General journals

The leading expert on bone injuries in court cases on baby deaths has referred himself to the General Medical Council after a High Court judge accused him of having “a closed mind” and making “a number of repeated mistakes.”12In a High Court family division case last year, Mr Justice Keehan said that David Mangham was “currently the only forensic consultant histopathologist accepting instructions in cases of suspicious death and/or inflicted injuries in this country.” The judge added, “The consequences of this state of affairs, however, is that he has a huge workload.”Doubts over his evidence in criminal cases have since come to light. Three months after the High Court judgment Laura Langley was cleared at Preston Crown Court of murdering her 7 week old daughter, after two defence experts disputed Mangham’s evidence about the cause of rib fractures, agreeing that they were instead caused by cardiopulmonary resuscitation (CPR). Now three... [...]

Discontent between the GP profession and the government is becoming more evident as sparks fly over how reforms of online consultations are being implemented.New rules came into force on 1 October saying that all general practices in England must keep online consultation tools open from 8 am to 6 30 pm, Monday to Friday. The BMA warned that this could result in a surge of consultation requests with no additional workforce to deal with it, and as a result it has entered a formal dispute with the government.1The issue has now flared up again after national media coverage of a letter from GPs in northeast England about how the new consultation rules should be implemented. The letter, reported on by the Times2 and seen by The BMJ, set out seven “pre-set messages” that general practices might want to use for patients seeking a consultation after they have been triaged through... [...]

The US CDC’s Advisory Committee on Immunization Practices (ACIP) has announced plans for a new working group to review childhood vaccine schedules, including data on timing, coadministration, and safety.However, the group’s work may be disrupted by the federal shutdown,1 during which the CDC (Centers for Disease Control and Prevention) issued—and later rescinded—hundreds of termination notices to staff.The federal shutdown began on 1 October after the Senate failed to pass a funding bill for 2026. Over the weekend of 11-13 October several thousand government employees, furloughed as part of the shutdown, were dismissed by the administration of President Donald Trump.The Department of Health and Human Services (HHS) is among the departments to have had major cuts to their staff. A court document indicates that the government is seeking to cut 1100-1200 employees.2 An HHS spokesperson, Andrew Nixon, told Politico on 10 October that the dismissals were of “non-essential” staff.3Stat News reported... [...]

The Medicines and Healthcare Products Regulatory Agency (MHRA) has just approved gepotidacin (Blujepa), the UK’s first new type of antibiotic for urinary tract infections (UTIs) in nearly 30 years.1For the millions of women with recurring UTIs, this is life changing news. UTIs affect half of all women at some point in their lives and lead to millions of NHS appointments and prescriptions each year.23 For the estimated 1.6 million women in the UK with chronic UTIs, repeated infections mean days off work, cancelled plans, and constantly worrying about the next one.4The problem is that many UTIs no longer respond to the antibiotics we’ve relied on for decades: more than 90% of UTI causing bacteria are now resistant to at least one common medicine.5 The more we continue to use these, the more resistant the bacteria become. This results in infections that won’t clear up or that keep coming back.And the... [...]

Putting job advisers in more general practices to help sick and disabled people back into work risks discouraging some patients from seeking medical help, doctors have warned.In the Connect to Work programme specialist employment advisers in practices support people who have a long term condition or disability, regardless of whether they are claiming benefits. People can refer themselves or be referred by a GP.The programme currently operates in 21 areas of England. On 9 October the government announced it was expanding it to another nine areas, including Cumbria, Oxfordshire, and West Sussex, to provide “intensive support” to more than 40 000 people through £167m of investment.1The Department for Work and Pensions (DWP) plans to invest £1bn to eventually roll out the scheme to all of England and Wales and help around 300 000 people into work by the end of the decade. The government estimates that around 2.8 million people... [...]

In 2018 Prime Minister Narendra Modi launched his government’s flagship healthcare initiative, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). AB PM-JAY aimed to provide comprehensive health coverage of up to Rs500 000 (£4175; €4800; $5640) for each of the 120 million poor and vulnerable families across India. Seven years later, it is facing a backlash.Delays in payments are causing financial burdens for patients, and for the hospitals that have signed up to the scheme. Researchers from the Association for Socially Applicable Research India and the Centre for Health Equity, Law, and Policy looked at 111 223 consumer grievances filed by beneficiaries between October 2018 and March 2022.1 They found that patients struggled with the poor quality services and infrastructure offered by empanelled hospitals (those that have signed up to AB PM-JAY), with the states of Assam, Chhattisgarh, Jharkhand, and Uttarakhand being the worst affected.But perhaps the biggest... [...]

A plurality of nounsI have previously commented on a strapline, published under the heading of a recent article in the online version of The Times newspaper titled “How to become a doctor—a step-by-step guide by those who’ve done it.”1 It began “The entry criteria is tough and the course even tougher ....” Now pluralising English nouns is not always as straightforward as you might think. In most cases, of course, you just add the letter /s/—doctor/doctors, nurse/nurses, and so on.But what about words ending, for example, in –ic? “Physic” was an archaic word for medical science, but, like logic, magic, and rhetoric, “physic” in this sense is a non-count noun, which can’t be pluralised. “Physics” is something else again.Which raises the question of words ending in –ics. Are they singular or plural? Americans seem to think that mathematics is singular—they abbreviate it “math”; but in British English it’s “maths.” Of... [...]

An author’s name was misspelt in this paper by El-Taji and colleagues (BMJ 2025;390:e087524, doi:10.1136/bmj-2025-087524, published 25 September 2025). The first name of the fourth listed author should be Abdullah [not Abdallah] Ghali. [...]

Defective sunscreens sold in Australia and exported to other countries offered as little as a 10th of the sun protection factor (SPF) stated on their labels, Australian regulators have said.The affected products are sold by leading brands such as Bondi Sands, Banana Boat, and Cancer Council and were passed by an international network of laboratories headquartered in the UK. At least 18 products have been withdrawn from sale in Australia, with manufacturing of some also halted as authorities continue to investigate.Australia’s Therapeutic Goods Administration (TGA), which regulates the sunscreen industry in the country, said a defective base formula was found to have been used in at least 21 different products. In a statement it said, “Preliminary testing indicates that this base formulation is unlikely to have an SPF greater than 21.”1Seven of the “SPF 50” products had an SPF [...]

The outgoing chair of the Royal College of General Practitioners (RCGP) has urged the government not to exacerbate the ongoing unemployment crisis in the profession by imposing tax increases on GPs.In a speech1 at the college’s annual conference, Kamila Hawthorne also called for ministers to provide ringfenced funding to allow general practices to employ the growing number of doctors who are completing their GP training.Last month it was reported that Chancellor of the Exchequer Rachel Reeves was considering plans to levy national insurance on partnerships including general practices to try to raise almost £2bn a year for the Treasury.2Hawthorne warned that general practices were already struggling with the impact of the rise in employer national insurance contributions, with some unable to afford to replace doctors who had left “let alone take on more GPs.” She gave an example where the increased cost of national insurance contributions amounted to around £40... [...]

Mahase reports on the increasing number of people in England who smoke both cigarettes and e-cigarettes (vapes).1 Despite substantial evidence that vaping exposes users to much lower levels of toxicants than smoking,2 most adults in Britain who smoke think that vaping is equally or more harmful.34 This widespread misperception is not just an issue of misinformation—it has important implications for public health. Evidence indicates that it can prevent people from switching completely from smoking to vaping,256 resulting in more disease, disability, and premature death.In the UK, approximately six million adults smoke7 and around two million of them also vape.8 These “dual users” are already using e-cigarettes and are therefore potentially more amenable to fully quitting smoking. Within this group, around 600 000 people vape daily but do not smoke cigarettes daily.8 These people could be relatively easy to support to quit smoking altogether. But their misperceptions probably present a barrier,... [...]

UK ministers are reportedly drawing up plans to change the law to make it easier to suspend doctors accused of misconduct from practising while they are under investigation.1The move has been prompted by the health secretary, Wes Streeting, being dissatisfied with the handling of the case of a British-Palestinian doctor, Rahmeh Aladwan, who is currently under investigation by the General Medical Council (GMC) over allegations of antisemitic remarks. Streeting is also reported to be planning to legislate for a new duty on NHS staff that would specifically prohibit them from making “racist” statements.2What sparked this?Aladwan, a trainee in trauma and orthopaedics, sparked outrage on 2 October after claiming that a decision to temporarily restrict emergency department access in Manchester to prioritise victims of the local synagogue attack was evidence of “exceptionalism for Jews.”3 She has also shared a social media post suggesting that the media’s focus on the Manchester terror... [...]

Between 2016 and 2022, the rate of US adults with type 2 diabetes who used glucagon-like peptide-1 (GLP-1) receptor agonists rose from about 4% to nearly 20%, according to the Medical Expenditure Panel Survey Household Component. Now, new data from the Centers for Disease Control and Prevention reveal that almost 27% of adults diagnosed with diabetes used injectable GLP-1 drugs in 2024, often while taking some other diabetes medication. [...]

deep and complex, slow to mend, I’d trace the outline with a Sharpie. Checked daily, I’d see no change. But weekly, my wound would diminish. [...]

This JAMA Medical News article discusses updated guidance on COVID-19 vaccination in pregnant people from the American College of Obstetricians and Gynecologists. [...]

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

Level I evidence and recommendations from international guidelines have led to prostate magnetic resonance imaging (MRI) becoming integral to the diagnosis and staging of prostate cancer over the past 15 years, with millions of examinations now performed annually around the world. Multiparametric prostate MRI, composed of T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast–enhanced imaging, has changed the standard of care by improving detection of clinically important prostate cancer while decreasing overall biopsy frequency and diminishing detection of clinically insignificant prostate cancer. This has been a remarkable transformation in a relatively brief time frame, particularly considering the typical pace of medical implementation. [...]

This multinational prospective noninferiority trial assesses whether biparametric magnetic resonance imaging (MRI) is noninferior to multiparametric MRI for diagnosis of clinically significant prostate cancer in biopsy-naive men with elevated prostate-specific antigen level and/or abnormal digital rectal examination findings. [...]

This cohort study examines the availability and representativeness of data supporting US Food and Drug Administration–authorized artificial intelligence and machine learning devices to treat Alzheimer disease and related dementias. [...]

To the Editor A recently published Viewpoint titled “Observations on the Discovery of Glucagon-Like Peptide-1 Action” was based on the authors’ personal recollections and contains statements that are inconsistent with the published and legal record, US patents (5,118,666; 5,120,712; 5,5614,492; 6,849,708; and 7,138,486 B2), and dated entries in my laboratory notebooks. My foundational research in this field predated the summer of 1984, when Dr Daniel Drucker, along with the Viewpoint authors, Drs Jacques Philippe and Alvin C. Powers, joined Dr Joel Habener’s Laboratory of Molecular Endocrinology at Massachusetts General Hospital (MGH). [...]

In Reply We thank Dr Mojsov for her comments on our Viewpoint and for her contributions to the field. In our Viewpoint, we sought to provide a more complete chronology of events surrounding the discoveries related to GLP-1. As we noted, we were working in the Habener laboratory at MGH from 1984 to 1988, and our observations on GLP-1–related discoveries, timelines of the experiments, and key contributions are somewhat different than those stated by Mojsov, who worked in another laboratory in the Peptide Chemistry Unit within the Endocrine Division at MGH. [...]

This review summarizes current evidence regarding the pathogenesis, etiology, diagnosis, and treatment of diverticulitis. [...]

To the Editor A recent Viewpoint described the launch of a new artificial intelligence (AI) governance initiative to promote trustworthy and responsible AI. As Black scholars, one of whom is also Native American, working at the intersection of AI and health equity, we offer several points for further consideration. [...]

In Reply We appreciate Drs Bright and Norris’ thoughtful response to our Viewpoint and the opportunity to address several important points they raised. [...]

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 In this article, we present the state-of-the-art on socioeconomic health inequalities with a focus on the Nordic countries. Health inequalities have increased over time and can be observed for both mortality and morbidity. We show that cross-national comparisons reveal surprisingly high inequalities in the Nordic countries. It is now well established that health and mortality inequalities prevail also at older ages. We show, with data from Sweden, that the interpretation of how mortality inequalities evolve over the life course is markedly different depending on whether we focus on absolute or relative inequalities. Although there is a consensus on basic descriptive facts, disagreements on how these facts are best explained and why they persist and even increase remain. We present a general discussion on how to explain health inequalities, as well as a discussion on why patterns may differ between European regions and across the life course. We introduce a framework for understanding health inequalities, fundamental cause theory and discuss to what extent the evidence aligns with the theory. We review contemporary discussions on health inequalities in light of recent evidence based on novel methods for causal inference. We argue that health inequalities have important ramifications for population health regardless of whether they are primarily shaped by social causation or social selection and end by noting that as modern societies aspire to become more meritocratic, it is possible that socioeconomic position becomes increasingly important for health. [...]

Abstract Background Systemic lupus erythematosus (SLE) mainly affects women of reproductive age. Late-onset SLE patients (lo-SLE, ≥50 years) are generally indolent and have less severe manifestations. Objective The present study aims to decode molecular differences underlying the distinct clinical presentations between lo-SLE and early onset SLE patients. Methods In a cohort of 243 treatment-naïve Chinese SLE female patients, we carried out clinical analysis and experimental validation studies. RNA-seq was used to identify differentially expressed genes (DEGs) of lo-SLE patients. Reverse transcription quantitative polymerase chain reaction and flow cytometry were utilized to validate DEGs and enriched cell types. The discovery was further compared to findings in a European cohort. The immunosuppressive function of CD71+CD235a+ erythroid cells (CECs) was evaluated by coculturing peripheral blood mononuclear cells (PBMCs) with CECs. Results Differential expression analysis identified a group of hub upregulated genes in lo-SLE patients. These genes, overrepresented in erythrocyte differentiation, are highly enriched in CECs. In our Chinese cohort, CECs abundance in peripheral blood was inversely correlated with disease activity. Increased CECs in treatment-naïve lo-SLE patients may play an immunosuppressive role by inhibiting CD8⁺ T cell function and IFN-γ production. This immunosuppressive role was evidenced by the significant suppression of IL-6, IFN-γ, and IL-17A production by healthy donor's PBMCs cocultured with SLE bone marrow-derived CECs. Conclusions This pioneering study has revealed a panel of CECs genes as potential molecular markers for lo-SLE, supporting a novel erythroid modulation theory. These novel findings provide valuable insights into previously unrecognized molecular mechanisms underlying the latent disease activity of lo-SLE. [...]

Abstract Background Due to the expanding screening of coeliac disease (CeD), low positive and borderline negative serum transglutaminase 2 antibody (TGA) values are causing increasing confusion in clinical practice. Objectives To investigate the significance of these findings in a well-defined patient cohort. Methods Altogether 311 IgA-competent adults, with clinical suspicion or family history of CeD, underwent duodenal sampling and testing for TGA (ImmunoCAP EliA, cut-off 7.0 U/mL) and endomysial antibodies (EmA). TGA values 7.0–14.0 U/mL were defined as low positive and 3.0–6.9 U/mL as borderline negative. Besides conventional histology, small bowel mucosal TGA-targeted IgA deposits and γδ+ intraepithelial lymphocytes (IELs) were determined as CeD-specific markers. Results Twenty-eight (9%) individuals had low positive TGA, and 22 (79%) were also positive for EmA. Among those with low positive TGA, all EmA positive and 50% of the EmA negative subjects were diagnosed with CeD. Thirty-nine individuals (13%) had borderline negative TGA, and 36% were positive for EmA. Of these, 79% of EmA positive and 12% of EmA negative subjects were diagnosed with CeD. Additionally, 29% of the subjects with borderline negative TGA and no diagnosis exhibited signs of incipient CeD, including positive IgA deposits, increased density of γδ+ IELs and presence of human leukocyte antigen DQ2/DQ8. All subjects with TGA ≥ 3.2× upper limit of normal (22.4 U/mL) received a CeD diagnosis. Conclusion Low positive and borderline negative TGA frequently implies a CeD diagnosis, particularly in EmA positive individuals, or at least may be an indicator of an early stage of the disease. [...]

Journal of Internal Medicine, Volume 298, Issue 4, Page 279-279, October 2025. [...]

Abstract Background Limited data exist on the prevalence of gastrointestinal bleeding (GIB) in patients with new-onset atrial fibrillation (AF) and the impact of GIB on the initiation of oral anticoagulation (OAC) therapy. Methods A population-based registry-linkage study included all patients diagnosed with new-onset AF in Finland during 2010–2018 who had available laboratory data and a definite indication for OAC therapy. The primary outcome was OAC initiation within 90 days following AF diagnosis. Factors associated with OAC initiation were assessed using modified Poisson regression. Results Among 117 997 patients with new-onset AF, 6628 (5.6%) had GIB, of which 5336 occurred more than 30 days prior to AF diagnosis, and 1292 were temporally (±30 days) associated with new-onset AF (GIBTAF). Patients with GIB compared to those without GIB were older (mean age 78.3 vs. 75.3 years), more frequently men (48.5% vs. 41.9%), and had more comorbidities. The occurrence of GIB was associated with a lower probability of initiating OAC (RR 0.84, 95% CI 0.81–0.86). Among patients with GIB, an obscure origin of GIB (RR 0.93, 95% CI 0.88–0.99) or GIBTAF reduced the likelihood of OAC initiation (RR 0.72, 95% CI 0.66–0.79). The initiation of OAC did not depend on the known GIB bleeding site (lower vs. upper). Overall, the initiation of OAC therapy increased from 2010 to 2018 but remained consistently lower in patients with GIB. Conclusion Prior and concurrent GIB is common among patients with new-onset AF, and despite the overall increasing use of OACs, they remain less utilized in patients with GIB. [...]

Abstract Background VEXAS syndrome is an autoinflammatory disease caused by somatic UBA1 mutations on the X chromosome, predominantly affecting men. Objective To characterize VEXAS syndrome in women and to compare the features of VEXAS syndrome between sexes. Methods We conducted an international, multicenter study, including 12 women and 301 men with genetically confirmed VEXAS syndrome. Data were collected using a standardized case report form. Bone marrow analyses and molecular investigations were performed locally. Results Clinical features, age at onset, UBA1 mutation type, variant allele frequency, and mortality were comparable between sexes. Acquired X monosomy was found in 6/8 tested women. Additional clonal mutations were present in 3/5 tested women. Three additional UBA1-mutated women without typical inflammation are described separately. Conclusion VEXAS syndrome affects women with clinical features similar to men, supporting the need for UBA1 testing in women with compatible presentations. X monosomy is common but not universal, suggesting alternative pathogenic mechanisms. [...]

Abstract Alcohol and other substance use disorders (ASUDs) are prevalent and major contributors to global morbidity and mortality. Their impact extends beyond the individual, imposing significant burdens on families, communities, healthcare systems, and society at large. Treatments include psychosocial, behavioral, and pharmacological interventions. However, available pharmacological treatments remain limited, primarily targeting alcohol, tobacco, and opioid use disorders, with a lack of approved pharmacotherapies for other substance use disorders. This gap highlights a critical need to develop novel treatment options. Emerging evidence suggests that bidirectional brain-periphery communications play important roles in the pathophysiology and progression of ASUDs. Gut–brain hormones that are involved in the regulation of feeding and metabolism have been shown to influence reinforcing properties of food, alcohol, and other addictive substances. Additionally, stress-related pathways, especially the hypothalamic–pituitary–adrenal axis, play a significant role in regulating behaviors that are related to ASUDs. Accordingly, feeding- and stress-related neuroendocrine pathways represent novel pharmacotherapeutic targets for ASUDs. This narrative review discusses preclinical and clinical evidence for emerging pharmacotherapies that target ASUD-related neuroendocrine systems. Special emphasis is placed on recent work with glucagon-like peptide-1, ghrelin, fibroblast growth factor-21, amylin, glucocorticoids, and mineralocorticoids. [...]

Abstract Background The association between albuminuria and dementia has been insufficiently studied, possibly due to not considering dementia subtypes, the interplay with estimated glomerular filtration rate (eGFR), and the use of varying albuminuria measurement techniques. Objectives This study aimed to investigate the eGFR-independent risk of all-cause and type-specific dementia associated with albuminuria, measured by the urine albumin-creatinine ratio (ACR) and dipstick. Methods The main analysis included 132,869 subjects aged ≥65 years without a history of dementia and with at least one ACR test from the Stockholm Creatinine Measurements (SCREAM) project between 2006 and 2019. The primary and secondary outcomes were the incidence of all-cause dementia and type-specific dementia, respectively. Cox regression models were used to calculate hazard ratios (HRs, 95% CIs). Results During a median follow-up of 3.9 (interquartile ranges, 1.8–7.1) years, 9435 (7%) subjects developed incident dementia. After multivariable adjustments, including eGFR, an ACR level of 30–299 and ≥300 mg/g was associated with a 25% (HR, 1.25; 95% CI, 1.19–1.31) and a 37% (HR, 1.37; 95% CI, 1.23–1.51) higher risk of developing all-cause dementia, respectively, compared to an ACR level of [...]

Abstract Background The optimal remission induction therapy for severe antineutrophil cytoplasmic antibody-associated vasculitis (AAV) remains unclear. This study evaluated the effectiveness of rituximab (RTX) as a remission induction therapy for severe AAV compared with intravenous cyclophosphamide (IVCY). Methods Patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) treated with systemic glucocorticoids (GCs) and IVCY or RTX as initial remission induction therapy in multicenter REVEAL study between 1991 and 2024 were enrolled. We compared efficacy and safety outcomes between the two groups. Effectiveness was evaluated using all-cause mortality, GC-remission rate, relapse rate, and end-stage renal disease (ESRD) progression rate. Safety was evaluated based on complications from severe infections. Inverse probability of treatment weighting (IPTW) was applied for selection bias. Results Of 555 patients with AAV, 178 with severe MPA or GPA were identified (IVCY group: N = 133, RTX group: N = 45). After adjustment by IPTW, no significant differences in baseline clinical characteristics were observed between them. The 10-year survival rate and GC-remission rate at 6 months were significantly higher in the RTX group (p = 0.04, p = 0.017, respectively). ESRD progression and relapse rates were comparable between two groups. Regarding safety, 15.2% of patients in the IVCY group died due to severe infections, whereas none did in the RTX group (p = 0.007). Conclusions RTX demonstrated superior efficacy in improving survival and achieving GC remission, with fewer infection-related deaths compared to IVCY in patients with severe AAV. These findings reveal the efficacy and safety of RTX as a remission induction therapy in real-world Japanese clinical practice. [...]

  Abstract Background Hereditary transthyretin (ATTRv) amyloidosis was first described in Sweden in the late 1960s. Selected patient data have been collected since then and have now been transferred to a national quality registry. Methods This is the first report from SveATTR—a longitudinal Swedish web-based registry open for TTR variant carriers and patients with ATTR amyloidosis. The registry covers basic background information, as well as relevant clinical follow-up measures and data on disease-modifying therapies. Data from all ATTRv amyloidosis patients registered through December 2022 were included. Results In total, 1055 patients were included, of whom 65% were males and 95% carried the V30M variant. Median age of onset was 64 years, and 79% had a late disease onset (≥50 years). Eighty-seven percent of the patients had peripheral polyneuropathy at onset, whereas 10% had cardiac symptoms, 8% had visual disturbances, and 6% had gastrointestinal symptoms. A total of 159 patients had undergone liver transplantation, and 233 had received a disease-modifying drug. Improved survival was seen for transplanted patients and for patients on drug therapy. Conclusion This report highlights the importance of SveATTR for further characterization of the Swedish ATTRv amyloidosis population as well as for evaluating the efficacy of disease-modifying therapies. [...]

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

Abstract Background High-density lipoprotein (HDL) function, rather than its concentration, plays a crucial role in the development of coronary artery disease (CAD). Diminished HDL antioxidant properties, indicated by elevated oxidized HDL (nHDLox) and diminished paraoxonase-1 (PON-1) activity, may contribute to vascular dysfunction and inflammation. Data on these associations in CAD patients, including acute coronary syndrome (ACS), remain limited. The aim of this study is to assess the association of oxidized HDL with PON-1 activity, oxidized low-density lipoprotein (LDL), vascular cell adhesion molecule-1 (VCAM-1), IL-6 levels, and nitric oxide (NO) production as markers of vascular health. Methods We assessed HDL function in three groups: 90 CAD patients, 90 healthy controls, and 90 ACS patients. HDL antioxidant function was measured using a validated biochemical assay to quantify oxidized HDL (nHDLox). Plasma PON-1 activity, oxidized LDL, VCAM-1, IL-6, and NO production were also evaluated. Results ACS patients had nHDLox levels 140% higher than healthy controls (p  [...]

Failures of non-technical skills (NTS) contribute substantially to patient harm. Few NTS improvement opportunities are available in Australia—fewer still for rural surgeons. Remote video-based coaching is feasible and may be effective as a method to improve rural surgeons' NTS. ABSTRACT Background Many adverse events are caused by failures of surgeons' non-technical skills (NTS). The aim of this study was to investigate the feasibility and effectiveness of a remote video-based coaching (RVBC) intervention conducted in rural settings. Methods This study was a multi-centre, prospective, pre-post intervention study with ethical approval granted by CALHN HREC (ID#16888). Enrolled consultant surgeons were allocated a coach, then audio-visually recorded in three clinical contexts (outpatient consultation, ward round and operating theatre) three times. The first round of filming formed the pre-intervention baseline, the second round occurred after a single coaching session and the third occurred after two coaching sessions. After the first two rounds of filming, recordings were sent to coaches for review, followed by a one-on-one remote coaching session using teleconference. Feasibility was assessed across three metrics: recruitment and retention, data management and acceptability. Effectiveness was analysed through post-intervention questionnaires and objective, blinded NTS assessment using validated tools. Results Eighteen surgeons were recruited, with 17 completing all rounds of filming and coaching. Most surgeons perceived RVBC as valuable, enabling the identification of strengths, weaknesses and strategies for improvement. Objective NTS improvements were seen for 13 out of 17 surgeons in ward rounds and 10 out of 17 surgeons in both clinic and operating theatre settings. Conclusion RVBC is feasible across multiple hospitals and clinical settings and was effective for the improvement of surgeons' NTS in most participating surgeons. RVBC could be offered to surgeons as an evidence-based NTS improvement activity. [...]

ABSTRACT Background Sacrococcygeal pilonidal sinus disease (SPD) is a chronic inflammatory condition that can significantly impact quality of life. While recurrence and surgical site infection (SSI) rates are well documented, less is known about how different surgical techniques affect patient-reported outcome measures (PROMs). Methods This study employed mixed methods, including standardised mail questionnaires and telephone interviews (May–September 2020), to conduct a multi-centre retrospective decade follow-up review of definitive SPD surgery participants from Western Australia. Six surgical technique groups were analysed: Karydakis flap (KF), modified Karydakis flap (MKF), Limberg flap (LF), modified Limberg flap (MLF), other flap techniques (OFT) and secondary intention healing techniques (SIT). PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction—secondary outcomes examined recurrence, SSI and other complications. Results A total of 136 patients met the inclusion criteria. MLF and OFT achieved the fastest functional recovery, with median return-to-work times of 14 and 21 days, respectively, compared to 60 days for SIT (p = 0.007). MKF and LF achieved the highest body image and cosmetic satisfaction scores (medians of 20 and 19), whereas SIT and OFT scored the lowest. MKF yielded the highest overall satisfaction (100%). SIT was associated with the highest recurrence rate (52.2%) and SSI rates (30.4%), while MLF and MKF combined had low recurrence rates with favourable PROMs. Conclusion Flap-based techniques, particularly the MKF and MLF, offer an optimal balance of functional recovery, cosmetic outcomes and low recurrence rates. Incorporating PROMs into SPD surgical planning can better align treatment with patient priorities and the underlying pathophysiology of the disease. [...]

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

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

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

ABSTRACT Background Single-port thoracoscopic surgery (SPTS) has emerged as a cornerstone of minimally invasive lung cancer management. However, visible chest wall scars remain a persistent concern. The pursuit of scarless surgery has driven the exploration of concealed incision techniques. This study evaluates the feasibility and safety of a novel areola-concealed incision approach for SPTS in lung cancer resection. Methods Following the administration of successful general anesthesia, an incision measuring approximately one-sixth to one-third of the areolar circumference was made along its outer margin. Between April and July 2024, 33 patients with early-stage lung cancer underwent SPTS via periareolar incision. Technical success, operative metrics, complications, and cosmetic outcomes were prospectively analyzed. Results All procedures were completed without conversion to multi-port or open surgery. The average surgical time was 107.1 min, with an average intraoperative bleeding of 33 mL. Chest tubes were removed at a median of 3 days postoperatively. At 3-month follow-up, all incisions healed without visible scarring, and nipple-areola complex integrity was preserved. No major complications occurred. Conclusions The areola-concealed SPTS technique demonstrates safety and technical feasibility for early-stage lung cancer, achieving scarless outcomes while maintaining oncological rigor. This approach may redefine aesthetic standards in minimally invasive thoracic surgery. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2400083283 [...]

Conversion metabolic surgery performed in a government-funded setting is safe and effective, with low hospital bed days. Medium-term weight loss is comparable between conversion RYGB and OAGB. ABSTRACT Background The demand for conversion gastric bypass bariatric procedures has increased; however, the ideal procedure remains contentious, and access to government-funded procedures remains limited. This study aimed to determine if the medium-term weight loss, reflux, and safety outcomes are significantly different in patients who receive conversion Roux-en-Y gastric bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in an Australian government-funded hospital (GFH). Design This was a retrospective observational study of 251 adult participants who received conversion gastric bypass surgery at the Royal Brisbane and Women's Hospital between January 1, 2015, and April 30, 2023. The primary outcome measure was the annual percentage total weight loss (%TWL) from 12 months to 5 years following conversion to RYGB versus OAGB. Secondary outcome measures were post-operative reflux, hospital length of stay (LOS), and complications within 90 days. Results The annual median %TWL from 1 to 5 years post-surgery did not demonstrate a statistically significant difference between conversion RYGB and OAGB. Participants who had previously received a laparoscopic adjustable gastric banding (LAGB) and had a conversion to RYGB for gastro-oesophageal reflux demonstrated statistically significantly better annual %TBWL out to 4 years compared to those who had received a prior sleeve gastrectomy (SG) χ 2(1) = 6.4, p = 0.011. Similarly, there was a statistically significant improved %TWL in patients with gastro-oesophageal reflux, who were converted to OAGB from primary LAGB compared to primary SG; however, this was only statistically significant out to 2 years χ 2(1) = 4.2, p = 0.041. Pre- and post-operative gastro-oesophageal reflux and LOS were comparable in conversion RYGB and OAGB procedures. RYGB demonstrated a significantly higher incidence of the post-operative complications out to 90 days; p = 0.008. Conclusion RYGB and OAGB provide durable medium-term weight loss when performed as conversion procedures. Our results suggest that consistent, improved medium-term weight loss can be achieved in participants who undergo conversion gastric bypass in the context of reflux if they have previously received LAGB. There was no significant difference in the incidence of de-novo gastro-oesophageal reflux following either RYGB or OAGB. [...]

ABSTRACT Purpose Acute diverticulitis is a common presentation to hospital emergency departments (ED) and a significant burden on healthcare resources worldwide. Multiple studies have shown that outpatient management of uncomplicated diverticulitis is safe, yet many patients are still treated in the hospital. We instituted a protocol for the outpatient treatment at our institution, focusing on safety and healthcare costs. Methodology From February 2021, the new outpatient management of uncomplicated left-sided diverticulitis protocol was implemented; all patients that presented through the ED with a computed tomography diagnosis of uncomplicated left-sided diverticulitis were managed as an outpatient with oral antibiotics unless they met exclusion criteria (insulin-dependent diabetes, immunosuppression, active malignancy, pregnancy, or inflammatory bowel disease). This was compared to a historical comparison immediately prior. The primary outcome of interest was length of stay (LOS) in hours. Results There were 106 patients in each group. The LOS in the outpatient group was 29.7 h less than in the inpatient group (95% CI 21.9–37.5; p  [...]

ABSTRACT The detrimental effect of poor operative ergonomics in surgery cannot be underestimated. It's associated with negative outcomes such as increased burn-out, fatigue, clinically relevant pain, and early retirement. Pregnancy creates additional challenges for female surgeons to prevent injury while adjusting to anthropometric changes that are difficult to accommodate for using open and laparoscopic surgical techniques. The robotic platform has been associated with improved ergonomic capabilities while maintaining dexterity and access. Robotic surgery will likely chaperone in a new era of possibility for female surgeons in particular of career longevity, reduced leave requirements, and improved comfort while operating pre- and post-partum. [...]

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

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

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

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

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 7, Page 699-703, October 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue S1, Page S4-S6, October 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue S1, Page S18-S21, October 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue S1, Page S12-S17, October 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue S1, Page S7-S11, October 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue S1, Page S1-S3, October 2025. [...]

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

ABSTRACT Interventional Radiology (IR) is a relatively young specialty that has experienced rapid development since Charles Dotter performed the first percutaneous transluminal angioplasty in 1964. Since then, IR has expanded to include a diverse array of minimally invasive image-guided procedures. It was the same Charles Dotter who early on recognized that the Interventional Radiologist must be involved in patient care as a true clinician, not just a skilled mechanic. However, outpatient and periprocedural clinical patient management by IR has remained underdeveloped when compared to the significant procedural advancements seen over the past four decades. We present local Australian health service data reinforcing the value of formal outpatient clinics in delivering adequate patient counselling, improving consent rates prior to the procedure day, and decreasing costly day-of-procedure cancellations and reschedulling. [...]

ABSTRACT Introduction While gender disparities in the radiology workforce are well-documented, there has been no analysis of outcomes for competitive awards in Australia and New Zealand. As formal recognition is critical for career progression, this study aimed to investigate gender-based differences in application and success rates for grants, prizes and educational fellowships within the Australasian context. Methods We retrospectively reviewed applications for Royal Australian and New Zealand College of Radiologists' (RANZCR) Faculty of Clinical Radiology grants, prizes and educational fellowships from 2011 to 2024. Application and success rates were stratified by gender and compared to College membership demographics. Significance was assessed using Fisher's exact test. Results Across 333 total applications, 227 (68.2%) were from males and 106 (31.8%) from females, closely reflecting College membership gender ratios (69.2% male vs. 30.8% female). No significant gender disparity was found in the success rates for grants (40.3% for males vs. 35.0% for females, p = 0.58), prizes (8.8% vs. 11.1%, p = 0.08) or educational fellowships (36.7% vs. 32.1%, p = 0.32). Application rates for each award type also broadly reflected the gender composition of the College membership. Conclusion This study is the first to examine gender differences in clinical radiology grant, prize and educational fellowship outcomes in Australia and New Zealand. We found no significant disparities in success rates, and application rates generally mirrored College membership, suggesting the award process itself is equitable. However, the continued underrepresentation of women in radiology underscores the need to examine broader structural and sociocultural factors that may impact engagement with competitive academic opportunities. [...]

ABSTRACT Sulfur Hexafluoride, one of the most potent greenhouse gases, is used in radiation oncology as a dielectric in linear accelerator waveguides. Given the high global warming potential of SF6, its use is heavily regulated, and possible leaks should be proactively monitored. Truebeam Linac diagnostic log files record SF6 pressure metrics every 2 h. These log files were parsed, and the high time resolution pressure data were studied across a fleet of 15 Varian Truebeam Linear Accelerators for a 1 year period. Average SF6 leak rates were low, but highly variable (8.6 g/year/Linac, std dev 17.7 g). Pressure fluctuation due to temperature change was found to be a similar magnitude to real SF6 losses over months. Leak rates calculated from pressure loss were significantly below those reported in the literature and manufacturer specifications. Pressure fluctuation proportional to temperature change caused by Linac use makes SF6 pressure an unreliable metric to sample infrequently if the aim is to detect small leaks. A novel method for calculating leak rate using high sample rate log files mitigates this effect, giving a more accurate measurement. [...]

ABSTRACT Introduction Decision-making for adjuvant therapy regimen of elderly patients with glioblastoma may be based on age alone rather than prognostic factors. This study assesses treatment outcomes for elderly patients with good prognostic factors managed with the EORTC-NCIC Protocol. Methods Patients treated for glioblastoma with adjuvant chemoradiotherapy in accordance with the EORTC-NCIC (Stupp) Protocol between 2008 and 2021 were entered into a prospective database. Outcomes for patients aged  75 years. Overall survival (OS) and progression-free survival (PFS) were the primary and secondary endpoints, respectively. Results The study included 437 patients, of whom 319 were aged [...]

Australian Journal of Rural Health, Volume 33, Issue 5, October 2025. [...]

Australian Journal of Rural Health, Volume 33, Issue 5, October 2025. [...]

ABSTRACT Objective Describe Australian occupational therapy (OT) workforce distribution trends by total numbers, demographics, work type, and job roles across remoteness levels. Design Exploratory spatial analysis of workforce distribution compared to total populations between 2013 and 2021. Setting Australia. Participants OTs participating in registration surveys (2013–2021) and Australians from the 2011, 2016, and 2021 National censuses. Main Outcome Measures Proportion of occupational therapists, hours worked, First Nations inclusion, leadership roles, and practice areas across Modified Monash Model (MMM) levels of remoteness compared to populations. Results Despite a 72% national workforce increase (over 10 000 OTs) over nine-years, metropolitan areas consistently retained a disproportionate share of workforce, hours worked, specialised practice areas, leadership roles, and First Nations identifying therapists. Regional centres showed the highest growth but would require similar growth for 4–15 years to equal metropolitan ratios, while workforce gaps will likely widen for other remoteness levels. Private sector hours increased substantially by 100-h/10 000 population, while public sector hours increased by just 1-h. However, private sector growth did not extend equitably to rural and remote places. Metropolitan, regional, and large rural towns outpaced all other remoteness levels in leadership growth suggesting a centralising tendency. At current rates, representative First Nations proportions will not be achieved. Equity against 2021 numbers requires redistribution of at least 1717 therapists, 278 formalised leadership positions, and increased specialised services to rural and remote places. At least 598 additional First Nations identifying therapists are needed nationally, of which 406 (68%) are needed in regional, rural, and remote places. Conclusion Persistent maldistribution of the OT workforce across remoteness levels reflects structural inequities unlikely to resolve through organic growth. Current rural workforce strategies appear insufficient to address geographic and cultural disparities. Targeted investment in rural workforce development, including incentives and pipeline models are likely required to support equitable availability of OT services. [...]

ABSTRACT Objective This study aimed to explore healthcare experiences of transgender and gender diverse (TGD) individuals, their whānau (family), and primary care clinicians in rural Aotearoa New Zealand. It explored the enablers of gender-affirming care (GAC) and the challenges that remain, using these insights to build a culturally responsive, strengths-based model of care. Design Qualitative study using semi-structured interviews, analyzed via reflexive thematic analysis. Setting Whanganui, a regional district in Aotearoa New Zealand. Participants Participants included 12 TGD individuals, two whānau members, and five clinicians providing GAC within primary care. Main Outcome Measures Experiences of accessing and delivering healthcare, with a focus on GAC pathways, mental health support, and culturally appropriate service models. Results TGD participants described fragmented systems requiring self-navigation, with delays, gatekeeping, and limited access to affirming mental health services. Clinicians reported gaps in training, a lack of clear pathways, and few referral options. Both groups emphasized the value of peer support, whānau-centered models, and culturally safe approaches. There was shared support for a local, centralized GAC service in Whanganui, building on existing resources and grounded in cross-sector collaboration, clinician education, and local leadership. Conclusion This study demonstrates both the challenges and potential of rural TGD healthcare. Findings support a regionally tailored model of GAC involving services and community, sustained through partnership and grounded in cultural safety. In Whanganui, strong foundations already exist to support such a model. With local adaptation, it could guide equitable service development in other rural regions of Aotearoa. [...]

ABSTRACT Objective To explore the use of flipped classroom (FC) design for occupational therapy and speech pathology students studying in regional Australia. Setting Occupational therapy and speech pathology students in a regional Australian university in Central Queensland. Participants 33 occupational therapy and speech pathology students provided survey data; 5 students supplied in-depth data from focus groups; three educators completed teaching reflections. Design A multiple case study methodology was implemented based on Yin's definition1. Case study one involved occupational therapy students and case study two involved speech pathology students. A sequential exploratory mixed methods design was embedded within each case study. After participation in a unit using FC design, students completed a quantitative survey followed by a focus group for each case. Document analysis of teacher reflections and unit evaluations was also completed. Results Quantitative results show that student confidence, knowledge, and satisfaction are strongly supported by the FC approach. Rich qualitative data from the cases yielded four themes: individual attributes of the educator; purposeful and flexible design features; the role of the student as an active learner; facilities and resources for flipped classrooms. Conclusion This case study data supports the benefits of FC design for health professions students, has enabled the development of a conceptual framework which could be applied to health professions and beyond to other disciplines, and has also provided the foundations for guidelines to support educators to implement FC methodology. [...]

ABSTRACT Objective To examine the demographic differences between individuals with Type 2 Diabetes (T2D) enrolled in rural and urban clinics and evaluate the quality of care they receive. Design Cross-sectional observational study. Setting Primary care data from four large Primary Healthcare Organisations across the Auckland and Waikato regions of New Zealand. Participants Patients aged 18–75 years with T2D from February 2021 to August 2022. Main Outcomes Measures Associations between rurality and sociodemographic variables, clinical measures, and prescribing rates. Results A total of 56 937 patients with T2D were included, with 85.3% enrolled in urban practices and 14.7% in rural. Rural clinics had a significantly higher proportion of Māori individuals than urban clinics (31.4% vs. 17.4%). Patients in rural clinics had lower but not clinically significant reductions in mean HbA1c, LDL-c, blood pressure, and eGFR than those in urban clinics; however, the number of laboratory tests completed during the study period was lower in rural clinics. Māori were less likely to receive HbA1c and uACR tests than non-Māori. Clinically indicated prescribing for metformin (79.1% vs. 72.5%), ACE inhibitors (80.5% vs. 75.2%), and statins (61.2% vs. 54.4%) was higher in patients enrolled in urban than rural clinics (all p  [...]

ABSTRACT Objective To examine differences and changes in workplace and demographic factors between metropolitan and rural surgeons in Australia over 10 years. Methods A retrospective study which analysed data from the Health Workforce Dataset Online Data Tool, based on annual registration data from the Australian Health Practitioner Regulation Agency (AHPRA) spanning 2013–2022. The dataset includes information on all surgeons who have completed their training and are registered as fellows with the Royal Australasian College of Surgeons, and who were working in Australia during the study period. The factors analysed included mean hours worked per week, gender, age, and origin of qualification. Regions of work were defined using the Modified Monash Model (MM) model. Results During the study period, the number of surgical fellows in Australia increased from 4568 to 5724, with a notable increase in the proportion working in metropolitan regions. On average, these surgeons worked 45 h per week across most regions. The percentage of female surgeons rose from 9.6% to 15.4% in metropolitan regions and from 6.9% to 12.4% in rural regions. Surgeons working in rural regions tended to be older. However, there has been an increase in the number of surgeons aged 35–44 working in these areas. Additionally, sub-specialties other than general surgery were rarely found in rural areas. Conclusion While the number of surgeons in Australia has increased, there is a disproportionate shortfall of surgeons practising in rural areas. [...]

ABSTRACT Aim To propose the novel role of Aboriginal and/or Torres Strait Islander Allied Health Co-Worker to address an urgent unmet need in rural and remote Australia that focuses on disability, rehabilitation and preventative health needs in a unique cultural context. Context Allied health and therapy assistants represent a rapidly expanding workforce with considerable potential to relieve workforce shortages and address urgent and unmet healthcare needs in rural and remote Australia. However, the current recognised roles of “Allied Health Assistant” or “Therapy Assistant” are incompatible with the needs of the Aboriginal and Torres Strait Islander communities. Approach This commentary prosecutes the case that for Aboriginal and Torres Strait Islander families and communities, the allied health assistant role should be adapted to an Aboriginal and/or Torres Strait Islander Allied Health Co-Worker (AHCW). The AHCW would provide allied health clinical care within the scope of an allied health assistant, as well as cultural brokerage and leadership to support the cultural needs of the people and communities with which the services are interacting. Recommendations are proposed for sustainable implementation of this role. Conclusion It is proposed that Aboriginal and/or Torres Strait Islander Allied Health Co-Workers' roles and appropriate recognition of their cultural leadership roles be introduced and embedded in health and disability employment policies. [...]

ABSTRACT Objectives Determine counts, characteristics and outcomes following transport by the Royal Flying Doctor Service Western Operations (RFDSWO) to Perth. Study Design Retrospective cohort study of the RFDSWO aeromedical patient dataset linked to administrative datasets. Participants Suspected acute coronary syndrome (ACS) patients aged ≥ 25 years transported from rural Western Australia to Perth between 2001 and 2017. Main Outcome Measures Basic counts and proportions. Poisson regression was used to determine absolute change in number of transports and relative risk (RR) of receiving diagnostic coronary angiography; logistic regression to model odds ratio (OR) of death between transport and end of hospital care. Results RFDSWO carried out 11 390 transports for suspected ACS between 2001 and 2017, with the absolute number of annual transports increasing by 6.0%. After excluding 164 transports without linked records, the remaining 11 226 consisted of patients with a mean age of 60.3 years and 70.8% male. Most (99.1%) were hospitalised and 1.8% died. Among those hospitalised, 84.5% received diagnostic coronary angiography and 74.5% were discharged with a diagnosis of ACS. Females (RR = 0.97; CI = 0.95–0.99), higher comorbidity scores, and those from the Pilbara/Midwest/Wheatbelt regions (compared to South West) were less likely to receive diagnostic coronary angiography. Older patients (OR = 1.07; CI = 1.06–1.11), earlier transport years, higher comorbidity scores, those with priority 1 transport or requiring medical escort, and those from the Kimberley (compared to South West) were more likely to die. Conclusions Findings suggest a high suspicion of coronary artery pathology among transported patients. Patient-level and regional differences in outcomes warrant further investigation with more granular data. [...]

ABSTRACT Objective Explore Parkinson's Disease (PD) related prescription patterns for people with PD living in metropolitan and non-metropolitan areas of New South Wales, Australia. Methods Exploratory, cross-sectional data linkage study. Participants were grouped according to geographic location and by age group: metropolitan or non-metropolitan; rural, regional, and remote. Prescription patterns were analysed using descriptive and inferential statistics. Design The Sax Institute's 45 and Up Study data was linked to the Pharmaceutical Benefits Scheme (PBS) records (2004–2017) for all participants with PD. Setting Retrospective data exploration and analysis. Participants 1648 participants who self-identified as having PD and voluntarily contributed to the 45 and Up longitudinal study. Main Outcome Measures Statistical comparisons based on location were undertaken for the different groupings for PD-specific medications. Results Significant differences in the proportions of PD-related medications are observed between locations. Significant differences in the proportions of PD-related medications are observed between locations. A higher proportion of levodopa and levodopa combinations is reported for major cities (75.5%) compared with the inner region (70.3%) and outer and remote regions (74.1%). Additionally, other PD-related medications in the non-metropolitan areas are proportionally higher than those reported for major cities. Analysis by age groups suggests large effect sizes for the 75–79 and 45–49 age groups, while medium and small effect sizes are reported for the 55–59 and 70–74 age groups, respectively. Conclusion Inequities with best practice medication treatment for PD exist between metropolitan and non-metropolitan areas of NSW. Efforts are required to successfully bridge gaps. Upskilling GPs may provide one way to optimise therapy and quality of life. [...]

ABSTRACT Objective This study investigated local public health authorities' perspectives on implementing a new online STI testing service for young people in regional/rural Victoria, Australia. Setting Study was conducted to support the design of Test it, a free, online STI testing service being developed for Victoria. After completing an online registration and sexual health questionnaire, users receive an electronic test request form to take directly to a pathology centre without seeing a general practitioner (GP). Participants Ten individuals responsible for the coordination of community sexual health services within 7 Victorian Local Public Health Units (LPHUs) and the Department of Health, and a state-wide health promotion organisation. Design Semi-structured interview topics covered: attitudes towards online STI testing, advantages and challenges of online STI testing for regional and rural communities, and strategies to support effective implementation. Results Participants were enthusiastic about the potential of an online STI testing service, perceiving it to offer options in settings with limited sexual health providers, provide users with greater anonymity (bypassing GPs), improve efficiency, and support LPHUs to deliver their priorities. However, needing to attend a pathology service in-person may reduce appeal and create barriers given limited transport/opening hours and stigmatisation concerns by young people. Navigating treatment, if needed, may also be challenging. Conclusion Despite offering advantages, regional/rural young people are likely to encounter barriers to online STI testing that are different from and more significant than those faced by young people in urban areas. Strategies are needed to support implementation in regional/rural areas to realise the full potential of online testing to improve equitable access for underserved communities. [...]

ABSTRACT Aims This paper explores the pervasive influence of Commercial Determinants of Health (CDoH), particularly the proliferation of ultra-processed foods (UPFs), on rural diets, and introduces the concept of Commercial Determinants of Rural Health (CDoRH) to highlight the unique challenges faced by rural Australian communities. In response, we propose a framework for simple, low-cost, and adaptable initiatives aimed at improving rural food environments and dietary behaviours. Context Rural populations experience a disproportionately high burden of non-communicable diseases (NCDs), with poor diet and the widespread availability of UPFs as major contributing factors. The impacts of CDoH, amplified by centralised supply chains and limited market competition, are particularly acute in rural settings. As poor diet remains the most significant modifiable risk factor for NCDs, the need for targeted rural interventions is urgent. Approach The proposed model leverages the potential of small-scale, low-cost initiatives that harness social capital and local resources. These initiatives aim to transform local rural food environments and dietary habits through place-based, collaborative, educative, and practical activities such as community gardens, food events, and local partnerships. Conclusion This model intervenes in the space between large-scale systemic reform and the everyday food choices of individuals and communities. By fostering quick, accessible, and contextually grounded initiatives, it offers a practical framework for improving local food environments and behaviours, enhancing food literacy, and mitigating the harms of CDoRH in ways that resonate with rural lived experience. [...]

10.1542/6376238924112Video AbstractPEDS-VA_2024-0681336376238924112BACKGROUND AND OBJECTIVESex chromosome trisomies (SCT), including XXY, XYY, and XXX syndromes, have been historically underdiagnosed. Noninvasive prenatal cell-free DNA screening has significantly increased identification, leading to a need for pediatric care for a growing population of newborns with SCT. Our goal was to analyze and compare perinatal, medical, and physical features in infants with prenatal identification of SCT through 12 months of age.METHODSThe eXtraordinarY Babies Study is a prospective natural history study of prenatally identified children with SCT. Participants enroll prior to 12 months of age and have medical histories and examinations at 2-, 6-, and 12-month visits. Descriptive statistics were followed by comparisons between SCT groups (t tests, analysis of variance, Fisher exact tests). Relative risks were calculated compared to general population rates.RESULTSA total of 309 infants are included (XXY = 182; XXX = 76; XYY = 51). Relative risk (RR) compared to general population is elevated for breastfeeding difficulties (51.1%; RR 2.7 [CI 2.1–3.4]), positional torticollis (29.4%; RR 7.5 [5.3–10.7]), eczema (47.6%; RR 3.5 [3.1–3.9]), food allergies (19.4%; RR 2.4 [1.9–3.1]), small cardiac septal defects (7.8%; RR 17.3 [11.8–25.3]), and structural renal abnormalities (4.5%; RR 10.1 [6.0–16.8]), all P  [...]

We present a case of infectious endocarditis in the immediate post-transplant period in a 7-year-old child. On postoperative day 6, an elevation in inflammatory markers was detected, and the echocardiogram revealed a pedunculated mass on the mitral valve. The patient underwent surgical resection on postoperative day 14, followed by a 6-week course of antibiotics. The patient demonstrated complete resolution of endocarditis and, at 5-year follow-up, has excellent allograft function without recurrence of endocarditis. [...]

10.1542/6377236003112Video AbstractPEDS-VA_2025-0711346377236003112OBJECTIVETo examine the effects of acceptance and commitment therapy (ACT) on reducing psychological distress and promoting quality of life (QoL) in parents of children with cancer.METHODSA 2-arm paralleled randomized controlled trial was conducted with the intervention group receiving a 4-session weekly ACT-based intervention and the control group receiving the usual care. The primary outcomes were parental psychological distress and QoL. Secondary outcomes were parental experience of child’s illness, experiential avoidance, psychological flexibility, and child’s psychological adjustment to cancer. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the intervention (T2).RESULTSA total of 142 children and their parents were recruited. Generalized estimating equation analyses showed that the intervention group reported significantly positive changes in parental psychological distress (β = −13.54, 95% CI: −20.04 to −7.03, P  [...]

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” William Osler [...]

OBJECTIVEThe American Academy of Pediatrics (AAP) publishes evidence-based infant sleep recommendations to prevent sudden unexpected infant death (SUID). We defined common patterns of infant sleep and care practices in Illinois and assessed variation in patterns across demographic characteristics.METHODSWe measured maternal report of AAP recommended practices in the 2016–2020 Illinois Pregnancy Risk Assessment Monitoring System, including breastfeeding greater than or equal to 8 weeks; no maternal smoking; and 4 aspects of the sleep environment for infant sleeping on back, on an approved surface, without items in sleep area, and without bed sharing. We applied nonhierarchical cluster analysis, coupled with knowledge of AAP recommendations, to define 6 mutually exclusive patterns of infant sleep and care practices. We produced weighted prevalence estimates for each individual practice and pattern and examined differences by maternal race and ethnicity, age, parity, education, and socioeconomic status using χ2 tests.RESULTSPrevalence estimates for individual practices ranged from 49.6% for infants sleeping without items in sleep area to 90.8% for not smoking. When examining patterns, only 19.3% of new mothers reported all 6 recommended practices; this pattern varied significantly across all demographics examined. The prevalence of the other 5 patterns were as follows: 8.1% following all 4 sleep environment practices, 28.1% bed sharing and breastfeeding, 11.7% bed sharing and no breastfeeding, 25.1% no bed sharing and back sleep positioning, and 7.8% no bed sharing and no back sleep positioning.CONCLUSIONExamining common patterns of infant sleep and care practices provides improved understanding of how infant sleep recommendations are followed and may inform intervention strategies. [...]

In this issue of Pediatrics, Holicky and colleagues describe findings from the 2016 to 2020 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS), demonstrating important variations in maternal adherence to recommendations regarding infant sleep practices, breastfeeding, and smoking abstinence.1 Importantly, the report describes patterns of infant sleep and care practices instead of focusing on just 1 element. [...]

10.1542/6376239004112Video AbstractPEDS-VA_2024-0698086376239004112BACKGROUND AND OBJECTIVESHIV preexposure prophylaxis (PrEP) is a safe and effective way to reduce HIV acquisition and was approved for adolescents in 2018. We assessed whether states with minor consent laws (MCLs) allowing younger adolescents to receive PrEP without parental/guardian consent were associated with increased prescription fills.METHODSA legal review classified whether states had MCLs. A negative binomial regression model using national all-payer pharmacy claims compared PrEP fills between minors (13–17 years) and majority-age adolescents (18–19 years) between states with and without MCLs from 2015 to 2021, among 15 states with the highest minor PrEP fills. Key informant interviews (n = 25 experts from 7 states) elicited context for interpreting statistical results.RESULTSOn average, minors had lower PrEP fills than majority-age adolescents (incident rate ratio [IRR], 0.21; 95% CI, 0.17–0.24). However, the interaction term between MCL and age group was insignificant (IRR, 1.11; 95% CI, 0.91–1.36), indicating that age group differences were similar between MCL and non-MCL states. Experts described numerous barriers faced by adolescents in accessing PrEP, including confidentiality concerns, clinic access, stigma, providers’ hesitancy to discuss sexual health with and prescribe PrEP to minors, limited information on PrEP in school-based sexual education, and health care literacy.CONCLUSIONSWe did not find evidence that the gap in PrEP prescription fills between minor and majority-age adolescents was smaller among states with PrEP-inclusive MCLs. Strategies to address the numerous barriers in PrEP access experienced by adolescents may be needed. [...]

10.1542/6375930237112Video AbstractPEDS-VA_2025-0716056375930237112OBJECTIVESUnsafe sleep practices contribute to sleep-related infant mortality. Recent infant illness is a risk factor for sudden unexplained infant death. This study examined changes to safe sleep practices during and after infant illness.METHODSWe performed a prospective cohort survey study of caregivers of infants (aged 0–12 months) presenting to the pediatric emergency department (ED) for illness. Surveys assessed sleep practices before, during, and after illness (2-week and 1-month follow-ups). We assessed adherence to the American Academy of Pediatrics (AAP) safe sleep recommendations at each time point. Differences in adherence were evaluated using mixed-effects logistic regression, whereas Poisson regression was used to evaluate the change in number of safe sleep practices for selected participant characteristics.RESULTSOf 131 enrolled participants, 106 (81%) completed all follow-up surveys. Adherence to AAP recommendations was low ( [...]

OBJECTIVEThe objective of this study was to increase dental varnish application rates across a large pediatric primary care network for all children, regardless of insurance type or race and ethnicity, using a quality improvement (QI) intervention.METHODSFrom July 2023 to October 2024, we implemented a multifaceted, iterative QI intervention that included electronic health record (EHR) prompts, practice-level education, maintenance of certification credit with monthly audit-and-feedback, and financial incentives. The primary outcome was the proportion of eligible preventive care visits (children aged 6 months to 5.99 years) at which dental varnish was applied. Balancing measures included application rates by insurance type and race and ethnicity. We evaluated implementation using Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework measures as follows: “Reach” (number of visits with varnish applied), “Effectiveness” (proportion of children receiving ≥1 varnish annually), “Adoption” (proportion of practices administering varnish), “Implementation” (visit-level application rate), and “Maintenance” (annual reimbursement, comparing July 2022 to June 2023 with July 2023 to June 2024).RESULTSDuring the intervention, 92 056 eligible preventive care visits occurred. Varnish application increased from 3.7% preintervention to 30.5%, exceeding our 20% target. RE-AIM findings included the following: Reach, application at more than 4000 visits per month (up from ∼400); Effectiveness, more than 50% of children received varnish annually (vs 25% at baseline); Adoption, increased from 6 to all 33 practices; Implementation, 30.5% application rate; and Maintenance, reimbursement increased from $155 000 to $416 000. Improvements were consistent across child insurance and race and ethnicity.CONCLUSIONSA system-wide, EHR-enabled QI intervention significantly improved dental varnish application for all children, regardless of insurance type or race and ethnicity. This approach may serve as a scalable model for integrating dental varnish into pediatric primary care. [...]

10.1542/6376239505112Video AbstractPEDS-VA_2025-0718836376239505112OBJECTIVESTo assess the risk of concurrent emergency department use (Co-ED) among women with a preexisting disability and their infants.METHODSThis population-based cohort study was completed in Ontario, Canada. Included were all mother–infant pairs with a hospital delivery, 2008–2023. Those with a maternal physical (N = 152 171), sensory (N = 54 716), or intellectual/developmental (N = 2913) disability or multiple disabilities (N = 11 800) were compared with those with no disability (N = 1 548 178). Multinomial logistic regression–generated odds ratios (ORs) and 95% CI for Co-ED (ie, mother and infant both had emergency department (ED) visits within 90 days after hospital discharge), a maternal ED visit only, or an infant ED visit only were calculated, each vs no ED visit. Models were adjusted for maternal age, parity, income quintile, rurality, immigration status, and delivery year.RESULTSCo-ED was more likely among women with (5.4%) than without (3.4%) a disability (adjusted OR [aOR], 1.66; 95% CI, 1.62–1.71). The median number of days between the first maternal and first infant ED visit was 19 (IQR, 4–41) days, and 18.3% occurred within 24 hours of each other. The aOR for maternal ED visit alone was 1.38 (95% CI, 1.35–1.40) and 1.20 (95% CI, 1.19–1.22) for an infant ED visit alone.CONCLUSIONSCo-ED was an important outcome for all mother–infant pairs, particularly so for mothers with a disability, of whom about 1 in 20 experienced Co-ED. These dyads may benefit from careful postdischarge planning during the birth hospital stay and enhanced outpatient health care. [...]

In 1904, Abraham Jacobi envisioned a future where pediatricians used knowledge, privilege, and power for good, at the bedside and in society.1 His vision foreshadowed the Modern Hippocratic Oath, which acknowledges that we, as physicians, are members of a “society, with special obligations to [our] fellow human beings.”2–4 Every year, new physicians join our profession. New pediatricians conclude residencies, begin practice, or embark on further training. Our traditions ground and push us, new and seasoned, to act ethically and responsibly, to support children, and to advance and shape our field. Still, many of us are currently struggling to find our footing amid dizzying societal shifts affecting our patients, colleagues, science, and society. [...]