Search Results (4,996)

Objective: Modern high-intensity warfare, such as the Russo-Ukrainian conflict, generates a high incidence of multisystem polytrauma, blast-induced traumatic brain injury, and limb amputations often complicated by post-traumatic stress disorder and chronic pain. Traditional specialised rehabilitation protocols are structurally inadequate for these co-occurring symptoms and rely heavily on medical treatments, increasing the risk of opioid dependency. The primary aim of this review is to conceptualise a multidimensional integrative framework for war-related polytrauma; a secondary aim is to evaluate and summarise the evidence underpinning its key rehabilitation strategies for limited-resource, post-conflict environments. Methods: This narrative review synthesises evidence identified through targeted database searches and purposive selection guided by clinical relevance, methodological quality, and applicability to war-related polytrauma across physical, technological, and non-pharmacological rehabilitation domains. Evidence was evaluated using a four-tier (A–D) hierarchy, comprising Tier A (systematic reviews and RCTs), Tier B (prospective cohort studies and non-randomised controlled trials), Tier C (descriptive, case-series, and retrospective studies), and Tier D (exploratory, mechanism-based, or expert opinion evidence). No systematic inclusion/exclusion protocol was applied, and no claims of comprehensive search coverage are made. Results: Concurrent physical and trauma-focused psychological rehabilitation, evidenced by reduced pain and psychological symptom burden alongside improved functional independence, is supported by high-quality evidence (Tier A) for managing comorbid polytrauma. Robotic exoskeletons and AI-supported tele-rehabilitation demonstrate dose-dependent motor benefits in selected rehabilitation populations (Tier A–B), but their scalability in wartime settings is contingent on electricity supply, connectivity, equipment maintenance, and trained personnel. Acupuncture shows Tier A evidence for neuropathic pain and Tier B cost-effectiveness; evidence for phantom limb pain and PTSD is preliminary (Tier C–D) and requires dedicated RCTs in veteran populations. Ayurvedic herbal interventions are exploratory (Tier C–D) with no war-specific clinical trials; mechanistic plausibility is discussed as hypothesis-generating only. Conclusions: Addressing the war-related rehabilitation gap requires integration of biomedical care, technology-assisted rehabilitation, and evidence-graded non-pharmacological adjuncts within a structured biopsychosocial framework. Future priorities include pragmatic, adapted trial designs (e.g., stepped-wedge or cohort-embedded designs, which are more feasible than classical RCTs under wartime conditions) for acupuncture in phantom limb pain, feasibility trials for robotic rehabilitation in frontline-adjacent facilities, and health-economic modelling adapted to the Ukrainian context. Full article

Background: Medication non-adherence remains a major challenge in psychiatric care, yet its prediction often relies on clinical and sociodemographic characteristics, while giving comparatively limited attention to modifiable psychological–cognitive factors. Integrating mental health literacy and medication-related beliefs with explainable machine learning approaches may provide a more informative framework for understanding and predicting adherence. Objective: This study examined the association of mental health literacy and medication-related beliefs with psychotropic medication adherence and evaluated their explanatory and predictive values using conventional statistical modeling, machine learning, explainable artificial intelligence, and structural path analysis. Methods: A cross-sectional study was conducted with 225 psychiatric patients. Medication adherence; mental health literacy; and beliefs about medication necessity, concerns, harm, and overuse were assessed using self-report measures, including a MARS-derived eight-item adherence measure. Associations were examined using Spearman correlations, hierarchical regression with robust inference, and a secondary observed-variable path representation of multivariable associations with 5000 bootstrap resamples. The Elastic Net, Random Forest, and Gradient Boosting models were evaluated using repeated five-fold cross-validation. Shapley Additive exPlanations (SHAP) were used to interpret the best-performing model. Results: Greater adherence was associated with higher mental health literacy (ρ = 0.361) and stronger necessity beliefs (ρ = 0.353), whereas concern (ρ = −0.474), perceived harm (ρ = −0.528), and overuse beliefs (ρ = −0.284) were negatively associated with adherence (all p < 0.001). The psychological–cognitive model explained 40.0% of the variance in the primary eight-item adherence composite. The integrated Random Forest achieved the best out-of-sample performance (R² = 0.402, MAE = 0.958, RMSE = 1.299; n = 208), although the improvement over the psychological–cognitive Random Forest (R² = 0.375) was modest. SHAP identified perceived harm and medication concerns as leading predictors. Conclusions: Medication adherence in psychiatric patients was more strongly characterized by psycho-cognitive factors than by sociodemographic and clinical characteristics alone. Mental health literacy, necessity beliefs, medication concerns, and perceived harm may represent particularly informative targets for individualized adherence assessments and future intervention development. Prospective external validation is required before clinical implementation. Full article

Background/Objectives: Oral diseases are common, largely preventable and closely associated with social determinants, noncommunicable diseases and quality of life. Greece has historically had a high dentist-to-population ratio; however, oral health care remains highly dependent on private provision and out-of-pocket payment. This structured evidence synthesis and health-system mapping aims to summarize the current situation of oral health care in Greece, focusing on access, financing, workforce capacity, epidemiology, prevention, and quality measurement. Methods: A structured evidence synthesis and health-system mapping were conducted using publicly available and verifiable sources, including World Health Organization documents, OECD/European Observatory country health profiles, Eurostat data, official Greek government information, and peer-reviewed studies identified through PubMed, Google Scholar, publisher records, and reference-list searching. The final synthesis included 29 sources: 15 peer-reviewed articles and 14 official or institutional documents/data sources. A formal systematic review, with or without meta-analysis, was not methodologically feasible because the research question was not based on a single intervention, exposure, comparator, or outcome, and because key evidence on oral health-system organization, financing, and governance is contained in heterogeneous policy documents, administrative sources, official reports, and country profiles that are not consistently indexed in bibliographic databases. Evidence was organized across predefined health-system domains: governance, service delivery, financing, workforce, epidemiology, equity, information systems, and quality measurement. Results: Greece combines high dentist density with limited public dental coverage and major financial barriers. Current EOPYY rules list age-specific preventive and treatment benefits, and Dentist Pass provided a preventive dental-care voucher for children; however, no ring-fenced national dental-treatment allocation or nationwide uptake estimate was identified. Most routine adult dental care remains privately financed. Recent Eurostat data indicate that Greece has the highest reported unmet dental care needs in the European Union. Comparative WHO country-profile indicators suggest that Greece’s high dentist density does not, by itself, correspond to lower unmet dental care needs or stronger publicly reported coverage of routine and preventive oral health care. Epidemiological studies show persistent caries, periodontal disease and tooth loss, particularly among children, older adults and socioeconomically disadvantaged groups. Major system-level gaps include limited financial protection, weak integration with primary care, insufficient standardized referral pathways and limited routine measurement of oral health quality and outcomes. Conclusions: The findings suggest that strengthening oral health care in Greece would require a shift from fragmented, curative and privately financed care toward prevention-oriented, publicly accountable and measurable services integrated with universal health coverage and national quality-of-care reforms. Full article

Background and objectives: Type 2 diabetes mellitus (T2DM) care depends on sustained self-management behaviour and psychological wellbeing. This study examined diabetes self-management behaviour, depressive symptom burden, and associated demographic factors among adults with T2DM. Methods: The present cross-sectional study was conducted among T2DM patients attending 10 primary healthcare centres in the Al-Jouf region, northern Saudi Arabia. Diabetes self-management behaviour was assessed using the Summary of Diabetes Self-Care Activities, and depressive symptoms were assessed using Patient Health Questionnaire-9. Binomial logistic regression identified factors associated with low self-management behaviour and no-to-mild depressive symptom status. Results: Of the 350 T2DM patients studied, the mean self-care activity score was 28.38 ± 12.10, and the mean PHQ-9 score was 6.39 ± 3.91. Moderate-to-severe depressive symptoms were present in 87 participants (24.9%). Low self-management behaviour was significantly associated with obesity (Ref: normal body mass index; AOR: 1.47, 95% CI: 1.10–2.06, p = 0.041), T2DM duration of 6–10 years (Ref: 0–5 years; AOR: 2.12, 95% CI: 1.18–3.83, p = 0.013), other chronic illnesses (Ref: no; AOR: 1.93, 95% CI: 1.18–3.16, p = 0.004), and moderate-to-severe depressive symptoms (Ref: none-to-mild; AOR: 1.76, 95% CI: 1.21–3.06, p = 0.034). Conclusions: Suboptimal diabetes self-management behaviour and depressive symptom burden were observed. Integrating structured self-management education, repeated behavioural counselling, and depressive symptom screening may improve patient-centred diabetes care. Full article

Background/Objectives: Obesity is a well-established risk factor for several cancers, yet few studies have explored survivorship outcomes among obesity-related cancer (ORC) survivors—a growing public health concern. Beyond cancer risk, obesity is associated with poorer health-related quality of life (HRQoL), greater comorbidity burden, and adverse lifestyle behaviors during survivorship. This study examined differences in these outcomes between ORC and non-ORC survivors living in Puerto Rico. Methods: We analyzed 569 cancer survivors aged ≥21 years actively undergoing treatment from the Impact of Social Determinants of Health on the Cancer Care Continuum in Cancer Survivors in Puerto Rico Study, with survey data collected between 2023 and 2025. ORC status was classified based on the presence of a primary ORC (n = 262); all others were classified as non-ORC (n = 307). Outcomes included: (1) HRQoL, assessed using the Functional Assessment of Cancer Therapy-General overall score and domains; (2) comorbidities; and (3) lifestyle behaviors (i.e., physical activity, alcohol use, and smoking status). Poisson regression models with robust standard errors estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for all outcomes except smoking status and comorbidity burden, which were analyzed using multinomial logistic regression models to estimate adjusted relative risk ratios (aRRRs). Results: ORC survivors had a higher relative risk of former smoking (vs. never smoking) than non-ORC survivors (aRRR: 1.74, 95% CI: 1.02–2.96). No other differences were observed between groups. Older ORC survivors reported better emotional (aPR = 0.59, 95% CI: 0.41–0.85) and physical (aPR = 0.74, 95% CI: 0.58–0.95) well-being than older non-ORC survivors. Among male participants, ORC survivors reported a lower prevalence of moderate/exceeded drinking than non-ORC survivors. Conclusions: Findings highlight a higher relative risk of former smoking (vs. never smoking) among ORC survivors compared with non-ORC survivors, with additional sex- and age-specific patterns in alcohol use and emotional/physical well-being. Full article

The building industry is the largest consumer of energy and the largest source of carbon emissions, and the sustainable development of building envelopes is thus inevitable. Among the facade systems, metal cladding materials offer a number of benefits such as high durability, architectural freedom, and recyclability; however, the choice of these materials needs to be based on several performance aspects. This research presents a novel comprehensive approach for analyzing metal cladding options in a health care building through the integration of building energy simulation and multi-attribute decision analysis (MADA) techniques. A primary health care facility in Istanbul, Türkiye, was used as a case example. Eight metal cladding materials—steel, aluminum, copper, zinc, titanium, stainless steel, Corten steel, and magnesium alloy—were evaluated against various wall and insulation combinations. The assessment combined energy with physical–mechanical, thermal, acoustic, and sustainability indicators such as density, thermal conductivity, Young’s modulus, damping capacity, traffic noise insulation, service life, and recyclability. A series of building energy simulations was performed to estimate the effect of facade design options on yearly energy consumption, and the resulting data set was analyzed based on the CRITIC, LOPCOW and ALPAS methods. This method allows the comprehensive evaluation of metal cladding material on energy efficiency, structural strength, acoustic performance, durability, and circularity simultaneously. The results provide a practical decision support framework for sustainable facade material selection in health care and other energy-intensive buildings. Titanium emerged as the optimal metal cladding material, distinguished by its superior combination of low thermal conductivity, damping capacity, and recyclability under both CRITIC and LOPCOW weighting schemes. Comparative analysis across nine MADA methods (ρ = 0.932) and sensitivity analysis over 70 scenarios confirmed the robustness of this finding, with titanium retaining first place in 64 out of 70 perturbation scenarios. These outcomes provide materials engineering insight into how the mechanical, thermal, and durability characteristics of structural metals and alloys translate into differentiated in-service performance, offering evidence-based guidance for metal selection in facade applications. The outcomes reported relate to one health care facility located in Istanbul and demonstrate the potential of the novel framework for the specific investigated case but are not intended to be generalized across all building types and climatic zones or to provide universally applicable material rankings. Full article

Background: Cardiovascular complications of cancer therapy may affect patients far beyond conventional measures of cardiac function, yet their relationship with health-related quality of life (HRQoL) remains incompletely defined. This review examined how cardiovascular status and cardiotoxicity-related interventions relate to HRQoL across cancer treatment and survivorship. Methods: Twenty-one studies were reviewed and reassessed according to four research questions: established cardiovascular disease or cardiac dysfunction and HRQoL; subclinical cardiovascular abnormalities and subsequent HRQoL; interventions targeting cardiotoxicity with HRQoL assessment; and supportive interventions improving HRQoL without demonstrated cardioprotection. Evidence was additionally considered across diagnostic, pharmacological/cardioprotective, exercise, and supportive-care domains. Results: The available evidence revealed a clinically relevant pattern. Established cardiovascular disease or cardiac dysfunction showed the clearest association with poorer HRQoL, particularly in physical domains, whereas evidence linking subclinical abnormalities to subsequent patient-reported deterioration was sparse. Most studies evaluated interventions, including cardioprotective pharmacological strategies and exercise-based approaches, but improvements in HRQoL were not consistently accompanied by, or attributable to, demonstrated cardioprotection. Exercise and supportive interventions were also associated with improvements in functional or patient-reported outcomes in some studies, independently of demonstrable cardiovascular benefit. Across domains, substantial heterogeneity in populations, cardiovascular measures, interventions, HRQoL instruments, and study designs limited direct comparison and causal interpretation. Conclusions: Cardiovascular health and HRQoL appear closely interconnected, but the available evidence does not establish a consistent link between cardiovascular injury and subsequent changes in HRQoL. The literature is richer in prevention and intervention studies than in longitudinal assessment of the patient-reported consequences of cardiovascular injury. Larger prospective studies incorporating standardized serial cardiovascular assessment and HRQoL as a predefined primary endpoint are needed to establish temporal relationships and clinically meaningful cardiovascular determinants of HRQoL. Full article

Background/Objectives: Preterm birth remains a significant global public health challenge, associated with increased morbidity, rehospitalisation, and long-term vulnerability. The transition from the neonatal intensive care unit (NICU) to the home environment represents a critical phase. This practice-focused narrative review synthesises current evidence on community-based post-discharge follow-up for preterm infants, with particular emphasis on the complementary contribution of community health nursing and midwifery within multidisciplinary follow-up models, endocrine-metabolic surveillance and coordinated care for medically complex infants. Methods: A narrative synthesis of review articles, clinical guidelines, and empirical studies published between 2016 and 2026 was undertaken. Searches were performed in PubMed, Scopus, and CINAHL using terms related to preterm birth, NICU discharge, community follow-up, family-centred care, community health nursing, midwifery, and metabolic disorders. Results: Community-based, family-centred follow-up programmes are associated with improved continuity of care, increased parental confidence, enhanced breastfeeding outcomes, and reduced healthcare utilisation. Community health nurses, midwives and health visitors contribute complementary expertise within multidisciplinary follow-up by coordinating continuity of care, providing clinical surveillance of growth and feeding, supporting caregiver education, facilitating early identification of complications, and ensuring timely referral. However, endocrine and metabolic vulnerabilities remain underrepresented in many follow-up models, while infants with complex healthcare needs require individualised, risk-stratified surveillance. Conclusions: Community-based, interdisciplinary, and family-centred follow-up after NICU discharge is essential to enhance the quality and safety of care for preterm infants. Integrated, risk-stratified models of follow-up that combine preventive surveillance, family education, multidisciplinary coordination, and continuity of care may facilitate earlier recognition of complications and improve long-term outcomes. Full article

Background: Hypertension commonly complicates Type 2 diabetes mellitus (T2DM), contributing significantly to increased morbidity and mortality. This study determined the prevalence and factors associated with hypertension among people with T2DM at a tertiary health facility in Northern Uganda. Methods: A hospital-based cross-sectional study was conducted from 18 July to 24 October 2024. Participants with confirmed T2DM were selected through systematic random sampling at Lira Regional Referral Hospital (LRRH) in Lira City, Uganda. Data were collected using a structured questionnaire adapted from the WHO STEPS (2022) tool. Patient charts and registers were used to verify information. Data were analyzed using STATA version 16. Multivariable logistic regression was performed, and p-values < 0.05 were considered statistically significant. Results: A total of 340 participants were enrolled in the study; the median age was 55 years; 244 (71.8%) were female; and nearly half of the participants (163, 47.9%) had attained primary education. Overall, 67.1% (228/340) of the participants with T2DM had hypertension. Factors independently associated with higher odds of hypertension were as follows: age 61+ years (aOR = 5.55, 95% CI: 1.34–23.1, p = 0.018), being overweight (aOR = 3.77, 95%CI: 1.05–13.57, p = 0.042), T2DM duration of more than five years (aOR = 2.51, 95% CI: 1.41–4.67, p = 0.002), and being widowed (aOR = 8.04, 95% CI: 1.87–34.61, p = 0.005). Earning UGX 50,001–100,000 per month (aOR = 0.35, 95% CI: 0.13–0.93, p = 0.037) was associated with 65% lower odds of having hypertension. Conclusions: Two-thirds of patients with T2DM had hypertension, and factors such as older age, being overweight, a longer T2DM duration, and marital status significantly increased hypertension risk; meanwhile, moderate-income status offered a protective effect. The high burden of hypertension among patients with T2DM demonstrates the necessity for targeted public health interventions such as comprehensive lifestyle modification programs, routine screening for hypertension, early detection, and its management among patients with T2DM through enhanced healthcare access. These interventions should focus on integrated care approaches that monitor and manage T2DM alongside hypertension. Full article

Background/Objectives: Children and adolescents living with HIV (ALHIV) are among the most vulnerable groups affected by HIV and AIDS. Their vulnerability exposes them to several challenges, such as HIV-related stigma and/or interrupted academic activities due to health-related complications. Since they are still minors who cannot independently make decisions regarding their own lives, most of the challenges extend to their caregivers, who sometimes provide care and support under difficult psychological, social, and economic conditions. This study aimed to explore the lived experiences and challenges of primary caregivers caring for ALHIV in Gauteng Province of South Africa. Methods: A qualitative exploratory design with phenomenological orientation was adopted. Eight primary caregivers of ALHIV were purposively sampled and interviewed using individual face-to-face semi-structured interviews. Data was analysed thematically according to the eight steps of Tesch’s qualitative analysis framework. Since it involved human participants, this study was subjected to ethical clearance by the Research Ethics Committee of the University of South Africa, which imposed conditions for upholding ethical principles such as informed consent and confidentiality. Results: Primary caregivers encounter challenges such as regular monitoring of ALHIV who are always sick, treatment adherence monitoring, behavioural management, financial strain, stigma and discrimination, lack of proper nutrition and managing adolescents’ academic difficulties. These challenges require support from multidisciplinary team members which include nurses because they play a crucial role in supporting treatment adherence among ALHIV and in strengthening the capacity of primary caregivers to provide effective treatment support. Conclusions: It is essential to adopt an integrated approach to psychosocial, as well as financial support interventions targeting primary caregivers. Full article

Background: Population aging has led to an increasing proportion of older adults (aged 65 and older) acting as informal caregivers. These caregivers face risks of burden, stress, and depression. While research frequently documents negative psychological outcomes, resilience represents a crucial protective process. This systematic review synthesizes and maps the empirical evidence regarding the association between the socio-ecological resilience process and the well-being of older informal caregivers. Methods: Following Joanna Briggs Institute (JBI) mixed-methods guidelines, a convergent segregated mixed studies systematic review was conducted. A systematic search of Medline (PubMed), CINAHL, PsycINFO, and Scopus identified primary articles (2014–2025) in English and Spanish. Methodological quality was appraised using JBI critical appraisal checklists and the Mixed Methods Appraisal Tool. PROSPERO registration number: CRD420251142190. Results: Thirty-one studies were included. Elevated caregiver resilience was associated with lower reported symptoms of depression and anxiety, higher self-rated health, and positive psychological adaptation. Framed within a social ecological model, personal resources such as spirituality, hope, and self care, alongside relational assets like dyadic relationship quality and mutual coping, demonstrated a positive association with resilience and a reduction in subjective burden. Within the community context, informal peer networks and Online Health Communities functioned as essential supportive resources. On a structural level, both household wealth and the regional availability of long-term care beds acted as moderators for spousal well-being, whereas exceeding 30 weekly caregiving hours acted as a temporal threshold for positive adaptation. Conclusions: These findings suggest that resilience in older caregivers may be best conceptualized not as a static individual trait, but as a multi-level, dynamic socio-ecological process. Rather than relying on individual coping alone, public policies and clinical practice should prioritize systemic, relational, and structural environmental support, including formal respite services and long-term care infrastructure, to preserve the well-being of older spousal caregivers. Full article

Background: Endothelial dysfunction is a key component of sepsis pathophysiology. The Endothelial Activation and Stress Index (EASIX) is a practical biomarker derived from routine laboratory parameters and indirectly reflects endothelial injury. This study aimed to evaluate the prognostic association of EASIX with in-hospital mortality and organ-support requirements among patients with pneumosepsis admitted to the intensive care unit (ICU). Methods: This retrospective cohort study included 1787 adult patients with pneumosepsis admitted to a tertiary ICU from January 2018 to December 2025. EASIX was calculated from laboratory parameters obtained at ICU admission, and log2-EASIX was used in all analyses. The primary outcome was in-hospital mortality. Secondary outcomes included the need for invasive mechanical ventilation (IMV), vasopressor therapy within the first 24 h, second-line vasopressor therapy, and continuous renal replacement therapy (CRRT) within the first 7 days after ICU admission. Associations with the primary and secondary outcomes were evaluated using univariable and multivariable logistic regression, and discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: The in-hospital mortality rate was 56.2%. Log2-EASIX was independently associated with in-hospital mortality (OR: 1.191, 95% CI: 1.119–1.268; p < 0.001). ROC analysis showed moderate discrimination for predicting in-hospital mortality (AUC: 0.673, 95% CI: 0.648–0.698), with a ROC-derived exploratory cut-off of 1.47. Patients with log2-EASIX ≥ 1.47 had approximately a two-fold higher risk of in-hospital mortality (OR: 2.039, 95% CI: 1.610–2.584; p < 0.001). In multivariable analyses of the secondary outcomes, log2-EASIX remained independently associated with second-line vasopressor requirement (adjusted OR: 1.104, 95% CI: 1.040–1.171; p = 0.001) and CRRT requirement within 7 days (adjusted OR: 1.317, 95% CI: 1.236–1.404; p < 0.001). However, its associations with IMV and initial vasopressor requirements were not statistically significant after adjustment. Adding log2-EASIX to the Acute Physiology and Chronic Health Evaluation (APACHE) II resulted in a statistically significant but small improvement in discrimination compared with APACHE II alone (AUC: 0.761 vs. 0.740; ΔAUC = 0.021; 95% CI: 0.010–0.032; p < 0.001). Conclusions: EASIX was independently associated with in-hospital mortality and second-line vasopressor requirement, and it remained associated with CRRT requirement after multivariable adjustment. However, serum creatinine alone showed superior discrimination for CRRT, suggesting that the association between EASIX and CRRT may be driven, at least in part, by its creatinine component and should therefore be interpreted cautiously. In contrast, the associations of EASIX with early IMV and initial vasopressor requirements were not significant after multivariable adjustment. Although its discriminative performance for mortality was moderate when used alone, EASIX may provide complementary prognostic information when added to established disease severity assessment. These findings warrant validation in prospective, multicenter studies. Full article

Background: General Practice is facing workforce shortages across Europe. In Italy, the estimated shortage was 5575 General Practitioners in 2024, with high retirement rates and persistent difficulties in attracting new physicians to the profession. This study investigated postgraduate career intentions among medical students and factors associated with interest in General Practice. Methods: A cross-sectional survey using an anonymous 39-item questionnaire was conducted among fifth- and sixth-year medical students at the University of Milan. Associations were assessed using ordinal and multinomial logistic regression. Results: Among 359 respondents (response rate: 46.8%), only 2.2% identified General Practice as their preferred postgraduate career. Students considering General Practice attributed greater importance to community-based work (OR = 18.49, 95% CI 3.35–102.02) and professional autonomy (OR = 4.47, 95% CI 1.03–19.44). Previous community-based primary care experience was associated with choosing General Practice (OR = 32.43, 95% CI 3.85–273.50). Most students perceived theoretical and practical General Practice training as less adequate than that of other specialties, and only 25.1% considered their preparation sufficient to support career decision-making. Conclusions: Strengthening the academic integration of General Practice and meaningful community-based learning opportunities may contribute to more informed career choices while better preparing future physicians for healthcare systems increasingly centred on Primary Health Care. Full article

Background: The COVID-19 pandemic simultaneously affected vascular risk and healthcare utilization. We evaluated whether monthly trajectories of Brazilian Unified Health System (Sistema Único de Saúde; SUS)-financed hospitalizations for different cerebrovascular categories changed differently during the pandemic in the municipality of São Paulo. Methods: We conducted an ecological time-series study using monthly Hospital Information System of the Brazilian Unified Health System (SIH-SUS), Department of Informatics of the Unified Health System (DATASUS) data from January 2017 through December 2021. Nontraumatic intracranial hemorrhage (I60–I62), cerebral infarction (I63), unspecified stroke (I64), and other cerebrovascular diseases (I65–I69) were included. The analytical dataset comprised 240 monthly observations. Annual IBGE population estimates were used as denominators. The primary analysis used segmented negative-binomial regression with log(population) offset, temporal trend, an immediate level change from March 2020, post-intervention slope change, and annual harmonic terms for seasonality. Poisson and negative-binomial models were compared using overdispersion diagnostics and Akaike information criterion (AIC). Residual autocorrelation, category-by-intervention interactions, alternative intervention dates, and leave-one-month-out influence were assessed. Results: A total of 60,756 hospitalizations were identified. Descriptive differences in mean annual counts between the pre-pandemic and pandemic periods were +3.7% for intracranial hemorrhage, +15.2% for cerebral infarction, −16.2% for unspecified stroke, and −27.2% for other cerebrovascular diseases. All categories were overdispersed (Pearson ratios 2.16–5.05), and AIC was consistently lower for negative-binomial models. In the primary segmented model, March 2020 was associated with an immediate 39.3% decrease in other cerebrovascular diseases (incidence rate ratio [IRR] 0.607; 95% confidence interval [CI] 0.512–0.720; p < 0.001) and a 10.0% decrease in unspecified stroke (IRR 0.900; 95% CI 0.817–0.991; p = 0.032). No statistically significant immediate level change was found for intracranial hemorrhage (IRR 1.018; p = 0.760) or cerebral infarction (IRR 0.868; p = 0.086). No category showed a significant post-intervention slope change. The formal category-by-level-change interaction was significant (Wald p = 0.004), indicating heterogeneity among categories. LjungBox tests at 12 lags showed no significant residual autocorrelation. Conclusions: SUS-financed cerebrovascular hospitalizations showed heterogeneous temporal changes during the pandemic, particularly immediate decreases in I64 and I65–I69. The findings support differences in trajectories across diagnostic categories but do not demonstrate diagnostic migration, individual biological mechanisms, or causality. Changes in care-seeking, referral, coding, diagnostic availability, and healthcare organization remain plausible but untested explanations. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article