Tag: pubmed

JMIR Med Educ. 2026 Jan 26;12:e75021. doi: 10.2196/75021.

ABSTRACT

BACKGROUND: Virtual reality (VR) technology is increasingly used in health care professionals’ education as a novel tool for teaching, learning, and assessment.

OBJECTIVE: This study explored the experiences of clinical students and lecturers with VR for training and assessment at a Nigerian institution. It also explored students’ perceptions of the usefulness of VR in improving their clinical abilities, knowledge retention, engagement, and overall learning experience.

METHODS: A qualitative research study was conducted among 24 clinical students and 8 clinical lecturers. A developed Virtual reality model to TRain and Assess Clinical Students (VTRACS) was used to train and assess clinical students using clinical scenarios. Data were collected through 4 focus group discussions conducted among the clinical students and 8 in-depth interviews conducted among the clinical lecturers. Trustworthiness was maintained, and ethical approval for the study was obtained. The focus group discussions and in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo (version 11; QSR International).

RESULTS: Many of the participants had no previous experience with VR in teaching and learning activities, but judging from their engagement with VTRACS, they defined VR as an alternative learning method (alternative to the traditional physical method). Major themes emerging from the study were expression of excitement, simple and useful innovation, proficiency enhancement, challenges with innovation, and uniformity. The clinical students adjudged VTRACS as an educational supplement with a feeling of unlimited learning access, enhancing clinical abilities while positively impacting their confidence and reducing clinical errors. The participants also described the objectivity and standardization of clinical scenarios as drivers of uniformity in training and assessment of clinical students. The participants were, however, concerned about the loss of empathy with the use of VTRACS, which may negatively impact the affective domain of learning.

CONCLUSIONS: The use of VR in the teaching and assessment of clinical students at a Nigerian university is perceived as a complementary method of learning that increases skill acquisition, provides unlimited access to training, and enhances proficiency. While VR is considered to be engaging and beneficial to health care professionals’ education, there is a need for its effective incorporation into clinical courses and mitigation of challenges such as cost and technology to ensure the realization of the full potential of VR in health care professionals’ education.

PMID:41587456 | DOI:10.2196/75021

JMIR Med Educ. 2026 Jan 26;12:e60452. doi: 10.2196/60452.

ABSTRACT

BACKGROUND: The Icarus Paradox in health care refers to the tension between the ambition to succeed as a specialist doctor and the limitations of the medical education system. Indonesia aspires to produce quality doctors, yet limited infrastructure and resources hinder the educational journey of prospective specialists.

OBJECTIVE: This study aimed to identify the Icarus Paradox in Indonesia’s specialist medical education by examining prospective specialist medical students and the quality of health services and by analyzing how this paradox is reflected in society’s perspectives.

METHODS: Using a convergent mixed methods design, this study integrated quantitative content analysis of 5047 online reviews across multiple platforms with qualitative thematic and cognitive analysis using NVivo 14, combining sentiment classification and topic coding.

RESULTS: Twitter contributed 573 (11.3%) of 5047 reviews, with 218 (38%) negative, 251 (43.8%) neutral, and 104 (18.2%) positive entries. TikTok generated 282 (5.6%) reviews, the majority being neutral (n=225, 79.5%). YouTube produced 96 (1.9%) reviews, with 89 (92.7%) neutral entries. News platforms exhibited the largest volume (n=3040, 60.2%) of reviews, with 2885 (94.9%) neutral, 105 (3.5%) positive, and 50 (1.6%) negative entries. Blogs and websites contributed 353 (7%) and 692 (11.3%) reviews, respectively, with neutral sentiment dominating (n=329, 93.2%, for blogs and n=599, 86.6%, for websites). Three cognitive perspectives demonstrated the Icarus Paradox in the Indonesian medical education system: education system, society’s views of students, and health care services. Although there are aspirations to improve education and health care quality, these ambitions often collide with structural challenges, such as resource shortages, heavy workloads, and limited accessibility, which link directly to cognitive themes of stress, resilience, and ethical dilemmas. We proposed a conceptual model to illustrate these dynamics.

CONCLUSIONS: Our findings offer insights into the Icarus Paradox in Indonesia’s medical education system, highlighting its complexity and reinforcing the need for systemic reform. Beyond academic relevance, the findings also emphasize the importance of strengthening student mental health support, ensuring equitable access to health care, and enhancing regulatory oversight of training. This was not a clinical trial. Although limited by reliance on online reviews, the results underscore the urgent need for targeted policy interventions in medical education and health care services.

TRIAL REGISTRATION: ClinicalTrials.gov registration: NCT123456.

PMID:41587450 | DOI:10.2196/60452

JMIR Mhealth Uhealth. 2026 Jan 26;14:e58930. doi: 10.2196/58930.

ABSTRACT

BACKGROUND: Intermittent fasting emerges as a promising dietary approach against obesity, offering a cost-effective strategy for implementation via web-based platforms. We developed a Brief Online Intermittent Fasting Program (OIF), featuring a self-administered, weekly 1-day fasting regimen with replacement meals delivery, online guidance, and app messaging to support adherence.

OBJECTIVE: This pilot study aimed to assess the preliminary effectiveness, feasibility, and safety of the OIF on weight loss in adults with overweight and obesity in Japan. Secondary objectives were to assess its effects on body composition and metabolic markers.

METHODS: This 12-week, 1:1 randomized controlled trial recruited adults with overweight and obesity (BMI from 23 to <35) in 1 university, 1 hospital, and 2 company offices. Participants were randomized into 2 groups stratified by sex and age (<40 or ≥40 years). The intervention group received very low-calorie (407 kcal) meal replacements for weekly intermittent fasting, online guidance via Zoom (Zoom Video Communications, Inc), and app messages encouraging fasting and healthy lifestyles. The control group received app messages promoting healthy lifestyles only. Interventions were administered by a nonblinded researcher. The primary outcome was the change in body weight after 12 weeks, analyzed using intention-to-treat principles and adjusted for sex, age, and baseline weight. Secondary outcomes encompassed body composition, blood pressure, biomarkers (eg, hemoglobin A_1c, triglycerides, and cholesterol), quality of life, physical activity, intervention adherence, and adverse events.

RESULTS: A total of 57 individuals were enrolled (28 in the intervention group and 29 in the control group). At 12 weeks, 25 participants in the intervention group and 27 participants in the control group completed follow-up. The baseline median weight was 75.8 (IQR 68.3-80.6) kg for the intervention group and 74.8 (IQR 69.8-81.8) kg for the control group. The mean weight change was -0.9 (SD 1.9) kg in the intervention group and +0.6 (SD 1.4) kg in the control group. The adjusted between-group difference in weight change was statistically significant at -1.6 (95% CI -2.5 to -0.8) kg. Fat mass change was not statistically significant (-0.1, 95% CI -1.3 to 1.4 kg), but muscle mass reduction was implied (-1.3, 95% CI -2.5 to -0.2 kg). Intervention adherence was 79% (22/28) in the intervention group. No serious adverse events were reported, and there were no significant changes in key biomarkers, such as hemoglobin A_1c or quality of life.

CONCLUSIONS: The OIF demonstrated effectiveness in promoting modest weight loss among adults with overweight and obesity over 12 weeks, with high feasibility and safety indicated by low dropout rates and absence of serious adverse events. However, the observed reduction in muscle mass indicates a need for program refinement, such as incorporating exercise guidance, to optimize health outcomes.

TRIAL REGISTRATION: UMIN-CTR UMIN000050437; https://tinyurl.com/4x5h2t2x.

PMID:41587446 | DOI:10.2196/58930

J Med Internet Res. 2026 Jan 26;28:e77510. doi: 10.2196/77510.

ABSTRACT

BACKGROUND: Home health aides and attendants (HHAs) provide in-home care to the growing population of older adults who want to age in place. Despite their vital role in patient care, HHAs are an underserved and vulnerable population of health care professionals who often experience poor health themselves. Activity tracking devices offer a promising way to improve HHAs’ health-related awareness and promote health behavior change, particularly regarding physical activity and sleep quality, 2 areas in which the workforce struggles.

OBJECTIVE: This study aimed to understand how feasible it is for HHAs to use activity tracking devices and assess their perceptions of such devices for improving their health. Specifically, we conducted (1) a field study to assess the use, feasibility, and acceptability of these devices among HHAs and (2) a qualitative study to understand HHAs’ perspectives on and reactions to activity trackers on and off the job.

METHODS: We partnered with the 1199 Service Employees International Union Training and Employment Fund to conduct a field study with home care agency-employed HHAs working in New York City, New York. Participants wore activity tracking devices for 4 weeks that collected data on physical activity and sleep. The HHAs were subsequently interviewed on their experiences with and attitudes toward the devices and asked to reflect on personalized visualizations of their data to prompt them to think aloud. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using grounded theory.

RESULTS: A total of 17 HHAs participated; their mean age was 48.7 (SD 12.2) years, 15 (88%) were women, 11 (65%) identified as Black, 5 (29%) identified as Hispanic or Latinx, and they had worked as HHAs for a mean of 11.7 (SD 7.5) years. In total, 94% (n=16) of the HHAs wore their activity trackers for the full 28-day study period. Participants took a mean of 10,230 (SD 3586) daily steps during the study period and slept for a mean of 6.27 (SD 0.58) hours per night. Overall, 4 key themes emerged: (1) activity tracking devices enhanced participants’ health awareness by providing empirical data for self-reflection; (2) this increased awareness led to positive behavior changes, including setting and achieving health-related goals; (3) HHAs believed that these devices could improve not only their own health but also that of their patients through positive behavior changes; and (4) despite this optimism, participants emphasized that their ability to modify sleep and activity patterns was constrained by social and occupational determinants, with sleep improvements being particularly challenging.

CONCLUSIONS: Our findings suggest that appropriately designed personal tracking interventions could offer a promising approach to supporting positive health-related changes in this historically overlooked workforce, potentially improving their well-being and the quality of care they provide to their patients.

PMID:41587444 | DOI:10.2196/77510

Ann Plast Surg. 2026 Jan 26. doi: 10.1097/SAP.0000000000004672. Online ahead of print.

ABSTRACT

BACKGROUND: Age-related physiological changes may influence surgical outcomes following breast reduction. This study investigates the association between patient age and postoperative complications using a large institutional cohort.

METHODS: We retrospectively reviewed 985 patients who underwent bilateral reduction mammaplasty between 2002 and 2024 by a single surgeon. Patients were stratified by age into 3 groups: <31, 31 to 50, and >50 years. Baseline demographics, comorbidities, surgical techniques, and complication rates were analyzed. Univariable and multivariable logistic regression was used to assess associations between age and minor and major complications, adjusting for diabetes, hypertension, smoking history, and prior radiation.

RESULTS: Our patient cohort’s mean age was 39.3 (13-76) years. A total of 276 (28.0%) had either a minor or major complication. The minor complications across the cohort (154) included seroma, skin necrosis, delayed wound healing, infection, nipple necrosis, hematoma, and fat necrosis. Major complications (122) included cases requiring readmission and/or reoperation. Patients in the 31- to 50-year age group were more likely to have a minor complication (17.9%) compared to those in the <31-year age group (13.1%) (P = 0.05). Patients aged 31 to 50 years (13.0%) and >50 years (18.7%) were more likely to develop major complications than those aged <31 years (6.56%) (P < 0.05 and P = 0.0001, respectively). The >50-year age group was more likely to be readmitted (7.4% vs 1.3%, P = 0.05) and reoperated (11.3% vs 5.3%, P < 0.05) compared to the <31-year age group. However, no statistically significant relationship was found with minor or major complication rates in senior groups with age ≥ 60 years. In adjusted models, age was not an independent predictor of minor or major complications; instead, diabetes (minor; odds ratio, 1.80; 95% confidence interval, 1.04-3.07; P = 0.03) and smoking (major; odds ratio, 2.16; 95% confidence interval, 1.12-3.98; P = 0.02) were associated with increased risk.

CONCLUSION: Older patients show higher unadjusted morbidity after reduction mammaplasty, but age itself is not an independent risk factor once comorbidities are considered. Preoperative counseling and optimization should prioritize diabetes, hypertension, and smoking over rigid age thresholds.

PMID:41587443 | DOI:10.1097/SAP.0000000000004672

AIDS. 2026 Jan 23. doi: 10.1097/QAD.0000000000004453. Online ahead of print.

ABSTRACT

OBJECTIVE: HIV has been shown to persist in cerebrospinal fluid (CSF) in persons on antiretroviral therapy (ART), which may be linked with inadequate ART exposure, potentially contributing to neurocognitive dysfunction. Our objective was to compare ART regimen inhibitory activity in CSF with participant outcomes.

METHODS: A5321 is a prospective study of HIV reservoirs among persons with HIV on long-term ART with documented suppressed viremia; 44 participants who underwent lumbar puncture were evaluated. CSF trough concentrations were determined and inhibitory quotients (IQs) calculated for each antiretroviral (ARV) in a participant’s regimen as the ratio of CSF concentration to literature values for in vitro HIV IC50or90. The geometric mean (GM) of CSF IQs of all drugs in each participant’s ART regimen was calculated (CSF ART-IQGM). Statistical analyses evaluated associations among ART-IQGM and CSF HIV DNA, biomarkers and global deficit score (GDS).

RESULTS: The median (Q1, Q3) CSF ART-IQGM was higher in those with undetectable vs detectable CSF HIV DNA: 0.9 (0.5, 1.6) vs 0.5 (0.3, 0.9), p = 0.027. Higher ART-IQGM was associated with lower GDS (i.e., better global cognitive function, Spearman: -0.30, p = 0.05). There was no association between CSF inflammatory biomarkers and ART-IQGM.

CONCLUSIONS: The CSF ART-IQGM is a novel approach to assess ART regimen activity. This metric was associated with lack of CSF HIV DNA detection and better GDS, which suggests ART regimen activity affects HIV persistence in CSF. This tool motivates further investigations of relationships between regimen activity and biomarkers of HIV persistence in CSF and in other anatomic HIV reservoirs.

PMID:41587440 | DOI:10.1097/QAD.0000000000004453

Ann Plast Surg. 2026 Jan 26. doi: 10.1097/SAP.0000000000004643. Online ahead of print.

ABSTRACT

BACKGROUND: The quantification of phantom limb pain (PLP) is challenging due to the heterogeneity of patient experiences. This study evaluated the use period prevalence questionnaires in assessing PLP in patients with lower limb osseointegrated implant (OI) prostheses.

METHODS: The study included patients who received single-stage lower limb OI prostheses at our institution. Period prevalence questionnaires included questions regarding frequency and duration of PLP prior to OI implantation and in the last year postoperatively. The frequency of PLP was assessed by asking participants how often they experienced PLP pain. The duration of each episode was evaluated by asking how long the PLP pain lasted. Nerve reconstruction procedures included targeted muscle reinnervation (TMR) or combined TMRpni.

RESULTS: A total of 11 patients completed the questionnaire (7 transtibial and 4 transfemoral). The median age was 52 years, and the median BMI was 29.7 kg/m2. Of the 11 patients, 8 underwent nerve reconstruction (72%): 5 with combined TMRpni and 2 with TMR. Six patients reported a reduction of PLP episodes (54%), whereas the remaining 5 patients experienced the same frequency of PLP. Statistical analysis revealed a significant reduction in PLP frequency from preop to postoperative time points (median, 4 vs 3; P = 0.016). For PLP duration, 5 patients reported shorter episodes (45.5%), 5 patients reported the same duration (45.5%), and 1 patient experienced a longer duration (9%). There was no significant difference in duration between preoperative and postoperative assessments. When examining the total scores, there was a significant reduction of PLP from preoperative to postoperative time points (median, 6 vs 5; P = 0.048).

CONCLUSIONS: We introduced a novel method to assess PLP using period prevalence instead of pain intensity. OI prostheses, with or without nerve reconstruction, significantly reduced PLP frequency and combined frequency-duration measures. Future work will validate the period prevalence survey against established PLP instruments.

PMID:41587428 | DOI:10.1097/SAP.0000000000004643

Ann Plast Surg. 2026 Jan 26. doi: 10.1097/SAP.0000000000004615. Online ahead of print.

ABSTRACT

INTRODUCTION: Positional plagiocephaly is characterized by cranial asymmetry and can be the result of prolonged uneven pressure on the developing skull. Extrauterine causes include extended time in the supine position, one-sided feeding, or insufficient tummy time. Beyond cosmetic concerns, it can affect visual, auditory, dentofacial, and speech development. Following the “Back-to-Sleep Campaign,” prevalence rose to 16% to 22.1% in 6-week-old infants (Iran J Child Neurol. 2022;16(2):85-92). Despite its extensive impact on development and finances, many caregivers and parents lack awareness, underscoring the need for improved education and prevention strategies.

METHODS: In this 2-arm, partially blinded randomized controlled trial (June 2022 to April 2025) at UMass Memorial Medical Center, we compared standard care to an educational intervention for plagiocephaly prevention. The primary outcome was cephalic index (CI), measured at 2, 4, and 6 months, with higher values indicating greater deformity. Secondary outcomes included parent-reported adherence to prevention strategies. Group comparisons used unpaired t tests and difference-in-difference models.

RESULTS: A total of 109 subjects were enrolled (intervention, 62; control, 47). The average CI differed significantly between groups at the 4-month mark (control, 89.84; intervention, 86.91; P = 0.05). Difference-in-difference analysis did not yield statistically significant results at any time point, but all intervention groups had a lower average CI. Survey data assessing parental adherence to plagiocephaly prevention behaviors showed a significant difference at 4 months (control, 15.87; intervention, 13.75; P = 0.03), with no significant differences at 2 or 6 months.

CONCLUSIONS: The intervention was associated with reduced cranial deformation, reaching statistical significance by 4 months. This correlated with better parental compliance, suggesting early education as an effective preventive strategy.

PMID:41587421 | DOI:10.1097/SAP.0000000000004615

J Phys Chem A. 2026 Jan 26. doi: 10.1021/acs.jpca.5c06933. Online ahead of print.

ABSTRACT

This study re-examines the bond cleavage mechanisms of fluoromethane cations (CH₃F⁺) in their low-lying electronic states (X²E, A²A₁, B²E) using a combination of threshold photoelectron photoion coincidence (TPEPICO) velocity map imaging and quantum chemical calculations. The C-H bond cleavage from the X²E state is confirmed to proceed via a statistical, thermodynamically controlled mechanism, as evidenced by a Boltzmann kinetic energy release distribution (KERD). In contrast, the C-F bond cleavage from the excited A²A₁ and B²E states exhibits nonstatistical dynamics. For the A²A₁ state, the dissociation is direct and rapid, characterized by a Gaussian-type KERD and a negative anisotropy parameter (β ≈ -0.5). Crucially, for the B²E state, our results contradict the previously proposed mechanism of internal conversion to the X²E state followed by statistical dissociation. Instead, we provide compelling evidence that CH₃F⁺(B²E) undergoes internal conversion to the A²A₁ state, which then dissociates directly. This revised pathway is supported by RRKM calculations, the near absence of CH₂F⁺ fragments, and the similarities in KERD and β parameters between the B²E and A²A₁ states.

PMID:41587419 | DOI:10.1021/acs.jpca.5c06933

Clin Exp Dent Res. 2026 Feb;12(1):e70278. doi: 10.1002/cre2.70278.

ABSTRACT

OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate the impact of open proximal contacts on peri-implant tissue changes, specifically marginal bone levels, probing pocket depth, and the incidence of peri-implant diseases.

METHODS: Electronic databases were searched to identify non-randomized observational studies comparing open and closed proximal contacts. Risk of bias was assessed using the Cochrane Collaboration’s tool and data were analyzed with a statistical software.

RESULTS: Out of 276 studies initially identified, five met the inclusion criteria, involving 4882 dental implants. Meta-analysis indicated that open proximal contacts were associated with greater, but not statistically significant, marginal bone changes (mean difference (MD) 0.07; 95% confidence interval (CI) -0.09 to 0.24; p = 0.38); probing pocket depths (MD 0.11; 95% CI -0.29 to 0.51; p = 0.59) and a higher incidence of peri-implantitis (relative risk (RR) 1.63; 95% CI 0.88-3.02; p = 0.12) compared to closed contacts. Open proximal contact was associated with a significant increase in incidence of peri-implant mucositis (RR 1.74; 95% CI 1.06-2.86; p = 0.03).

CONCLUSIONS: Open proximal contacts are associated with increased probing pocket depths and marginal bone changes and could be a risk indicator for peri-implant mucositis. Further research is needed to assess long-term effects and to develop preventive measures.

PMID:41587408 | DOI:10.1002/cre2.70278