults with epilepsy and at least one seizure in the prior six months were randomized 2:1 to either a physical activity intervention or a healthy living education control arm. The intervention group received a 12-week program led by a trained health coach aimed to progressively increase daily steps while the control group received biweekly telephone education on healthy living. Sustainability was assessed at 12 weeks post-intervention. Daily steps and activity intensity were continuously measured by a Garmin Forerunner 45.

RESULTS: A total of 21 participants were randomized (15 intervention; 6 control), and 17 completed the full study (14; 3). There was high retention (93%), attendance (80%), and acceptability in the intervention group. While the proportion of the intervention group who strictly adhered to their daily step goal was low (26.67%; 95% CI 0.076 – 0.581), there was a significant increase in mean daily steps (3495 (95% CI 2,170-4,821) to 5591(4,271-6,911), p < 0.001) and mean daily moderate-to-vigorous intensity activity minutes (17.98 (5.55-30.41) to 30.11 (17.93-42.28), p < 0.001) in the intervention group compared to the control group. Both measures remained elevated at follow-up (4,758 (3,437-6,079) and 35.26 (23.03-47.49), respectively) while the control group showed no statistically significant changes over time.

CONCLUSION: A remotely delivered daily steps-based physical activity intervention is feasible for people with epilepsy and shows promising immediate and sustainable effects on physical activity behaviors.

PMID:41985206 | DOI:10.1016/j.yebeh.2026.111051

Epilepsy Behav. 2026 Apr 14;180:111052. doi: 10.1016/j.yebeh.2026.111052. Online ahead of print.

ABSTRACT

BACKGROUND: Self-limited epilepsy with centrotemporal spikes (SeLECTS) is the most common focal epilepsy syndrome in childhood. Although its clinical course is generally benign, concerns remain regarding potential cognitive effects of both the disease and antiepileptic treatments. This study aimed to evaluate visuospatial abilities and cognitive perception in children newly diagnosed with SeLECTS and to compare the cognitive outcomes of levetiracetam and valproic acid monotherapy.

METHODS: This prospective study included 64 children aged 5-10 years who were newly diagnosed with SeLECTS and initiated on monotherapy with either levetiracetam or valproic acid. Cognitive functions were assessed using the Bender-Gestalt Visual-Motor Perception Test at the baseline and after 6 months of treatment. Test results were compared within and between treatment groups.

RESULTS: Of the 64 children, 38 (59.4%) were male and 26 (40.6%) were female, with a mean age of 8.5 ± 1.7 years. Valproic acid was prescribed to 34 patients (53.1%), and levetiracetam to 30 patients (46.9%). There were no significant differences between the groups in terms of age or sex distribution (p = 0.052 and p = 0.63, respectively). In the levetiracetam group, the mean Bender-Gestalt error percentile score increased from 32.0 ± 25.0 at baseline to 37.3 ± 25.2 at month 6, while in the valproic acid group, the corresponding values were 30.6 ± 21.7 and 30.9 ± 25.4. No statistically significant differences were observed between baseline and 6-month cognitive assessments within or between the two treatment groups (p = 0.30 and p = 0.83).

CONCLUSION: In children newly diagnosed with SeLECTS, neither levetiracetam nor valproic acid monotherapy was associated with significant changes in visuospatial abilities and cognitive perception over a 6-month follow-up period. Further long-term and larger-scale studies are warranted to clarify these findings.

PMID:41985205 | DOI:10.1016/j.yebeh.2026.111052