General journals

bmj;393/apr02_10/s609/FAF1faJohn was born in Northern Rhodesia (now Zambia) where his parents were working with a Church of Scotland mission, his father as medical officer. After his mother contracted poliomyelitis, the family moved with their four children to a general practice south of Edinburgh. From George Watson’s College John proceeded to the University of St Andrews and, for his clinical years, to Dundee. St Andrews—the little grey town by the grey North Sea—was always a “region of his heart’s desire” and it was where he met and married Christine Davidson, a fellow medical student.After hospital posts, the Martins settled in Inverness, both in general practice. For many years John was a GP trainer and had a particular interest in the expectations of, and challenges faced, by sixth formers considering a life in medicine and by medical students planning their careers. Towards the end of his years in Inverness he took a... [...]

A preschool child presented with a three day history of painless, non-pruritic pustules on her right palm (fig1). She was otherwise well, with no relevant medical history. The family reported keeping a pet rabbit at home.bmj;393/apr02_9/e086736/F1F1f1Fig 1Physical examination showed erythema, vesicles, and pustules localised to the ulnar aspect of the right palm. Bacterial culture of the pustule fluid showed negative results, whereas the results of the fungal culture were positive for Trichophyton mentagrophytes. Direct microscopic examination of skin scrapings showed abundant fungal hyphae. A fur sample taken from the rabbit was positive for the same fungal species when tested with a fungal culture.A diagnosis of inflammatory tinea manuum was made.T. mentagrophytes is a common causative pathogen in dermatophytosis, which affects about 25% of the global population, with markedly higher prevalence in tropical and subtropical regions.1Rodents and rabbits serve as primary reservoir hosts for zoophilic T. mentagrophytes. When humans are infected,... [...]

The covid-19 pandemic exposed three longstanding problems with pulse oximetry. Firstly, pulse oximeters can produce inaccurate readings in some patients.12 Secondly, even small levels of inaccuracy can harm patients when clinicians follow guidelines in which critical clinical decisions are based on an absolute or narrow range of oxygen saturation values.3 Thirdly, many clinicians are unaware of the potential for pulse oximeters to produce inaccurate readings and the factors that can cause this (including patients with darker skin tones), as well as the importance of interpreting and evaluating oxygen saturation readings in their clinical context and with an understanding of the limitations and imperfections of pulse oximetry.1456Since the pandemic, the focus has been on improving the performance, testing, and regulation of pulse oximeters. But improvements in accuracy must be accompanied by improvements in training in pulse oximetry.Most clinicians have little, if any, training in pulse oximetry and no national guideline or... [...]

The theme of World Health Day 2026, on 7 April, is “Together for health. Stand with science.”1 It marks the beginning of a year long campaign “celebrating the power of scientific collaboration to protect the health of people, animals, plants, and the planet.” This could not be more timely. In the immediate aftermath of the 2024 US presidential election, we warned that a second Trump administration would be a grave threat to evidence informed public health.2 But we, like many others, had no idea just how bad things would become.The damage to US science has been immense. The Trump administration has targeted the foundations of the science-policy interface, taking control of appointments, advisory processes, data access, and funding rules. The health consequences are already apparent, with the vaccine scepticism that has become an article of faith among the president’s acolytes contributing to outbreaks and some deaths from measles.3 Looking ahead,... [...]

Few developments in psychopharmacology attract as much attention among clinicians, researchers, and the public alike, as psychedelics. The psychoactive compounds psilocybin and 3,4-methylenedioxymethamphetamine (MDMA), which produce profound alterations in consciousness and mental state, have reached phase 3 trials for treatment resistant depression and post-traumatic stress disorder (PTSD) respectively. These advances reflect a resurgence of interest after decades of regulatory prohibition,1 with few trials conducted before 2017, rising to over 134 registered for psilocybin alone by 2023.2 Today, what makes these drugs fascinating is their unconventional treatment model: rather than prolonged and sometimes lifelong daily dosing, psychedelics are hypothesised to produce acute and enduring change after only one to three doses.A recent review on psychedelic medicine in TheBMJ synthesises a complex body of data on the mechanisms, clinical findings, and translational challenges, and discusses key challenges including mechanistic uncertainty, functional unblinding, inconsistent adverse event monitoring, and scalability (doi:10.1136/bmj-2024-081723).3 Although findings from... [...]

Just a few weeks apart, parliaments in Scotland and Jersey voted on assisted dying legislation with very different outcomes. The Assisted Dying for Terminally Ill Adults Bill was rejected in Scotland, while a draft law on assisted dying was approved in Jersey.12 The Terminally Ill Adults (End of Life) Bill for England and Wales is likely to fall in the House of Lords despite being approved by the House of Commons, and the prospect of it returning in the future is uncertain.34 It is important to consider the factors contributing to varying outcomes and reflect on what can be learnt from Jersey and Scotland.The legislative proposals in Scotland and Jersey have key differences.12 The Scottish bill bears greater similarity to the one going through the Westminster parliament. Two doctors must assess eligibility, approve the assisted dying decision, and then one doctor prescribes the medication that the patient self-administers. The Jersey... [...]

A Colorado state ban on conversion therapy for minors likely violates constitutional protections of free speech, the US Supreme Court has ruled.The decision—widely criticised by LGBTQ+ advocacy groups—will send the case to the lower courts to determine whether therapists can resume offering gender conversion therapy to minors.This could have implications for similar laws in states across the US.The case was brought by Kaley Chiles, a counsellor from Colorado Springs, who argued that the state’s 2019 ban on licensed doctors or mental health professionals “converting” lesbian, gay, or transgender people unlawfully restricted her ability to provide talk therapy to clients who sought to change their sexual orientation or gender identity.The court voted 8-1 to side with Chiles, with liberal justices Elena Kagan and Sonia Sotomayor joining the conservative majority.Justice Neil Gorsuch said in his written decision, “While the First Amendment protects many and varied forms of expression, the spoken word is... [...]

If you ask any doctor how their day is going, they’ll almost certainly reply “busy.” It’s an almost universal state of being in medicine, and we declare it like a kind of tic. But what if being perpetually busy isn’t just a symptom of being under pressure but one of its principal causes? Bob Klaber—a paediatrician at Imperial College Healthcare NHS Trust and its director of strategy, research, and innovation—argues that our collective busy-ness is a barrier to all the changes we say we want. When every minute is ridiculously full there’s no space for reflection, human connection, or the careful conversations from which better care emerges—and no time for teaching the next generation.Klaber invites us to adopt a different attitude to our work, one that de-emphasises frantic activity and multitasking and gives priority to being available for people and listening. As a clinician, he seems to practise what he... [...]

Social media use makes it hard to separate a genuine rise from diagnostic inflation, but blaming it is an oversimplification—Annabeth P Groenman, Tessa Copp, Kirsten McCaffery, and Jesse JansenThe Lancet Psychiatry commission on youth mental health has called for action on a global “youth mental health crisis.”1 Rates of diagnosed mental health conditions have been rising in young people. For example, 11.4% of children in the US currently have a classification of attention deficit/hyperactivity disorder (ADHD). In specific groups this figure is even higher: around 22% of 17 year old boys in the US have received an ADHD classification at some point in their life.2This raises the question of whether young people’s mental health is actually worse than in the past, or whether we’re simply recognising and labelling what was always there.Many academics point to social media as a key driver for the rise in mental health conditions among young... [...]

In a recent high profile case, a GP was suspended for five months for falsifying patient appointments in order to collect her children from an afterschool club finishing at 6 pm.1 While this is an extreme example, it highlights the challenges many doctors face balancing work and childcare responsibilities. My GP friends tell me of increasingly difficult timetables, with new requirements for core hours from 8 am to 6 30 pm.2 For most doctors who are parents, inflexible working arrangements constrain their careers.345Various reports on parenthood among surgical staff or across the NHS highlight working parents’ need for flexibility.345 In a survey of 313 surgeons who were parents, 46% reported childcare as their biggest issue.3 Predictability and flexibility were also troublesome, and 55% had considered leaving surgery.3 Women were substantially more likely to be told that a surgical career was incompatible with parenthood.3 A BMJ survey found that 93% of... [...]

From the outside, I looked calm and composed. I cracked jokes, followed instructions, and wrote clear emails. I sounded like someone managing a complicated but containable issue. But inside I was overwhelmed.Functioning to copeDuring my liver transplant evaluation and the months that followed, my mind narrowed to whatever task was directly in front of me. I didn’t look like someone in crisis because my coping mechanism was to keep functioning, no matter what. Because of covid-19 restrictions, I was alone for nearly all appointments. Most communication happened by phone or email. Ten days before my transplant call I was still emailing the team about laboratory orders, imaging appointments, vaccine rescheduling, and whether the roads would even allow me to make the trip because of the weather. I sounded steady and organised, but in reality I was holding everything together one task at a time. My inbox from that time reads... [...]

We agree with Sun’s central assertion: glucagon-like peptide-1 (GLP-1) receptor agonists are not “magic bullets” for the treatment of obesity.12 West and colleagues’ meta-analysis showed that discontinuation of pharmacotherapy often leads to weight regain, particularly when it has not been paired with structured behavioural interventions.3 Rather than viewing this as a pharmacological failure, we think it reflects a deeper need to embed such agents into systems that prioritise durable behaviour change.The Look Ahead trial indicated that continued engagement in weight loss maintenance behaviours was associated with sustained weight loss.4 West and colleagues found that people discontinuing weight management drugs regained more weight than those stopping behavioural weight management programmes.3 This indicates that behavioural weight management programmes are indispensable, particularly when weight management drugs are used.In Japan, GLP-1 drugs for obesity are regulated and are administered within a defined therapeutic framework. Under national guidelines, they are indicated only for “obesity disease,”5... [...]

Data from more than 6 million US children found that about 20% of those aged 2 to 19 years had obesity. [...]

This observational follow-up of patients in the Appendicitis Acuta multicenter randomized clinical trial conducted in Finland assesses the 10-year appendicitis recurrence and appendectomy rate in adult patients with uncomplicated appendicitis treated with antibiotics. [...]

This Medical News article discusses patient-facing artificial intelligence applications that are in various stages of development. [...]

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA. [...]

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA. [...]

In the Original Investigation titled “Donation After Circulatory Death Heart Transplant Without Preimplant Reanimation Using Rapid Ultraoxygenated Recovery,” published online January 26, 2026, the surname of author Mias Pretorius was misspelled in the byline. This article was corrected online. [...]

Automated screening and education for urinary incontinence in primary care settings may increase awareness and promote treatment among women, according to research published in JAMA Internal Medicine. [...]

To the Editor A recent article comparing bioresorbable vs metallic occluders for transcatheter atrial septal defect closure demonstrated excellent bioresorption at 2 years and noninferior efficacy of the bioresorbable device. I wish to highlight several aspects that help contextualize the implications of this study. [...]

In Reply Dr Carminati provides an insightful commentary about our randomized clinical trial comparing bioresorbable and metallic occluders for transcatheter atrial septal defect closure. Unlike coronary stents typically used in older patient populations, metallic occluders are often implanted during childhood or early adulthood. Their lifelong presence may have anatomical, psychological, and social implications—potentially limiting future transseptal access for procedures (such as atrial fibrillation ablation) and possibly affecting quality of life and psychosocial adaptation of individuals with congenital heart disease. In contrast, bioresorbable occluders leave no residual material after complete degradation. [...]

In this narrative medicine essay, a critical care physician who recovered from a critical illness reflects on the importance of empathy and how patients and families can feel and see things physicians can’t. [...]

The Centers for Medicare and Medicaid Services (CMS) has announced the removal of immunization measures from the Child Core Set and Adult Core Set in a letter to state health officials. [...]

This study describes secular trends in organ donation after circulatory death in the United States between 2000 and 2025. [...]

The treatment landscape for first-line oncogene driver-negative metastatic non-small-cell lung cancer (NSCLC) has remained largely unchanged in recent years. Since the 2016 approval of the anti-PD-1 immune checkpoint inhibitor (ICI) pembrolizumab for front-line treatment of patients with metastatic NSCLC with PD-L1 expression of 50% or greater,1 numerous ICI monotherapies and combination regimens have followed. With an abundance of treatment options already available in the first-line setting, the HARMONi-2 trial—the results of which are presented by Anwen Xiong and colleagues in The Lancet2—raises critical questions: does ivonescimab, a novel bispecific antibody targeting VEGF and PD-L1, offer meaningful clinical advantages over existing PD-1 or PD-L1 inhibitors? And is there a compelling need for another therapeutic option in this space? [...]

In the Chief Medical Officer for England's 2018 independent annual report, we called for the creation of a Composite Health Index (CHI)1,2 to track and inform efforts to improve the nation's health. The UK Office for National Statistics (ONS) responded by developing a beta Health Index3 followed by three updates, the latest covering 2015–21, which was published in June, 2023.4 We commend the ONS for their work, although funding constraints have since halted updates. With the new Secretary of State prioritising health-driven economic growth, we believe a renewed CHI should play a key part in tracking and informing these efforts over the coming years. [...]

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required. [...]

Our findings indicate that young children with AIPL1-related retinal dystrophy benefited substantially from subretinal administration of rAAV8.hRKp.AIPL1, with improved visual acuity and functional vision and evidence of some protection against progressive retinal degeneration, without serious adverse effects. [...]

Inherited retinal dystrophies are a genetically heterogeneous group of disorders that cause vision loss through degeneration or dysfunction of retinal photoreceptors. Gene-based therapies aim to correct the underlying molecular defect to arrest further degeneration or to ameliorate the dysfunction. Large improvements in vision have been reported in early phase clinical trials of gene-based therapies for some inherited retinal dystrophies characterised by functional defects with preservation of cellular architecture,1–4 and one gene therapy, voretigene neparvovec, has received regulatory approval. [...]

We are writing to respond to comments from Joshua W Miller and colleagues1 regarding our 2024 report of the Lancet standing Commission on dementia prevention, intervention, and care.2 Miller and colleagues propose adding homocysteine to the list of potentially modifiable dementia risk factors, citing a 2013 post hoc analysis of data from the VITACOG trial.3 This analysis suggested that lowering homocysteine concentrations through vitamin B supplementation reduced atrophy in a subgroup of people with mild cognitive impairment. [...]

Street vendors, who make up a substantial portion of the informal workforce in many low-income and middle-income countries, remain largely excluded from formal health insurance coverage, which poses a major risk to their health and financial wellbeing. Despite their key economic role, street vendors often do not have the legal recognition, stable income, and collective bargaining power required to access public or private health insurance schemes.1 [...]

Gill Livingston and colleagues report an updated combined population attributable fraction (PAF) of 45% for modifiable dementia risk.1 This statistic provides important direction for risk reduction and will receive much attention. [...]

I read with interest the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission by Gill Livingston and colleagues.1 The authors present an updated meta-analysis on the association between hearing loss and dementia, reporting a pooled hazard ratio (HR) of 1·37 (95% CI 1·00–1·87), which is lower than previous estimates (1·9; 1·4–2·7).2 [...]

In the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, Gill Livingston and colleagues identify a final set of 14 modifiable risk factors for delaying or preventing dementia.1 However, although sleep was discussed, it was not included in this final set. [...]

We read with great interest the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.1 Although the report offers valuable insights, we believe it overlooks the substantial role of oral health in dementia risk. [...]

We are pleased that our 2024 Lancet Commission's1 discussion of dementia risk has prompted international interest. Within it, we have been transparent about the assumptions behind our new population attributable fraction (PAF) calculations and present the best current estimates. These estimates will continue to change with new research and adjustments in the way people live. We discuss other risk factors that might be included in the future as stronger evidence emerges, but which have not yet reached the consistent, high-quality evidence threshold for inclusion. [...]

Abstract Background Microscopic colitis (MC) is an inflammatory disease of the colon. Although there is a known association between inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), evidence linking MC and PSC remains scarce. We aimed to investigate the bidirectional association between MC and PSC. Methods Leveraging the nationwide Swedish histopathology cohort Epidemiology Strengthened by histoPathology Reports in Sweden, we conducted a matched cohort study (2002–2023, follow-up until 2024) and a case–control study (1987–2023). Patients with IBD were excluded. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using Cox regression and adjusted odds ratios (aORs) using conditional logistic regression. Results The cohort study included 21,340 patients with biopsy-confirmed MC and 101,707 matched reference individuals (matched by age, sex, birth year and county). Over a median follow-up of 7 years, PSC was diagnosed in 21 patients with MC and 15 reference individuals, corresponding to incidence rates of 11.9 (95% CI = 7.8–18.3) and 1.7 (95% CI = 1.0–2.8) per 100,000 person-years, yielding an aHR of 7.17 (95% CI = 3.69–13.9). The case–control study included 22,729 MC cases and 108,467 matched controls. Prior PSC was more frequent among MC cases (19/22,729; 0.08%) than controls (12/108,467; 0.01%), yielding an aOR of 7.26 (95% CI = 3.50–15.1). Our findings remained robust across multiple sensitivity analyses, including sibling-controlled analyses. Conclusion This nationwide study reveals a bidirectional association between MC and PSC. Although absolute risks are low, these findings suggest that MC may have diagnostic relevance in suspected PSC cases, and vice versa. Physicians treating MC patients should be alert to signs and symptoms of PSC. [...]

Abstract Background Cardiovascular risk factor control reduces the risk of recurrent events after acute coronary syndrome (ACS). Long-term post-ACS management is poorly studied. Objectives To assess frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post-ACS. Methods Data from all patients hospitalized for ACS in Uppsala between 2012 and 2020 were obtained from electronic health records (EHRs). The probability of measurement and target achievement was estimated with adjusted regression models. Associations were assessed for sex, participation in cardiac rehabilitation (CR), presence of diabetes with nurse-led follow-up and documentation of an ICD-10 code for chronic ischaemic heart disease in the EHR. Results Among 6083 patients (median age 73 years, 34% female), follow-up data were available for 72% in year 1, 56% in year 2 and 44% in year 3. Year 3 LDL-C was not measured in 48% of patients, and 19% were at target ( [...]

Abstract Background North Korean defectors in South Korea offer a rare natural model to trace cancer risk evolution after rapid environmental transition, given shared genetics but markedly contrasting early life exposures with South Korean residents. Methods Using the Korean National Health Insurance database, we constructed a nationwide matched cohort of 25,798 North Korean defectors and 1,276,601 South Korean residents (1:50 frequency matching by sex, age, and index year). We compared overall and site-specific cancer risks and examined time-varying hazard ratios (HRs) since resettlement. Results Overall cancer risk was higher among defectors (HR 1.13; 95% confidence interval, 1.07–1.18), particularly in men (HR 1.31). Liver (HR 2.53), uterine cervical (HR 2.10), and lung cancer (HR 1.69) were markedly elevated, reflecting infection- and deprivation-related legacies. In contrast, cancers more prevalent in developed countries, notably breast (HR 0.48) and colorectal (HR 0.71), were initially lower. However, HRs began to rise over time, especially for breast cancer, indicating a trend toward convergence with host-population patterns. Conclusion The cancer profile of North Korean defectors demonstrates a dual burden: persistent risks from infection-related cancers rooted in pre-defection exposures and growing vulnerability to lifestyle-related cancers after resettlement. These findings highlight the importance of dual-track prevention strategies that address both legacy and emerging cancer risks in rapidly transitioning populations. [...]

Background Current guidelines recommend at least 10 years of follow-up for all pheochromocytoma and paraganglioma (PPGL) patients and lifelong monitoring for high-risk individuals. Nonetheless, data identifying patients who may not require routine lifelong follow-up are scarce. Methods Among 999 patients with PPGL, 703 who were non-metastatic, non-hereditary, and had undergone complete resection were included. Variables that significantly differed between the recurrence (n = 50) and non-recurrence groups over 10 years (n = 83) were identified, and cutoff values were determined using receiver-operating characteristic curve analysis. These very low-risk criteria were validated in an internal cohort and an external dataset from the National Institutes of Health. Results The non-recurrence group was older and had smaller pheochromocytomas (PCCs) than the recurrence group, with cutoffs of 37 years and 5.7 cm, respectively. The non-recurrence group had a higher percentage of patients with pheochromocytoma of the adrenal gland scaled score (PASS) [...]

Journal of Internal Medicine, Volume 299, Issue 4, Page 421-421, April 2026. [...]

Abstract Objective To compare the efficacy and safety of extended interval (Q3–4W) enzyme replacement therapy (ERT) versus standard biweekly (Q2W) ERT in clinically stable type 1 Gaucher disease (GD) patients. Methods We emulated a target trial with a sequential trial design, using data from the French Gaucher Disease Registry. Eligible patients were treated for ≥2 years biweekly without clinical events. Every 3 months, switchers to Q3–4W were matched to Q2W patients by age, sex, referral center follow-up, disease history (bone events, anemia, thrombocytopenia, splenectomy, and hepatosplenomegaly), and dose of ERT. The primary outcome was a composite of GD-related events (bone events, anemia, and thrombocytopenia). A 10% non-inferiority margin was prespecified. Secondary outcomes were biomarker changes and economic analyses. Results Among 280 eligible GD patients, 63 switched to Q3–4W and were matched to a total of 215 Q2W patients, followed for an average of 6.3 years. No significant difference in the risk of clinical events was observed between groups (hazard ratio: 0.98 [95% confidence intervals (CI): 0.54–1.51]). During follow-up, absolute risk difference remained below the 10% non-inferiority threshold at all timepoints. Biomarkers remained stable or slightly decreased in the Q3–4W group. The dosing interval extension led to an average reduction of 55 infusions per patient, corresponding to approximately €450,000 saved per patient over 6 years. Conclusion In stable GD1 patients, extending ERT administration to every 3–4 weeks was non-inferior to the standard biweekly regimen, supporting personalized spacing strategies that may improve quality of life and reduce healthcare costs. [...]

Journal of Internal Medicine, EarlyView. [...]

Abstract Background Chronic intestinal pseudo-obstruction (CIPO) is a severe gastrointestinal motility disorder that may be idiopathic or associated with systemic disease. In idiopathic cases, the pathophysiological mechanisms remain poorly defined. Although mutations in angiogenic factors have been reported in mitochondrial forms of CIPO, their role in non-mitochondrial cases is still unclear. Objective To investigate genetic and molecular contributors to CIPO, with a specific focus on intestinal microvasculature. Methods Jejunal samples from patients with CIPO were analysed by whole exome sequencing (WES) and mitochondrial DNA (mtDNA) profiling. Morphometric and immunohistochemical studies assessed collagen remodelling, vascular architecture, neuromuscular integrity and hypoxia. Expression of angiogenic factors, including thymidine phosphorylase (TP) and vascular endothelial growth factor (VEGF), was evaluated. Results WES did not identify known CIPO-causing variants, but rare mutations in collagen-related genes were detected in a subset of patients. Tissue analysis revealed higher fibrosis, vascular remodelling with a predominance of very small vessels, thinning of the longitudinal muscle and neuronal loss. TP and VEGF expression were significantly reduced, whereas hypoxia-inducible factor-1α (HIF-1α) was markedly upregulated. mtDNA integrity and copy number were preserved, whereas haplogroup J was overrepresented. Multivariate analysis linked these alterations to a higher frequency of sub-occlusive episodes. Conclusions Vascular dysfunction and collagen abnormalities emerge as key contributors to neuromuscular degeneration in CIPO. These findings provide novel mechanistic insights into disease pathophysiology and support further exploration of vascular-targeted therapeutic strategies. [...]

Abstract Background and objective The development of Type 1 diabetes (T1D) is shaped by genetic predisposition and epigenetic regulation. Human leukocyte antigen (HLA) risk alleles are major genetic determinants, but the epigenetic landscape in relation to disease onset remains unclear. Early-life epigenetic modifications may reveal how environmental and epigenetic factors interact in T1D pathogenesis. Methods We investigated epigenetic differences in cord blood DNA from individuals with different HLA risk alleles who later developed T1D using epigenome-wide association studies. Result High-risk HLA carriers showed differentially methylated genes (DMGs) mainly involved in immune and autoimmune processes, resembling patterns in other autoimmune diseases. In contrast, low-to-neutral risk carriers exhibited DMGs linked to signaling cascades, metabolic pathways, and Type 2 diabetes–related mechanisms such as beta cell function and insulin signaling. Conclusion These findings indicate that heterogeneity in T1D pathogenetic mechanisms based on HLA background may influence disease development. [...]

Journal of Internal Medicine, EarlyView. [...]

Journal of Internal Medicine, EarlyView. [...]

Abstract The integration of immune checkpoint inhibitors into perioperative management marks a major evolution in curative-intent oncology. This review examines the current evidence for perioperative immunotherapy encompassing neoadjuvant, adjuvant, and combined strategies in melanoma and non-melanoma skin cancers, non-small cell lung cancer (NSCLC), triple-negative breast cancer (TNBC), esophageal and gastroesophageal junction cancer, renal cell carcinoma, urothelial carcinoma, head and neck squamous cell carcinoma, colorectal cancer, gynecological malignancies, and hepatocellular carcinoma. Neoadjuvant immunotherapy demonstrates biological advantages by exposing the immune system to intact tumor antigens, consistently improving event-free survival and pathological response rates across tumor types. Notable successes include CheckMate 816 in NSCLC, KEYNOTE-522 in TNBC, and emerging trials in melanoma that show superior outcomes compared to adjuvant-only approaches. Pathological complete response and major pathological response have emerged as robust surrogate endpoints correlating with long-term survival. In contrast, adjuvant immunotherapy shows more variable results, with demonstrated recurrence-free survival benefits but inconsistent overall survival (OS) advantages—particularly concerning given the risk of overtreatment in patients potentially cured by surgery alone. Critical challenges include the absence of predictive biomarkers in most cancer types, immune-related adverse events occurring in up to 30% of patients, substantial healthcare costs, and insufficient OS follow-up duration in many approved indications. Future priorities include biomarker development, adaptive trial designs incorporating response-guided therapy, and long-term toxicity assessment. Although perioperative immunotherapy is reshaping curative-intent cancer treatment, optimal patient selection, treatment sequencing, and safety optimization remain essential for widespread implementation. [...]

ANZ Journal of Surgery, EarlyView. [...]

ABSTRACT Background Advances in imaging, non-operative management, and endovascular techniques have reshaped abdominal trauma care, but their impact on operative trends in blunt-dominant Australian trauma systems is incompletely described. Aims To describe temporal trends in operative and minimally invasive management of abdominal trauma at an Australian Level 1 trauma centre, and to discuss their implications. Methods A retrospective study of the Alfred Health Trauma Registry (2001–2024) identified adult major trauma (MT) patients (ISS > 12) undergoing emergency laparotomy, laparoscopy, or solid-organ embolisation within 24 h of admission. Temporal trends were assessed using linear regression and offset Poisson models. Sensitivity analyses used abdominal AIS ≥ 2 as the denominator. Results Among 25 497 major trauma patients, 1330 (5.2%) underwent laparotomy, 107 (0.4%) laparoscopy, and 417 (1.6%) embolisation. Annual major trauma presentations increased from 643 to 1498, while the number of patients with abdominal AIS ≥ 2 also rose. Laparotomy rates declined significantly over time, from 10.7% to 2.7% of major trauma admissions (R2 = 0.80; p  [...]

ANZ Journal of Surgery, EarlyView. [...]

ABSTRACT Background En bloc transurethral resection of bladder tumour (ERBT) has been increasingly adopted to improve pathological accuracy and reduce recurrence rates compared with conventional TURBT. However, the influence of surgeon experience on procedural quality, oncologic outcomes, and learning curve dynamics remains underexplored. Methods A retrospective cohort study was performed on 80 consecutive patients undergoing ERBT between 2018 and 2024 at Palmerston North Hospital. Surgeons were stratified by experience ( [...]

ABSTRACT Objective Nephrectomy remains the cornerstone treatment for localised renal cancer (RC). The objective of this study was to assess outcomes of nephrectomy in a single regional centre. Methods We conducted a retrospective cohort study of 114 patients undergoing nephrectomy with three surgeons at a regional referral centre between January 2019 and April 2024. Primary outcomes included operative time, ICU admission, and in-hospital mortality. Secondary outcomes included blood loss, post-operative complications, and preservation of renal function. Rurality was stratified according to the Modified Monash Model (MMM) rurality classification. Statistical analyses included chi-square, t-tests, Spearman correlation, and multivariate regression. Results Of the cohort, 71.9% underwent laparoscopic and 28.1% underwent open nephrectomy. The open group had significantly longer operative time (217.5 vs. 180.0 min; p  [...]

ABSTRACT Background Managing patients with adhesive small bowel obstruction (ASBO) requiring surgery is challenging, particularly in performing adhesiolysis safely while minimizing iatrogenic complications. Identifying at-risk patients is important, as it may facilitate earlier diagnosis and strengthen prophylactic measures. We conducted this study to report factors associated with ASBO. Methods A case–control study was conducted in the general surgery “B” department of Rabta Hospital, including patients operated on for ASBO between 2004 and 2020. Patients were asked to report ASBO occurrence following index surgery. Logistic regression analysis was used to determine associated factors. Results Two hundred patients were included, with 100 patients in each group. Radiological ischemic features were observed in 14.5% of cases. Surgery was performed in 35 patients, with laparoscopy attempted in 8.6% but converted in two cases. Postoperative complications occurred in 31.4% (n = 11), with two deaths (5.7%). Logistic regression revealed three independent factors associated with ASBO: male sex (adjusted OR = 7.489, 95% CI: 2.726–20.578; p  [...]

ABSTRACT Background Acute pancreatitis is a common acute surgical condition worldwide as well as in Fiji. The incidence, epidemiology, management, and outcomes have not been previously documented. The aims of this study were to determine the causes, treatment and outcomes of acute pancreatitis at Colonial War Memorial Hospital (CWMH) in Fiji. Method This was a retrospective, single center, descriptive study conducted over a 5-year period for all adult patients diagnosed with acute pancreatitis at CWMH, a tertiary hospital and regional referral center. Results There were 156 patients; 50% were female; 53% were of I-Taukei origin; and a median age of 44.5 years. The most common cause identified was idiopathic/unknown (38%) followed by gallstones (36%), alcohol (13%), hyperlipidaemia (7%) and others (6%). The incidence was 49 per 100 000 with majority mild (89%) in severity, 10% moderately severe and 1% severe. Inappropriate prophylactic antibiotics were given to 30% of the patients. For gallstone pancreatitis, only 17% had cholecystectomy on index admission while 20% underwent cholecystectomy within 6 weeks. Major morbidity occurred in 8%. There were no inpatient mortality recorded. No patients received minimally invasive treatment for complicated pancreatitis. Conclusion The management of acute pancreatitis in Fiji is largely in line with international standards, but in some aspects severely limited by lack of resources, a common issue in developing countries. Establishment of pathways for antibiotic use and index admission cholecystectomy is recommended. Further resourcing for infrastructure and training is needed to improve diagnosis for etiology, as well as radiological and endoscopic treatment of complications. [...]

ABSTRACT Naevus sebaceous (NS) is a congenital cutaneous hamartoma characterised by epidermal, follicular, sebaceous and apocrine components, with a rare but significant potential for malignant transformation, most commonly into basal cell carcinoma (BCC). Syringocystoadenoma papilliferum (SCAP), a rare adnexal tumour, occasionally arises within NS lesions and may progress to malignancy. This study presents a comprehensive narrative review and a rare case of SCAP arising within NS and subsequently transforming into BCC, highlighting the interplay between these lesions. A systematic review adhering to PRISMA guidelines was conducted using databases including PubMed, OVID Medline and Cochrane, yielding 34 relevant articles after rigorous selection. While NS is present at birth, SCAP can emerge later in life, with hormonal and environmental factors contributing to its development. Both lesions exhibit overlapping genetic alterations, particularly involving PTCH and p16, which are also implicated in the pathogenesis of BCC. This genetic convergence suggests potential mechanisms linking NS and SCAP to malignant transformation, although further research is needed to appreciate their interrelationship fully. This review highlights the need for vigilant monitoring of NS lesions, particularly in the presence of multiple risk factors such as sun exposure and a family history of skin cancer. Early detection and management are critical to mitigate the risk of malignant progression. [...]

ANZ Journal of Surgery, EarlyView. [...]

ABSTRACT Background Neoadjuvant systemic therapy (NAST) induces morphological changes within the axilla; however, its impact on lymph node yield (LNY) following axillary lymph node dissection (ALND) is less clear. Methods A retrospective cohort study was performed including female patients who underwent ALND for biopsy-proven node-positive breast cancer within Western Sydney Local Health District hospitals between 2010 and 2022. Patients were grouped by receipt of NAST versus primary surgery (PS). LNY was compared between groups. Within the NAST group, univariate and multivariable logistic regression analyses identified variables associated with LNY ≥ 10. Results Among 768 patients, 217 (28.3%) received NAST and 551 (71.7%) underwent PS. Median LNY was lower following NAST compared to PS (17 [IQR: 10] vs. 21 [IQR: 10], p  [...]

ABSTRACT Objectives To assess the effectiveness of a pre-operative triaging model for paediatric adenotonsillectomy in identifying risk of early post-operative respiratory complications, in order to propose an evidence-based triaging model for day-case paediatric adenotonsillectomy. Study Design A retrospective cohort study of 2953 children between 2- and 12-years-old undergoing adenotonsillectomy for obstructive sleep apnoea (OSA) between January 2011 and December 2019. Patients were triaged as either low-risk or high-risk for post-operative respiratory complications based on age, comorbidities and results of pre-operative investigation with either overnight oximetry or polysomnography. Pre-operative factors including respiratory investigations, intra-operative factors and post-operative course were analysed. Results Of the 2953 patients enrolled in this study, 1229 patients were deemed low-risk, and 1724 patients were deemed high-risk. Total respiratory complication rate in low-risk patients was 1.5% requiring either repositioning or prolonged oxygenation, with no major respiratory complications requiring admission to the intensive care unit (ICU) or non-invasive ventilation. Total respiratory complication rate in the high-risk cohort was 11.7%. In this cohort, five patients required non-invasive ventilation and seven had an unplanned admission to ICU for monitoring. Severity of OSA and the presence of recovery room complications were the most significant independent risk factors associated with post-operative respiratory compromise, with severe OSA conferring an odds ratio of 9.5 (95% CI 5.0–18.0) of respiratory compromise and 13.6 (95% CI 3.4–54.9) in the presence of any complications in the recovery room. Conclusions Pre-operative oximetry and/or polysomnography are useful tools to aid triaging patients and stratifying risk when determining safety for day-case paediatric adenotonsillectomy. [...]

ANZ Journal of Surgery, EarlyView. [...]

ABSTRACT Introduction To assess competing US techniques in evaluation of chronic liver disease, we performed a study to determine the diagnostic accuracy of 2D-shear wave elastography (2D-SWE) and attenuation imaging (ATI) compared with more established methods of point shear wave elastography (pSWE) and visual B-mode grading of hepatic steatosis. Magnetic resonance elastography (MRE) and proton density fat fraction (MR-PDFF) were used as respective reference standards. Methods Fifty-five patients underwent same-day liver ultrasound (conventional B-mode, pSWE, 2D-SWE, and ATI) and 3 T MRI (MRE and MR-PDFF). Diagnostic performance for steatosis (mild, moderate, severe) and fibrosis (≥ F2, ≥ F3, and F4) grades was assessed using receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) calculated. Agreement was evaluated using Cohen's kappa for categorical comparisons and intraclass correlation coefficients (ICC) for continuous measurements within the same modality. Results For fibrosis, 2D-SWE demonstrated high sensitivity (100%) for advanced fibrosis (≥ F3; AUC 0.87), compared with pSWE (sensitivity of 71.4%). In contrast, pSWE showed higher specificity (92.3%) for significant fibrosis (≥ F2) compared to 2D-SWE (73.9%). Categorical agreement with MRE was higher for pSWE (kappa = 0.66) than 2D-SWE (kappa = 0.45). For steatosis, visual B-mode across all grades had AUC 0.85–0.89 compared to 0.68–0.85 for ATI. ATI performed best in detecting severe steatosis (AUC 0.85). Conclusion Across the spectrum of clinically relevant assessment of liver fibrosis and steatosis, pSWE and visual B-mode grading showed better correlation with MRI results than 2D-SWE and ATI, respectively. However, they did provide good diagnostic performance in grading liver fibrosis and steatosis in advanced disease. Further research may better define more accurate standardised cut-off scores for the 2D-SWE and ATI techniques. [...]

ABSTRACT Background Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, particularly among patients with chronic liver disease and cirrhosis. Non-contrast magnetic resonance imaging (NC-MRI) has emerged as a potential alternative imaging modality for HCC surveillance and diagnosis, avoiding the risks associated with contrast agents; however, its diagnostic performance has not been fully established. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of NC-MRI for the detection and surveillance of HCC. Methods A comprehensive systematic search of five electronic databases (PubMed, EMBASE, Scopus, the Cochrane Library, and Web of Science) was conducted. Eligible studies evaluated NC-MRI for HCC diagnosis or surveillance and reported sufficient data to construct diagnostic accuracy measures. Data were extracted on study characteristics, patient populations, NC-MRI protocols, reference standards, and diagnostic outcomes, including sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios. Subgroup analyses were performed according to study design, reference standard, and imaging intent (diagnostic vs. surveillance). Results Twenty-one studies comprising 7412 participants were included. The pooled sensitivity and specificity of NC-MRI for HCC detection were 84% and 94%, respectively. The pooled DOR was 78 (95% CI: 50–122), with a positive likelihood ratio (LR+) of 13 (95% CI: 9–19) and a negative likelihood ratio (LR−) of 0.17 (95% CI: 0.13–0.22). Subgroup analyses demonstrated higher diagnostic performance in prospective studies and when NC-MRI was applied for surveillance purposes. Studies using histopathology as the reference standard also showed high diagnostic accuracy, with a DOR of 74. Conclusion NC-MRI demonstrates consistently high diagnostic accuracy across diverse study settings and represents a promising contrast-free imaging option in selected high-risk populations. However, its role in population-based surveillance requires cautious interpretation, particularly for early-stage disease and warrants further prospective validation. [...]

ABSTRACT Introduction Adrenal incidentalomas are common lesions with potential functional activity such as autonomous cortisol secretion (ACS), which influences management. Current diagnosis relies on biochemical testing, notably the dexamethasone suppression test (DST). This study aimed to evaluate whether CT-derived volumetry of adrenal incidentalomas and contralateral adrenal glands—specifically the ratio of adenoma volume to contralateral volume (AV/CV) could serve as a reliable screening marker for ACS. Methods We retrospectively analysed all adult patients referred with unilateral adrenal adenomas between January 2022 and January 2023. Patients with bilateral lesions, metastatic disease, or interfering medications were excluded. All underwent standard hormonal assessment with 1 mg overnight DST and had volumetric analysis of adrenal glands on CT imaging performed independently by two radiologists, calculating AV, CV and their ratio. The correlation between AV/CV and post-DST cortisol levels was assessed using Pearson's coefficient, and ROC analysis evaluated the predictive accuracy. Results Inter-observer variability was r = 0.997 for AV and r = 0.791 for CV. There was no significant correlation between AV/CV ratio and cortisol post-DST. An AV/CV ratio ≥ 1 demonstrated low sensitivity (52%) and specificity (48%) for ACS prediction. Although a ratio ≥ 3 was highly specific (> 90%), its sensitivity was limited (17%). Conclusion Our study did not show a correlation between AV/CV ratio and the presence of ACS, contrasting earlier promising studies. [...]

ABSTRACT Objective To systematically review and compare reduced-dose and standard-dose computed tomography (CT) protocols for craniocerebral and craniofacial trauma, focusing on image quality and radiation dose optimisation strategies. Methods A systematic review was conducted following the PRISMA 2020 guidelines. Searches were performed across PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, LILACS, and TripDatabase for studies published between November 2024 and January 2025. Observational studies comparing reduced-dose with standard-dose CT protocols were eligible. Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by consensus. Data were extracted regarding scanner type, acquisition parameters, dose metrics (CTDIvol, DLP) and image quality assessments. Results Of 641 records screened, 7 studies met the inclusion criteria. None reported diagnostic accuracy metrics; therefore, a quantitative descriptive synthesis was performed. Across studies, reduced-dose CT protocols achieved 21%–89% dose reduction while maintaining comparable subjective and objective image quality. Iterative reconstruction, spectral shaping and current modulation were the most effective techniques for optimising image quality with lower radiation. Limitations Evidence was limited to observational studies without diagnostic reference standards, and heterogeneity in protocol reporting restricted data comparability. Conclusion Reduced-dose CT protocols demonstrate comparable subjective and objective image quality to standard-dose acquisitions while achieving substantial radiation dose reductions. Techniques such as iterative reconstruction, tube-voltage modulation, spectral shaping and automated exposure control were consistently associated with meaningful dose optimisation. These findings support the clinical feasibility and safety of implementing dose-optimised CT protocols in trauma imaging. Implications for Practice Findings support the clinical feasibility and safety of implementing dose-optimised CT protocols for trauma imaging. [...]

ABSTRACT Introduction Higher BMI is associated with reduced breast screening participation but it is unclear if BMI is a proxy for other potential barriers to screening. This study describes the correlations between BMI and body image, perceptions of risk, and pain in a large sample of breast screening participants to help identify targets for improving screening participation within people with obesity. Methods A survey collected information on body image, perceived risk of breast cancer, and pain experienced during mammography from 10,751 participants attending BreastScreen Western Australia between June and December, 2023. Latent variable analysis was used to generate single unobserved index variables for perceived risk, body surveillance, and body shame. Spearman's rho correlations were estimated between BMI, four body shame variables, six body surveillance variables, overall perceived risk index, and a pain score. Results BMI was significantly positively correlated with responses indicating increased body shame and increased body surveillance, except for one question where participants with increased BMI indicated that they think it is more important that their clothes are comfortable than look good. BMI was also positively correlated with overall perceived risk index (r s  = 0.08, p  [...]

ABSTRACT Introduction This study aims to analyse the practice patterns of radiotherapy (RT) for pancreatic cancer (PC) in Korea. Methods A questionnaire comprising 17 questions on RT for PC was sent to board-certified radiation oncologists participating in the Division for Pancreaticobiliary Cancer of the Korean Radiation Oncology Group. Results Twenty-three hospitals participated in the survey. In 2022, 11 hospitals reported adjuvant RT cases after resection (66 patients), 4 hospitals reported neoadjuvant RT cases before surgery (80 patients), and 16 hospitals reported definitive RT cases for locally advanced PC (197 patients). Adjuvant RT dose and fractionation varied across institutions, either conventional (45–54 Gy in 25–30 fractions) or hypofractionated (37.5–45 Gy in 15 fractions) regimen. Definitive RT indications included progressive disease or an increase in tumour markers during systemic therapy (12 responses), incomplete systemic therapy due to treatment-related adverse event (10 responses), ineligibility for multiagent chemotherapy due to patient performance including old age or comorbidities (9 responses), planned RT after completion of chemotherapy according to the institutional protocol (3 responses), and ineligible for conversion surgery despite the completion of chemotherapy (3 responses). The application of RT techniques and dose-fractionation schedules also varied depending on the available equipped machine, tumour location, and relationship with neighbouring organs at risk. Conclusions Current analysis showed significant heterogeneity in the practice patterns of RT for PC in Korea, particularly in dose fractionation schedules and RT indications. These findings highlight the need for further research and standardisation of RT practices to optimise treatment outcomes. [...]

ABSTRACT Background Beta Thalassaemia Major is a hereditary disorder characterised by defective protein synthesis in the beta-globin chain, leading to chronic anaemia. As a consequence of repeated blood transfusions used to manage anaemia, excessive iron accumulation occurs, primarily in the liver and other vital organs, leading to organ damage. Purpose To determine the correlation between liver iron concentration and iron accumulation in the liver due to blood transfusions in paediatric patients diagnosed with Beta Thalassaemia Major, using shear wave elastography and liver magnetic resonance imaging apparent diffusion coefficient measurements. Materials and Methods A prospective study was conducted from January 2025 to April 2025 on 77 paediatric patients diagnosed with Beta Thalassaemia Major, utilising liver shear wave elastography, liver apparent diffusion coefficient, T2* values and serum ferritin levels. Results Descriptive statistics for the continuous variables of the patients: elasticity median (10.39 ± 4.39 kPa), velocity median (1.81 ± 0.36 m/s), liver ADC (0.52 ± 0.42), liver T2* (4.93 ± 5.15), LIC (9.45 ± 5.7). The median elasticity values differed significantly across the iron overload severity groups (p = 0.006). A post hoc analysis was performed to identify the groups responsible for this difference. The analysis revealed that the differences originated from comparisons between the mild (9.58 ± 3.62) and severe (14.44 ± 5.91) groups, the moderate (9.47 ± 3.24) and severe (14.44 ± 5.91) groups and the severe (14.44 ± 5.91) and normal (8.16 ± 2.44) groups (p ac [...]

ABSTRACT Purpose This study aims to estimate the carbon footprint associated with external beam radiotherapy in a low- and middle-income country (LMIC) context, specifically at the Uganda Cancer Institute (UCI), and to evaluate whether sustainability should be a priority alongside treatment access in such radiation therapy settings. Methodology A carbon footprint analysis was conducted for patients treated for locally advanced cervical cancer at UCI between 2023 and 2024. The assessment included emissions from three key components: (1) patient travel to and from the facility, (2) pre-treatment imaging using CT and 2D simulation and (3) energy consumption by three Varian TrueBeam linear accelerators during treatment and idle times. Emission estimates were calculated using activity data and standard global warming potential (GWP) conversion factors. Results Patient travel emerged as a major contributor to carbon emissions due to the centralisation of services in Kampala and the lack of regional treatment centres. Energy use from LINACs and imaging contributed less significantly, owing in part to Uganda's low-carbon electricity grid powered largely by hydropower. CT scans generated approximately 0.105 kg CO2 per scan, and LINAC operations added modest emissions depending on usage patterns and machine idle time. Conclusion While radiotherapy-related emissions in LMICs like Uganda are relatively modest compared to high-income countries, they are non-negligible and expected to rise with growing access to cancer care. Incorporating sustainability considerations into the future planning of radiotherapy infrastructure and service expansion is both feasible and necessary. Carbon-conscious planning should be integrated into decisions around siting and radiotherapy expansion to promote environmentally responsible cancer care in LMICs. [...]

Journal of Medical Imaging and Radiation Oncology, EarlyView. [...]

ABSTRACT Introduction The reality of rising greenhouse gas emissions and global temperatures underscores the urgency of transitioning to a net-zero energy system. Modern radiotherapy contributes to the total healthcare domain emissions. As the global incidence of cancer rises, expanding treatment capabilities is critical. However, sustainability in high-emission healthcare disciplines is equally paramount. This paper explores the academic knowledge base and practical strategies for understanding and managing emission contributions to align with sustainability goals. The European Union's Corporate Sustainability Reporting Directive and climate disclosure frameworks in Australia and New Zealand require certain organisations, including large hospitals and radiotherapy networks, to report their direct and indirect emissions. Methods Climate disclosure frameworks emphasise transparency and resilience to climate risks, supported by methodologies such as the Greenhouse Gas Protocol and ISO 14064. The study narratively examines existing literature and practical solutions through engaged scholarship and provides insights into modelling radiotherapy emissions guided by the principles of the Corporate Sustainability Reporting Directive. Results Radiotherapy emissions are a small but significant share of healthcare emissions, with indirect emissions dominating. They are estimated at 6.75 Mt. CO2e, accounting for approximately 0.3% of global healthcare emissions. While sustainable construction and innovative technologies reduce upstream impacts, downstream greenhouse gas reductions remain limited despite travel minimisation efforts. Conclusions By advancing sustainability in radiotherapy, this work contributes to the broader healthcare sector's efforts to mitigate climate impacts and aligns with international climate commitments. [...]

ABSTRACT Introduction 68Ga prostate-specific membrane antigen (PSMA) has been shown to have prognostic value in detecting PSMA expressing metastasis from prostate cancer, but inevitably, there are cases in which suspected metastases demonstrate equivocal uptake. This study aims to assess whether there is a direct relationship between SUVmax of the primary prostate lesion and the presence of nodal and distant metastasis. Methods Retrospective review of 265 primary staging 68Ga-PSMA PET/CT studies performed at a single centre on a single PET/CT was performed for the SUVmax of the primary lesion, and the presence of PSMA-avid nodal/distant metastases. Results Analysis shows that a single unit increase in SUVmax of the primary prostatic lesion corresponds with a 1.6% increased odds of nodal metastases, 1.7% increased odds of distant metastases and a 2% increased odds of having either. A single unit increase in the log of the SUVmax corresponds with odds ratios of 2.061, 2.038 and 2.294 respectively. Conclusion There is a weak but statistically significant correlation between the SUVmax of the primary prostate lesion and the presence of metastases on primary staging 68Ga-PSMA PET/CT for biopsy-proven prostate cancer. However, because the relationship is so weak and the significant overlap in SUVmax in local versus advanced disease, using SUVmax as the sole predictor of advanced disease is unreliable. [...]

ABSTRACT Background Evaluating therapeutic efficacy in colorectal malignancies presents significant challenges when relying solely on conventional anatomical imaging approaches. The primary aim of this prospective study was to compare the diagnostic effectiveness of integrated positron emission tomography–computed tomography (PET-CT) and diffusion-weighted magnetic resonance imaging (DWI-MRI) for monitoring chemotherapy response in patients with colorectal cancer. Methods This prospective comparative analysis included 132 histologically confirmed patients with colorectal cancer planned for first-line chemotherapy (FOLFOX, FOLFIRI, or CAPOX). Twelve of 132 patients left the study during follow-up. Patients underwent baseline PET-CT and DWI-MRI exams, with repeat scans at 3, 6, and 12 weeks post-treatment. Response assessment used RECIST v1.1 for morphology, PERCIST v1.0 for metabolism, and quantitative apparent diffusion coefficient (ADC) analysis for DWI-MRI. Survival outcomes, correlation studies, and receiver operating characteristic curve analysis were used. Results Patients had a mean age of 62.7 ± 9.6 years, with 51.7% men. PET-CT indicated a 36.0% ± 25.3% SUVmax reduction, and DWI-MRI showed a 51.4% ± 42.1% ADC rise at 12 weeks (p  [...]

ABSTRACT Objective To explore the perspectives of University Departments of Rural Health (UDRH) clinical educators and partner aged care provider managers involved in the Rural Health Multidisciplinary Training (RHMT) Aged Care pilot programmes, and to identify the barriers, enablers and context-specific strategies that supported the establishment of nursing and allied health student placements in rural and remote aged care settings. Setting Five pilot sites were established through RHMT Aged Care Service Grants in partnership with aged care providers across New South Wales, Tasmania, South Australia, Western Australia and Queensland. Participants Twelve participants, including nine UDRH clinical educators (CEs) and three partner aged care service managers, supported student placements at four of the five pilot sites. Design Qualitative exploratory study using semi-structured interviews. Data were analysed using a thematic approach. Results Three interdependent themes were identified: (1) engaged partnership; (2) creating a learning environment that benefits everyone; and (3) adapting to the local context. Participants valued strong relational partnerships, role clarity and the CE role. While perceived benefits to students, services and staff ensured buy-in to the value of creating a learning environment through placements. Feasibility required local adaptation to challenges, such as service capacity and workforce pressures. Conclusion Rural aged care placements are feasible and valuable when supported by strong academic–provider partnerships, perceived benefits for everyone through establishing learning environments, and context-sensitive implementation. These findings offer practical guidance for implementing aged care placements in rural settings, while highlighting the need for further research into student, staff, and resident outcomes. [...]

ABSTRACT Objective This project aimed to document the experiences of Aboriginal people living in the Kimberley region who have experienced diabetes-related foot disease (DFD) so that service delivery can be optimised. Setting The Kimberley region, Western Australia. Participants Aboriginal People in the Kimberley with DFD. Design A mixed methods study design was used, incorporating quantitative analysis of primary and outpatient care presentations and hospitalisation data collected from in-depth medical record reviews (n = 35) and semi-structured interviews with participants (n = 28). Results This study highlighted that DFD in the Kimberley has a significant impact on individuals and communities. While primary and outpatient services play a key role in DFD care, there is an opportunity to strengthen preventive foot care services. Participants valued flexibility and autonomy in managing their care, especially with the support of Aboriginal Community Controlled Health Services (ACCHS). Recommendations to improve DFD care are provided, incorporating the perspectives of patients and of the health professionals who participated in the data interpretation workshop. These include facilitating patient self-care, expanding high-quality foot care within ACCHS, strengthening support for hospitalised patients, and advocating for upstream service improvements. Conclusion Addressing geographical and systemic barriers through improved patient education, better access to primary care resources, and increased patient choice may enhance autonomy and long-term DFD outcomes. [...]

ABSTRACT Objective To explore whether sexual health is discussed in regional settings between primary care clinicians (General Practitioners (GPs) and Practice Nurses (PNs)) and older patients (aged 60 and over), and the barriers and enablers of sexual healthcare for older adults in regional areas. Setting Participants were based throughout regional Victoria, with all five regions of Victoria represented. Participants Two participant groups were included: older adults aged 60 and over, and primary care clinicians (GPs and PNs). Nine older adults (5 women, 4 men, ranging in age from 60 to 87 years), and 8 clinicians (4 women, 4 men, 6 GPs and 2 PNs) were interviewed. Design Data were collected via semi-structured interviews between July and December 2024. Data were analysed using qualitative content analysis. Results Sexual health conversations were rare and ad-hoc between older adults and primary care clinicians. Key barriers for both groups included stigma around sexual activity and ageing, privacy concerns in small communities, high staff turnover, and structural challenges such as cost and time. Key enablers for both groups included telehealth, systematic inclusion of sexual health in routine care such as the 75+ health check, training for regional clinicians, and health promotion campaigns for older adults living regionally. Conclusion Older adults and primary care clinicians agree that sexual health is important to older adults' quality of life, although such conversations are rarely prioritised. This study offers suggestions for clinicians to broach sexual health so that it stays on the agenda as part of older patients' overall care within regional primary care. [...]

Australian Journal of Rural Health, Volume 34, Issue 2, April 2026. [...]

ABSTRACT Aim To outline key criteria when choosing how to measure remote area primary health care workers' retention preferences and compare six different methodological approaches against these criteria. Context Australians living in remote communities experience poorer health outcomes. Many health services serving remote populations have persistent workforce shortages, high staff turnover and short retention which adversely affect access to timely, appropriate health care, care continuity and cultural appropriateness of care. Improved understanding of staff preferences for different retention initiatives could inform initiatives to improve workforce stability. Approach Measuring the preferences of remote primary health care staff is complex. Key criteria to guide methodology choice include: i) logistical considerations related to geographical remoteness, ii) diversity of primary care staff, iii) minimising participants' cognitive load and time required for data collection, iv) ability to quantify preferences, v) appropriateness of methodologies for staff from different socio-cultural backgrounds, vi) minimising bias, and vii) making trade-offs given limited resources for implementing retention incentives. Six different methodological approaches are compared: Rating, Ranking, Best Worst Scaling (BWS) Object Case, BWS Profile Case, BWS Multi-profile Case and conventional Discrete Choice Experiments (DCE). Conclusion The comparison of different methodologies reveals the advantages of using a BWS Object Case methodological approach for measuring primary health care service workers' preferences in remote primary health care settings. Importantly, this paper demonstrates how the quantified results from BWS object case analysis can be translated into actionable retention initiatives designed to retain remote area health workers, given ongoing budget constraints and the need to ensure cultural appropriateness. What is already known on this subject? Remote Australian health services have been persistently impacted by high turnover of health care staff. Stated preference survey methods have only been occasionally applied in health research in high income countries to understand health care workers' preferences in remote settings. Different methodological approaches have a range of strengths and weaknesses which may make them more or less suitable for use in remote settings. What does this study add? This study compares a range of methodological approaches that could be used to measure remote primary health care service staff members' preferences. A rationale is provided for using a Best-Worst Scaling Object Case methodological approach for measuring primary health care service staff members' preferences in remote Aboriginal health care settings. [...]

ABSTRACT Objective This study explored allied health students' understanding and perceptions of student supervision during remote clinical placements that had adopted a newly developed structured clinical supervision model. Setting The study was conducted in the remote Kimberley region of Western Australia. Participants Participants were 60 occupational therapy, physiotherapy and speech pathology students who completed placements facilitated by Majarlin, a University Department of Rural Health, in the region between February and December 2021. Design A convergent mixed-methods design was used to study pre- and post-placement surveys with Likert-scale and open-ended items. Quantitative data were analysed descriptively, qualitative responses were thematically analysed, and data were integrated to contextualise student perceptions across the two cross-sectional samples. Results Thirty-eight students (63% participation) completed at least one survey (25 completed both surveys; 6 completed only the pre-placement survey; and 7 completed only the post-placement survey). Pre-placement responses to quantitative questions commonly reflected limited or uncertain understandings of supervision; fewer than half understood their university's expectations for supervision; and only 29% had received information about the structured clinical supervision model. Post-placement qualitative reflections frequently described supervision as a structured, reflective, and supportive process. Most students reported receiving weekly one-to-one and group supervision (84%), opportunities for peer-assisted learning (88%), and supervision that incorporated reflective practice, education, and client safety (69%). Two-thirds (66%) indicated they would recommend the model to future students. Conclusion Students described the structured clinical supervision model as enhancing their learning, confidence and engagement with supervision during remote placements. Both qualitative and quantitative findings emphasised the value of consistent, structured supervision, including protected one-to-one and group supervision time. Variability in supervision delivery, particularly where students had multiple clinical educators or fieldwork supervisors, highlighted the importance of clear pre-placement communication and consistent supervisory practices in remote contexts. [...]

ABSTRACT Objective To investigate community pharmacy density (CPD) at national and subnational (i.e., below-national) levels in Australia, and examine area-level factors associated with CPD. Methods Aggregate, 2024 data on Australia's community pharmacies (CPs) and Statistical Area Level 3 (SA3) populations were sourced. CPD (number of CPs/10 000 population) was calculated nationally and sub-nationally. SA3 characteristics associated with CPD quintiles were examined via partial proportional odds regression. Statistical significance was set at p  [...]

ABSTRACT Objectives First, to examine how short rural placements and increasing placement time are related to rural workforce outcomes. Second, to estimate the reliability of Australian Health Practitioner Regulation Agency (AHPRA) data to measure rural workforce outcomes by comparing AHPRA and self-reported rural practice locations. Methods Design Primary objective—retrospective cohort study. Secondary objective—validation questionnaire. Participants/Setting University of Adelaide medical alumni graduating from 2010 to 2021. Main Outcome Measures The primary outcome of interest was the proportion of alumni practising in rural locations (Modified Monash Model, MMM2-7). Logistic regression was used to examine associations between time in Adelaide Rural Clinical School rural placements and working rurally after graduation, adjusted for rural background and sociodemographic factors. The secondary outcome measure was agreement between self-reported and AHPRA rural practice locations for a sample of alumni. Results Practice locations were identified for 1664 alumni (97%). When compared to no rural placements, completing a short placement of 4–8 weeks had no effect, but a full-year rural placement was associated with a 2-fold increase in the odds of working rurally (OR 1.97, 95% CI 1.05–3.72). This effect increased to over five times when combined with two additional short rural placements (OR 5.57, 95% CI 2.32–13.37). AHPRA provided a reliable indicator of rural practice location when compared to self-reported (94.3% agreement, κ = 0.85, p  [...]

ABSTRACT Objective Ear disease and hearing loss are largely preventable; however, Aboriginal and Torres Strait Islander children experience some of the highest rates globally. National and state guidelines recommend involving Aboriginal Health Workers/Practitioners (AHWP) in ear and hearing screening, but no investigation has been conducted into stakeholder perspectives on their role. Setting, Participants and Design Key stakeholders involved in ear and hearing screening participated in semi-structured interviews via teleconference to explore their views on current screening processes, AHWP engagement and strategies for improvement. Results Thirteen stakeholders participated. Five themes were identified: (i) a fragmented, short-sighted and inconsistent system; (ii) confusion around scope of practice; (iii) workforce capacity; (iv) community awareness and knowledge and (v) service provision and utilisation. Strategies for improvement included strengthening workforce capacity, implementing a family friendly approach (e.g., no age limits), dedicated ear health champions to facilitate timely and appropriate follow-up and the potential role for technology in the ear health pathway. Stakeholders also advocated for the need for community education to raise awareness of the impacts of poor ear and hearing health. Conclusions This study describes the current state of ear and hearing health services for Aboriginal children and provides insights into improving ear and hearing screening programmes. [...]

ABSTRACT Introduction Tobacco smoking is an important preventable cause of death and disease in Australia. Smoking rates are higher in the Northern Territory (NT) among Aboriginal peoples living in remote areas. Understanding smoking-attributable mortality and burden of disease in the NT population is important for building awareness and implementing targeted public health strategies. Objective To estimate the impact of tobacco smoking on mortality and morbidity in the NT Aboriginal and non-Aboriginal populations aged 30 years and above between 2014 and 2018. Setting NT, Australia. Participants Adults (> 30 years) who were NT residents. Methods We used the NT Burden of Disease study (2014–2018) results and Global Burden of Disease methods to estimate smoking-attributable deaths and smoking-attributable burden of disease for the NT Aboriginal and non-Aboriginal populations. The smoking prevalence data were based on 2018–19 National Aboriginal and Torres Strait Islander Heath Survey and 2016 National Drugs Strategy Household Survey. Results Smoking was attributable to 18.3% of the total deaths for NT adults aged 30 years and above with 23.8% in Aboriginal and 13.9% in the non-Aboriginal population. Smoking explained 19.5% and 10.7% of total disability adjusted life years among the NT Aboriginal and non-Aboriginal populations respectively. The top three smoking-attributable burden of diseases for the Aboriginal population were ischaemic heart disease, diabetes and chronic obstructive pulmonary disease. In the non-Aboriginal population, lung cancer, chronic obstructive pulmonary disease and back pain were the leading causes of smoking-attributable burden. Leading causes of smoking-related mortality in the Aboriginal population were ischaemic heart disease, chronic obstructive pulmonary disease, lung cancer and diabetes, while in non-Aboriginal population the most common causes were lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and Alzheimer's disease. Conclusions Tobacco smoking was associated with a higher burden of disease among the Aboriginal population than the non-Aboriginal population. Our study quantifies the disproportionate impact of tobacco smoking within the Aboriginal population and the NT as a whole compared to the rest of Australia. [...]

ABSTRACT Introduction There appears to be a spatial mismatch in rural communities between demand for and uptake of mental health services. There is currently no existing evidence synthesis of mental health research priorities pertaining explicitly to rural and coastal contexts. Objective The rapid review aimed to identify and map existing international evidence on rural and coastal mental health research priorities. Design A rapid systematic review was conducted, consistent with guidelines from the Cochrane Rapid Review Methods Group and PRISMA. Keywords and subject headings were searched in PubMed and PsycINFO. Supplementary searching was performed in Google Scholar. Data were extracted using an adapted version of the REPRISE framework. Content analysis was conducted to establish priorities. Findings 1285 studies were screened and 20 publications included (Australia n = 8, USA n = 9, UK n = 2, no geographic focus n = 1). The content analysis grouped the priorities into seven categories: (1) interventions; (2) space and place; (3) stakeholder engagement; (4) improving understanding; (5) standardising data and terminology; (6) outreach; and (7) collaboration. Within these categories, there were 16 priorities and 53 sub-priorities. No evidence focused on mental health research priorities in coastal contexts. Discussion Future rural mental health research requires stronger collaboration between relevant stakeholders to reflect local needs. Participatory research is key to achieving that. There was no mental health research priority setting exercise that accounted for the coastal context, highlighting a notable gap. Conclusion The findings can inform how rural and coastal mental health research proceeds at a local, national, and international level. [...]

ABSTRACT Objective With a lack of medical workforce delaying patient access to general practitioners (GPs) in rural and remote regions, models of care are urgently needed to improve access and continuity of care. This evaluation aims to understand implementation outcomes, determinants and strategies to support broader implementation of the Virtual Integrated Practice (VIP) Program. Setting VIP provides an urban-based GP to a rural general practice in Queensland, offering ongoing care to patients remotely via telehealth. Participants The VIP GP joins the practice part-time for a minimum of 12–18 months and works onsite for a short period (3–5 days) every 6 months. Design This mixed methods evaluation reviewed the service, billing, cost and patient survey data collected, and qualitative interviews were conducted with VIP GP delivery staff. The interview transcripts were coded, and thematic analysis was guided by the Consolidated Framework for Implementation Research and used to derive implementation determinants. Results The service was delivered in eight rural/remote Queensland practices (2021–2024) involving 8309 episodes of care. Recurrent costs included staff wages, GP onsite visits and digital infrastructure. Qualitative interviews conducted with 15 VIP GP delivery staff highlighted determinants related to VIP GP model design and relative advantage, partnership codesign and funding, cost, infrastructure, and program staff. Conclusion This evaluation highlighted the ongoing feasibility of the VIP model in supplementing rural workforce and improving patient access and continuity of care. Strategies key to implementation include partner and recruitment support and ensuring suitable practice staff and digital infrastructure at the practice. [...]

10.1542/6388093973112Video AbstractPEDS-VA_2025-0738006388093973112BACKGROUND AND OBJECTIVESDespite the increase in social risk screening protocols across health care, evidence suggests that interest in resources does not necessarily correlate with positive screening results and that screening may limit acceptance of resources due to fear of negative repercussion. This study’s objective is to determine the effect of social risk screening on desire for and engagement with social resources.METHODSA multilingual sample of adult caregivers in the emergency department and 2 primary care clinics of a children’s hospital were randomized to receive (1) a social risk screener, (2) a “resource menu” to indicate desired assistance, or (3) no social assessment. All arms received electronic resources and optional individualized navigation. Between-group differences in resource desire, engagement with navigation, and reported resource use at 30-day follow-up were assessed with χ2 tests and regression analysis.RESULTSAmong 3949 caregivers randomized, a significantly higher proportion in the resource menu arm reported desire for resources compared with the screening arm (38.4% vs 29.0%, P  [...]

Patel AI, Schmidt LA, McCulloch CE, et al. Effectiveness of a School Drinking Water Promotion and Access Program for Overweight Prevention. Pediatrics. 2023;152(3):e2022060021 [...]

One in 3 US children are living in or near poverty and are disproportionately impacted by adverse social determinants of health that drive health inequities.1–3 Thus, the American Academy of Pediatrics recommends screening for social risks at all child health encounters, and more recently, multiple regulatory bodies including the Centers for Medicare & Medicaid Services, the National Committee for Quality Assurance, and the Joint Commission launched standard-setting initiatives requiring screening for and addressing social risks during hospitalizations.1,4 In this context, social risk screening is increasingly being integrated into routine pediatric care across various health care environments. However, it remains unclear how social care should be implemented to best identify families in need and to connect them with available resources in the most equitable and family-centered way. [...]

Pediatrics is dependent on its many reviewers for their generous donations of time, expertise, effort, and patience. The editors and the American Academy of Pediatrics take this opportunity to thank them publicly for their efforts. We are grateful for their help and honored that they are willing to assist us in maintaining high standards. [...]

In this issue of Pediatrics, Ramgopal and colleagues describe the extent to which Emergency Medical Services (EMS) agencies care for children with medical complexity (CMC).1 Although the field of EMS has evolved rapidly over the last 15 years, CMC, often considered a special population, have received limited focus.2,3 Children account for less than 5% to 10% of all EMS transports,4 and CMC represent just 1% to 2% of the overall pediatric population, although some estimates cite as much as 10% based on variable definitions.5–7 Regardless of the exact definition, CMC account for a disproportionate amount of pediatric hospitalizations (ie, 20% to 30%)8,9 and health care spending (ie, 34% of the Medicaid costs for children).10 Ramgopal and colleagues provide the first large-scale prehospital analysis of CMC and found that they comprise 20% of pediatric EMS transports.1 Categorization of CMC have included children with technology dependence, children with functional limitations, and, more broadly, children with greater health care needs than the general population because of chronic medical conditions that involve multiple organ systems.6,7 Owing to advancements in science and medicine, the population is growing.11,12 CMC represent a significant population from diverse settings who cannot be the sole responsibility of pediatric transport teams and regional pediatric centers; the entire emergency care system must be ready. [...]

10.1542/6386878180112Video AbstractPEDS-VA_2025-0748026386878180112OBJECTIVEThe care of children with medical complexity (CMC) in the prehospital setting is recognized as a priority in consensus-based Emergency Medical Services (EMS) guidelines. We examined EMS use, care patterns, and outcomes for CMC, including cardiac arrest and mortality.METHODSWe performed a multi-EMS agency and multicenter study of pediatric transports, from the scene to the hospital, to 1 of 17 hospitals within an integrated health system. We identified CMC based on encounter-level diagnosis and procedure codes. We described prehospital characteristics and identified which factors were associated with prehospital cardiac arrest and which factors were associated with in-hospital mortality.RESULTSOf 68 890 pediatric encounters, 13 732 (19.9%) involved CMC, most commonly owing to neuromuscular conditions (29.7%). Among EMS encounters for CMC, 33.0% resulted in hospital admission, and 7.2% required critical care. Prehospital cardiac arrest occurred in 1.0% of cases, and in-hospital mortality was 0.7%. Among CMC, the presence of prehospital cardiac arrest was associated with cardiovascular (odds ratio [OR] 3.10, 95% CI: 2.08–4.62), neuromuscular (OR 2.71, 95% CI: 1.82–4.03), and neonatal (OR 2.71, 95% CI: 1.65–4.44) conditions. The presence of medical complexity was associated with a 9.55-times higher odds of in-hospital mortality (95% CI: 6.01–15.18).CONCLUSIONSCMC account for one-fifth of EMS of pediatric encounters transported to the hospital. Our findings support targeted EMS training, technology-specific protocols, and integrated prehospital–hospital data systems to improve the safety and outcomes of CMC. [...]

BACKGROUND AND OBJECTIVESSuicidal ideation (SI) significantly increases during the transition from childhood to adolescence, serving as a key predictor of future suicidal behaviors. Despite this, research focusing on preadolescents is scarce and often overlooks immediate risk factors, which hampers the predictive accuracy regarding future suicidality. We examine the dynamic impact of late childhood factors on SI during the transition to early adolescence.METHODSThis study used data from the Adolescent Brain Cognitive Development study. SI was assessed via the Kiddie Schedule for Affective Disorders and Schizophrenia semistructured interview, while factors were evaluated across demographic, psychological, cognitive, and environmental domains. An improved random forest algorithm was employed for predictive modeling and feature selection, ensuring a robust analysis of contributing factors.RESULTSThe study included 9743 unrelated children, with female children accounting for 47.4%. Psychopathology was the most significant contributor to both newly onset (weight = 27.2%) and recurrent SI (35.0%), maintaining a stable impact throughout follow-up (27.7% to 29.9%). The influence of impulsive traits (16.4% to 19.5%) and cognitive functioning (12.6% to 19.5%) increased over time, emphasizing their dynamic role. The impact of the childhood rearing environment diminished (19.1% to 10.1%) but remained critical for the incidence of SI (26.1%).CONCLUSIONSThese findings highlight the importance of understanding the dynamic influences of late childhood factors to inform early identification and intervention strategies aimed at preventing SI during this pivotal transition. [...]

Although consensus on medical treatment for critically ill children is ideally achieved through shared decision making, disagreements on the appropriate course of action can occur. This clinical report provides practical guidance for pediatricians and other physicians in navigating and resolving disputes when parents (or other appropriate surrogate decision makers for children) request interventions that are not medically recommended and are determined to be “potentially nonbeneficial.” Although this can occur over a range of medical contexts, this statement focuses on life-threatening situations. This statement provides ethical background in a historical context, offers a basic framework for approaching disagreements about provision and continuation of life-sustaining interventions, and offers a stepwise approach to preventing intractable disputes. This process includes working to form a goal-concordant treatment plan and systematically responding to parental requests for potentially nonbeneficial treatment by way of diligent information gathering, mobilization of institutional resources, and providing families with options for transfer and appeal. This clinical report is supported by an accompanying technical report of the same title. [...]

Although consensus on a medical treatment plan is ideally achieved through a process of shared decision making, disagreements about whether life-sustaining interventions should be initiated or continued can occur and are sometimes difficult to resolve. When parents (or other appropriate surrogate decision makers) desire treatments for their child that are not medically recommended, these “potentially nonbeneficial” interventions must be systematically considered in the context of contemporary ethical principles and relevant laws and regulations while keeping in mind the historical and cultural underpinnings that might be playing a role, the potential for racial bias and socioeconomic disparities, the role of spirituality and values in consideration of quality-of-life determinations and end-of-life care, and the nuance of probabilistic uncertainty. This technical report accompanies a clinical report of the same name and offers a stepwise approach for responding to parental requests for potentially nonbeneficial treatment to support pediatricians and other physicians in engaging and supporting patients, their families, and care teams in navigating these disagreements. [...]

10.1542/6386879373112Video AbstractPEDS-VA_2025-0736616386879373112OBJECTIVETo examine associations between COVID-19 vaccination during pregnancy and the risk of various infections in early childhood.METHODSWe conducted a nationwide, register-based cohort study comprising all live-born infants in Norway between March 2021 and December 2023 with follow-up through 2023. We used Cox regression to estimate hazard ratios for infections diagnosed in primary or specialist health care. Separate analyses were performed for specific infections, including COVID-19.RESULTSAmong 146 031 infants born in Norway in the study period, 37 013 (25%) were exposed to COVID-19 vaccination in pregnancy. There was no difference in the overall risk of any infection registered in specialist care among offspring exposed to maternal vaccination (adjusted hazard ratio [HR], 0.99; 95% CI, 0.95–1.03). A slightly increased risk of being registered with any infection in primary care was observed among exposed offspring (adjusted HR, 1.05; 95% CI, 1.03–1.07), which was fully attenuated after excluding children of mothers who remained unvaccinated at the end of follow-up. The offspring’s protection against COVID-19 decreased over time, and the adjusted HRs for hospital contact were 0.48 for the first 2 months (95% CI, 0.40–0.56), 0.76 at 3 to 5 months (95% CI, 0.60–0.98), 1.13 at 6 to 11 months (95% CI, 0.82–1.56), and 1.14 after 12 months (95% CI, 0.72–1.79). No notable difference in the risk of hospital contacts for infections other than COVID-19 was observed.CONCLUSIONCOVID-19 vaccination during pregnancy protects the offspring against hospital contact for COVID-19 during the first 6 months of life. No apparent effect was observed for other infections. [...]

Newborn screening (NBS) is a public health program that identifies babies with health conditions that need early treatment. Determining benefit of NBS has traditionally focused on outcomes for children. Families also benefit from NBS, but the range of family outcomes has not been defined. We conducted a systematic process with extensive interest group input to identify 8 possible outcomes for families who have a child diagnosed with a condition after a positive NBS result: (1) families understand their child’s condition and treatment options; (2) families access medical care and treatments; (3) families manage their child’s needs and routines; (4) families advocate for their child; (5) families access community resources, services, and programs; (6) families access social support; (7) individual family members maintain personal well-being; and (8) families feel successful in functioning as a unit. These outcomes provide a framework for developing measurement tools by which benefits for families after NBS can be documented and ultimately used to evaluate strategies that could maximize outcome attainment. [...]

10.1542/6386522812112Video AbstractPEDS-VA_2025-0725046386522812112OBJECTIVEThe California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)–stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers.PATIENTS AND METHODSNAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities.RESULTSNAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2–14.8) more hospital stays (P  [...]