Search Results (4,971)

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

Background/Objectives: In Germany, women have direct access to gynaecologists without GP referral, making the GP’s role in female-specific conditions largely secondary. It has not previously been examined whether the sex of the GP is nonetheless associated with the documented prevalence of these conditions in primary care records. Methods: This retrospective cross-sectional study used data from the IQVIA™ Disease Analyzer. All women aged ≥18 years with at least one visit to one of 1183 GPs in Germany in 2025 were included. Women attending female and male GPs were matched 1:1 by propensity score on age, statutory health insurance, practice size, consultation frequency in 2025, and the van Walraven comorbidity score (excluding malignancy), yielding 661,485 women per group. Associations between GP sex and the documented prevalence of eight female-specific conditions were examined using conditional logistic regression within the age strata clinically relevant to each condition (from 18–30 to >75 years), with the age × GP-sex interaction tested in a single model per condition and E-values calculated to assess robustness to unmeasured confounding. Results: The association between GP sex and documented prevalence was strongly age-dependent, with a significant age × GP-sex interaction for seven of eight conditions (all p < 0.001). Female GP sex was associated with higher documented prevalence in mid-life, including menopausal and perimenopausal disorders (46–60 years: OR 1.37, 95% CI 1.28–1.46), endometriosis (31–45 years: OR 1.15, 1.03–1.28) and benign neoplasm of the female breast and genital organs (46–60 years: OR 1.16, 1.04–1.29); in the oldest women, the pattern attenuated or reversed (menopausal disorders > 75 years: OR 0.81, 0.72–0.90). No association was observed for breast cancer or female genital organ cancer at any age. Conclusions: In German primary care, the association between GP sex and the documented prevalence of female-specific disorders is age-dependent—most pronounced for conditions that require active clinical recognition and patient disclosure in mid-life, and absent for specialist-managed malignancies. Full article

Background/Objectives: Dental caries remains one of the most prevalent and preventable childhood diseases worldwide. Despite universal access to free dental care in Saudi Arabia, preventable oral diseases remain common, highlighting persistent gaps in oral health literacy and preventive behaviours among children. Male students consistently demonstrate poorer oral health knowledge and practices than their female counterparts, yet they remain understudied. This study aimed to assess oral health knowledge, attitudes, and practices (KAP) among male primary school students in Al Lith city, Saudi Arabia, and to identify their associated sociodemographic determinants. Methods: A school-based analytical cross-sectional study was conducted during the 2023–2024 academic year in Al Lith city, Makkah Province, Saudi Arabia. A total of 430 male students aged 10–13 years from grades five and six were recruited via multistage cluster sampling from 8 randomly selected schools. A validated, interviewer-administered, Arabic-language questionnaire assessed knowledge (18 items), attitudes (12 Likert-scale items), and practices (12 items) related to oral health, alongside sociodemographic data. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data were analysed using IBM SPSS Statistics version 27. Descriptive statistics and multivariable logistic regression were performed. Results: Of the 430 participants, 83.3% were aged 11–12 years, 89.8% were Saudi nationals, and 89.1% resided in intact, two-parent households. Knowledge deficits were widespread: only 8.4% correctly identified the recommended timing of sweet consumption, 20.2% understood dental plaque, and 28.6% recognised the protective role of fluoride. Attitudes were generally positive, with 80.1% agreeing that teeth should be brushed twice daily and 71.6% endorsing regular dental visits; however, 60.3% held that dental attendance was necessary only when pain was present. Substantial practice gaps were also evident: only 33.3% brushed for the recommended two minutes, and 12.6% had never visited a dentist. In multivariable analysis, low household income was independently associated with better oral health knowledge (adjusted odds ratio [AOR] = 2.22; 95% confidence interval [CI]: 1.04–4.74; p = 0.039), divorced parental status was independently associated with positive oral health attitudes (AOR = 5.40; 95% CI: 1.28–22.79; p = 0.022), and older age was independently associated with poorer oral health practices (AOR = 0.72; 95% CI: 0.55–0.93; p = 0.014). Conclusions: Male primary school students in Al Lith demonstrated generally positive oral health attitudes but significant deficits in knowledge and preventive practices. Comprehensive, school-based oral health promotion programmes that address key misconceptions, actively engage parents, and integrate culturally accepted practices—such as miswak use—with evidence-based preventive guidance are needed. Full article

Background/Objectives: Pharmacogenetics (PGx) may improve drug safety and effectiveness, but its integration into routine care remains heterogeneous across the Spanish National Health System (NHS). This article presents BioFRAM PGx, a multicentre implementation framework that defines the methodological and operational basis for subsequent observational validation in cardiovascular and mental-health care settings. Methods: The framework was developed by healthcare centres from eight Spanish Autonomous Communities through a structured review of PharmGKB/ClinPGx clinical annotations, CPIC and DPWG guidelines, and national regulatory resources. Gene–drug pairs were prioritized according to clinical actionability, therapeutic relevance, applicability to the Spanish population, and analytical feasibility. BioFRAM PGx defines a panel of seven pharmacogenes and 35 drugs, standardized genotyping and phenotype-assignment procedures, pharmacovigilance and clinical variables, healthcare-resource measures, and centralized data management. The proposed non-interventional validation phase includes adults receiving at least one selected drug in hospital or primary-care settings, with a minimum six-month follow-up. PGx results are not returned to clinicians and do not modify treatment. Its primary objective is to assess the predictive value of PGx genotyping for adverse drug reactions (ADRs); secondary objectives include ADR incidence and implementation feasibility. Results: The main outputs are the proposed multicentre observational design, the prioritized gene–drug panel, harmonized analytical and pharmacovigilance workflows, standardized data domains, and a centralized data-management strategy. No patient-level clinical, implementation, or economic outcomes are presented. Conclusions: BioFRAM PGx provides a structured multicentre framework for harmonizing pharmacogenetic procedures across the Spanish NHS. Its clinical effectiveness, influence on prescribing, scalability, and economic outcomes remain to be assessed in subsequent studies. Full article

Fibromyalgia (FM) causes widespread pain, poor sleep, fatigue, and reduced quality of life. Exercise is the best supported non-pharmacological treatment, yet many patients report that it is insufficient on its own. Somatic tracking is a component of pain reprocessing therapy. It is promising in chronic back pain but untested as a stand-alone intervention in FM. The Fibromyalgia Somatic Tracking and Exercise Program Study (FIBROSTEPS) is a single-center 2 × 2 factorial randomized controlled superiority trial estimating the separate and combined effects of group exercise and somatic tracking on the impact of FM. Two hundred adults aged 18–65 years, of either sex, with FM diagnosed by the 2016 criteria, are randomized 1:1:1:1 after an 8-week baseline period to general activity recommendations plus usual care (control), supervised group exercise, somatic tracking, or both. Both interventions run for 16 weeks with one session per week (45 min physiotherapist-led group exercise; 40 min guided somatic tracking with a certified therapist). The primary outcome is change in total original Fibromyalgia Impact Questionnaire score (0–100) from week 8 to week 24, analyzed by intention-to-treat. Secondary outcomes include insomnia severity, daily pain intensity, and Fitbit-measured activity and sleep. The trial has 80% power for the two main effects; the exercise × somatic-tracking interaction is prespecified as exploratory. No results are reported; the trial will provide randomized evidence on somatic tracking in FM, alone and combined with exercise, informing multi-component FM rehabilitation. Trial Registration: ClinicalTrials.gov (NCT06922747). Ethics Approval: Regional Committee for Medical and Health Research Ethics (REK), reference 2025/853403. Full article

Background: Chronic lower limb wounds, such as diabetic and vascular ulcers, affect up to 2% of the global population, imposing high healthcare costs and a significant risk of amputation. Although nursing care and traditional treatments are fundamental, single-use portable Negative Pressure Wound Therapy PICO 7 system, has emerged as a cost-effective alternative. The objective of this study was to evaluate the effectiveness of PICO 7, compared to the usual treatment in chronic lower limb wounds or their dehiscence in amputations. Methodology: A randomized, controlled, open-label clinical trial was conducted at the Hospital Universitario de Toledo (2024–2026). The final analyzed sample consisted of 31 patients (Intervention Group, IG: 14; Control Group, CG: 17). Both groups followed the dynamic TIME strategy to standardize wound bed preparation. Primary variables included healing rate, healing time, wound area reduction, clinical safety (infections and adverse effects), pain levels, health-related quality of life, and physical activity. Statistical analysis was performed using SPSS v.28. Results: The IG showed a higher mean percentage reduction in wound size, although the between-group difference did not reach statistical significance. No infections were recorded in the IG. Regarding quality of life and physical activity, the CG showed a significant post-intervention decline, whereas the IG remained stable. A significant negative correlation was found between final wound size and hours of sleep, suggesting that wound reduction facilitates better rest. Conclusions: The PICO 7 system appears to be a safe and feasible alternative to conventional wound care. Favorable trends in wound area reduction should be interpreted cautiously given the lack of statistically significant between-group differences. Full article

Background/Objectives: Family dietary imbalance is an important source of the double burden of malnutrition, and dietary arrangements in multigenerational households are often deeply embedded in intergenerational caregiving relationships. However, the cognitive formation mechanism through which dietary caregiving behaviors driven by care and responsibility may instead lead to dietary imbalance still lacks systematic explanation. Therefore, this study aimed to examine the cognitive formation mechanism of dietary imbalance behaviors in Chinese multigenerational households. Methods: This study takes primary dietary caregivers in Chinese three-generation households as the research subjects. It integrates the false consensus effect, cognitive dissonance theory, and the information–motivation–behavioral skills (IMB) model. Based on 467 valid samples, the study conducts empirical analysis using partial least squares structural equation modeling (PLS-SEM) and importance-performance map analysis (IPMA). Results: The results show that caregivers’ subjective judgments about family members’ dietary needs based on their own experience trigger cognitive dissonance and further promote their re-examination of dietary risk information, caregiving responsibilities, and family normative expectations. Among these factors, caregiving responsibilities and subjective norms are key factors in improving dietary regulation self-efficacy, whereas the effect of risk information perception on self-efficacy is not significant. The IPMA results further show that self-efficacy is the most important factor driving the formation of behavioral intention to regulate healthy family diets. Conclusions: This study reveals the psychological mechanism through which dietary imbalance behavior in multigenerational households moves from subjective need judgment to the formation of future regulation intention. It extends the application of the IMB model in family caregiving contexts and provides a theoretical basis and practical implications for the formulation of family health promotion and dietary intervention strategies. Full article

Background/Objectives: Eating disorders (EDs) have historically been associated with young women, and their presence in older adults remains poorly recognized despite evidence that they can persist, recur, or emerge in later life. Primary care nurses are strategically positioned for community-based detection, yet their perspective has been scarcely explored. This study aimed to examine the experiences, perceptions, and described practices of primary care nurses regarding EDs and disordered eating in older adults, identifying patterns, barriers to detection, and training needs. Methods: A qualitative study with a descriptive design was conducted in three Primary Health Care Centers from different health areas of Spain. Thirty-two registered practicing nurses participated in three focus groups, guided by a clinical vignette and a semi-structured interview guide. Data were analyzed following Braun and Clarke’s reflexive thematic analysis, supported by ATLAS.ti software (version 24.2, 2024). Results: EDs in older adults frequently remained invisible to professionals, sustained by three interrelated mechanisms: the cultural hegemony of the biomedical paradigm, which reframes symptoms as organic or cognitive; a selective historicization that attributes altered eating to the postwar “hunger years”; and an “ageism of care” that normalizes warning signs as expected features of aging. Notably, when the diagnostic possibility was explicitly named, participants retrospectively reinterpreted cases they had previously explained in other terms. Conclusions: This invisibility stems not from an absence of clinical signs, but from professional, cultural, and institutional interpretive frameworks. Findings underscore the need for specific training, adapted screening tools, and a critical perspective on ageism in nursing practice. Full article