FAMILY HEALTH

Complex patients present an increasing challenge to the health care system and family physicians play an important role in their care. As part of a larger project exploring family physicians’ perceptions of complex patients, we sought to understand how complex patients affect family physicians and if these effects might be related to physician burnout.

Understanding the Impact of Complex Patients on Family Physicians: Exploring Perceptions and Possible Links to Burnout

ENDO-DIABETOLOGY

Lower socioeconomic groups may face greater exposure to unhealthy food outlets, highlighting food environment inequalities.

Socioeconomic Inequalities in Neighborhood Food Environments

A systematic review of 167 studies from high-income countries found that populations with lower socioeconomic position had modestly greater exposure to some unhealthy food outlets. Differences in access to healthy outlets were mixed or largely nonsignificant, highlighting socioeconomic disparities in neighborhood food environments and the need for standardized measures and equity-focused policies.

Alcohol may amplify the obesogenic effects of ultra-processed diets by promoting protein dilution and higher energy intake.

Alcohol and Ultra-Processed Diets May Increase Energy Intake

A mechanistic-ecological model suggests alcohol may affect energy intake differently depending on diet quality. While alcohol adds ethanol calories regardless of diet, its effects may be greater with ultra-processed savory foods, where alcohol-driven changes in umami preference could promote protein dilution, reduced satiety, and higher food and macronutrient intake.

Family-based interventions significantly improve BMI and body fat outcomes in children with obesity when parents actively participate.

Family-Based Interventions Improve Childhood Obesity Outcomes

A systematic review and meta-analysis of 20 RCTs involving 1,740 participants found that family-based interventions significantly reduced BMI z-scores in children with obesity, with additional improvements in long-term BMI z-score and body fat. Programs combining education, behavioral strategies, and motivational support were most effective, particularly when parents actively participated.

A review highlights major outcome variation in school-based obesity trials, supporting development of a standardized Core Outcome Set.

Standardizing Outcomes in School-Based Childhood Obesity Prevention

A scoping review of 262 studies evaluating 242 school-based obesity prevention interventions in children aged 6–12 identified 642 different reported outcomes. BMI was most frequently assessed, followed by BMI-z and BMI categories. Experts consolidated these into 69 unique outcomes, highlighting the need for a standardized Core Outcome Set to improve comparability across trials.

A scoping review will assess how AI agents support personalized behavior change and obesity management from 2020–2025.

AI-Supported Interventions for Obesity Behavior Change

A scoping review will examine AI-supported interventions designed to influence obesity-related behaviors through personalized feedback, natural language communication, and adaptive content. Studies published from 2020–2025 will be assessed for AI agent characteristics, interaction design, targeted behaviors, and outcomes, helping clarify the potential role and impact of AI in obesity management.

DERMATOLOGY

Advances in chronic urticaria treatment are expanding options and moving care toward personalized, biomarker-driven therapy.

Chronic Urticaria: Advances in Personalized Treatment

Chronic urticaria is a heterogeneous mast cell-driven disease with major effects on quality of life. Current care emphasizes diagnosis, limited targeted testing, disease monitoring and stepwise treatment, beginning with second-generation H1-antihistamines and up-dosing when needed. Omalizumab and newer therapies such as dupilumab and remibrutinib expand options for refractory disease, while future care may be guided by biomarkers and disease endotypes.

NEUROLOGY

Reduced sleep spindle oscillations may provide a new marker linking sleep dysfunction with Alzheimer’s disease pathology.

Sleep Oscillations May Link Sleep Dysfunction to Alzheimer’s Disease

A study found that the peak amplitude of infraslow oscillations in sleep spindle activity was significantly reduced in people with Alzheimer’s disease, while frequency and bandwidth remained preserved. Changes in these oscillations were associated with Alzheimer’s-related and neurodegeneration biomarkers, suggesting a potential electrophysiological marker connecting sleep microarchitecture with disease pathology.

Better age-friendly environments were linked to a lower risk of motoric cognitive risk syndrome in older adults.

Age-Friendly Environments May Reduce Motoric Cognitive Risk

A prospective cohort study of 7,608 older adults found that better age-friendly environments were associated with a lower risk of developing motoric cognitive risk syndrome (MCR), a predementia condition. Over 4 years, participants with the highest AFE scores had a 38% lower MCR risk than those with the lowest scores, supporting age-friendly environments as a potential dementia-prevention strategy.

Miltefosine and liposomal amphotericin B showed promising cure rates for cutaneous leishmaniasis, but stronger evidence is needed.

Systemic Treatments for Cutaneous Leishmaniasis: Cure Rates

A systematic review and meta-analysis of 83 studies involving 4,603 patients found variable cure rates with systemic treatments for cutaneous leishmaniasis. Pooled cure rates were highest with liposomal amphotericin B (77%) and miltefosine (75%), compared with 59% for meglumine antimoniate. However, limited comparative evidence highlights the need for species-specific, high-quality randomized trials.

Non-contrast CT markers may identify patients at high risk of hematoma expansion after factor Xa inhibitor-associated ICH.

CT Markers Predict Hematoma Expansion in Factor Xa-Associated ICH

A post hoc analysis of the ANNEXa-I trial involving 434 patients with factor Xa inhibitor-associated intracerebral hemorrhage found that 72.1% had at least one non-contrast CT marker of hematoma expansion risk. Heterogeneous density, hypodensity, and the black hole sign were independently associated with hematoma expansion, supporting their use for early risk assessment.

PEDIATRICS

Placenta accreta was associated with greater treatment escalation after uterine compression sutures for postpartum hemorrhage.

Placenta Accreta Linked to Treatment Escalation After Uterine Compression Sutures

A retrospective study of 33 women with postpartum hemorrhage during cesarean delivery found that uterine compression sutures achieved hemostasis in 69.7% of cases. Additional treatment was required in 30.3%, including embolization or emergency hysterectomy. Suspected placenta accreta spectrum was significantly more common among women needing escalation (60.0% vs. 8.7%; p=0.004).

PULMONOLOGY

ICS–SABA reduced asthma exacerbations and corticosteroid use without increasing adverse events in a five-RCT meta-analysis.

ICS–SABA Reduces Asthma Exacerbations Compared With SABA Alone

A meta-analysis of five randomized controlled trials found that as-needed ICS–SABA significantly reduced asthma exacerbations compared with SABA-only reliever therapy. ICS–SABA lowered exacerbation rates and the risk of experiencing at least one exacerbation by 31%, while extending time to first exacerbation and reducing systemic corticosteroid exposure by about 39 mg, without increasing adverse events.

Teach-back with communication supports may improve informed-consent participation among people with aphasia.

Teach-Back Improves Consent Participation in People With Aphasia

An exploratory study found that the teach-back method, supported by multimodal communication strategies, improved understanding during a simulated informed-consent process among people with aphasia. Eight participants with aphasia showed significantly higher post-test scores after the intervention, while no significant improvement was observed in the non-aphasia control group.

OPHTHALMOLOGY

Cataract led adult blindness in a Somali tertiary center, while trauma predominated among younger adults.

Trauma, Cataract and Glaucoma Drive Adult Blindness in Somalia

A retrospective study of 9,740 adults at a tertiary ophthalmic center in Mogadishu found blindness in 12.7% of patients. Cataract was the leading cause, followed by trauma-related ocular disease, glaucoma, and corneal opacity. Trauma-related blindness was more common among younger adults, while cataract and glaucoma predominated in older age groups.

VR significantly reduces anxiety in children and guardians before eye surgery, while improving information needs and satisfaction.

Virtual Reality Reduces Anxiety in Pediatric Eye Surgery

A randomized study of 31 children aged 3–10 years found that virtual reality (VR) significantly reduced preoperative anxiety in children and their guardians undergoing eye surgery under general anesthesia. VR exposure also reduced guardians’ information needs and improved satisfaction, supporting its potential as a simple, nonpharmacological approach to surgical anxiety.

Complex patients’ effect ...

Complex patients’ effect on family physicians: high cognitive load and negative emotional impact