Tag: pubmed

JAMA Netw Open. 2026 Jun 1;9(6):e2620264. doi: 10.1001/jamanetworkopen.2026.20264.

ABSTRACT

IMPORTANCE: Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions.

OBJECTIVE: To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025.

EXPOSURES: Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener.

MAIN OUTCOMES AND MEASURES: Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status.

RESULTS: Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity.

CONCLUSIONS AND RELEVANCE: In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.

PMID:42377959 | DOI:10.1001/jamanetworkopen.2026.20264

JAMA Netw Open. 2026 Jun 1;9(6):e2620504. doi: 10.1001/jamanetworkopen.2026.20504.

ABSTRACT

IMPORTANCE: Area-based social risk indices allow researchers to analyze social exposures when individual measures are not available. However, small area location data are absent from many research datasets, which motivates researchers to use higher-level geographies and clinic addresses for social risk measurement.

OBJECTIVE: To assess the suitability of using social risk indices calculated with higher-level geographies and clinic addresses.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used primary care patient records from those seen at clinics included in the American Family Cohort from 2019 through 2021. Records were linked to area-based social risk indices using either patient’s residential address or their primary care clinic’s address in a cross-sectional cohort design that included geographic levels ranging from Census block group to 3-digit zip code tabulation area (ZCTA). Data were analyzed from December 2025 to February 2026.

EXPOSURES: Three area-based social risk indices: Reproducible Area Deprivation Index (ReADI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI).

MAIN OUTCOMES AND MEASURES: Using indices calculated with patient block group as the reference, correlation of indices across geographic levels and address types (residence vs clinic) were compared, as were the indices’ associations with chronic kidney disease, hypertension, and diabetes.

RESULTS: We included 2 995 479 patients (1 667 673 [55.7%] female, 952 227 [34.0%] rural) seen at 809 clinics. Correlation of indices at the reference level (ie, block group) with the same index at the 3-digit ZCTA ranged from 0.34 to 0.48. ReADI had the highest correlation with all other geographic levels. Indices at clinic addresses were uncorrelated with patient reference values. Adjusted odds ratios (ORs) for reference indices and diabetes were between 1.21 (95% CI, 1.19-1.23) and 1.37 (95% CI, 1.34-1.40). ORs for other diseases were similar. These associations were primarily lower when higher-level geographies and clinic addresses were used.

CONCLUSIONS AND RELEVANCE: In this cohort study of the association between patient outcomes and area-based social risk indices at different geographic levels and using clinic location as a proxy for home address, indices calculated using county and 3-digit ZCTA data available in popular claims databases generally misrepresented patient risk at more granular area levels of Census block group and tract. Clinic addresses were not useful for measuring patients’ social risks.

PMID:42377958 | DOI:10.1001/jamanetworkopen.2026.20504

JAMA Netw Open. 2026 Jun 1;9(6):e2620512. doi: 10.1001/jamanetworkopen.2026.20512.

ABSTRACT

IMPORTANCE: Human papillomavirus (HPV)-related cancers cause substantial morbidity and mortality. People with HIV (PWH) and solid organ transplant recipients (SOTRs) are at heightened risk due to impaired immune function, but direct comparisons of these groups within the same population are limited; understanding the relative risk and contributing factors is essential for targeted prevention and screening.

OBJECTIVE: To compare the odds of HPV-related cancers in PWH and SOTRs with control participants and assess how clinical and sociodemographic factors modify these associations.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study used incidence density sampling within the Swedish population. Individuals born between 1940 and 2000 and who were a resident of Sweden from 1983 to 2024 were included. HPV-related cancer cases were matched 1:10 with controls based on sex, year of birth, and region of birth.

EXPOSURE: HIV infection or history of organ transplant.

MAIN OUTCOME AND MEASURES: The primary outcome was HPV-related cancers, identified via diagnostic codes from the Swedish Cancer Registry. Odds ratios (ORs) with 95% CIs of HPV-related cancers by immunosuppression were estimated using conditional logistic regression. In secondary analyses, comparisons were stratified by sex, age at cancer diagnosis, calendar period of diagnosis, HPV-related cancer site, region of birth, education, income, income type, and civil status.

RESULTS: The study included 32 093 cases (21 206 female [65.5%]; 12 534 aged <50 years [39.4%]) and 320 930 matched control encounters (308 507 unique individuals; 201 667 female [65.4%]; 122 055 aged <50 years). Both PWH and SOTRs had elevated odds of HPV-related cancers compared with controls (PWH: adjusted OR [aOR], 4.50; 95% CI, 3.46-5.84; SOTRs: aOR, 2.23; 95% CI, 1.85-2.68). Among PWH, the highest site-specific odds were observed for anal (aOR, 58.79; 95% CI, 22.63-152.79) and penile (aOR, 8.05; 95% CI, 3.38-19.16) cancer. Among SOTRs, the highest odds were for vulvar (aOR, 7.07; 95% CI, 4.31-11.60) and penile (aOR, 6.01; 95% CI, 3.47-10.52) cancers, with variation by organ sites and time since transplant (>10 years posttransplant). In PWH, lower nadir (aOR 5.90; 95% CI, 4.04-8.61) and current (aOR, 8.62; 95% CI, 3.70-20.04) CD4 counts, shorter duration of viral suppression (aOR, 7.04; 95% CI, 4.40-11.27), and higher peak plasma HIV RNA levels (aOR, 5.66; 95% CI, 2.96-10.84) were associated with increased odds. In secondary analyses, sociodemographic factors such as lower income and nonmarried status were associated with elevated odds in both groups.

CONCLUSIONS AND RELEVANCE: In this case-control study of immunosuppressed populations, HPV-related cancer odds were increased among both PWH and SOTRs, with larger magnitudes of association observed in PWH; variation was observed by immune status, transplant characteristics, and sociodemographic factors. These findings highlight the need for enhanced prevention, including HPV vaccination, screening, and optimized immunosuppressive regimens.

PMID:42377957 | DOI:10.1001/jamanetworkopen.2026.20512

JAMA Netw Open. 2026 Jun 1;9(6):e2620871. doi: 10.1001/jamanetworkopen.2026.20871.

ABSTRACT

IMPORTANCE: Clean intermittent catheterization (CIC) is the preferred management for urinary retention. Single-use catheters generate substantial environmental and financial burdens, whereas evidence on the safety of reusable catheters is limited.

OBJECTIVE: To examine whether reusable catheters are noninferior to single-use catheters for CIC with respect to urinary tract infection (UTI) incidence.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, noninferiority randomized clinical trial was conducted between February 21, 2020, and April 3, 2025, at 12 Dutch hospitals and included patients aged 16 years or older performing CIC at least twice daily, with 1-year follow-up.

INTERVENTIONS: Participants were randomly assigned to reusable or single-use catheters. Reusable catheters were disinfected daily in 2% sodium hypochlorite solution, rinsed before and after use, and replaced every 2 weeks; single-use catheters were permitted for 20% or less of weekly catheterizations in the reusable group.

MAIN OUTCOMES AND MEASURES: The primary outcome was UTI incidence per patient-month. Secondary outcomes included catheter-related complications, adverse events, and patient-reported outcomes. The noninferiority margin was set at an absolute difference of 0.07 UTIs per patient-month.

RESULTS: A total of 386 patients (mean [SD] age, 61.4 [15.9] years; 243 [63%] male; and 139 [36%] with neurogenic lower urinary tract dysfunction) were included. In the reusable catheter group, 72 of 185 participants (39.0%) discontinued study participation, mainly due to reduced ease of use and urethral irritation. In the modified intention-to-treat population (n = 326), mean (SD) follow-up was 12.0 (1.9) months in the single-use group and 11.4 (2.9) months in the reusable group. During this period, 1 or more UTIs occurred in 59 of 191 single-use catheter users (30.9%) and 40 of 134 reusable catheter users (29.9%). The incidence rate was 0.054 (95% CI, 0.040-0.069) vs 0.050 (95% CI, 0.035-0.067) UTIs per patient-month, with an absolute difference of -0.004 (95% CI, -0.025 to 0.019), meeting the predefined noninferiority margin. Catheter-related complications and serious adverse events were comparable between groups, whereas low-grade adverse events, mainly urethral irritation, were more frequent in the reusable group (37 [20.0%] vs 9 [4.7%]). Catheter-related quality of life was higher with reusable catheters, whereas catheterization satisfaction was higher with single-use catheters; overall health-related quality of life did not differ between groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with urinary retention, reusable catheters were noninferior to single-use catheters for UTIs, with variable tolerability and patient-reported outcomes highlighting the importance of individual preference and the need for design enhancements to improve usability and broaden implementation.

TRIAL REGISTRATION: National Trial Register: NL8296.

PMID:42377956 | DOI:10.1001/jamanetworkopen.2026.20871

JAMA Netw Open. 2026 Jun 1;9(6):e2621242. doi: 10.1001/jamanetworkopen.2026.21242.

ABSTRACT

IMPORTANCE: Performing germline genetic testing of family members following the identification of an individual with a pathogenic variant in a cancer predisposition gene, a process known as cascade testing, is a critical step in maximizing the preventive benefit of genetic testing for hereditary cancer.

OBJECTIVE: To determine how often family members undergo cascade testing and to evaluate demographic, socioeconomic, and clinical factors associated with this process.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study analyzed demographics, cancer history, genetic test results, and cascade testing data from probands who underwent multigene panel testing between December 2016 and August 2020 at a single diagnostic laboratory. The study cohort included probands found to have a pathogenic or likely pathogenic variant (P/LPV) in Lynch syndrome (MLH1, MSH2, MSH6, PMS2, or EPCAM) or hereditary breast and ovarian cancer (ATM, BRCA1, BRCA2, CHEK2, or PALB2) genes. Statistical analyses were conducted between June 2023 and March 2025.

EXPOSURE: Identification of a P/LPV in a cancer predisposition gene.

MAIN OUTCOMES AND MEASURES: Variables assessed included proband age, sex, race and ethnicity, socioeconomic status (SES), availability of free testing for family members, cancer history, type of test ordered, and clinician credentials. Differences in cascade testing rates were calculated via 2-sided χ2 test.

RESULTS: Of 22 932 probands (18 949 [81.38%] female; mean [SD] age at testing. 51.6 [14.5] years), 5559 (24.24%) had at least 1 family member who underwent cascade testing. Higher rates of cascade testing were seen in individuals aged 40 to 79 years compared with those aged 20 to 39 years (age 40-59 years: 2587 of 10 420 probands [24.83%]; P < .001; age 60-79 years: 1960 of 6869 probands [28.53%]; P < .001; age ≥80 years: 129 of 462 probands [27.92%]; P < .001), women (4740 of 18 948 female probands [25.02%] vs 817 of 3963 male probands [20.62%]; P < .001), non-Hispanic White individuals (3762 of 13 834 probands [27.19%]), those with a personal cancer history vs those without (4712 of 16 674 probands [39.43%] vs 847 of 6261 probands [15.64%]; P < .001), and those whose care involved genetic counselors vs those whose did not (3614 of 13 847 probands [26.10%] vs 1948 of 9088 probands [21.43%]; P < .001). People with BRCA1 or BRCA2 variants had higher cascade testing rates compared with those with ATM, CHEK2, or PALB2 variants (2614 of 9699 probands [26.95%] vs 2015 of 8973 probands [22.46%]; P < .001). Several disparities were identified, including lower rates of cascade testing among male probands and probands from racial or ethnic minority groups compared with non-Hispanic White probands (227 of 1406 African American or Black probands [16.15%]; P < .001; 175 of 875 Asian probands [20.00%]; P < .001; 319 of 1616 Hispanic probands [19.74%]; P < .001; 17 of 146 Middle Eastern probands [11.64%]; P < .001). SES had minimal associations with testing rates, and free family testing was not associated with boosting participation.

CONCLUSIONS AND RELEVANCE: In this retrospective cross-sectional study, cascade testing was underused, especially among specific demographic groups, with clinical and cultural factors appearing to play a larger role than financial barriers. These findings may guide efforts to address barriers preventing wider uptake of cascade testing and improve cancer prevention efforts, particularly among racial and ethnic minority groups.

PMID:42377955 | DOI:10.1001/jamanetworkopen.2026.21242

JAMA Netw Open. 2026 Jun 1;9(6):e2621250. doi: 10.1001/jamanetworkopen.2026.21250.

ABSTRACT

IMPORTANCE: Breast cancer incidence among Asian American, Native Hawaiian, and Pacific Islander females as an aggregated group have been increasing rapidly. The extent to which these trends apply across Asian American, Native Hawaiian, and Pacific Islander ethnic groups is unclear.

OBJECTIVE: To examine incidence trends of invasive breast cancer in 7 Asian American (Asian Indian or Pakistani, Chinese, Filipino, Japanese, Korean, Laotian or Kampuchean, and Vietnamese) and 2 Native Hawaiian or Pacific Islander (Guamanian, Chamorro, and Samoan and Native Hawaiian) ethnic groups overall and by age, stage, and subtype.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, descriptive, cross-sectional study used National Cancer Institute Surveillance, Epidemiology, and End Results Program data contributed by 14 US states (3 in the Northeast, 2 in the Midwest, 4 in the South, and 5 in the West). Asian American, Native Hawaiian, and Pacific Islander females of any age diagnosed with invasive breast cancer between January 1, 2000, and December 31, 2022, were included. Data were analyzed between September 2025 and March 2026.

MAIN OUTCOMES AND MEASURES: Annual (or triannual) percentage change (APC) and 95% CIs of incidence rates were estimated using joinpoint regression, by age (<50 years, ≥50 years), stage (localized, regional, distant), and subtype (hormone receptor [HR] and ERBB2 [formerly HER2/neu] negativity and positivity).

RESULTS: A total of 148 608 Asian American, Native Hawaiian, and Pacific Islander females with breast cancer (44 234 aged <50 years [29.8%] and 104 374 aged ≥50 years [70.2%] at diagnosis; 138 808 of Asian American [93.4%] and 9800 of Native Hawaiian or Pacific Islander [6.6%] race and ethnicity) were included, among whom 63.9% were diagnosed at a localized stage and 66.6% with the HR-positive and ERBB2-negative subtype. Increased incidence rates of invasive breast cancer were observed among Asian American females (APC, 2.34%; 95% CI, 1.83%-3.68%) from 2012 to 2022, surpassing the trend in other racial and ethnic groups. A smaller steady increase was observed among Native Hawaiian or Pacific Islander females (APC, 0.84%; 95% CI, 0.48%-1.29%) from 2000 to 2022. Significant increases in overall and early-onset (ie, age <50 years) breast cancer were evident in all Asian American, Native Hawaiian, and Pacific Islander ethnic groups, with Chinese and Vietnamese females experiencing increased APCs of 4.57% (95% CI, 2.03%-8.36%) and 4.30% (95% CI, 1.98%-8.93%) since 2015 and 2016, respectively. Incidence increases were most pronounced for distant stage disease, with APCs of 4.02% (95% CI, 2.74%-5.72%) for Asian Indian and Pakistani females and 4.52% (95% CI, 2.55%-7.09%) for Chinese females. All Asian American groups, except Laotian and Kampuchean females, experienced increasing trends of HR-positive and ERBB2-negative cancer, with APCs ranging from 2.10% (95% CI, 0.74%-3.45%) for Japanese females to 6.00% (95% CI, 3.62%-8.78%) for Korean females since 2010, whereas Native Hawaiian and Pacific Islander groups saw stable trends. Nearly all Asian American groups experienced increases in triple-negative breast cancer, with an APC as high as 6.17% (95% CI, 3.30%-11.73%) among Chinese females for 2017 to 2022.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that breast cancer incidence rates increased rapidly across Asian American, Native Hawaiian, and Pacific Islander ethnic groups over a 20-year period. Research tailored to these distinct ethnic groups is needed to discern potentially novel risk factors for breast cancer. Culturally sensitive efforts are needed to promote awareness and increase breast cancer screening in distinct ethnic groups. The rapid recent increases in breast cancer incidence in Asian American, Native Hawaiian, and Pacific Islander women, especially early-onset disease, warrant urgent attention.

PMID:42377954 | DOI:10.1001/jamanetworkopen.2026.21250

JAMA Intern Med. 2026 Jun 30. doi: 10.1001/jamainternmed.2026.3411. Online ahead of print.

NO ABSTRACT

PMID:42377942 | DOI:10.1001/jamainternmed.2026.3411

Ann Afr Med. 2026 Jun 30. doi: 10.4103/aam.aam_12_26. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar facet joint pain is a common cause of chronic low back pain and contributes substantially to physical disability, reduced functional capacity, and socioeconomic burden. Radiofrequency ablation (RFA) and steroid injection therapy are widely used interventional procedures for managing facet-mediated pain, yet their comparative effectiveness in routine clinical practice remains an area of ongoing investigation.

AIM: To compare the clinical efficacy, functional outcomes, and duration of pain relief achieved with RFA versus steroid injection therapy in patients with lumbar facet joint pain.

MATERIALS AND METHODS: This prospective comparative study included 132 adult patients with lumbar facet joint pain diagnosed on clinical evaluation and confirmatory medial branch block. Patients were allocated into two groups: RFA group (n = 66) and steroid injection group (n = 66). Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for function, and duration of pain relief over a 6-month follow-up period. Adverse events and the need for repeat interventions were also documented. Statistical analysis included paired and unpaired t-tests, Chi-square test, and repeated-measures analysis of variance, with P < 0.05 considered statistically significant.

RESULTS: Both groups demonstrated significant short-term improvement in VAS and ODI scores; however, the RFA group showed greater reduction in pain intensity and functional disability at 3 and 6 months. The proportion of patients achieving sustained pain relief and the mean duration of clinically meaningful benefit were higher in the RFA group than in the steroid injection group. Minor transient complications were observed in both groups, with no major adverse events or procedure-related neurological deficits.

CONCLUSION: RFA provides superior long-term pain relief and functional improvement compared with steroid injection therapy for lumbar facet joint pain. RFA may be considered a more durable and effective interventional option in patients with chronic facet-mediated lumbar pain.

PMID:42377934 | DOI:10.4103/aam.aam_12_26

Clin Nucl Med. 2026 Jun 29. doi: 10.1097/RLU.0000000000006564. Online ahead of print.

ABSTRACT

BACKGROUND: To compare HER2-targeted with ¹⁸F-FDG PET/CT for detecting axillary lymph node metastasis in patients with newly diagnosed HER2-positive or HER2-low breast cancer.

METHODS: In this prospective study, HER2-expressed breast cancer participants underwent both 18F-FDG and Al18F-NOTA-HER2-BCH PET/CT within 1 week. On the basis of IHC and/or FISH, participants were categorized as HER2-positive (n=25) or HER2-low (n=26). Histopathology or imaging follow-up served as reference standards. Statistical analyses utilized the paired McNemar test for diagnostic performance, and the Wilcoxon signed-rank and Mann-Whitney U tests for paired and unpaired comparisons of uptake parameters, respectively.

RESULTS: Between August 2024 and October 2025, 51 participants with breast cancer were enrolled. Among 40 participants with lymph node metastasis, Al18F-NOTA-HER2-BCH detected metastatic lymph nodes exclusively in one HER2-positive participant and more lesions than 18F-FDG in 11 cases. On a per-lesion analysis, Al18F-NOTA-HER2-BCH demonstrated significantly higher sensitivity, accuracy, and negative predictive value than 18F-FDG for detecting metastatic axillary lymph nodes in the HER2-positive cohort (94%, 94%, 93% vs. 79%, 85%, 84%, all P<0.001). This superiority was particularly pronounced for small lymph nodes (<5 mm), with a detection rate of 90% versus 62% for 18F-FDG (P<0.001). Al18F-NOTA-HER2-BCH PET/CT directly influenced nodal staging and subsequent treatment decisions in 4 of 25 (16.0%) HER2-positive participants. In the HER2-low cohort, however, the diagnostic performance of the 2 tracers did not differ significantly, although 18F-FDG PET/CT led to clinically relevant nodal upstaging in one case.

CONCLUSIONS: Al18F-NOTA-HER2-BCH retains developmental potential for detecting axillary lymph node metastasis in HER2-positive breast cancer, complementing 18F-FDG.

PMID:42377932 | DOI:10.1097/RLU.0000000000006564

Food Sci Anim Resour. 2025 Jul;45(4):1129-1147. doi: 10.5851/kosfa.2024.e85. Epub 2025 Jul 1.

ABSTRACT

Wet brewer’s spent grain (WBSG), a major brewing industry byproduct, is generated in large quantities annually and used as feed ingredient for animal production. The low cost of this feed also has a positive impact on the economics of production. This work focused on the supplementation of WBSG in the feeding diet and its effects on the yield, nutritional quality, and sensory attributes of fresh cheese. The investigation was conducted on two cohorts of Holstein-breed cows. The first group was fed on pasture supplemented with hay, silage, and concentrate, while the second group received the same diet with the addition of WBSG. Statistical analysis was carried out using analysis of variance test to compare cheeses on a nutritional and sensory basis. The results obtained reveal that incorporating WBSG can enhance the nutritional quality of fresh cheese. It was observed that lower titratable acidity was associated with a higher yield in the WBSG cheese group (p<0.001). Additionally, cheese derived from cows fed on WBSG exhibited a lower ratio of Σn-6 to Σn-3 fatty acids (p<0.001), as well as a higher ratio of unsaturated to saturated fatty acids (p<0.05). The vitamin E analysis showed highly significant differences and predominant amounts for fresh cheese WBSG. Additionally, they exhibited superior sensory attributes such as darker color, grainy and softer texture, and a more pronounced odor. The utilization of WBSG use is promising for the breeding of dairy cattle and makes it possible to obtain a fresh cheese with attractive sensory quality.

PMID:42377876 | DOI:10.5851/kosfa.2024.e85