Search Results (756)

Background: Achieving remission of type 2 diabetes mellitus (T2DM) after bariatric surgery represents a critical opportunity to reduce long-term diabetes-related complications, including cardiovascular disease, nephropathy, neuropathy, and retinopathy. However, remission rates vary widely across patients, and identifying modifiable clinical and behavioral determinants remains essential for optimizing integrated metabolic care. Objectives: In the current study, we aimed to (1) classify type 2 diabetes mellitus (T2DM) remission status after bariatric surgery through clinical, anthropometric, and behavioral variables at follow-up; (2) identify the main model-based determinants of remission status and explainable machine learning using the preoperative model for baseline risk stratification with surgical candidates. Methods: We performed a retrospective cross-sectional study on 233 patients with T2DM who had bariatric surgery at a tertiary referral center. We made use of two analytical frameworks: a full-feature approach to identify the current remission status in a cross-sectional manner and a preoperative approach to make a temporal classification of the baseline for the first time. We trained and internally assessed 14 machine learning and deep learning classifiers. We evaluated model interpretability using SHAP. Results: In the full-feature cross-sectional classification, the Bottleneck Network performed best (ROC AUC = 0.889). SHAP data identified percentage weight regain, pre- and post-surgical body mass index, HbA1c, and oral hypoglycemic agent use as the dominant model-associated factors. In the restricted preoperative setting, the Extra Trees model achieved an AUC of 0.707, which is a lower level but still represents good baseline risk stratification performance. Conclusions: The findings indicate that remission status after bariatric surgery is both clinical as well as behavioral, but the post-operative or contemporaneously assessed variables should be looked at as classification (as opposed to prediction) models. The preoperative model may be able to be used in risk stratification, but clinical validation and prospective evaluation should be made prior to clinical implementation. Full article

Undiagnosed diabetes and prediabetes are common among trauma patients and increase perioperative complication rates, yet routine glycemic screening at hospital admission is rarely performed. We compared 10 supervised machine learning (ML) algorithms for early detection of impaired glucose metabolism in 1789 trauma surgery patients (1095 normal; 694 prediabetes/diabetes) using questionnaire data and preoperative laboratory values within a nested cross-validation framework with hyperparameter optimization. On the combined feature set, XGBoost achieved the highest area under the receiver operating characteristic curve (ROC-AUC; 0.815), followed by multilayer perceptron (0.814) and Gradient Boosting (0.813); adding blood parameters significantly improved performance for nine of ten algorithms (DeLong’s test, p < 0.05). SHapley Additive exPlanations (SHAP) and XGBoost feature gains identified six overlapping predictors, yielding a simplified model with comparable mean discrimination. Inter-model differences were small, and a fully interpretable logistic regression model remained within one percentage point of XGBoost. The best-performing model demonstrated strong calibration and a higher net benefit than either universal testing or no testing across the evaluated threshold probabilities. In routine trauma practice, such a model could identify patients who would benefit from confirmatory glycated hemoglobin (HbA1c) testing, enabling earlier detection of dysglycemia, risk-stratified glucose management, and timely referral for lifestyle intervention in patients with prediabetes. Full article

Background: Medical students are vulnerable to sleep disturbance and nocturnal eating behaviors that may jointly increase psychiatric and metabolic morbidity. Comprehensive sleep-eating evaluations in Turkish medical students remain limited. To determine the prevalence of poor sleep quality and night eating syndrome (NES) risk and to examine their cross-sectional associations with insomnia, anxiety, emotional eating, restless legs symptoms, chronotype, and lifestyle factors. Methods: This cross-sectional study, conducted from March to December 2023, included 265 medical students who completed validated instruments assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), night eating syndrome (NES) risk (a score of ≥25 indicating high risk), insomnia severity, daytime sleepiness (Epworth Sleepiness Scale [ESS]), anxiety, emotional eating, Restless Legs Syndrome (RLS) symptoms, and chronotype. Group comparisons, Spearman’s correlation analyses, and multiple linear regression were conducted. Results: Poor sleep quality (PSQI > 5) affected 50.2% of participants, and high NES risk affected 14.7%. PSQI correlated with NEQ (r = 0.301; p < 0.001), insomnia severity (r = 0.538), anxiety, and emotional eating. Mean NEQ was higher in the poor-sleep group (18.67 ± 8.00 vs. 15.38 ± 6.36; p < 0.001; Cohen’s d = 0.455). Females had higher PSQI and ESS scores, anxiety, and emotional eating scores; high NES risk was numerically more frequent in males (18.6% vs. 11.8%; p = 0.175). RLS symptoms (score > 0) were present in 34.7% (mild 22.6%; moderate 7.9%; severe 4.2%). In the primary multivariable model (PSQI and sex), PSQI was the strongest independent correlate of NEQ (standardized β = 0.325; p < 0.001); sensitivity analyses showed stable PSQI estimates after additional covariate adjustment, whereas sex coefficients were non-significant and unstable across models. A secondary model excluding PSQI identified alcohol use as a significant lifestyle correlate (standardized β = 0.167; p = 0.014). R² = 0.148 for the full covariate model and R² = 0.108 for the primary model. Conclusions: Sleep disturbance and NES risk are prevalent and cross-sectionally associated in Turkish medical students. Poor sleep quality was the strongest independent correlate of night eating scores. Integrated campus screening targeting sleep, eating behavior, anxiety, and comorbid sleep symptoms may facilitate prevention and referral. Full article

Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour. Full article

Background: Patients with stage IIB–IIIB cutaneous melanoma remain at substantial risk of recurrence despite complete surgical resection. Accurate risk stratification is essential to optimize patient selection for adjuvant therapy and surveillance strategies. We aimed to evaluate the clinicopathological and molecular factors associated with recurrence in a real-world cohort of high-risk melanoma patients. Methods: We retrospectively analyzed 97 patients with stage IIB–IIIB cutaneous melanoma treated at a single tertiary referral center. Clinicopathological characteristics, molecular features, treatment-related variables, and sentinel lymph node (SLN) pathological characteristics were evaluated. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Independent prognostic factors were identified using multivariable Cox proportional hazards regression. Results: After a median follow-up of 88 months, 31 patients (32.0%) developed recurrence. Stage IIC showed the highest recurrence rate in the cohort (52.4%), compared with 25% in stage IIIA and 31.4% in stage IIIB. Consistently, in the multivariable analysis, compared with stage IIB, only stage IIC remained independently associated with worse recurrence-free survival (hazard ratio [HR] = 3.57, 95% confidence interval [CI]: 1.08–11.82; p = 0.037), whereas neither stage IIIA nor stage IIIB differed significantly from stage IIB. Female sex was independently associated with a lower risk of recurrence (HR 0.33, 95% CI 0.14–0.79; p = 0.012). Although BRAF V600E-mutated tumors showed higher recurrence rates and shorter recurrence-free survival in univariable analyses, BRAF V600E status was not independently associated with recurrence in the multivariable model (p = 0.250). Higher lymphoid infiltration density was associated with improved RFS in univariable analysis, although this finding was limited by substantial missing data and non-standardized pathological assessment. Conclusions: In this exploratory retrospective analysis, female sex and stage IIC were independently associated with RFS. These findings should be interpreted cautiously given the small sample size, limited number of recurrence events, and incomplete availability of some clinicopathological and molecular variables. The prognostic associations observed for BRAF V600E status and lymphoid infiltration, as well as the analyses according to adjuvant treatment, should be considered exploratory and hypothesis-generating. The unfavorable outcomes observed in stage IIC disease support growing evidence that this subgroup represents a biologically aggressive form of melanoma despite the absence of regional nodal involvement. Our findings do not challenge the validity of the AJCC staging system but suggest that clinically relevant heterogeneity may exist within established AJCC stage groups. Full article

Background/Objectives: In Germany, women have direct access to gynaecologists without GP referral, making the GP’s role in female-specific conditions largely secondary. It has not previously been examined whether the sex of the GP is nonetheless associated with the documented prevalence of these conditions in primary care records. Methods: This retrospective cross-sectional study used data from the IQVIA™ Disease Analyzer. All women aged ≥18 years with at least one visit to one of 1183 GPs in Germany in 2025 were included. Women attending female and male GPs were matched 1:1 by propensity score on age, statutory health insurance, practice size, consultation frequency in 2025, and the van Walraven comorbidity score (excluding malignancy), yielding 661,485 women per group. Associations between GP sex and the documented prevalence of eight female-specific conditions were examined using conditional logistic regression within the age strata clinically relevant to each condition (from 18–30 to >75 years), with the age × GP-sex interaction tested in a single model per condition and E-values calculated to assess robustness to unmeasured confounding. Results: The association between GP sex and documented prevalence was strongly age-dependent, with a significant age × GP-sex interaction for seven of eight conditions (all p < 0.001). Female GP sex was associated with higher documented prevalence in mid-life, including menopausal and perimenopausal disorders (46–60 years: OR 1.37, 95% CI 1.28–1.46), endometriosis (31–45 years: OR 1.15, 1.03–1.28) and benign neoplasm of the female breast and genital organs (46–60 years: OR 1.16, 1.04–1.29); in the oldest women, the pattern attenuated or reversed (menopausal disorders > 75 years: OR 0.81, 0.72–0.90). No association was observed for breast cancer or female genital organ cancer at any age. Conclusions: In German primary care, the association between GP sex and the documented prevalence of female-specific disorders is age-dependent—most pronounced for conditions that require active clinical recognition and patient disclosure in mid-life, and absent for specialist-managed malignancies. Full article

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Background and objectives: Melanoma survivors may develop additional primary malignancies, but data from Eastern European hospital cohorts are scarce. We aimed to estimate the observed incidence of second primary cancers (SPCs) within a Romanian referral-centre cohort, identify associated factors, and explore the association of SPC occurrence with overall survival. Methods: We conducted a retrospective, hospital-based cohort study of 394 patients with histopathologically confirmed cutaneous melanoma followed at two referral centres in Cluj-Napoca. Additional malignancies were counted as new primaries only when clinical and/or histopathological documentation distinguished them from recurrence or metastasis. Incidence density was expressed per 1000 person-years. Multivariable logistic regression assessed age, sex, residence, and Breslow thickness. Fixed-covariate Cox and Kaplan–Meier analyses were considered exploratory because of immortal-time and competing-risk limitations. Results: Over 1848 person-years, 79 patients (20.1%) developed at least one SPC (131 events; observed incidence 70.9/1000 person-years), most frequently cutaneous (53.6/1000 person-years). SPC occurrence increased with age (Cochran–Armitage Z = 5.63, p < 0.001); the Kaplan–Meier complement estimate reached 20.7% at five years. Age independently predicted SPC (OR 1.86 per decade, p < 0.001), whereas greater Breslow thickness was inversely associated (OR 0.86, p = 0.008). Actinic keratosis showed a strong unadjusted association (OR 6.64, p < 0.001) but was not included in the adjusted model. The fixed-status Cox model showed lower mortality among patients with an SPC (HR 0.36, p < 0.001), a finding vulnerable to detection and immortal-time bias. Conclusions: SPCs were frequent in this hospital cohort and predominantly cutaneous. Older age was an independent predictor, while actinic keratosis was a strong unadjusted marker. Prospective, population-based validation is needed before surveillance intensity is individualised. Full article

Background: Postpartum depression (PPD) is an important maternal mental health concern. Knowledge, self-efficacy, and social support may be associated with the recognition and severity of depressive symptoms. This study assessed PPD knowledge among pregnant women/mothers and adults from the broader population in Saudi Arabia and examined the associations of self-efficacy and perceived social support with depressive-symptom scores in the maternal group. Methods: A cross-sectional online survey was conducted in Saudi Arabia from January to March 2021. Convenience and chain-referral sampling were implemented through WhatsApp. The analytical sample included 432 pregnant women/mothers aged ≥18 years and 275 broader-population participants. Arabic-language questionnaires assessed sociodemographic characteristics and PPD knowledge; the maternal-group questionnaire also assessed depressive symptoms, self-efficacy, and perceived social support. Descriptive statistics, Pearson correlations, linear regression, and one-way ANOVA were used. Results: Good PPD knowledge was observed in 73.8% of the maternal group and 77.5% of the broader-population group. Self-efficacy (r = −0.246, p < 0.001) and perceived social support (r = −0.197, p < 0.001) were negatively correlated with depressive-symptom scores. Both variables were statistically significant in the regression model; self-efficacy had the larger absolute standardized coefficient (β = −0.246) compared with perceived social support (β = −0.197). Depressive-symptom scores also differed across categories of age, family income, education, and previous PPD history. Conclusions: The study demonstrated a relatively good level of knowledge about postpartum depression among the surveyed participants. Higher perceived social support and self-efficacy were associated with better maternal mental health outcomes, highlighting their important role in the context of postpartum depression. These findings underscore the relevance of knowledge, social support, and self-efficacy in understanding postpartum mental health among the study population. Full article

Background: Limited access to trained providers remains a barrier to basic obstetric ultrasound use in low-resource antenatal care settings. This study aimed to explore trainer and trainee experiences of Zimbabwe’s six-week Basic Obstetric Ultrasound Short Course (BOUSC) and its perceived relevance to promoting healthy pregnancy through antenatal risk recognition and referral readiness. Methods: A qualitative study using transcendental phenomenology was conducted in the Fetal Medicine Units of Sally Mugabe Central Hospital and Parirenyatwa Group of Hospitals. Sixteen semi-structured interviews were conducted between September and October 2023 with eight trainers and eight trainees purposively selected from course records. Interviews were audio-recorded, transcribed verbatim, and analysed using Moustakas’ approach, including bracketing, horizontalisation, clustering of significant statements, and theme synthesis. Results: Thematic saturation was achieved. Four themes emerged: interactive and clinically situated teaching; confidence and basic skill development through supervised scanning; interprofessional learning that reduced hierarchy; and sustainability concerns related to equipment, mentorship, refresher training, and post-training practice. The most salient finding was that midwives trained as advanced obstetric sonographers were perceived as credible trainers for doctors and other cadres when operating within a supervised fetal medicine governance structure. Conclusions: Participants perceived the BOUSC as a practical and collaborative training model for basic obstetric ultrasound. The study does not demonstrate clinical outcome effects, but suggests that supervised basic ultrasound training may help promote healthy pregnancy when embedded within clear competency limits, quality assurance, and referral pathways. Full article

Background/Objectives: Termination of pregnancy (TOP) following a prenatal diagnosis of congenital heart disease (CHD) is a complex decision shaped by clinical, ethical, and psychosocial factors. This study evaluated the clinical factors associated with parental acceptance of TOP after prenatal diagnosis of CHD in a multidisciplinary counselling setting. Methods: This retrospective cohort study was conducted at a tertiary referral center where fetal CHD cases are evaluated in a multidisciplinary perinatology council. Pregnancies with a prenatal CHD diagnosis for which TOP was medically recommended between December 2023 and February 2026 were included. Maternal, fetal, and genetic data were analyzed. Cardiac severity was classified using the fetal cardiovascular disease severity scale. Because the cohort included only 62 pregnancies, a simplified multivariable logistic regression model with three clinically prespecified variables (four parameters: gestational age, cardiac severity, and genetic-evaluation status) was used to identify variables associated with termination acceptance. Results: Sixty-two pregnancies were included; 41 (66.1%) accepted termination and 21 (33.9%) continued the pregnancy. Maternal characteristics and gestational age at diagnosis were similar between groups. In the multivariable model, genetic-evaluation status was the only variable independently associated with termination acceptance. Compared with cases without genetic testing, both major chromosomal/pathogenic anomalies (aOR 4.97; 95% CI 1.29–19.11; p = 0.020) and a normal genetic-evaluation status (aOR 4.71; 95% CI 1.07–20.77; p = 0.041) were associated with higher termination acceptance. Cardiac severity and gestational age were not independently associated with parental decision. Conclusions: Genetic-evaluation status was associated with parental acceptance of termination after prenatal CHD diagnosis in a multidisciplinary counselling setting; given the small sample size and the selected, council-recommended cohort studied, this association should be interpreted as hypothesis-generating rather than as evidence of a causal or independent predictive effect. Full article

Background: Advances in neonatal intensive care have improved survival in congenital diaphragmatic hernia (CDH), shifting the clinical focus toward long-term complications such as feeding difficulties. Initiation of enteral feeding varies across centers, with evidence suggesting that intra-abdominal pressure (IAP) may influence time to feeding and clinical decision-making. We explored associations of early postoperative heart rate (HR), recorded Apgar score, and intra-abdominal pressure (IAP) with time to enteral trophic feeding. Methods: We retrospectively evaluated 28 consecutive neonates undergoing CDH repair at a national referral center between January 2022 and June 2025. Trophic enteral feeding (≥10 mL/kg/day for ≥24 h) was the primary endpoint. Aalen–Johansen estimates and two parsimonious Fine–Gray models (HR plus Apgar; IAP plus Apgar) were primary analyses and cause-specific Cox models were sensitivity analyses. Results: Within 30 postoperative days, trophic enteral feeding was achieved in 21 cases, six patients died before feeding, and one did not achieve feeding before censoring. Each 10 bpm higher HR was associated with lower feeding incidence (subdistribution HR 0.62, 0.46–0.85; p = 0.003); the cause-specific point estimate was also below 1 (HR 0.65, 0.47–0.89; p = 0.007). Mean IAP was not clearly associated with feeding incidence (subdistribution HR 1.01 per mmHg, 0.82–1.25; p = 0.925). Both Cox models failed global proportional-hazards tests. Conclusions: Each 10 bpm increase in HR was associated with a longer time to trophic enteral feeding, and the cause-specific sensitivity analysis pointed in the same direction. Because both estimates derive from the same 28 infants, their agreement is expected rather than corroborative. These findings are exploratory and do not establish causality, individual predictive value, or superiority of HR over IAP. Prospective multicenter studies with adequate sample sizes are needed to confirm these findings. Full article

Background/Objectives: Childhood cancer outcomes are influenced by clinical, socioeconomic, and territorial factors, particularly in resource-limited settings. This study characterized pediatric cancer patients from Córdoba and Sucre, Colombia, and evaluated factors associated with clinical outcomes in a regional referral center. Methods: A retrospective hospital-based study included 434 patients aged 0–18 years diagnosed between 2018 and 2024. Sociodemographic, clinical, and territorial socioeconomic variables were analyzed using the Multidimensional Poverty Index (MPI). Clinical outcomes were classified as favorable, non-favorable, or death. Firth-penalized logistic regression models were used to assess adjusted associations. Results: Hematologic malignancies predominated (65.9%), with acute lymphoblastic leukemia as the most frequent diagnosis. Most patients came from municipalities with moderate or high multidimensional poverty (85.2%), and the rural territories of origin showed greater deprivation in education, employment, housing, water access, and sanitation. Favorable outcomes occurred in 82.9% of patients, while 8.5% had non-favorable outcomes and 8.5% died. Older age and non-hematologic malignancies were associated with non-favorable outcomes. Mortality was associated with older age, subsidized health insurance, and non-hematologic malignancies. MPI and rural residence were not independently associated with outcomes after adjustment. Conclusions: Although MPI was not independently associated with clinical outcomes, it identified substantial territorial deprivation. Integrating clinical and territorial indicators may support equity-oriented surveillance and pediatric oncology interventions. Full article

Background: Prenatal diagnosis of congenital heart defects (CHD) is important for perinatal planning, yet the gestational week at which CHD is diagnosed varies considerably. In referred cohorts, diagnostic timing may be influenced by maternal, fetal, temporal, and lesion-specific factors. This study examined factors associated with the gestational week of prenatal diagnosis among pregnancies with prenatally recognized and subsequently confirmed CHD referred to a national tertiary fetal cardiology centre. Methods: This study analyzed 833 pregnancies with confirmed CHD managed between 2005 and 2020. The primary outcome was the gestational week of prenatal diagnosis. Univariable associations with binary predictors were assessed using Student’s t-test, Welch’s t-test, or the Mann–Whitney U test according to distributional assumptions. A primary fully adjusted multivariable linear regression model with heteroscedasticity-robust standard errors was used to evaluate variables associated with the gestational week of diagnosis. The model included maternal age, calendar year as a continuous variable, twin pregnancy, amniotic fluid abnormalities, chromosomal status, and selected lesion-specific diagnoses. Chromosomal status was modelled hierarchically as no chromosomal abnormality, Down syndrome, or other chromosomal abnormality. Results: In univariable analyses, advanced maternal age, Down syndrome, and chromosomal abnormalities were associated with earlier diagnosis, whereas oligohydramnios was associated with later diagnosis. In the primary fully adjusted multivariable model, increasing maternal age was associated with earlier diagnosis (β = −0.169 weeks per year, 95% CI −0.238 to −0.099; p < 0.001), as was later calendar year (β = −0.211 weeks per year, 95% CI −0.311 to −0.111; p < 0.001). Coarctation of the aorta/aortic arch stenosis (β = 2.276 weeks, 95% CI 0.787 to 3.764; p = 0.003), pulmonary stenosis (β = 1.996 weeks, 95% CI 0.376 to 3.617; p = 0.016), and oligohydramnios (β = 2.097 weeks, 95% CI 0.228 to 3.965; p = 0.028) were associated with later prenatal diagnosis. Down syndrome showed a borderline association with earlier diagnosis (β = −1.350 weeks, 95% CI −2.702 to 0.002; p = 0.050). The model explained 12.2% of the variability in the gestational week of diagnosis, with an adjusted R² of 0.107. Conclusions: In this tertiary referral-centre cohort of pregnancies with prenatally recognized and confirmed CHD, the gestational week of prenatal diagnosis was associated with maternal age, calendar year, oligohydramnios, and selected lesion-specific diagnoses. These findings should be interpreted as observational associations within an already recognized referral cohort rather than determinants of prenatal CHD detection in the general pregnant population. Future studies should incorporate referral pathways, screening history, ultrasound quality, operator experience, fetal position, and lesion-specific imaging characteristics to better characterize factors influencing the timing of prenatal CHD diagnosis. Full article

Background/Objectives: AI chatbots may shape patient expectations before professional consultation. This scenario-based first-response study evaluated whether four user-facing chatbots provided orthodontic treatment-direction advice concordant with an expert benchmark and whether responses contained safety, referral, or overconfidence concerns. Methods: Forty fictional Turkish patient-oriented scenarios across eight categories were independently coded by three orthodontists as clear aligners, fixed appliances, both options, examination required, or advanced specialist/surgical evaluation required. Each scenario was submitted once to ChatGPT, Claude, Copilot, and Gemini on 20 May 2026. Two independent non-author orthodontists coded 160 archived first responses using a predefined framework, with adjudication before analysis. Results: Inter-expert agreement was moderate (Fleiss kappa = 0.491; Gwet AC1 = 0.528). Under the majority benchmark, exact concordance was 82.5% for ChatGPT, 67.5% for Claude, 42.5% for Copilot, and 37.5% for Gemini (Cochran Q = 34.105, p < 0.001). The overall difference remained significant in the 17 unanimous scenarios (Q = 11.455, p = 0.010), but a post hoc alternative-reference analysis that adopted the dissenting expert code in the 23 non-unanimous scenarios attenuated the rates to 57.5%, 52.5%, 52.5%, and 42.5%, respectively (Q = 4.222, p = 0.238). Coded safety-concern rates ranged from 15.0% to 62.5%. Conclusions: The sampled first responses differed in treatment direction and safety coding, but estimates were sensitive to the expert reference definition. Under the tested single-date, single-language, and single-run conditions, the findings represent a conditional snapshot rather than a time-invariant ranking of model capability. Patient-facing chatbots should support nondirective pre-consultation education and referral, not autonomous appliance selection. Full article