Search Results (4,978)

Pharmacogenomics can convert stable DNA variation into prescribing information, but its value in primary care depends on whether a result changes a decision at the right moment. This narrative review critically examines selected actionable gene–drug pairs, implementation models, conflicting evidence, and unresolved questions for family physicians managing multimorbidity and polypharmacy. A targeted search of PubMed/MEDLINE and current pharmacogenomic guideline resources was updated through 14 August 2026, prioritizing clinical guidelines, randomized and pragmatic trials, implementation studies, and primary-care evidence. Guideline actionability describes how an available result can guide treatment; it does not by itself establish that testing should be ordered. Selected examples include clopidogrel, statins, metoprolol, antidepressants, codeine and tramadol, proton-pump inhibitors, nonsteroidal anti-inflammatory drugs, and warfarin, together with shared-care medicines such as thiopurines and carbamazepine. In PREPARE, a defined 12-gene panel linked to prescribing recommendations reduced clinically relevant adverse drug reactions within a specific European workflow. Other trials showed that benefit is drug-, population-, comparator-, and workflow-dependent. Pharmacogenomics does not replace assessment of organ function, interactions, adherence, frailty, or patient preference. This review proposes selective, clinically triggered panel testing as a pragmatic model for primary care, with structured, reusable results and concise decision support. Future work should define who benefits, improve ancestry representation, account for phenoconversion, and demonstrate health-system-specific cost-effectiveness. Pharmacogenomics is best understood as an additional medication-safety input rather than a stand-alone precision-medicine solution. Full article

Background: Depression is a major global health burden, requiring culturally appropriate assessment instruments, but no validated Kazakh-language version of the Patient Health Questionnaire-9 (PHQ-9) is available. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Kazakh PHQ-9 in a community-based, non-clinical sample. Methods: This cross-sectional study included 503 Kazakh-speaking adults (mean age = 24.0 years, SD = 10.1; 51.3% women and 48.7% men) who completed the Kazakh PHQ-9 and Generalized Anxiety Disorder-7 (GAD-7) questionnaires. Internal consistency, structural validity, measurement invariance across genders, and convergent validity were assessed. Results: Internal consistency was excellent (Cronbach’s α = 0.91), and both one-factor and correlated two-factor models showed excellent fit (CFI = 0.998; TLI = 0.997–0.998; RMSEA = 0.046–0.048; SRMR = 0.050–0.052), with a slightly better fit for the latter. Measurement invariance across genders was supported, and PHQ-9 and GAD-7 scores were strongly correlated (r = 0.68, p < 0.001). Conclusions: The Kazakh PHQ-9 demonstrated excellent internal consistency and structural validity, measurement invariance across genders, and strong convergent validity in this non-clinical sample. These findings support its use for assessing depressive symptoms in Kazakh-speaking adults. Clinical validation is needed to establish diagnostic validity and screening performance. Full article

Ebola alerts reveal the truth about preparedness. They show whether a health system can recognize danger early, protect health workers, isolate and care for patients, trace contacts, communicate clearly, and sustain public trust before fear replaces cooperation. In the Pandemic Agreement Era, this truth has become harder to ignore. The 2026 Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda is a sharp reminder that the principles of pandemic prevention, preparedness, response, equity, and cooperation become meaningful only when they work where the first cases occur. In the absence of licensed vaccines and specific treatments for Bundibugyo virus disease, preparedness depends on the basic functions of public health: surveillance, diagnosis, infection prevention and control, referral, risk communication, community engagement, and operational coordination. These functions are often described as routine. They are not. During high-consequence infectious disease alerts, they serve as the primary protective infrastructure. Ebola also exposes a deeper ethical failure. Frontline countries and communities are expected to contain threats of global relevance, but international support often intensifies only after the risk becomes visible beyond the affected area. This reactive model is neither fair nor efficient. The WHO Pandemic Agreement defines a political direction for a more equitable and coordinated global response. Here, Ebola is not presented as a typical pandemic event but as an operational test of preparedness, solidarity, early support to affected settings, and international cooperation. Ebola alerts test whether that direction can become an operational reality before escalation. Digital tools, telemedicine, and artificial intelligence may strengthen this agenda but only when they make local systems faster, safer, more trusted, and more usable. Ebola preparedness is therefore not only a technical task. It is a test of responsibility. Full article

(1) Background: Preconception care (PCC) is an important component of preventive reproductive healthcare and public health because modifiable risk factors affecting maternal, neonatal, and longer-term health may be present before conception. Despite broad recognition of its potential value, substantial uncertainty remains regarding how PCC should be organised, financed, and implemented across different healthcare systems. (2) Methods: This structured narrative review synthesised evidence on healthcare- provider models, financing, affordability, willingness to pay (WTP), and barriers and facilitators affecting PCC implementation. A structured search of PubMed, Scopus, and Web of Science Core Collection covered publications from January 2010 to March 2026 and was updated on 14 July 2026. Original research studies, systematic and scoping reviews, narrative reviews, clinical guidelines, policy reports, and relevant methodological or health-economic publications were considered. A structured qualitative appraisal was used to interpret evidence according to study design or evidence type, directness to PCC, healthcare-system context, methodological limitations, and consistency across sources. A total of 61 publications were retained in the structured evidence synthesis. (3) Results: No single PCC delivery model was consistently supported as universally applicable. Across heterogeneous settings, the evidence more consistently supported broad principles including accessibility, continuity of care, multidisciplinary coordination, clear professional roles, financial accessibility, and integration with existing healthcare pathways. Implementation was constrained by insufficient training, consultation-time limitations, unclear professional responsibilities, fragmented service organisation, inadequate reimbursement, and socioeconomic inequalities. Evidence on WTP, specific financing arrangements, and digital delivery models was more limited and context-dependent. (4) Conclusions: The available evidence supports PCC as an important preventive reproductive-health strategy, but the optimal organisational and financing models remain uncertain and are likely to depend on healthcare-system context. Integrated and multidisciplinary approaches appear promising, although specific provider configurations, financing mechanisms, and digital interventions require further comparative and longitudinal evaluation. The author-developed hypothetical conceptual model proposed in this review should therefore be interpreted as a hypothesis-generating synthesis of the available evidence rather than as an empirically validated clinical pathway or causal model. Full article

Background/Objectives: Although lung cancer is the leading cause of cancer-related deaths in the United States, rates of screening have remained persistently low nationwide. This study sought to identify barriers, facilitators, and support strategies necessary for implementing a novel community health navigator workflow to improve lung cancer screening uptake in both rural and urban settings. Methods: Semi-structured interviews were conducted with primary care providers (n = 5), community scientists (n = 7), community health navigators (n = 4), and radiology staff (n = 2). Interview transcripts were analyzed using a rapid qualitative analysis approach. Three authors coded based on the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) frameworks using a hybrid deductive–inductive approach. Results: Participants highlighted several primary barriers: access to knowledge and information (e.g., knowledge of eligibility, knowledge of insurance coverage), IT infrastructure (e.g., quality of pack-year data), relative priority (e.g., need to discuss other conditions), and patient needs and resources (e.g., time off work, transportation, difficulty scheduling). Key facilitators for screening were again IT infrastructure (e.g., automated electronic health record alerts) as well as relational connections (e.g., trust between patients and providers). To address provider-level barriers, participants recommended educational meetings, using clinical champions, and providing feedback on current lung cancer screening rates. To address patient-level barriers, participants recommended health education tools, providing transportation vouchers, hosting weekend lung cancer screening clinics, and assisting with scheduling. Conclusions: A community navigator approach to lung cancer screening should address key barriers to implementation on both the patient and provider level, including knowledge, prioritization, and patient access. Full article

Background/Objectives: Prehospital identification of non-ST-elevation acute coronary syndrome remains unresolved, and available risk scores incorporate troponin categorically. We compared the discriminative performance of cardiac troponin I measured in a blood sample obtained at first prehospital medical contact, analysed as a continuous variable, against the HEART, GRACE, and TIMI scores for predicting 30-day major adverse cardiac events. Methods: We conducted a prospective cohort study in 333 adults with non-traumatic chest pain suggestive of non-ST-elevation acute coronary syndrome, which was attended by two physician-staffed advanced life support units. Venous blood was drawn at first medical contact and analysed later in the laboratory; the results were not available during patient care. All three scores used this same determination as their troponin component. The primary outcome was a composite of all-cause mortality, type 1 myocardial infarction, and unplanned coronary revascularisation at 30 days. Results: The primary outcome occurred in 82 patients (24.6%). Prehospital troponin discriminated better (area under the curve 0.916, 95% CI 0.875–0.952) than TIMI (0.817), GRACE (0.767), and HEART (0.721); all comparisons were p < 0.001. An exploratory rule-out threshold of 80 ng/L identified 61 patients (18.3%) with no events (sensitivity and negative predictive value 100%, exact 95% CI 95.6–100 and 94.1–100), whereas the ≥780 ng/L stratum showed an event rate of 69.4%. Conclusions: A blood sample obtained at first prehospital medical contact carries substantial prognostic information that clinical scores discard by categorising it. Because it was analysed subsequently in the laboratory, these findings do not evaluate a real-time strategy; they support development and validation of point-of-care devices. Full article

Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour. Full article

Background and Objectives: The 2024 Korean medical–political conflict caused the mass resignation of trainee physicians, raising concerns about the quality of care for time-critical emergencies. This study aimed to assess the impact of workforce disruptions on the management and outcomes of adults presenting to the emergency department (ED) with septic shock. Materials and Methods: This retrospective single-center cohort study was conducted at a tertiary care ED and included adults with septic shock between September 2022 and August 2025. This study compared the pre-conflict period, operating under a resident-supported model, with the conflict period characterized by a specialist-led staffing model. The primary outcome was the all-cause in-hospital mortality. The secondary outcomes included process-related time intervals and clinical course measurements. Multivariate logistic regression was used to identify the independent predictors of mortality. Results: Altogether, 343 patients were included (159 pre-conflict, 184 conflict). During the conflict, ED crowding significantly decreased (average concurrent ED patients: 14.9 vs. 7.6, p < 0.001). Key diagnostic process metrics, including time to blood gas analysis, blood sampling, blood culture, computed tomography, and total ED length of stay, were significantly shortened. Time-critical therapeutic intervals, such as time to empirical antibiotics, remained unchanged. In-hospital mortality did not differ significantly between the pre- and conflict periods. Multivariate analysis demonstrated that the conflict period was not independently associated with mortality; only initial serum lactate levels and Acute Physiology and Chronic Health Evaluation II scores remained significant predictors. Conclusions: The 2024 Korean medical–political conflict was not associated with increased in-hospital mortality among patients with septic shock. Process-related metrics improved, while key therapeutic intervals and overall clinical outcomes remained stable. These findings may reflect reduced ED crowding, organizational adaptation, and continued adherence to established septic shock management practices. Reduced ED volume likely contributed substantially to improvements in diagnostic and throughput-related processes. Full article

Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention to improve dementia diagnosis in Australian general practice. A mixed-methods process evaluation used the RE-AIM framework with the addition of Appropriateness. The intervention included Primary Health Network (PHN) engagement, GP education, clinical resources, audit and benchmarking reports, specialist support, and a dementia risk-alert tool. Data were collected through surveys, stakeholder interviews, website analytics and program documentation. Clinicians who participated reported increased confidence and changes in dementia-related clinical behaviours, while education, resources and benchmarking were perceived as valuable. However, overall reach was limited by competing clinical priorities, workforce pressures, lack of financial incentives, and PHN implementation challenges. The dementia risk-alert tool was feasible but achieved limited uptake because of software compatibility, usability concerns and incomplete electronic medical record data. Although the program was acceptable to participating clinicians, limited reach constrained its potential impact. These findings highlight organizational, workforce, digital infrastructure and policy factors that influenced implementation of multicomponent interventions in routine primary care. Full article

Background: Current evidence on diabetes care interventions is either fragmented or focused on specific interventions targeting healthcare professionals or patients. This study aims to categorize diabetes care interventions involving physicians or nurses and their impact on health outcomes for individuals with diabetes. Additionally, it aimed to determine the proportion of favorable findings across healthcare intervention categories. Methods: This scoping review was conducted in primary care settings and guided by a health system framework. We searched articles from inception to June 2022 in databases including CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. The classification of healthcare interventions was guided by the Cochrane Effective Practice and Organization of Care taxonomy and health system framework. Results: Results were reported following the PRISMA Extension for Scoping Reviews. From the initial pool of 13,406 articles, 116 met the eligibility criteria and reported interventions conducted across 119 countries or regions, of which 94 were high-level economies. Five healthcare intervention categories were identified: transforming the workforce; service content; re-designing the service delivery system; information and communication technology; and multifaceted. Patient health outcomes were classified into 3 overarching categories with 11 subcategories: clinical outcomes, behavioral outcomes, and psychosocial outcomes. The proportion of statistically significant favorable findings differed across intervention categories and outcome domains. Multifaceted interventions showed relatively higher proportions of favorable findings for clinical outcomes, whereas re-designing the service delivery system interventions showed relatively higher proportions for behavioral outcomes. ICT interventions frequently reported favorable findings related to blood glucose indicators. Conclusions: This study provides a comprehensive overview of healthcare interventions and health outcomes for diabetes in primary care settings. It emphasizes the importance of tailored interventions, delivery methods, and technology integration for effective diabetes management, advocating for a comprehensive approach from individual to societal levels. Full article

Background: The global prevalence of oral disease including dental caries varies significantly across different regions, and South Africa is no exception. Although dental caries is a major public health concern, it is largely preventable through the promotion of proper oral hygiene practices and screening. The study aimed to assess the oral health status of school children within selected primary schools in the Tshwane District, South Africa. Methods: The study used a quasi-experimental design employing a quantitative research approach, structured into three phases: a pre-test assessment, the implementation of the intervention, and a post-test evaluation. A total of 390 primary school learners from five selected schools underwent dental screening and were included in the study on a voluntary basis. Data analysis was conducted using IBM SPSS version 30, incorporating both descriptive and inferential statistical tools. Results: Prior to screening, 75.9% of participants exhibited dental caries, while only 24.1% showed no signs of tooth decay. Following the intervention, improvements in oral hygiene status were observed among participants. The proportion of children presenting with high plaque scores decreased markedly from 19.0% at baseline to 1.8% post-intervention. Similarly, the prevalence of poor oral hygiene declined from 30.1% pre-intervention to 16.2% after the intervention, indicating an overall enhancement in hygiene practices. The proportion of dmft in primary teeth recorded 37.3% pre intervention, higher than post intervention (23.2%). Additionally, the record of DMFT in permanent teeth (49.2%) pre-intervention compared to the post intervention (40.8%). The study reported a similar percentage on the treatment during pre and post intervention (75.9%). Conclusions: Dental screening intervention yielded promising short-term results, particularly in plaque reduction and caries detection. However, its long-term success hinges on integrating school efforts with parental support and improving access to follow-up dental care. A comprehensive, multi-stakeholder approach remains essential to ensure lasting oral health benefits for children. Full article

Background/Objectives: Primary health care (PHC) utilization in rural communities may depend not only on service availability but also on residents’ knowledge of available services, beliefs about service providers, and expectations regarding the value of care. This analytical cross-sectional study examined factors associated with PHC utilization among adults in the catchment areas of subdistrict health promoting hospitals (SHPHs) in Roi Et Province, Northeastern Thailand. Methods: Using multistage sampling, 10 districts, 20 subdistricts, and 20 villages were selected, followed by convenience recruitment of eligible adults within the sampled villages. A total of 461 participants completed a structured questionnaire assessing sociodemographic characteristics, perception, attitudes, expectations, and PHC utilization. Content validity was supported by Index of Item–Objective Congruence values of 0.67 to 1.00, and Cronbach’s alpha coefficients ranged from 0.97 to 0.98. Data were analyzed using descriptive statistics, correlation analysis, and multivariable linear regression. Results: Participants were predominantly female (65.08%), with a mean age of 49.90 years (SD = 15.23). Using predefined equal-width score intervals, perception was classified as moderate (M = 3.59, SD = 0.36), attitudes as positive (M = 3.91, SD = 0.50), expectations as high (M = 4.18, SD = 0.47), and PHC utilization as high (M = 4.13, SD = 0.53). Relatively higher expectation (β = 0.388, p < 0.001), attitude (β = 0.279, p < 0.001), and perception scores (β = 0.149, p < 0.001) were independently associated with greater overall PHC utilization. The adjusted analysis included 446 participants and explained 46.8% of the variance in PHC utilization (R² = 0.468; adjusted R² = 0.453; overall model p < 0.001). Conclusions: These findings identify residents’ service-related knowledge, beliefs, and anticipated value as factors associated with PHC utilization and as potential areas for further evaluation in communication and service-improvement initiatives. However, causal direction cannot be established, and the findings should not be generalized beyond the sampled communities in Roi Et Province without further research. Full article

The medication-related problems identified by clinical pharmacists during hospitalisation may be better addressed after patient discharge and recovery from acute illness. This approach enables follow-up and may reduce the risks associated with multiple medication changes. However, inadequate information transfer at discharge is a recognised patient safety risk. Referral-based communication between clinical pharmacists and general practitioners (GPs) is a novel procedure in southern Sweden. This retrospective observational study aimed to describe the patient population, medication-related problems, their clinical relevance, and resulting GP actions. Data were collected from pharmacist referrals and electronic medical records between Q4 2021 and Q4 2023. Medication-related problems were categorised, recommendations were assessed for clinical relevance, and follow-up within six months after discharge was analysed to determine whether GPs accepted the recommendations. Forty patients with 58 medication-related problems were included. Women accounted for 70% of the patients, the median age was 79.5 years, and 75% had extensive polypharmacy. Adherence problems were most common (22%). Overall, 98% of the recommendations were considered clinically relevant. Of the 48 assessable recommendations, 77% were implemented in primary care. No statistical association between clinical relevance and implementation was detected (odds ratio 2.27, p = 0.247, CI 0.57–9.04). Pharmacist referrals at discharge may support information transfer and provide clinically relevant recommendations that improve medication safety. Full article

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary feeding up to two years or beyond. However, many mothers are unable to meet their breastfeeding expectations, resulting in a significant emotional impact shaped by social, cultural, and occupational factors. Objective: The aim of this study was to explore mothers’ perceptions and experiences of desired but unattained breastfeeding, with particular attention to its cultural–religious dimension. Methods: A qualitative descriptive study within an interpretivist paradigm was conducted between September 2024 and February 2025. Thirty women (15 Christian and 15 Muslim) receiving care from a primary care midwife in a Spanish city in North Africa participated. Data were collected through semi-structured interviews and analysed using inductive thematic analysis following Braun and Clarke’s approach. Results: Four main themes were identified: (1) emotional experiences and feelings, (2) reasons for breastfeeding discontinuation, (3) contextual and structural barriers, and (4) the influence of the social environment and support networks. Although both groups shared emotions such as guilt, frustration, and sadness, some differences were observed in how breastfeeding discontinuation was interpreted and experienced within this sample. Several Muslim participants expressed distress in relation to maternal identity and perceived maternal inadequacy, whereas several Christian participants more frequently emphasised contextual factors such as perceived lack of support or social pressure. Conclusions: The experience of desired but unattained breastfeeding is complex and may be shaped by cultural–religious context alongside individual, social, and structural factors. Integrating a transcultural approach into healthcare provision may improve emotional support and help reduce the burden of guilt and distress associated with breastfeeding discontinuation. Full article