Tag: pubmed

J Nutr Health Aging. 2026 Jun 15;30(7):100884. doi: 10.1016/j.jnha.2026.100884. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the association between food insecurity (FI) and functional disability (FD) among older adults over time in Ghana and South Africa (SA), and the mediating roles of childhood parental employment (CPE) and adult education (AE) statuses.

METHODS: Data were from 6,569 and 4,663 older adults (60+years) who participated in WHO-SAGE Ghana and SA (Waves 1-3), respectively, between 2007-2019. Multivariable-adjusted logistic mixed effects models were performed to examine the roles of CPE and AE statuses on the associations between FI, in general, and its measures – hunger and food insufficiency – with FD in older adults.

RESULTS: After adjusting for significant covariates, older adults who reported being food insecure (Ghana: aOR = 1.20, 95%CI: 1.03, 1.41, p = 0.024; SA: aOR = 1.98, 95%CI:1.54, 2.56, p < 0.001) and those who reported consuming insufficient food (Ghana: aOR = 1.21, 95%CI: 1.03, 1.42, p = 0.018; SA: aOR = 1.96, 95%CI:1.52, 2.53, p < 0.001) had higher odds of FD over time, compared with those who were food secure. For both Ghana and SA, hunger was associated with higher odds of FD. However, the association remained statistically significant only for SA. CPE and AE statuses proved to be relevant pathways through which FI was associated with increased odds of FD among older adults in Ghana and SA.

CONCLUSION: CPE and AE statuses mediated the associations between FI and FD among older adults in Ghana and SA. This highlights the importance of adopting early–late-life interventions to support the health and economic wellbeing of families to accumulate wealth for food security and functional wellbeing in later life.

PMID:42296619 | DOI:10.1016/j.jnha.2026.100884

Lung Cancer. 2026 Jun 6;218:109486. doi: 10.1016/j.lungcan.2026.109486. Online ahead of print.

ABSTRACT

BACKGROUND: In the phase III LAURA study, osimertinib demonstrated a statistically significant progression-free survival benefit versus placebo, and a generally tolerable safety profile, after definitive chemoradiotherapy (CRT) in unresectable stage III EGFR-mutated non-small cell lung cancer. We report in-depth safety data from LAURA.

PATIENTS AND METHODS: Patients without progression during/after definitive CRT were randomized 2:1 to receive osimertinib or placebo. Safety was assessed at baseline, week 2, week 4, every 4 weeks until week 24, every 8 weeks until week 48, and every 12 weeks until study treatment discontinuation. Adverse events (AEs) of special interest included grouped terms of radiation pneumonitis (RP) and interstitial lung disease (ILD, including pneumonitis).

RESULTS: Overall, 216 patients were randomized (osimertinib, 143; placebo, 73) and received ≥1 dose of study treatment; median exposure 24.0 months (osimertinib), 8.3 months (placebo). Exposure-adjusted rates of grade ≥3 AEs and serious AEs were 18 versus 13 and 20 versus 15/100 patient-years with osimertinib versus placebo, respectively. Exposure-adjusted AEs that occurred at the greatest increased frequency with osimertinib versus placebo were diarrhea and paronychia. AEs led to treatment interruption in 56 % versus 25 % of patients and to discontinuation in 13 % versus 5 % with osimertinib versus placebo, respectively. RP (grouped term) events were numerically higher in the osimertinib (48 %) versus placebo (38 %) arm but were mostly low grade; almost all events were reported by 18 weeks post-randomization. Protocol-mandated toxicity management guidelines effectively managed RP; most patients (60/69; 87 %) continued osimertinib, with or without interruption, and without recurrence (64/69; 93 %). ILD (grouped term) was mainly grade 1-2 and manageable; most events occurred within 20 weeks post-randomization.

CONCLUSIONS: Osimertinib after definitive CRT had an acceptable and manageable safety/tolerability profile, with no new safety findings, supporting osimertinib as the new standard of care in this setting. LAURA clinical trial registration number: NCT03521154.

PMID:42296617 | DOI:10.1016/j.lungcan.2026.109486

Burns. 2026 Jun 3;52(8):108100. doi: 10.1016/j.burns.2026.108100. Online ahead of print.

ABSTRACT

Keloids are benign tumors resulting from pathological scarring and excessive collagen deposition with diverse clinical presentations. The treatment of keloids remains challenging, often leading to recurrences. In this study, we propose an enhanced morphological classification, derived from both previous research and a retrospective analysis of 95 keloids treated surgically in our department with a global recurrence rate of 41.1% over an average follow-up of 3.75 years. We have analyzed the clinical presentation, together with prognosis and recommendations of treatment for the several keloid phenotypes we identified. This analysis enables us to propose a keloid classification defining 5 categories: type I – Acne keloïdalis nuchae (AKN); type II – Nodular outside the ear; type III – Nodular of the ear; type IV – Superficial spreading; type V – Mixed shape. This new clinical classification of keloids was statistically predictive for the risk of recurrence after surgery (p = 0.0158). Of interest, this proposed classification not only captured all keloid presentations but also provided valuable insights for prognosis and treatment. Type I showed a favorable prognosis, with less than 20% recurrence after extralesional excision and wound healing. Types II, III, and IV had moderate recurrence rates (30-50%). Nodular keloids were treated with intralesional excision and suture, followed by corticosteroid injections. Type V, however, had a poor prognosis with a 75% recurrence rate post-surgery. This phenotype-based classification offers a better understanding of keloid pathophysiology and optimization of treatment strategies tailored to specific keloid types.

PMID:42296612 | DOI:10.1016/j.burns.2026.108100

Burns. 2026 May 18;52(8):108071. doi: 10.1016/j.burns.2026.108071. Online ahead of print.

ABSTRACT

INTRODUCTION: American Burn Association (ABA) referral criteria help identify patients to be transferred. Limited data exist on characteristics of patients being transferred and utilization of these criteria at non-burn centers (NBC).

OBJECTIVES: To describe pediatric emergency department (ED) disposition practices at a non-burn center and compare these practices to ABA referral criteria.

DESIGN/METHODS: Retrospective review of electronic records of patients < 18 years old, with discharge diagnosis of burn at a non-burn healthcare system, from December 2016 to June 2022, was performed. Descriptive statistics and multivariable logistic regression was used to analyze transfer rates and determine odds ratios of different factors, comparing transferred and discharged patients.

RESULTS: 1231 cases were identified with 35% transferred. Of the 65% of patients discharged, 52% met ABA referral criteria. For all visits, 64% met at least one ABA criterion, of which 47% were transferred. Infants had greatest odds of transfer (OR 9.62, 95% CI 4.6 – 20.1). Burns to high-risk anatomical zones (OR 5.89, 95% CI 4.1 – 8.4), those with > 20% total body surface area (OR 16.86, 95% CI 4.3 – 66.7) and full/partial thickness burns (OR 11.47, 95% CI 5.5 – 23.9) were also all associated with highest odds of transfer.

CONCLUSION: The majority of visits met ABA criteria for transfer to a burn center; however, only about half those qualified were transferred. Some may have been appropriately discharged. Infants, large burns, burns to high-risk anatomic zones, or full/partial thickness burns were more often transferred indicating appropriate adherence to the established guideline. These data suggest that ABA criteria are very broad for pediatrics and do not have face validity for community physicians. Further work is needed to refine pediatric ABA referral criteria.

PMID:42296607 | DOI:10.1016/j.burns.2026.108071

Burns. 2026 May 27;52(8):108084. doi: 10.1016/j.burns.2026.108084. Online ahead of print.

ABSTRACT

AIM: To study the validity, reliability, standard error of the mean (SEM), minimum detectable change (MDC₉₅), and learning effect of three functional capacity tests in hospitalized burn victims: 5-repetition Sit-to-Stand (STS_5r), 1-minute Sit-to-Stand (STS_1min) and Timed up-and-go (TUG).

METHODS: In a cross-sectional study, 64 subjects were evaluated. The tests were randomly applied by two evaluators in three assessment moments: twice by the same evaluator (intra-rater) with a 1-day interval; and once by a second evaluator after the first assessment (inter-rater). 6-minute walk test (6MWT) and assessment of quadriceps femoris (QF) muscle strength were also performed. For analysis of the learning effect, all tests were repeated two times at each assessment moment.

RESULTS: The TUG showed very strong correlation with the 6MWT (r = -0.90, p < 0.0001), whereas for the STS_5r and STS_1min the correlation was moderate (r = -0.55 and 0.60, respectively; p < 0.0001). As for the QF muscle strength test, there was moderate correlation with the TUG (r = -0.41, p = 0.0008) and rather modest correlations with the STS_5r (r = -0.30, p = 0.013) and the STS_1min (r = 0.21, p = 0.091). Intraclass correlation coefficient values were good to excellent in all intra- and inter-rater tests (0.88-0.97). MDC₉₅ values ranged from 19% to 23%. Moreover, a small but statistically significant learning effect was observed in all tests.

CONCLUSIONS: The STS_5r, STS_1min and TUG tests are valid and reliable to assess functional capacity of hospitalized burn victims, despite a small learning effect indicating the need to perform two tests. SEM and MDC values here described can be used in clinical practice to improve interpretability of the tests’ results.

PMID:42296604 | DOI:10.1016/j.burns.2026.108084

Burns. 2026 May 22;52(8):108076. doi: 10.1016/j.burns.2026.108076. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluated the clinical efficacy and safety of amniotic membrane transplantation (AMT) enhanced with a fornix support ring for the treatment of severe acute ocular burns.

METHODS: Eighteen eyes of 15 patients with severe ocular burns (Grades III and IV) were included. Twelve eyes received AMT alone, while six eyes received AMT combined with a fornix support ring. Clinical outcomes, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), and postoperative complications, were monitored over a follow-up period of 3-28 months.

RESULTS: In the Grade III burn group, the addition of a fornix support ring to AMT significantly reduced the incidence of entropion and trichiasis compared to AMT alone (p = 0.018 for both). While the differences in symblepharon, keratitis, BCVA, and IOP changes did not reach statistical significance, clinical improvements were noted. Although statistical significance was not achieved in the Grade IV burn group, the group with the fornix support ring showed a reduced incidence of keratitis and other clinical differences.

CONCLUSIONS: This study demonstrated that the fornix support ring is a reliable and effective option for enhancing surgical outcomes in acute ocular burns. By deepening the fornices, improving amniotic membrane adhesion, and reducing the need for extensive suturing, the ring significantly decreases the occurrence of complications, such as symblepharon, entropion, and trichiasis.

PMID:42296600 | DOI:10.1016/j.burns.2026.108076

Burns. 2026 Jun 1;52(8):108098. doi: 10.1016/j.burns.2026.108098. Online ahead of print.

ABSTRACT

BACKGROUND: Hypothermia is common after major burn injury and may influence both systemic and wound-related outcomes. Although hypothermia has been associated with coagulopathy and higher rates of mortality in the trauma patient cohort, limited literature has examined its effects on the outcomes for patients with burns. The aim of this study was to identify the rate of hypothermia in patients transferred to a specialised burn unit, and to assess the impact on morbidity and mortality.

METHODS: This retrospective, single-centre study examined all burns presentations between 2009-2013. Hypothermia was defined as a core body temperature ≤ 35 °C on arrival. Statistical analysis used logistic regression for binary outcomes and negative binomial models for continuous outcomes. Multivariable logistic regression assessed hypothermia using continuous age, total body surface area burned (TBSA), and their interactions.

RESULTS: Of 268 patients with recorded temperature, 41 (15%) were hypothermic. Hypothermia increased with burn size (11.6% in <20% TBSA vs 35.7% in >50% TBSA; p < 0.01). Hypothermic patients had higher mean age (46.6 vs 41.0 years; p < 0.05) and larger burns (22.8% vs 14.7% TBSA; p < 0.01). Adequate first aid and use of the modified Parkland Formula were less frequently documented in hypothermic patients (75.7% vs 92.3% and 60.7% vs 79.5%, respectively; both p < 0.01). There was no significant difference in burn size across age groups (p = 0.918). On multivariable analysis, increasing TBSA was independently associated with hypothermia, whereas age was not, and no significant age-TBSA interaction was identified (p = 0.647). Hypothermia was associated with higher in-hospital mortality (14.6% vs 3.5%), longer ICU LOS (4.39 vs 2.33 days), and higher sepsis rates (9.8% vs 2.6%); but lower rates of skin grafting (36.6% vs 51.1%) and shorter hospital LOS (17.3 vs 19.7 days). On multivariable analysis, hypothermia independently predicted mortality, LOS, grafting, wound infection and sepsis.

CONCLUSIONS: Hypothermia remains common in burn patients transferred to a tertiary centre in NSW and is associated with larger burns, a higher average age, reduced adherence to early management protocols and poorer systemic outcomes despite reduced grafting rates and shorter hospital admissions.

PMID:42296598 | DOI:10.1016/j.burns.2026.108098

Cancer Radiother. 2026 Jun 15;30(2):104828. doi: 10.1016/j.canrad.2026.104828. Online ahead of print.

ABSTRACT

PURPOSE: Modern adjuvant therapies, including systemic treatments and radiotherapy, have significantly improved outcomes for patients with breast cancer. However, isolated nodal recurrences remain rare, comprising less than 1 % of cases, and pose a therapeutic challenge, with historical 5-year overall survival rates below 50 %. This study evaluated the clinical outcomes of patients with isolated nodal recurrences in the modern era using the Surveillance, Epidemiology, and End Results (SEER) database and examined factors associated with survival.

MATERIALS AND METHODS: We analysed data from 1479 female patients with cT0N+M0 breast cancer diagnosed between 2000 and 2021 in the SEER database. Patients were categorized as having isolated nodal recurrences if they had prior ipsilateral breast cancer or occult primary breast cancer if presenting with a first cancer diagnosis. Demographics, tumour characteristics, and treatments were recorded. Survival outcomes were assessed using Kaplan-Meier and Cox regression models.

RESULTS: Of 1479 patients, 42 (2.8 %) had isolated nodal recurrences, and 1437 (97.2 %) had occult primary breast cancer. Median time to isolated nodal recurrences was 105 months. Most initial tumours were early-stage (T1-T2, 75 %) and node-negative (78.6 %). Five-year overall- and cancer-specific survival rates of patients with isolated nodal recurrences were 72.4 % (95 % confidence interval [CI]: 57.6-91.0 %) and 81.5 % (95 % CI: 67.8-97.9 %), respectively, compared to 80.4 and 86.6 % for patients with occult primary breast cancer. Trends toward improved survival with adjuvant chemotherapy (5-year overall survival rates: 78.0 versus 68.0 %) and radiotherapy (5-year overall survival rates: 83.6 versus 63.2 %) were observed but not statistically significant. No survival benefit was found for total mastectomy in cases of isolated nodal recurrences following breast-conserving surgery.

CONCLUSION: This study showed encouraging survival outcomes for patients with isolated nodal recurrences in the modern era, with 5-year overall survival exceeding historical benchmarks. Comparable survival between patients with isolated nodal recurrences and occult primary breast cancer highlights the potential for curative approaches. Further research is required to refine treatment strategies and identify patient subgroups that may benefit from tailored therapies.

PMID:42296574 | DOI:10.1016/j.canrad.2026.104828

Eur J Surg Oncol. 2026 Jun 12;52(8):111946. doi: 10.1016/j.ejso.2026.111946. Online ahead of print.

ABSTRACT

OBJECTIVE AND BACKGROUND: The optimal surgical strategy for patients with hepatocellular carcinoma (HCC) and liver fibrosis/cirrhosis presenting with a future liver remnant to standard liver volume (FLR/SLV) ratio of 30%-40% remains a subject of clinical controversy. This study aimed to evaluate the safety and efficacy of one-stage hepatectomy (OSH) versus Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) and to validate the feasibility of OSH by benchmarking it against the standard safety criterion (FLR/SLV ≥40%).

METHODS: We conducted a retrospective analysis of 219 patients with HBV-related HCC and liver fibrosis/cirrhosis who underwent right hemihepatectomy. Patients were stratified into three groups: the OSH group (FLR/SLV 30%-40%, n = 62), the ALPPS group (FLR/SLV 30%-40%, n = 20), and the standard control group (FLR/SLV ≥40% undergoing OSH, n = 137). Perioperative outcomes, including post-hepatectomy liver failure (PHLF) and complications, as well as long-term overall survival (OS) and disease-free survival (DFS), were compared.

RESULTS: In the 30%-40% cohort, the incidence of severe PHLF (ISGLS Grade B or C) in the ALPPS group was comparable to that of the one-stage hepatectomy group (P = 0.128), and no 90-day mortality was observed in either group. However, in terms of severe postoperative complications (Clavien-Dindo grade ≥ IIIa), the ALPPS group demonstrated a higher incidence rate compared to the one-stage hepatectomy group, although the difference did not reach statistical significance (P = 0.082). Long-term oncological outcomes, including OS and DFS, were comparable between the OSH and ALPPS groups (p > 0.05). Furthermore, benchmarking analysis revealed preliminary observations that patients in the OSH group (30%-40%) achieved perioperative and long-term outcomes comparable to those in the standard control group (≥40%) (p > 0.05).

CONCLUSIONS: For selected HCC patients with liver fibrosis/cirrhosis and FLR/SLV ratio of 30%-40% undergoing standardized right hemihepatectomy, one-stage hepatectomy might serve as a safe and feasible alternative to ALPPS, though large-scale prospective validation is warranted.

PMID:42296572 | DOI:10.1016/j.ejso.2026.111946

JMIR Mhealth Uhealth. 2026 Jun 15;14:e83162. doi: 10.2196/83162.

ABSTRACT

BACKGROUND: The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days.

OBJECTIVE: This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being.

METHODS: During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios.

RESULTS: During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors.

CONCLUSIONS: The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.

PMID:42296558 | DOI:10.2196/83162