General journals

France’s national blood service said one of its refrigeration monitoring and control suppliers was hacked on Monday, raising temperature and defrost thresholds in cold rooms at three preparation or distribution sites to “very high levels.”The attack came as more than 10 European countries, including France and the UK, were hit by cyberattacks1 at supermarket chains that also remotely manipulated refrigeration thermostats, turning them up to 50°C (122°F) or forcing defrost modes and spoiling large amounts of fresh food. Investigators have yet to establish whether the attacks were linked.Unlike the supermarkets, which had to jettison massive quantities of overheated fresh and frozen food, the blood stocks came out unscathed, the blood service Établissement français du sang (EFS) said.An EFS spokesperson told The BMJ that the cold rooms normally operated at -30°C but would not confirm a report in the French newspaper Le Canard enchaîné that hackers had reprogrammed the equipment to... [...]

The government is planning to put its NHS contract with the controversial US tech giant Palantir out to competitive tender, The BMJ understands.The move to retender the Federated Data Platform (FDP) contract would force Palantir to rebid against UK based competitors.A source at one British company with similar technology to the US giant, who wished to remain anonymous, told The BMJ that officials at the Department of Health and Social Care (DHSC) had approached a handful of British companies to see whether they had the capacity to run the FDP.The BMJ understands that the government will extend the deal by two years to minimise disruption while the retendering process occurs.The move comes as the Financial Times reported that the UK government was preparing to extend Palantir’s contract next year while ministers draw up plans to potentially replace it with a British alternative.1The £182m FDP has a break clause in February... [...]

A science communication organisation that provides expertise to major UK media outlets “amplifies” and “legitimises” the stances of “health harming industries,” new research concludes.1The Science Media Centre (SMC), which is based at the London headquarters of its major backer, Wellcome, provides interviews and press briefings on breaking science news to journalists at leading outlets across the UK. Its clients include The BMJ.But a study by researchers at the London School of Hygiene and Tropical Medicine (LSHTM) and the University of Edinburgh finds that the centre’s funding model “legitimises health harming industries as partners in public health endeavours.”SMC’s chief executive, Fiona Fox, defended the model, arguing that accepting small “no strings attached” donations from large numbers of organisations protected its editorial independence from individual corporate agendas.Researchers analysed SMC funding and governance data and extracted “SMC Rapid Reactions” on research studies from 2019, chosen because this was a pre-pandemic year in which... [...]

A doctor who made 20 false claims in his CV to secure an NHS job that he was not qualified for has been struck off the UK medical register.1Tochukwu Akah, who qualified as a doctor in Nigeria in 2016, was appointed as a clinical fellow in haematology at Hampshire Hospitals NHS Foundation Trust in September 2024.A medical practitioners tribunal heard that Akah admitted falsely claiming to have completed several courses, attained wide experience, authored a journal article, and received awards.Akah claimed that he had been a chief medical officer in an emergency department in Nigeria, had published a research article on sickle cell disease, and had independently completed tens of thousands of intravenous cannulation procedures, venous blood sampling procedures, and blood transfusions.Akah also falsely claimed to have won the “best student in internal medicine” and “distinction in pathology” awards at university and to have independent practical experience in exchange blood... [...]

In the heart of Russia, fear of plague is spreading. Unbeknown to the outside world, authorities have quietly commandeered the building where the first case emerged. Rifle wielding guards stand at the entrances. Inside, people are locked in quarantine rooms. There have already been deaths—pneumonic plague. And it came from a laboratory.This was the scene at a Moscow hospital in 1939, according to a handful of recollections written by scientists who lived through it. The microbiologist Abram Lvovich Berlin had travelled in from the outskirts of the capital to discuss his experiments with Yersinia pestis, the bacterium that causes plague. But he had inadvertently infected himself, becoming highly contagious. He would soon be dead.Sources differ on the details—was it two or three people who succumbed after coming into contact with Berlin? Most accounts say that the doctor who first diagnosed plague in the stricken microbiologist and a hotel barber were... [...]

jason.hancock@nhs.netChris Whitty’s recent lecture on risk, uncertainty, and medical decision making resonated with my experience as a psychiatrist, director of medical education, and clinical education researcher with an interest in uncertainty.1 I welcome his suggestion that educators should support resident doctors to hold and manage progressively greater levels of risk throughout their training.But the lecture placed considerable emphasis on probability and complexity as sources of uncertainty, with less attention given to ambiguity.2 Whitty called for the medical profession to insist that large language models used by the public indicate the degree of uncertainty associated with a proposed diagnosis, for example. This assumes that the level of uncertainty can be quantified, as may be possible when uncertainty arises from probability. But many clinical decisions are made in the context of ambiguity—where information is missing, imprecise, or conflicting—and the degree of uncertainty may not be known or straightforward to communicate.The skills needed... [...]

A patient can live longer, feel better, or function better—these are direct, patient relevant clinical outcomes.1 Surrogate endpoints, in contrast, are indirect measures intended to predict such benefits. They can be used to shorten the duration of trials and make treatments available sooner, but that comes at the cost of greater uncertainty: improving a surrogate may not improve what ultimately matters to patients.A linked article by Lo and colleagues (doi:10.1136/bmj-2026-100618) presents the REASSurE framework for evaluating a single surrogate against a clinical endpoint.2 Developed through a Delphi survey, consensus meeting, piloting, and finalisation, the framework deserves credit for its transparent methods and reporting. It provides a structured checklist of mandatory or recommended items across four areas. Joint evaluation of multiple surrogates remains outside its scope.REASSurE aims to go beyond existing approaches, including the IQWiG (Institute for Quality and Efficiency in Health Care) framework,3 the Biomarker-Surrogacy Evaluation Schema,4 and the three-level... [...]

US Military mightAs most GPs know from bitter experience, requesting testosterone levels on healthy men creates a lot of extra worry and work, without clinical benefits. In July, US Defence Secretary Pete Hegseth controversially announced that US military personnel aged 30 years and older would be required to have annual testosterone screening. Researchers have estimated how many low testosterone concentration, or low T, results army medics will need to churn through, using cross sectional data from the Military Health and Nutrition Examination Study. Analysing morning testosterone levels from 479 men with a mean age of 30, they estimated that one in four active duty US Army personnel would have a morning testosterone below the American Urology Association’s cut off of 300 ng/dL (10.4 nmol/L). Scaled up to the whole US army, that’s 100 000 positive results.JAMA doi:10.1001/jama.2026.19794What doctors search forOpenEvidence is marketed as an AI copilot for doctors and claims... [...]

Sleep and illnessWhen investigators interrogated accelerometer data from 96 000 UK Biobank participants, they found links between quality of sleep and the incidence of 156 different conditions (Plos Med doi:10.1371/journal.pmed.1005213). On the whole, more REM (rapid eye movement) and deep sleep were associated with lower risk of disease, while sleep irregularity and wakefulness after sleep onset were associated with higher risk. But it’s far from clear whether disturbed sleep contributes to illness or is an early sign of it.GLP-1 drugs and anaesthesiaGlucagon-like peptide 1 (GLP-1) receptor agonists delay gastric emptying, potentially increasing the risk of regurgitation and aspiration during anaesthesia. In a prospective study of 47 000 patients undergoing anaesthesia in UK hospitals, 2.9% were taking these drugs (Anaesthesia doi:10.1111/anae.70380). Regurgitation or pulmonary aspiration occurred in 1.41% of users, compared with 0.12% of non-users. Most events involved regurgitation rather than aspiration.Congenital infections and neurodevelopmentTORCH infections are a group of congenital... [...]

Smart watches, health and fitness apps, and social media have fuelled an explosion in people’s access to health information about themselves and other people. Yet as these innovations serve up ever more individual data, and the reach of influencers and entrepreneurs on social media expands, so the challenges facing health workers accumulate.With social media awash with inaccurate posts about health, should doctors be wading in to offer medical advice or to correct misinformation? When influencers are pushing iron or testosterone supplementation to their followers (doi:10.1136/bmj-2026-101080 doi:10.1136/bmj-2026-101300),12 do doctors need to be more active in outlining the risks and benefits? Our feature on “medfluencers” finds doctors arguing the case for engaging directly with influencers on social media, while others warn about the potential regulatory pitfalls (doi:10.1136/bmj-2026-101156).3 John Dale-Skinner, a medicolegal adviser at the Medical Defence Union, says that he would steer doctors “away from that minefield.”People understandably want to impose some... [...]

A woman in her 30s presented with a six hour history of epigastric pain. She described a sudden onset tearing sensation which developed into a constant sharp pain of eight out of 10 severity, accompanied by pre-syncopal symptoms. She had no relevant medical history.Her blood pressure was 93/58 mm Hg. Vital signs were otherwise normal.Physical examination showed right upper quadrant tenderness and a firm mass at the inferior pole of the liver. Initially, a ruptured liver tumour or liver vascular malformation with haemorrhage was suspected.Liver function and serum tumour markers were tested and showed mildly raised levels of alkaline phosphatase (121.96 U/L; reference 35-100 U/L) and markedly raised levels of alpha fetoprotein (AFP) (2603.78 ng/mL; reference < 9 ng/mL).High levels of AFP raised suspicion of hepatocellular carcinoma (HCC). Abdominal computed tomography showed a cystic solid mass in the right hepatic lobe with capsular rupture and pericapsular fluid (fig 1). Biopsy... [...]

Decades of progress in reducing global tobacco use have come under threat in the past 15 to 20 years because of the multibillion dollar tobacco industry’s backlash against efforts to move beyond controlling the tobacco epidemic to ending it—the “endgame” concept.1 Despite this hiatus, recent developments suggest that an endgame is achievable, but only if governments step up to the mark.In 2025, for example, the Maldives became the first country to implement a tobacco-free generation policy, a birthdate based sales restriction designed to prevent future generations taking up smoking.2 In 2027, the UK is set to become the second through its Tobacco and Vapes Act.2 Both legislative measures also seek to counter the rapid increase in non-therapeutic nicotine (NTN) use, with the Maldives going further by stopping the import and sales of e-cigarettes.2While positive, these developments23 show that endgame policies must now extend beyond tobacco to address NTN products. The... [...]

Rural health care in the US is discussed by JAMA Senior Editor Derek C. Angus, MD, MPH; Mark Holmes, PhD, director of The Cecil G. Sheps Center for Health Services Research at The University of North Carolina at Chapel Hill; and Julie Donohue, PhD, professor and chair of health policy and management at the University of Pittsburgh, for the Healthy Dialogue podcast. [...]

This difference-in-differences study assesses the adoption of 2016 trial evidence in clinical practice and postpartum infection trends among US pregnant persons undergoing unscheduled cesarean delivery compared with vaginal delivery. [...]

This Medical News article discusses the increase in routine cannabis use among younger adults, which corresponds with a decrease in regular alcohol use. [...]

Preventing maternal morbidity and mortality remains an urgent global priority, yet progress has been unsatisfactory. Although maternal mortality has declined globally, the rates have increased in the US and infections are among the top causes of preventable deaths. Among women undergoing cesarean delivery (the most common major surgical procedure in the US), the risk of infection is many times higher than after vaginal delivery, underscoring the importance of effective prophylaxis. [...]

A recent college drinking trend known as the “blackout rage gallon” (BORG) may promote high-intensity drinking and alcohol-related harm, a study suggests. [...]

One critical shortcoming of many clinical therapeutic trials is their focus on short-term effects, leaving unanswered questions about how participants fare in the longer term. Trial extension studies are conducted to address this gap, allowing assessment of both durability of treatment benefit (eg, whether disease remission or improvements in function are maintained or diminished over time) and long-term safety (such as incidence of delayed adverse events). In therapeutic trials, extension studies can mitigate the ethical burden associated with discontinuation of potentially effective treatments or long-term administration of placebo or inferior interventions among those initially assigned to the control group. The prospect of an extension study may also give participants greater incentive to enroll in trials, despite concerns about being assigned to the control group in the initial phase of the research. Because extension studies build on existing trial infrastructure, they also allow additional and potentially valuable information to be derived from trials that already require significant up-front investment. [...]

Any one who reads popular periodicals or follows the current trends in folk psychology and national habits of thought can readily discover the growing popular enthusiasm for the conservation of health. Obviously, all matters of health and disease are of foremost concern to the physician; in him rests the largest public obligation as well as personal necessity of keeping abreast not only of the discoveries that bear on diagnosis and treatment but also of the features somewhat indefinitely described as preventive medicine. Every professional organization to which he belongs is in some way identified with the program of modern public hygiene. [...]

This JAMA Insights discusses suggested language for clinicians to use when communicating with families about brain death evaluation and determination. [...]

In this narrative medicine essay, a pediatrician reflects back on difficult conversations with parents of patients and stresses the importance of conversational consent as a way to initiate and advance medical conversations with empathy and respect. [...]

This randomized clinical trial examines the effect of different digital outreach strategies vs usual communication on statin refill rates among patients with or at high risk for atherosclerotic cardiovascular disease and recent statin nonadherence. [...]

Living in a disadvantaged neighborhood was associated with adverse brain health, a retrospective study found. [...]

The Original Investigation titled “Adjuvant Nivolumab vs Observation in Resected Non–Small Cell Lung Cancer: A Randomized Clinical Trial,” published on June 1, 2026, was corrected to fix typographical errors in the text, including indicating that the trial was stopped for futility at 75% information, rather than 78%, and the number of participants lost to follow-up in the nivolumab group in Figure 1. This article was corrected online. [...]

The 2026 report of the Lancet Countdown on Health and Climate Change found that climate change has become an unprecedented global health emergency, requiring a new long-term emergency response mechanism to be effectively addressed.1 [...]

China's last-minute nomination of Dr Song Li as a candidate for Director-General (DG) of WHO surprised many observers of global health politics. But from the perspective of an emerging superpower, it was not surprising at all. The Chinese Government is ready to assert its claim to positions of global leadership, especially now that the USA has turned its back on multilateralism. In Beijing last week, I sat down with Dr Li to listen to her set out her manifesto. She has four pillars supporting her pitch: a more efficient WHO; a safer world; equitable health systems; and harnessing innovation. [...]

Richard Horton asks whether global health can recover its lost radicalism, referring to Saul Alinsky's Reveille for Radicals.1 Alinsky's ideas also reached Japan, where the book was translated and published in 1972.2 This Japanese translation arrived at precisely a moment when questions of citizen participation, organisation, and power had unusual resonance in Japan amid growing citizen movements against industrial pollution and other social problems. [...]

Although North Korea remains largely closed to the rest of the world, its recent state messaging suggests a shift in the country's approach to health care from long-standing isolation towards selective modernisation and digitalisation. Kim Jong Un's designation of 2025 as the first year of a health revolution warrants renewed attention to North Korean medical journals, which remain under-read in global health.1 [...]

Obstetric fistula is a devastating morbidity that rightly merits investigation and advocacy, as attempted in the World Report by Clotilde Bigot.1 However, we are dismayed by the quality of this reporting, which did not fact check the claims of its single source. The report does not meet the rigorous editorial standards that we expect from The Lancet. It does a disservice to vulnerable women who have obstetric fistula in Somalia and beyond. [...]

I would like to thank Carrie J Ngongo and colleagues for taking the time to write their Correspondence and for highlighting important aspects of obstetric fistula care in Somalia that could not be fully addressed within the constraints of the World Report.1 [...]

Boeddinghaus J, Bima P, Crisanti L, et al, PRESC1SE-MI investigators. Safety and efficacy of the 0/1 h pathway for myocardial infarction in the emergency department: an international, pragmatic, stepped-wedge, cluster-randomised, controlled trial. Lancet 2026; 408: 1941–52—In this Article, the affiliations of Paolo Bima and Prof Fulvio Morello should have been “Department of Medical Sciences, University of Turin, Turin, Italy” and “Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy”, and the appendix has been corrected. [...]

The Paris Agreement came into force in 2016, a watershed in collective international action on climate change. That year also saw the creation of the Lancet Countdown on health and climate change, established to track the health effects of climate change and climate action. The past 10 years may have brought disheartening setbacks in climate policy, but there have also been huge advances in the understanding of and attitudes towards climate change. [...]

Paediatric neurologist who identified neurological complications in children with HIV/AIDS. Born on Feb 20, 1940, in New York City, NY, USA, she died from complications of chronic obstructive pulmonary disease in New York on Aug 29, 2026, aged 86 years. [...]

David N Hackney opens his book Impossible Choices: A Physician's Guidance on High-Risk Pregnancy in a World Without Roe on June 24, 2022, with a description of how unprepared he and his colleagues were for the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization (hereafter Dobbs) that eliminated the constitutional right to abortion. Within hours, a near-total abortion ban took effect in Ohio. Senate Bill 23 prohibited abortion once embryonic cardiac activity could be detected, at about 6 weeks of gestation, with no exceptions for rape, incest, or fetal conditions, including life-limiting anomalies. [...]

In 2000, Professor Jemilah Mahmood watched television images of devastating floods in Mozambique as a helicopter rescued a woman giving birth in a tree. As an obstetrician and gynaecologist, the image stayed with her for nearly two decades. In 2019, while visiting clinics established after the floods, a midwife pointed to a young adult and said, “Their mother gave birth in a tree in the last flood.” Mahmood recalls: “It really hit me…we’ve been putting band aids on gaping wounds all these years.” She continues: “We just respond and we react and we don’t look at the underlying drivers of why women are in these situations. [...]

Even as smoking prevalence among adults in many high-income countries has fallen, the global burden of mortality attributed to tobacco has been estimated at 1 billion lives for the 21st century. We remain in the midst of an entirely preventable pandemic. [...]

Journal of Internal Medicine, Volume 300, Issue 6, Page 721-721, December 2026. [...]

Abstract Background Familial Mediterranean fever (FMF) and periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome share innate-immune features, but population-level data on oropharyngeal morbidity before FMF recognition are lacking. Objectives To examine the magnitude, timing, specificity, and treatment burden of a PFAPA-like oropharyngeal phenotype in patients later diagnosed with FMF. Methods Population-based matched case–control study in Leumit Health Services, Israel. FMF patients with colchicine dispensing (n = 3324) were matched 1:4 by birth year and sex to 13,296 controls. Oropharyngeal diagnoses, tonsil/adenoid surgery, antibiotic dispensing, and ear, nose, and throat (ENT) visits were compared across windows up to 20 and 10 years before diagnosis (30-day blackout), using streptococcal, hypertrophy, and non-ENT negative controls with false discovery rate (FDR) adjustment. Results A PFAPA diagnostic code was recorded in 2.6% of FMF patients versus 0.1% of controls (odds ratio [OR] 25.4, 95% confidence interval 14.3–48.5). Up to 20 years before diagnosis, future FMF patients had more acute tonsillitis (35.6% vs. 27.2%; OR 1.48, 1.37–1.61), viral-labeled tonsillitis (OR 2.65), oral aphthae (OR 1.72), and cervical lymphadenitis (OR 1.62; all q  [...]

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

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

Abstract Health inequalities are seen between populations, social groups in the same population and across populations ranked by social position. This paper focuses on trends in inequalities between countries and socio-economic inequalities in mortality within them. Mortality in most countries has improved since 1950 with some exceptions, notably: Younger adults in parts of Sub-Saharan Africa were associated with civil war, structural adjustment programmes and human immunodeficiency virus during the 1980s/1990s; the former USSR after the rapid adoption of neoliberal economic policies; European countries which implemented austerity in the 2010s; and globally in the shadow of COVID-19. Mortality differences between countries have narrowed, with the gap between the best and worst thirds of countries declining from 20.5 years for males and 22.6 years for females in 2000 to 15.6 years and 16.0 years, respectively, by 2021. Data for within-country inequalities are sparse and subject to measurement issues. Where trend data are available, they vary according to location and political context. For example, across many high-income countries, mortality inequalities improved in absolute terms between the 1990s and the early 2010s; however, relative inequalities widened. Inequalities in parts of Europe widened after 2012, reflecting austerity policies impacting the social and economic determinants of health, particularly for the poorest. Comparisons of between-country levels of inequality are problematic due to uncertainties of data recording and comparability; nonetheless, existing evidence demonstrates wider inequalities within particular ‘neoliberal’ political contexts. Future challenges include addressing such political determinants alongside the overlapping threats of climate change, social polarization, misinformation and erosion of democratic structures. [...]

Abstract Periodontitis is a common chronic inflammatory disease that has traditionally been considered primarily within the domain of dentistry. Increasing evidence, however, associates periodontitis with systemic inflammatory conditions, particularly atherosclerotic cardiovascular disease. Dysbiotic subgingival microbial communities, disruption of the periodontal epithelial barrier, transient bacteremia, microbial products, and locally generated inflammatory mediators provide biologically plausible pathways through which periodontal inflammation may influence systemic vascular biology. Epidemiologic and mechanistic studies support an association between periodontitis and cardiovascular disease, although direct causality has not been established. Importantly, periodontal treatment has been associated with improvement in endothelial function and reductions in selected systemic inflammatory biomarkers, but evidence that treatment prevents myocardial infarction, stroke, or cardiovascular mortality remains insufficient. For the practicing internist, the principal message is therefore both practical and appropriately cautious: Periodontal health should be recognized as one component of overall health, and closer collaboration between physicians and dental professionals may strengthen preventive care. This Perspective reviews the clinical evidence linking periodontitis with systemic disease, using cardiovascular disease as the principal example, and considers its implications for prevention, interdisciplinary care, and future research. [...]

Abstract Estimated glomerular filtration rate (eGFR) is indispensable for detecting, staging, prognosticating, and managing chronic kidney disease (CKD), but it measures filtration rather than defining the underlying disease. A reduced eGFR can reflect many different processes, including nephron loss, altered renal hemodynamics, glomerular injury, tubulointerstitial disease, vascular damage, congenital abnormalities, obstruction, systemic inflammation, recurrent acute kidney injury, or combinations of these mechanisms. Thus, patients with the same eGFR may have different kidneys, diseases, trajectories, prognoses, and treatment opportunities. Current CKD classification already incorporates cause, GFR category, and albuminuria category, but in clinical practice and research eGFR often remains disproportionately influential in language, referral pathways, trial eligibility, and treatment decisions. This simplification can obscure active or treatable disease, encourage over-investigation of stable vascular or age-related impairment, and create biologically heterogeneous trial populations that dilute treatment effects. Albuminuria substantially improves risk stratification, but it does not by itself define disease phenotype or mechanism. This review argues for broader implementation of the cause–GFR–albuminuria framework and for interpreting eGFR within a broader clinical and biological phenotype. A more comprehensive assessment should integrate albuminuria or proteinuria, urine sediment, longitudinal eGFR and albuminuria trajectories, hemodynamic context, medication and nephrotoxin exposure, systemic features, family history, kidney imaging, and targeted use of cystatin C, serology, monoclonal protein testing, genetic testing, kidney biopsy, and molecular biomarkers when clinically appropriate. The aim is not to replace eGFR but to place it in context. Precision nephrology will depend on distinguishing filtration level from disease identity, activity, chronicity, reversibility, and treatment responsiveness. [...]

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

Abstract Background Tea consumption has been associated with vascular health, but evidence regarding multidimensional tea-drinking characteristics and their joint associations with other lifestyle factors remains limited. Objectives To examine associations of multidimensional tea-drinking characteristics with vascular disease (VD) and assess joint associations and interactions with smoking and physical activity (PA). Methods We included 485,934 participants from the China Kadoorie Biobank (CKB). Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for total VD and 12 subtypes. Dose–response relationships and joint associations and interactions of tea consumption with smoking and PA were evaluated. Results During a mean follow-up of 9.05 years, 14,863 incident VD cases occurred. Habitual tea consumption was associated with lower total VD risk (HR = 0.888, 95%CI 0.857–0.921) and several major cardiovascular and cerebrovascular outcomes. Associations varied by tea-drinking characteristics: Black tea showed more consistent inverse associations than green tea, moderate-strength tea was associated with lower risk, whereas ‘burning hot’ tea was associated with higher VD risk (HR = 1.160, 95%CI 1.090–1.236). Tea intake showed non-linear dose–response associations, with the lowest estimated risk at approximately 6–8 cups/day among weekly drinkers. The combination of habitual tea consumption, non-smoking and high PA was associated with the lowest VD risk (HR = 0.548, 95%CI 0.492–0.609), with evidence of sub-additive tea–PA interaction. Conclusion Habitual tea consumption was associated with lower VD risk, with associations varying by drinking characteristics and intake level. Tea consumption combined with non-smoking and high PA was associated with the lowest risk. These findings support considering multidimensional tea-drinking and lifestyle patterns in vascular health research. [...]

Abstract Dengue is the most rapidly expanding mosquito-borne viral disease worldwide. The worst year on record was 2024, with over 100 countries reporting 14.4 million cases and over 11,000 deaths. Since then, and up to August 2026, another 7.4 million cases and over 5000 deaths have been reported. The region of the Americas was impacted the most, followed by South-East Asia and the Western Pacific. Both the spread of dengue viruses (DENV) and their primary vectors, Aedes aegypti and Aedes albopictus, are driven by several factors. Globalization has accelerated vector dispersal, particularly through international trade and transportation networks. The movement of desiccation-resistant eggs in used-vehicle tyres and the inadvertent transport of adult mosquitoes via trucks and passenger vehicles have enabled the establishment of vector populations in previously uncolonized regions. Human mobility and unplanned urbanization further contribute to dengue emergence by introducing DENV into susceptible populations where competent vectors circulate. Climate change has enhanced dengue transmission potential by altering temperature and rainfall patterns that influence mosquito survival, reproduction, biting behaviour and viral replication. Containing or even reversing this global dengue expansion will require a complementary set of interventions that rely on proven and novel control strategies, including sterile insect techniques, Wolbachia-infected mosquitoes, virus-resistant mosquito strains through CRISPR-Cas9 gene drive, vaccines, antiviral drug prophylaxis and urban interventions that eliminate Aedes habitats. Building climate-resilient urban environments through sustainable development to minimize the urban heat island effect and advancing climate-informed early warning systems are long-term strategies for effective dengue control. [...]

Abstract Prader–Willi syndrome (PWS) is a rare, neurodevelopmental, multisystemic syndrome caused by lack of expression of paternal genes on chromosome 15q11.2–13. PWS is characterized by muscular hypotonia, abnormal body composition, hormone deficiencies, cognitive dysfunction and behavioural issues, including hyperphagia, increasing the risk of severe obesity. A single causative gene for hyperphagia has not been identified, and regulation of hunger and satiety is complex and multifactorial, making it difficult to identify a specific neuropeptide or hormone as the most important. Cornerstone treatments are a strict, controlled diet and regular physical activity. Several clinical trials with different pharmacological agents have been performed attempting to reduce or treat hyperphagia and obesity. However, many drug programmes have been discontinued due to adverse events or not reaching endpoints. In this review, we have focused on phenomenology and management of hyperphagia, treatment with oxytocin (OT), glucagon-like-peptide-1 receptor agonists (GLP-1RA) and diazoxide choline. We conclude that controlled food access is crucial; managing expectations about food mitigates food-related behaviour; OT treatment of infants with PWS results in less severe hyperphagia at ages 3 and 4 years old; and that the effects of GLP-1RA on body weight seem modest. Studies of diazoxide choline extended-release (DCCR), the first approved treatment of hyperphagia in PWS, have shown promising results, particularly in managing severe hyperphagia, reducing fat mass and improving behavioural issues. Thus, although progress is being made in targeted pharmacological therapies to control hyperphagia, controlled food access remains crucial to prevent obesity but is not sufficient for management of food and behaviour. [...]

Abstract Glucagon-like peptide-1 (GLP-1) receptor agonists provide benefits in weight reduction, glycaemic control in Type 2 diabetes, and cardiovascular and renal outcomes. Their widespread use has given rise to concerns regarding rare but potentially serious adverse events. This narrative review appraises evidence regarding seven serious adverse events linked to GLP-1 receptor agonists: thyroid cancer, non-arteritic anterior ischaemic optic neuropathy (NAION), suicidal behaviours and self-harm, diabetic retinopathy complications, acute pancreatitis, gallbladder and biliary disease and intestinal obstruction. Evidence from mechanistic studies, spontaneous reports, randomized trials and cohort studies is considered. Gallbladder and biliary disease has the most consistent evidence supporting a causal association. Worsening of diabetic retinopathy appears most consistent with early worsening after rapid glycaemic improvement in patients with pre-existing retinopathy. For thyroid cancer, NAION, suicidal behaviour and self-harm, acute pancreatitis and intestinal obstruction, evidence regarding causality remains uncertain. Rare events, incomplete ascertainment in trials and residual confounding in observational studies limit inference. Because these events are rare, even substantial relative risk increases generally correspond to small absolute risk increases in broad populations but may become relevant in patients with high baseline risk. Treatment decisions should consider the strength and uncertainty of safety evidence, individual baseline risk, expected benefits relative to available alternatives and patient preferences. [...]

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

Trends over the last decade indicate that same-day hernia repair for privately insured patients is increasing, but uptake remains well below recommended targets. Variation across patient groups and hospital locations suggests that organisational change or incentives will be needed for same-day repair to become routine practice in Australia. ABSTRACT Background Hernia repair can safely be provided as a same-day procedure. However, despite advice from published guidelines, previous analyses of Australian data have shown low rates of same-day surgery in private hospitals for hernia repairs. Methods This study used aggregated administrative data for Medibank-insured patients treated in Australian hospitals between 1 January 2015 and 31 December 2024 for surgical repairs of inguinal, femoral, or umbilical hernias to analyse trends in same-day services. Results The proportion of hernia procedures performed as same-day separations increased over time, rising from 22.7% in 2015 to 31.0% in 2024 (p  [...]

Overview of the mixed-methods study examining gender dynamics in Australian orthopaedic surgery. Findings highlight gender-based disparities in workplace culture, professional expectations, harassment, career progression and remuneration, emphasising the need for organisational change to advance gender equity. ABSTRACT Introduction Orthopaedic surgery remains Australia's least gender-diverse medical specialty. Despite extensive global literature on barriers to gender equity, no prior study has applied an established gender bias instrument to assess gender bias in Australian orthopaedics. Methods A national mixed methods study was conducted comprising a cross-sectional survey and semi-structured interviews. Eligible participants included all practising orthopaedic surgeons and trainees in Australia. The survey utilised an adapted version of the 47-item Gender Bias Scale and was distributed via the Australian Orthopaedic Association and departmental mailing lists. Interviewees were recruited from survey volunteers and were undertaken to provide explanatory depth and contextualisation to the survey findings. Results 163 orthopaedic surgeons and trainees (85 male, 78 female) completed the survey. Female participants were significantly more likely to report barriers across the male culture and unequal standards domains. Twenty of the 47 GBS items showed significant gender differences (p  [...]

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

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

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

This systematic review evaluated the learning curve for intracorporeal anastomosis in minimally invasive right colectomy. Ten studies comprising 736 patients were included. Approximately 27 cases were required to achieve proficiency, with no significant difference between laparoscopic and robotic approaches. Findings were limited by heterogeneity in patient populations and surgical experience. ABSTRACT Background Intracorporeal anastomosis (ICA), compared with extracorporeal anastomosis (ECA) is associated with reduced risk of post-operative ileus without compromising on safety and oncological outcomes for minimally invasive right colectomy (MIRC). However, ICA is more technically challenging and comes with a learning curve (LC). This review aims to summarize the evidence and define the number of cases required to surmount the LC for ICA in MIRC, i.e., N LC. Methods A systematic search was performed on PubMed, Embase (Ovid), Scopus and the Cochrane database from inception to March 2026. Patients who underwent laparoscopic and/or robotic right and/or extended right colectomy were included. Data on the method of LC analysis, single surgeon vs. institutional LC and outcome measures were extracted and analysed. Poisson means were used to model the average N LC. Results There were six studies (n = 7 data sets; 440 patients) on laparoscopic colectomy and four studies (n = 6 data sets; 296 patients) on robotic colectomy. The pooled mean age was 67.9 years. Anastomotic leak occurred in 1.5% of laparoscopic cases and 3.0% of robotic cases. Operating time (OT) was the most evaluated surrogate marker of surgical proficiency. The pooled N LC for OT was similar between laparoscopic colectomy and robotic colectomy (laparoscopic: 27.2 (95% confidence interval (CI): 22.8–32.2), robotic: 26.6 (95% CI: 22.3–31.5), incidence rate ratio (IRR): 0.98, 95% CI: 0.48–2.00, p = 0.951). Conclusion This review provides a summary of existing evidence on the LC for ICA in MIRC. However, our findings are limited by heterogeneity in study populations, case selection and surgical experience. [...]

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

To establish an ex vivo normothermic machine perfusion (EV NMP) for research and clinical translation. Kidneys that declined for transplantation underwent 2-h EV NMP (see diagram). The perfusion dynamics were recorded. The biopsy and immunohistochemistry were performed for study of tissue injury. All kidneys shown satisfactory perfusion. An activation of necroptosis pathway was observed. A marginal donor kidney was utilised for transplantation following EV NMP evaluation. EV NMP is a useful tool for investigation of tissue injury. It also provides a platform for ex vivo evaluation of marginal donor kidneys and to increase utilization for clinical transplantation. ABSTRACT Background Ex vivo normothermic machine perfusion (EV NMP) enables functional assessment and reconditioning of marginal donor kidneys. This pilot study aimed to establish an EV NMP platform, characterise perfusion parameters and cell death pathways and facilitate clinical translation. Methods Six kidneys declined for transplantation underwent 2 h of EV NMP with a red blood cell-based perfusate. Perfusion dynamics, biochemistry and urine output were monitored. Histological injury was graded using the Remuzzi scoring system. Immunohistochemistry evaluated necroptosis (RIPK1, RIPK3, MLKL, pMLKL) and apoptosis (cleaved caspase-3, caspase-8). Results All kidneys produced urine and achieved Remuzzi scores ≤ 3. Renal vascular resistance declined 78% over the perfusion period. Perfusate creatinine and potassium decreased significantly (reduction 69.7 μmol/L, 95% CI [22.4, 117.0], p = 0.006 and 2.4 mmol/L, 95% CI [0.4, 4.4], p = 0.021, respectively). Necroptosis markers were prominent within tubular epithelium; pMLKL positivity in 18.5% of proximal tubules at baseline indicated active necroptotic signalling prior to perfusion. Apoptotic markers were comparatively sparse. A marginal DCDD kidney declined by all allocated transplant units was assessed using EV NMP and accepted for transplantation. The recipient experienced delayed graft function resolving within 1 week and mixed rejection at 6 months that responded to treatment, with maintained graft function at 2-year follow-up (serum creatinine 159 μmol/L). Conclusion EV NMP is feasible and clinically translatable within a kidney transplant programme. Prominent baseline necroptotic signalling, reflected by pMLKL burden at commencement of perfusion, identifies the RIPK3–MLKL axis as a rational therapeutic target during ex vivo organ reconditioning, warranting investigation in prospective trials. [...]

ANZ Journal of Surgery, Volume 96, Issue 10, Page 2715-2718, October 2026. [...]

Following the introduction of Aotearoa New Zealand's Bowel Screening Programme pilot, acute colorectal cancer presentations at a single centre fell by 61% and patients who still presented acutely were less likely to have metastatic disease or die within 1 year. ABSTRACT Background The Bowel Screening Programme (BSP) in Aotearoa, New Zealand, was introduced to facilitate earlier detection of colorectal cancer (CRC), yet its impact on acute CRC presentations remains incompletely characterised. This study evaluated changes in the incidence and clinical features of acutely presenting, previously undiagnosed CRC before and after BSP implementation. Methods A single-centre retrospective cohort study was conducted at North Shore Hospital, Auckland. Adults (≥ 16 years) acutely admitted with a first diagnosis of CRC were identified in the 3 years preceding the BSP pilot (2009–2011) and the 3 years following national rollout (2018–2020). The primary outcome was the age-standardised population incidence of acute CRC. Incidence rate ratios (IRRs) were estimated using age-adjusted Poisson regression. Results Three-hundred twenty three patients were included (pre-BSP n = 215; post-BSP n = 108). The age-standardised incidence of acute CRC declined from 9.71 per 100 000 population (95% CI: 7.56–12.27) in 2009 to 3.79 per 100 000 (95% CI: 2.70–5.17) in 2020. Following BSP implementation, acute CRC presentations were reduced by 61% (IRR 0.39, 95% CI: 0.31–0.49, p  [...]

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

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

ABSTRACT In Stage III endometrial cancer (EC), treatment paradigms have evolved from being based on a purely surgical pathology classification to a nuanced system integrating molecular risk stratification and advances in immunotherapy and targeted agents. This narrative review summarises current adjuvant management of stage III EC with an emphasis on clinical management in Australia, given the challenges in decision-making with the development of new predictive and prognostic markers and systemic agents. We discuss the importance of surgical staging, the evidence for radiotherapy and chemotherapy, explore emerging targeted and immunotherapy options, and outline barriers such as cost, access to molecular testing and systemic therapy in the Australian context. Molecular profiling is transforming adjuvant therapy in EC, but gaps in knowledge persist. Further research will help clarify the role of targeted treatments and immunotherapy in the adjuvant setting in this group of patients. [...]

ABSTRACT Introduction Acute cholecystitis is commonly evaluated with ultrasound using established sonographic features. The Tokyo Guidelines 2018 recognise gallbladder enlargement as a characteristic imaging finding; however, the diagnostic value of quantitative gallbladder dimensions remains uncertain. This study evaluated whether gallbladder length (GBL), width (GBW), and volume (GBV) provide additional diagnostic value beyond conventional ultrasound features. Methods This retrospective case–control study included 176 patients undergoing abdominal ultrasound between 2019 and 2024: 88 with histopathologically confirmed acute calculous cholecystitis and 88 age- and sex-matched controls. Gallbladder dimensions were independently measured by two blinded readers, with GBV approximated using an ellipsoid formula. Logistic regression, nested model comparisons, interobserver reliability and receiver operating characteristic analyses were performed. Results All conventional sonographic features and gallbladder measurements were significantly associated with cholecystitis on univariate analysis. After adjustment for age, sex, weight and conventional sonographic features, GBL remained independently associated with cholecystitis (adjusted OR 1.045, 95% CI 1.014–1.077; p = 0.004) and improved model fit. GBV also provided incremental value (p = 0.020), whereas GBW did not (p = 0.44). Interobserver reliability was excellent for GBL (ICC 0.94), GBW (0.91) and GBV (0.93). GBL demonstrated the highest diagnostic performance (AUC 0.76), followed by GBV (0.74) and GBW (0.63). A 71-mm GBL cutoff yielded 72% sensitivity and 71% specificity. Conclusion GBL and GBV provide incremental diagnostic information beyond conventional sonographic features. GBL is the strongest quantitative marker and may serve as a reproducible adjunct to established ultrasound findings. External validation of the proposed thresholds is required before broader clinical implementation. [...]

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

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

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

ABSTRACT Benign breast lesions, anatomical variants, and imaging artefacts can closely mimic malignancy on screening mammography and are a frequent diagnostic challenge in the assessment setting. This pictorial review showcases a spectrum of benign lesions encountered in a high-volume breast screening assessment setting that initially raised suspicion for malignancy but were subsequently confirmed as benign through a combination of digital breast tomosynthesis (DBT), targeted ultrasound, and clinicopathological correlation. Examples include cutaneous lesions, sebaceous cysts, intramammary lymph nodes, hamartomas, fat necrosis, vascular lesions, simple cysts and summation artefact. Through illustrative cases, we highlight key imaging features that support accurate lesion characterization and demonstrate the complementary roles of mammography, DBT, and ultrasound in distinguishing benign entities from breast cancer. Familiarity with these imaging appearances can improve diagnostic confidence, reduce false-positive recalls, and minimize unnecessary biopsies within breast screening programs. [...]

ABSTRACT Introduction There is a shortage of radiologists practicing in regional and rural Australia. The Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Government have published their commitment to address this workforce maldistribution. This project aims to identify the future work intentions of radiology registrars training in South Australia (SA) and the Australian Capital Territory (ACT), focusing on attitudes toward a career in rural radiology practice. Methods A cross-sectional study of SA and ACT RANZCR registrars was performed via an online questionnaire consisting of tick box and short answer questions relating to demographics, previous rural exposure, future work intentions, and perceived barriers to rural practice. Results A total of 72 (82%) registrars responded to the survey. While 59% agreed they would enjoy living and working rurally, 19% intend to work in regional/rural areas. Although 15% intend to live and work in these locations, 38% of registrars intend to contribute to the rural workforce through irregular locum work. Registrars who spent at least 1 year at a rural clinical school were more likely to intend to practice in a regional/rural area. Qualitative analysis revealed barriers to a rural career centred on familial opportunity, while key facilitators centred on work-life balance and collegial support. Conclusion Most radiology registrars in SA and the ACT intend to base their practice in metropolitan Australia. Rural exposure during medical school significantly influenced rural practice intent, consistent with the broader literature. Coordinating funding and training opportunities with key barriers and facilitators can help build a sustainable rural radiology workforce. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S197-S208, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S1-S3, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S19-S43, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S4-S18, October 2026. [...]

ABSTRACT Objective Problematic substance use can significantly affect the wellbeing of family members and friends (hereafter concerned significant others—CSOs). Despite the substantial burden they experience, CSOs face multiple barriers when seeking support for themselves. Further, limited research has explored what CSOs need from support services, particularly in rural contexts. This study aimed to identify (1) the enablers and barriers to accessing support services reported by CSOs in rural Australia and (2) to explore what CSOs in rural Australia want and need from services to support their own wellbeing. Design A descriptive qualitative study involving semi-structured interviews. Data was analysed using thematic analysis with a pragmatic focus. Setting Interviews were conducted via zoom, across rural Australia. Participants Twenty-six CSOs are living across rural Australia. Results Two domains, each containing three themes, were identified. Domain 1 Factors influencing access to formal support included the themes: (1) personal barriers, (2) structural and systemic factors and (3) modes of delivery. Domain 2 Preferences and needs in support services included the themes: (1) the need for professional support, (2) recognition of CSOs' own needs and (3) qualities of effective professional support. Conclusion CSOs' access to support is shaped by multiple structural and interpersonal factors. CSOs value professional and non-judgemental support delivered by clinicians knowledgeable about substance use. Findings highlight the need to strengthen rural service capacity and extend research involving CSOs who are not currently accessing support or those experiencing additional risks such as domestic violence. Trial Registration Charles Sturt University Human Research Ethics Committee (approval number H23769), registered with the Australian New Zealand Clinical Trials Registry (ANZCTR, ACTRN12623000796684) [...]

Australian Journal of Rural Health, Volume 34, Issue 6, December 2026. [...]

Australian Journal of Rural Health, Volume 34, Issue 6, December 2026. [...]

ABSTRACT Objective To describe the experience of non-government organisation (NGO) staff implementing a community-based stroke recovery program based on the principles of environmental enrichment. Design A qualitative descriptive study to capture staff experiences. Semi-structured interviews with staff were analysed using reflexive thematic analysis. Setting A community-based NGO service in regional New South Wales, Australia. Participants Eight staff members employed in a regional NGO and involved in the implementation of the program, including a program coordinator, a physiotherapist, allied health assistants, creative artists and managers. Results Four themes were identified: (1) We've got a great space here—highlighted the importance of the physical environment, access and location; (2) There's an order to it—described the program's strong foundations formed through training, defined processes and support; (3) We make it work—demonstrated the flexibility and adaptability of staff in responding to individual needs and overcoming challenges and (4) Enriching lives—captured the sense of community, positivity and recovery outcomes. Staff experiences aligned closely with self-determination theory, reflecting feelings of capability, confidence and connection. Conclusion Staff in a regional NGO felt well-supported and capable of delivering a community-based stroke program. This demonstrates the potential role NGO services may play in addressing gaps in stroke recovery care in regional Australia. The methods used in this study can be used to implement this and other similar community-based programs with NGO services in the future. [...]

ABSTRACT Objective To examine the trend of locational equity in utilising Medicare-reimbursed psychiatric consultations (face-to-face and telepsychiatry) across states/territories. Design Time series analysis of administrative data. Setting Medicare-reimbursed private psychiatric consultations. Main Outcome Measures Greater coefficients of variation (CVs) represented higher state/territory variations in per capita consultations (2005 Q3–2023 Q4). We ran an autoregressive integrated moving average model for telepsychiatry-related CV change, with restricted rural-remote telepsychiatry items (2005–2022) and unrestricted telepsychiatry items (2020 Q1–2023 Q4) as the predictors. We examined the association between distance from mean per capita consultations and the fraction of per capita telepsychiatry consultations using state/territory-level data in another regression analysis, with telehealth legislative policy changes as another independent variable. Results Including telepsychiatry items since their introduction resulted in lower all-item CVs (i.e., reduced state/territory variation) than the corresponding CVs for face-to-face items only. The rural-remote-restricted telepsychiatry items had a larger effect than the unrestricted ones. Every 1000 restricted consultations were associated with 0.287 units of CV improvement (i.e., reduction in regional variation), in contrast to 0.007 units per 1000 consultations for unrestricted items. Telehealth-enabling policy changes significantly modified the association between distance from mean per capita face-to-face consultations and the fraction of telepsychiatry consultations. Lower per capita face-to-face consultations were associated with higher telepsychiatry fractions. Conclusion Telepsychiatry may help improve mental health equity. Bulk-billed, incentivised telepsychiatry for rural and remote areas may enhance regional health access. [...]

ABSTRACT Objective This study examines barriers and enablers to implementing Clinical Yarning into health care from the perspective of health care staff. Setting The Midwest Region (> 60,000 km2), Western Australia (WA). Design Semi-structured interviews with health care practitioners across four regional, rural and remote centers. Interview schedule was drawn from the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim and analysed using inductive and framework analysis, informed by the TDF and Mechanisms of Action. Results Interviews with 53 health care practitioners (17% Aboriginal, 83% non-Aboriginal) ranged from 14 to 60 min in length. Barriers and enablers coalesced around three main themes: knowledge/perceptions of Clinical Yarning, training practices in general and Clinical Yarning specifically, and environmental conditions including general cultural safety and executive support. The barriers and enablers found in each of the domains lead to implementation strategies which use program champions and executive support, build on the positivity towards Clinical Yarning, pay attention to training delivery modes like including local cultural experts where able and acknowledge the larger cultural safety/security barriers within the health service. The barriers presented by workforce challenges are important key variables in any success of the Clinical Yarning intervention. Conclusion The documented enablers and barriers to implementing Clinical Yarning in the Midwest when viewed through a TDF/MoA framework provide a way to create a systematic implementation strategy to address the identified barriers and enablers. The findings have implications for other health services wishing to implement Clinical Yarning as well as culturally secure health care more broadly. [...]

ABSTRACT Objective Despite sustained investment in research capacity building, embedding research within clinical practice remains challenging, particularly within regional, rural and remote healthcare settings where workforce shortages, geographic dispersion and limited research infrastructure constrain research engagement. This paper presents the Integrated Research Enablement Framework (IREF), explaining how clinician-led research is activated, supported and embedded within healthcare settings. Methods A theory-informed framework development approach integrated cumulative empirical evidence generated through 9 years of implementation and evaluation of a regional research capacity building program with an interpretive synthesis of relevant research capacity building and implementation science literature. Framework development iteratively integrated empirical observations and theoretical models to identify mechanisms underpinning research enablement. Results The IREF comprises three interdependent domains: capability development, relational expertise and enabling infrastructure. These operate through integrated mechanisms including facilitation, mentorship, organisational alignment and resourcing, to support the activation, sustainment and embedding of clinician-led research. The framework conceptualises research capability development as a relational, practice-integrated process responsive to the contextual realities of regional and rural healthcare delivery. Conclusion The IREF complements existing research capacity building and implementation science frameworks by explicitly articulating the mechanisms through which clinician-led research becomes embedded within routine clinical practice. It provides an operational framework for developing research capability while strengthening the organisational conditions required to sustain research within healthcare systems. [...]

ABSTRACT Aim This commentary explores the growing financial challenges associated with rural and remote clinical placements for nursing and allied health students and considers their implications for workforce development in regional Australia. Drawing on routinely collected survey data provided by the Western Australian Centre for Rural Health (WACRH) between 2017 and 2024, we use student-reported experiences as evidence of persistent concerns about financial burdens during rural clinical placements and discuss potential policy and practice responses. Context Rural workforce shortages remain a persistent national challenge for University Departments of Rural Health which facilitate rural training experiences for health science students. Rising costs of living, housing shortages across Australia, and a policy shift towards longer rural placements have increased concerns about placement poverty, a term used to describe the financial burden students experience because of completing mandatory professional placements. WACRH includes support for students undertaking clinical placements in our regions through accommodation at no personal cost to the student, vehicle access for placement activities and limited travel subsidies to remote sites. Approach Data from pre- and post-placement surveys (2017–2024) was analysed. Quantitative data from Likert-style questions on financial concerns were analysed in Stata, while qualitative open-ended responses describing financial challenges were manually coded. Analyses examined variation by year and location. Conclusion Financial concerns have increased over time, with a notable rise in students reporting being “Concerned” or “Very concerned” since 2022. Many students reported significant cost-of-living pressures, dual accommodation expenses, additional food and travel costs, and limited financial support. Achieving national rural workforce policy outcomes requires greater support for rural placements, including funding that reflects the true costs of rural training. [...]

Australian Journal of Rural Health, Volume 34, Issue 5, October 2026. [...]

Australian Journal of Rural Health, Volume 34, Issue 5, October 2026. [...]

ABSTRACT Introduction Health professionals in rural and remote settings face distinct challenges including geographical isolation, workforce shortages, limited continuing professional development and reduced exposure to high-acuity, low-occurrence (HALO) clinical scenarios. Simulation-based education (SBE) has been proposed as a strategy to address these challenges; however, its design, implementation and evaluation in rural and remote contexts has not been comprehensively synthesized. Objective To map and characterize existing literature on SBE designed and delivered to rural and remote health professionals in high-income countries. Design A scoping review was conducted in accordance with JBI guidelines using the participant, concept, context (PCC) framework. Screening and data extraction were conducted using Covidence and results reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Findings Thirty-seven articles met the inclusion criteria, predominantly from the United States of America (USA), Australia and Canada. Most used quantitative or mixed methods designs. SBE was characterized across six areas: Simulation activity, modality, facilitators, support structures, research methods and learning objectives. Emergency care training, particularly for the management of deteriorating patients and HALO scenarios, was most prevalent. Modalities included simulated patients, in situ simulation, virtual simulation and procedural simulation. Technology-enabling approaches, including telemedicine and mobile simulation units, were increasingly reported. Discussion Reporting quality was variable. Most studies focused on learner-level outcomes, with limited evidence on system-level, workforce or patient outcomes. Rural-metropolitan collaboration through telemedicine and virtual facilitation was a recurring theme. Conclusion SBE sustains clinical capability in rural and remote settings, particularly for deteriorating patient management, HALO scenarios and for introducing emerging technologies. Further research on implementation, outcomes and workforce impact is warranted. [...]

ABSTRACT Objective To examine whether a VR rural health experience, co-created using an established process and research protocol, could achieve similar impacts on rural practice intent and reflective engagement in a different geographic and organisational context. Setting Metropolitan Sydney and Central Tablelands of New South Wales, Australia. Participants Forty-one health science students and professionals recruited at careers-related events or while on placement. Most participants (81.1%) were from metropolitan areas, and 39% had no prior rural work exposure. Design A parallel convergent mixed-methods study. Participants completed pre- and post-viewing surveys assessing intended practice location and presence in the VR environment. A subset (n = 38) participated in semi-structured interviews exploring their experiences. Quantitative data were analysed descriptively and using Wilcoxon Signed Rank tests; interviews underwent reflexive thematic analysis. Results Post-VR, there was a significant shift in intended practice location (p = 0.035, r = 0.233), with increased interest in inner regional and small rural communities. Participants reported high levels of presence and engagement. Three themes and four subthemes were developed, summarised as: (1) VR as immersive and convenient, though limited in interactivity; (2) a rural education and awareness tool that contextualised the rural environment and challenged assumptions; and (3) a career decision-making aid that reduced uncertainty, supported exploration and helped assess person–environment fit. Conclusion A locally tailored VR rural health experience reproduced, and built on the key outcomes of an earlier study in a different context, supporting its adaptability and potential as a scalable tool for rural workforce development through critical reflection and informed career exploration. [...]

Errors occurred in the article by Parks SE et al, titled “A Resource to Understand and Prevent Sudden Unexpected Infant Deaths,” published in the August 2026 issue of Pediatrics (2026;158[2]: e2025075460; doi: 10.1542/peds.2025-075460). [...]

Nephrotic syndrome in children and atopic dermatitis (AD) share a common type 2 inflammatory substrate driven by interleukin (IL)-4 and IL-13 dysregulation. We report the case of a 9-year-old girl with AD and frequently relapsing steroid-sensitive nephrotic syndrome. Given the broad atopic phenotype and increasing relapse frequency despite dual immunosuppressive therapy, dupilumab 300 mg every 2 weeks was introduced. The patient achieved rapid and complete clearance of cutaneous lesions alongside sustained complete remission of nephrotic syndrome, maintained over nearly 2 years. Both corticosteroids and tacrolimus were fully discontinued within 2 months of dupilumab initiation, with no subsequent relapse of either condition. This case supports the hypothesis that dupilumab may represent an effective steroid-sparing therapeutic option in children with nephrotic syndrome arising in an atopic context. [...]

Errors occurred in the article by Laverty M et al, titled “Health Outcomes in Young Children Following Pertussis Vaccination During Pregnancy,” published in the May 2021 issue of Pediatrics (2021;147[5]: e2020042507; doi: 10.1542/peds.2020-042507). [...]

To the Editor: [...]

We thank Dr Cuc Do for their thoughtful questions regarding the article, “Maternal RSV Vaccination, Infant Nirsevimab, or Both: Interim Analysis of a Randomized Trial.” For this study, we performed an interim analysis to present timely data to inform clinical decision-making in the 2025 to 2026 respiratory season in the United States. Therefore, the cutoff for the interim analysis was based on a calendar date (May 15, 2025), which included immunogenicity data up to 3 months and safety data up to 4 months after delivery for a subset of participants. Since the available immunogenicity data were collected prior to Group 1c’s receipt of nirsevimab at 3 months, Groups 1a and 1c were combined for analysis. By design, the interim analysis was not intended to capture a full respiratory season, the impact of the 3-month dose of nirsevimab, or the differential antibody kinetics over time. These important measures will be included in the final study report, where we plan to include safety and immunogenicity data through 12 months, stratified by study group. [...]

OBJECTIVETo characterize clinical manifestations and complications of children with Zika-related microcephaly in the first 5 years after birth.METHODSA cohort of children with Zika-related microcephaly were observed up to age 60 months as part of the Microcephaly Epidemic Research Group Pediatric Cohort.RESULTSAmong the 181 children, 43.1% were male and 77.2% were born at term. The median birth weight was 2700 g, with 64.8% classified as small for gestational age. Notably, 22.3% were diagnosed with microcephaly after birth, and 48.8% had severe microcephaly. Most common phenotypic characteristics were craniofacial disproportion (54.1%), arthrogryposis (35.9%), and exacerbated occipital protuberance (35.5%). Approximately one-third (33.1%) presented with dysphagia (n = 151 evaluated at median age of 28.2 months), and 13.3% of children had gastrostomies (median age of 24 months). Hearing anomalies were detected in 9.7% (n = 93 evaluated at median age of 30 months). In ophthalmological evaluation, 30.4% showed changes in the retina and 28.5% in the optic nerve; strabismus was observed in 53.4%. During neurological assessment (median age at first assessment of 15.9 months), 73.8% presented with abnormalities. Imaging examinations showed ventriculomegaly and cortical atrophy in 75.3% and 64.4% of the children, respectively. Electroencephalography was performed based on clinical indication in 84 children, of whom 92.9% had pattern alterations. Over the 5 years, 62.4% were hospitalized, mainly for respiratory problems and seizures.CONCLUSIONSThe study highlights the severity of Zika-related microcephaly. Future research should prioritize continued systematic monitoring of these children to understand the frequency and timing of late-onset manifestations and complications, including death. [...]

OBJECTIVEChildren born very preterm (VP; [...]

10.1542/6404219308112Video AbstractPEDS-VA_2026-0767756404219308112CONTEXTHospital at Home (HaH) is an acute care model that delivers hospital-level services to the patient’s home as a substitute for conventional inpatient admission. Although pediatric HaH programs are well established internationally, the evidence base remains limited.OBJECTIVETo map the operational characteristics, outcomes, and evidence gaps of pediatric HaH programs.DATA SOURCESA comprehensive literature search was conducted for studies published between January 1, 2000, and July 25, 2025.STUDY SELECTIONEligible studies included programs with patients aged 18 years or younger and aligned with the World Hospital at Home Congress definition.DATA EXTRACTIONData were extracted on study characteristics; implementation, infrastructure, and program design; clinical safety and effectiveness; cost-effectiveness and economic impact; and patient, caregiver, and/or clinician perspectives and experiences.RESULTSThirty-four studies met eligibility criteria. Most were observational, with few randomized or nonrandomized controlled studies. Programs varied substantially in admission pathways, staffing, eligibility criteria, monitoring, and clinical populations. Studies demonstrated low escalation and readmission rates, infrequent serious adverse events, high caregiver satisfaction, and generally comparable or lower health care costs relative to conventional inpatient care. Few studies directly evaluated clinical effectiveness, included rigorous economic analysis, or incorporated child and clinician perspectives.LIMITATIONSThe literature was limited by heterogeneous study populations, program designs, outcome reporting, and variable definitions and descriptions of HaH models, introducing potential for misclassification.CONCLUSIONSPediatric HaH shows promise as a safe and family-centered alternative to conventional hospitalization, though the existing evidence remains limited and heterogeneous, highlighting the need for more rigorous evaluation. [...]

Children and adolescents whose parents have an alcohol or substance use disorder are at increased risk of short- and long-term sequelae, ranging from medical conditions to psychosocial, safety, and behavioral challenges. In the course of providing health care services to children, pediatricians and other pediatric clinicians are likely to encounter families affected by parental substance use and are in a unique position to support the well-being of both the child and family. The purpose of this clinical report is to briefly discuss the epidemiology of substance use during pregnancy and while parenting in the United States; highlight the influence of bias, racism, and other structural inequities on families affected by substance use; describe the known risks associated with prenatal and postnatal parental substance use; discuss use and interpretation of toxicology testing as part of a substance exposure evaluation; review approaches to screening for prenatal and parental substance use; propose key topics for anticipatory guidance in the pediatric clinic; identify and address concerning parental and child presentations related to parental substance use leading to concern for child abuse or neglect; and provide recommendations for pediatric clinicians involved in the care of children from families affected by substance use. [...]

10.1542/6402481027112Video AbstractPEDS-VA_2026-0768216402481027112OBJECTIVETo document prevalence of reasons for nicotine pouch (NP) use and associations with use patterns among US youth.METHODSData were from US youth reporting ever NP use in the nationally representative 2025 Monitoring the Future survey. We estimated (1) prevalence of 10 reasons for NP use (yes/no) and (2) association of each reason with past 30-day NP use (yes/no) and frequency (1–30 days). For comparison, we contrasted reasons for NP and e-cigarette use among youth reporting NP use (n = 57) or e-cigarette use (n = 397) on at least 10 of the past 30 days.RESULTSAmong 484 respondents reporting ever NP use (6.1% of youth surveyed on NP use and reasons), the most common reasons were experimentation (32.3%), nicotine buzz (30.5%), relaxation (22.7%), appealing flavors (17.4%), convenience (16.5%), socializing (16.0%), boredom (11.7%), and ability to conceal use (11.0%). To quit smoking (6.2%) and feeling addicted (2.1%) were less common. Flavors, convenience, and feeling addicted were positively associated with both past 30-day NP use (prevalence ratios [PRs] range = 1.50–2.35) and frequency (incidence rate ratios [IRRs] range = 1.60–2.55). Nicotine buzz, relaxation, socializing, concealment, and to quit smoking were only associated with past 30-day use (PRs range = 1.57–1.85). Experimentation was inversely associated with frequency (IRR = 0.42). The prevalence of reasons overlapped between NPs and e-cigarettes, with relaxation, convenience, nicotine buzz, and flavors most prevalent among youth regularly using each product.CONCLUSIONSPrevention and regulatory strategies addressing NP use reasons, particularly flavors and convenience, are warranted. Existing effective strategies targeting youth nicotine vaping may be applicable to NP use. [...]

This statement updates recommendations of the American Academy of Pediatrics (AAP) for use of influenza vaccines and antiviral medications in prevention and treatment of influenza in children during the 2026–2027 influenza season. A review of evidence supporting these recommendations is in the accompanying technical report (https://doi.org/10.1542/peds.2026-078779).The AAP recommends annual influenza vaccination of all children without medical contraindications starting at 6 months of age. Influenza vaccination is an important strategy for protecting children and the broader community as well as reducing the overall burden of respiratory illnesses when other viruses are cocirculating. Any licensed influenza vaccine appropriate for age and health status can be administered, as soon as possible in the season, without preference for one product or formulation.Antiviral treatment of influenza may reduce the duration of symptoms; reduce complications, including hospitalization and death; and potentially reduce transmission. The AAP recommends antiviral treatment for children with suspected or confirmed influenza who are hospitalized or have severe or progressive disease. In ambulatory settings, antiviral treatment should be offered to children who are at high risk of complications from influenza, including those with chronic medical conditions and immunocompromised patients. In all these situations, antiviral treatment should be started as soon as possible regardless of duration of illness or receipt of influenza vaccine. Antiviral treatment is an option in the ambulatory setting for all children with suspected or confirmed influenza.Antiviral chemoprophylaxis is an option in certain individuals, especially exposed children who are asymptomatic and are at high risk for influenza complications but have not yet been immunized or, if immunized, those who are not expected to mount an effective immune response. [...]

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2026–2027 influenza season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated (non-live) and live attenuated influenza vaccines, available vaccines for the 2026–2027 influenza season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized. [...]