Tag: pubmed

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

Prostate. 2026 Mar 30. doi: 10.1002/pros.70169. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to compare the diagnostic accuracy of transrectal ultrasound (TRUS)-guided saturation biopsy (SB) and multiparametric MRI (mpMRI)-TRUS fusion-guided combined biopsy (CB) in patients with prior negative prostate biopsies.

METHODS: We retrospectively analyzed data from 160 patients who underwent transrectal prostate biopsy between January 2014 and March 2021. All had at least one prior negative biopsy. 80 patients underwent SB with a 20-core TRUS-guided approach. The remaining 80 patients, with mpMRI-detected PIRADS ≥ 3 lesions, underwent CB including 12-core systematic plus 2-4 targeted cores per lesion. Prostate cancer and clinically significant prostate cancer (csPCa) detection rates, and clinical parameters were compared between groups.

RESULTS: The groups had no statistically significant differences in baseline characteristics. The PCa detection rate was 20% in the CB group and 16.3% in the SB group (p = 0.682). csPCa detection rates were also similar: 11.3% in the CB cohort and 7.5% in the SB cohort (p = 0.589). Notably, the CB subgroup with PI-RADS ≥ 4 lesions had a significantly higher csPCa detection rate (28.6%) than SB group (7.5%) (p = 0.016). Patients diagnosed with PCa had significantly lower free PSA and free/total PSA ratios (p < 0.05). Complication rates were low and similar in both groups.

CONCLUSIONS: CB demonstrates the highest diagnostic yield for detecting csPCa, particularly in patients with PI-RADS ≥ 4 lesions. However, in resource-limited settings lacking mpMRI, systematic saturation biopsy remains a viable, safe, and effective alternative. PSA derivatives may serve as complementary tools to refine biopsy decisions.

PMID:41911500 | DOI:10.1002/pros.70169

Prostate. 2026 Mar 30. doi: 10.1002/pros.70166. Online ahead of print.

ABSTRACT

BACKGROUND: With global population aging, lifestyle transitions, and the widespread expansion of screening practices, the burden of prostate cancer has shown complex geographical variations. The study aims to dissect the age, period, and cohort effects on prostate cancer incidence dynamics using the Age-Period-Cohort (APC) model, and to infer potential drivers behind these effects so as to provide evidence for effective prevention and control strategies.

METHODS: Using data from the Global Burden of Disease (GBD) 2021, we analyzed trends in prostate cancer incidence among men aged 55 years and older from 1992 to 2021 across the globe, five sociodemographic index (SDI) regions, and 204 countries. An age-period-cohort model was applied to estimate net drifts, local drifts, longitudinal age curves, and period and cohort relative risks.

RESULTS: In 2021, approximately 1.26 million new cases of prostate cancer were reported in men aged 55 and older, accounting for 96% of global new cases. This represented a 135.86% increase in new cases compared to 1992. The global age-standardized incidence rate (ASIR) for this group was 180.94 per 100,000 (95% UI: 166.43-191.24). The APC model indicated a net drift of -0.36% (95% confidence interval [CI]: -0.57 to -0.15). A significant correlation was found between prostate cancer ASIR and SDI (r = 0.54, p < 0.001), with the highest rates observed in high SDI regions (416.24 per 100,000) and the lowest in low-middle SDI regions (78.18 per 100,000). Notably, low-middle SDI regions experienced the fastest increase in ASIR, with a net drift of 1.50% (95% CI: 1.15-1.86). This study revealed three distinct age-stratified incidence patterns across SDI regions. Meanwhile, APC analysis showed that incidence increased with age in all SDI regions. High SDI regions exhibited favorable period and cohort effects, while low-middle SDI regions showed unfavorable trends in both period and cohort relative risks. At the country level, the United States and China had the highest case numbers, while countries like Georgia and Russia showed the fastest increase. Canada and Australia demonstrated a downward trend.

CONCLUSIONS: Substantial health inequalities in prostate cancer screening, diagnosis, and treatment persist across SDI levels, with the future global burden expected to rise disproportionately in low-middle SDI regions. These disparities underscore the need for context-specific prevention and control strategies to promote global equity in prostate cancer management.

PMID:41911499 | DOI:10.1002/pros.70166

JMIR Med Educ. 2026 Mar 30;12:e82988. doi: 10.2196/82988.

ABSTRACT

BACKGROUND: Generative artificial intelligence (AI) tools, such as ChatGPT, are increasingly used in higher education and have raised significant concerns about assessment validity and academic integrity. In Digital Health and Health Information Management (DIGHIM) programs, assessments are designed to evaluate a mix of technical skills, contextual reasoning, and professional judgment that underpin medical and health practice. Understanding how generative AI performs across different assessment types is, therefore, critical to identifying which formats are most susceptible to AI-generated content and how assessments may be redesigned to remain authentic and educationally meaningful.

OBJECTIVE: This study aimed to evaluate ChatGPT’s performance across diverse assessment types in DIGHIM education by examining how task complexity influences AI-generated output quality, and develop recommendations for ethical and effective AI integration in assessments.

METHODS: A pilot quasi-experimental design compared ChatGPT-generated responses with deidentified student submissions across 5 assessment types: digital health solution design, business case analysis, reflective assessment, SQL health database programming, and a health classification quiz. For each task, multiple AI submissions were produced using different prompting strategies, including rubric integration and the use of ChatGPT (GPT-4 and o1 Preview model). Blinded academic markers evaluated all AI-generated submissions and previously submitted deidentified student assessments against standard rubrics, and descriptive statistics were used to compare performance.

RESULTS: ChatGPT’s performance varied considerably across assessment types. It achieved its highest accuracy scores in objective, rule-based tasks such as multiple-choice quiz items in health classification (mean 88%, SD 0%) and produced well-structured, coherent responses for reflective assessments (mean 69%, SD 12.8%), though these often lacked personalization and nuanced industry context. In descriptive analytical tasks, such as digital health business cases and solution designs, ChatGPT produced logically structured work with reasonable use of evidence but failed to provide deep contextualization, domain-specific insights, or visual elements expected in DIGHIM practice. Technical assessments revealed the greatest limitations: SQL programming tasks averaged 42% (SD 17.2%) with persistent schema errors, incomplete queries, and weak interpretation of health data outputs, while scenario-based clinical coding scored just 7% (SD 0%), reflecting a lack of precision in applying ICD-10-AM (International Classification of Diseases, Tenth Revision, Australian Modification) rules and coding conventions. Structured prompting and rubric integration improved results, particularly in descriptive and reflective tasks (up to 80%), but the advanced o1 Preview model did not consistently outperform earlier versions.

CONCLUSIONS: While ChatGPT performs well in structured, rule-based, and reflective tasks, it remains limited in technical accuracy, contextual reasoning, and applied DIGHIM competencies. To support academic integrity and workforce readiness, assessment design should prioritize critical thinking, ethical reasoning, and scenario-based problem-solving aligned with health care practice. Using AI as a tool for critique and refinement, rather than a substitute for student work, may help educators prepare learners for responsible AI use in medical and health professional education.

PMID:41911020 | DOI:10.2196/82988

JMIR Ment Health. 2026 Mar 30;13:e93040. doi: 10.2196/93040.

ABSTRACT

BACKGROUND: Generative artificial intelligence (AI) chatbots have rapidly entered public use, including in contexts involving emotional support and mental health-related interactions. Although these systems are increasingly accessible, concerns have emerged regarding potential adverse psychiatric outcomes reported in public discourse, including psychosis, suicidal ideation, self-harm, and suicide. However, these reports largely originate from journalistic accounts rather than systematically verified clinical data.

OBJECTIVE: This rapid scoping review aimed to systematically map and characterize mass media narratives describing alleged adverse psychiatric outcomes temporally associated with generative AI chatbot interactions.

METHODS: A rapid scoping review methodology was applied to publicly accessible news articles identified primarily through Google News searches. Articles published from November 2022 onward were screened for eligibility if they described a specific case in which psychiatric deterioration or crisis was temporally linked to generative AI use. Data were extracted using a structured coding template capturing article characteristics, demographic information, AI platform features, interaction intensity, outcome type and severity, type of evidence reported, and causal attribution language. Descriptive statistics and cross-tabulations were performed.

RESULTS: A total of 71 news articles representing 36 unique cases were included. Suicide death was the most frequently reported outcome (35/61, 57.4% cases with complete severity coding), followed by psychiatric hospitalization (12/61, 19.7%). Fatal outcomes were disproportionately represented among minors (19/21, 90.5%) compared with adults (17/35, 48.6%). ChatGPT was the most frequently cited platform (51/71, 71.8%), followed by Character AI (10/71, 14.1%). Causal attribution most commonly referenced AI system behavior (45/61, 73.8%), and the term “alleged” was the predominant causal descriptor (33/61, 54.1%). Evidence sources were primarily chat logs or screenshots (34/61, 55.7%), while police or medical documentation was rare (1/61, 1.6%). Regulatory calls were present in 51 of 60 (85%) articles with nonmissing data.

CONCLUSIONS: Mass media reporting of generative AI-related psychiatric harms is concentrated around severe outcomes, particularly suicide deaths among youth, and is frequently framed within regulatory and corporate accountability narratives. While causality cannot be established from media reports, consistent patterns of high-intensity interactions, user vulnerability, and limited safeguard reporting highlight the need for structured safety surveillance, transparent AI risk auditing, and clearer governance frameworks. As generative AI becomes increasingly integrated into everyday psychosocial contexts, systematic research and formal safety monitoring will be necessary to determine whether media-reported harms correspond to verifiable clinical risk patterns.

PMID:41911018 | DOI:10.2196/93040

Psychol Sci. 2026 Mar 30:9567976261432207. doi: 10.1177/09567976261432207. Online ahead of print.

ABSTRACT

Income inequality is frequently cited as a forceful determinant of mental health and as a possible contributor to the rising trend in adolescent depressive symptoms. However, research findings often rely on low-powered cross-sectional designs. We conducted a preregistered study of the within-municipality effect of income inequality on adolescent depressive symptoms in Norway, covering ≈550,000 respondents nested within 863 municipality years and 340 municipalities. Using multilevel modeling and equivalence testing, the overall within-municipality effect of income inequality was neither statistically significant nor practically meaningful and did not significantly interact with family financial situation. A significant gender interaction showed that rising inequality predicted slightly higher depressive symptoms among females and slightly lower among males; however, the main gender effects were also probably too small to be meaningful. We conclude that changes in income inequality likely do not meaningfully predict nor help explain changes in adolescent depressive symptoms in Norway from 2010 to 2019.

PMID:41911005 | DOI:10.1177/09567976261432207

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

ABSTRACT

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

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

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

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

PMID:41910994 | DOI:10.1002/jclp.70133

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

ABSTRACT

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

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

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

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

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

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

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

PMID:41910975 | DOI:10.1001/jamanetworkopen.2026.2420