搜索结果：Journal of family medicine and primary care

Family medicine and primary care are an urgent need to address at tertiary care institutions to envision with firming of primary care in the country. In reference to the growing burden of non-communicable diseases, triggering an alarming situation to public health, it may be alleviated by addressing primary care only. Primary healthcare has consistently played a crucial and unavoidable role in the public health system, but it is frequently presented as a standalone entity. Therefore, there is an immediate necessity to reintegrate primary care into the broader framework of the public healthcare system. Strategic preventive action, intervention, and coordination through person-centric care is the essential tool of family medicine, which paves the way for primary care leadership in public health. The linkage between family medicine and public health has to be reinforced at a tertiary care institution for wider acceptability of the concept. Reduction in morbidity and mortality from various spectrums of disease at the primary stage, cost-effective health care amenable to decreasing the huge burden at tertiary care institutions, which directly affect the quality of health care in India.

The Health Assessment Tool (HAT) is a validated instrument designed to comprehensively assess the health of older adults. This study examinedthe feasibility and acceptability of implementing the HAT in Swedish primary care, while exploring older patients' needs and professional perspectives, drawing on experiences from a multicenter prospective validation study. A qualitative design was employed using reflexive thematic analysis. Data were collected through semi-structured interviews with patients and healthcare managers, and a focus group discussion with healthcare staff familiarized with the HAT in six Swedish primary care centers. Analysis followed Braun and Clarke's six-phase thematic approach, integrating inductive and deductive reasoning. The analysis constructed one overarching theme: 'For the needs left waiting, the HAT is a feasible bridge to holistic care of older adults', supported by two main themes: 'Voices of aging, unmet needs unveiled' and 'The HAT: a dependable compass for decision making in the care of older people'. Findings revealed challenges for older adults, including rapid health decline, loss of independence, loneliness, and gaps in primary care. The HAT was positively received for its comprehensive, person-centered approach, despite some concerns regarding time required for its assessment. The HAT was perceived as feasible and acceptable by older patients and healthcare providers, with the potential to transform care of older adults through proactive, holistic assessments. Its use may foster collaboration between health and social care professionals, a key prerequisite for meeting the complex needs of older people. Future research should evaluate a HAT-based model to support its integration into routine primary care.

Prediabetes is a term that defines those people whose blood glucose levels are detected as being below the cut-off point to diagnose type 2 diabetes mellitus, but above what is currently established as "normal." In Mexico, an Mexican Institute of Social Security study reported a prevalence of 7.86% while according to the criteria of the FINDRISC scale, 66.7% of individuals presented a moderate to very high risk of developing diabetes. Determine the knowledge level of Family Physicians and Family Medicine Resident Physicians Regarding Prediabetes. Observational, descriptive, cross-sectional, and prospective study. Family Medicine Physicians and Resident Physicians who willingly accepted answering an evaluation on prediabetes through a previously validated instrument by expert personnel, were included. Descriptive statistics were calculated, and quantitative variables are expressed in terms of central tendency and dispersion measurements. Qualitative variables are expressed in percentages. Statistical analysis used IBM© SPSS® v. 20 for Microsoft© Windows® was used. 159 research subjects with an average age of 36.7 ± 7.9 were included. The 65% (n = 56) are women. 65% of the respondents were Family Medicine Physicians (n = 93) and 35% were Resident Physicians (n = 66). The obtained average score was 71.94 ± 11.9. Categorizing the owned knowledge, 27% (n = 43) had a good score and 11.95% (n = 19) had a very good score. In the bivariate analysis to search for associations between aging and being a permanent contract or resident physician versus the obtained scoring, no statistically significant differences (P = 0.57) were found. The knowledge level of family medicine specialists and residents regarding prediabetes is insufficient, underscoring the need for training courses with a preventive focus on prediabetes.

Despite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs' perceptions of barriers and facilitators for women's access to CC secondary prevention in Cochabamba, Bolivia. Qualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque's access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels. HCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal-community level, barriers included family-transferred misconceptions, gender norms, and women's fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational-structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening. HCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women's lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.

Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.

Attention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated globally. Primary healthcare physicians (PHCPs) serving as critical gatekeepers for early detection and management. This study assessed the knowledge, attitudes, practices, and barriers among PHCPs regarding ADHD diagnosis and management in Saudi Arabia. This cross-sectional study was conducted among primary healthcare physicians in the Riyadh Second Health Cluster from October to December 2024. Data were collected using a validated self-administered questionnaire. The instrument assessed demographic characteristics, ADHD knowledge (12 items), attitudes (four items), practice behaviors, confidence levels, and perceived barriers. Statistical analysis included descriptive statistics, Analysis of Variance (ANOVA), and Pearson correlations. Of the 325 participating PHCPs, 181 (55.7%) were male and 144 (44.3%) female, with 165 (50.8%) aged 20-29 years and 210 (64.6%) with &#x2264;5 years of experience. The mean knowledge score was 7.92 &#xb1; 1.84 of 12, with 135 (41.5%) demonstrating good knowledge. However, only 84 (26.0%) had diagnosed ADHD cases in the past year, 19 (6.0%) had prescribed treatment, and 175 (54.0%) referred patients to specialists. The mean confidence level was moderate (2.97 &#xb1; 0.91). High barriers were reported by 194 (59.7%) physicians, with predominantly limited training (78.2%), diagnostic complexity (72.0%), and limited resources (61.5%). Seminar attendance significantly improved knowledge scores (8.11 &#xb1; 1.84 vs. 7.54 &#xb1; 1.80, P = 0.008). Significant correlations emerged between knowledge-attitude (r = 0.156, P < 0.01), diagnosis-referral behavior (r = 0.516, P < 0.001), and confidence-diagnostic experience (r = 0.258, P < 0.001). Female physicians reported significantly higher barrier scores than men (4.08 &#xb1; 1.68 vs. 3.70 &#xb1; 1.58, P = 0.034). Despite moderate ADHD knowledge among primary care physicians, significant knowledge gaps existed, with low diagnostic engagement driven by training deficits and systemic barriers. Targeted educational interventions and system-level support are essential for enhancing the primary care ADHD capacity in Saudi Arabia.

Conforming to the global commitment of combating viral hepatitis by 2030, India launched the National Viral Hepatitis Control Program (NVHCP) in 2018. NVHCP is a comprehensive strategy that uses a cascade of care approach to tackle all forms of viral hepatitis. This study was conceptualized to assess the implementation status of NVHCP and to understand the key stakeholders' perspective on prevention, screening, diagnosis, and treatment of viral hepatitis in Uttarakhand. The study commenced in July 2021 and was conducted over a year in six districts of Uttarakhand. The program was evaluated using a sequential explanatory mixed-method approach with a pragmatic stance, incorporating a quantitative component of record-based analysis and a qualitative component of key informant interviews (KIIs) with program managers, physicians, and laboratory technicians. NVHCP integrated effectively with the preexisting healthcare infrastructure and programs to provide primary and secondary levels of prevention. The program picked up pace initially by identifying the service delivery points, training the nominated personnel, and supplying logistics for screening and treatment. However, the developments were halted by the COVID-19 pandemic, which ensued shortly after the first NVHCP budget allocation. From 2019-20 to 2020-21, the pandemic resulted in a 73% decline in hepatitis B virus (HBV) screening and a 76% decline in hepatitis C virus (HCV) screening. The biggest missing link in the cascade of care for HCV was the nonavailability of PCR-based diagnostic viral load testing at treatment centers. A lack of a dedicated data management portal, an inefficient supply chain, and a lack of nomination of pharmacists and peer support were some of the gaps that could be addressed to accelerate the elimination process.

Over the last two decades, there has been an increasing focus on quality in primary care. While the field initially centered around defining quality indicators and patient satisfaction, research has shifted to incorporate complex themes like equity, patient-centeredness, and integration of digital health. A comprehensive mapping of this progressing field is necessary to understand trends and guide future research. To systematically assess global scientific literature on quality in primary care from 2000 to 2025 using bibliometric analysis, and identify leading contributors, collaborative networks, and thematic trends. A structured search strategy was executed in the Scopus database using predefined keywords. Articles published between January 1, 2000, and June 30, 2025, were included. Data were analyzed using Biblioshiny for performance metrics and VOSviewer for network visualization. Of the 5679 articles identified, 4683 met the inclusion criteria. There has been a consistent rise in publications, with 365 articles in 2024 alone. The United States is the most productive and cited country, followed by the United Kingdom and Australia. Richard Grol, Lisa Rubenstein, and Stephen Campbell were among the most influential authors. Recent research themes include patient engagement, implementation science, digital health, and equity. India's contribution remained low at 0.6%. The global research landscape on quality in primary care has grown significantly in the last two decades. Trending topics like implementation science, digital health, patient activation, and social determinants of health are important areas for future research. Considering the low output from India, the research scope for the field is enormous in India.

Climate change is a serious and worsening public health crisis. Primary care clinicians and medical trainees understand the health effects of climate change yet participate in a carbon-intensive industry and often maintain lifestyles linked to high carbon footprints. Moral injury occurs when individuals perpetrate, witness, or fail to prevent acts that transgress deeply held moral beliefs. We hypothesized that primary care clinicians and medical trainees experience morally injurious circumstances in response to climate change. A cross-sectional survey was sent to University of Wisconsin family medicine clinicians and medical trainees. The survey assessed participant climate change attitudes, levels of moral injury specific to climate change (using an adapted Moral Injury Symptom Scale), and general dysphoria. A total of 131 surveys were completed (42.5% response rate). The average moral injury score was 45.5 (&#xb1;&#x2009;11.8); 80.2% of participants scored at or above the established threshold of 36. A significant, moderate positive correlation was found between climate change attitudes and moral injury (r&#x2009;=&#x2009;0.561; P&#x2009;<&#x2009;.0001), as well as between moral injury and associated functional impairment and distress (rs&#x2009;=&#x2009;&#x2009;0.463; P&#x2009;P&#x2009;<&#x2009;.0001). A high rate of climate change-related moral injury was detected in this sample. The degree of moral injury appears to be associated with climate change attitudes and awareness. Family medicine clinicians and medical trainees may represent motivated agents of change in the global climate health response.

Diarrheal diseases remain a significant public health concern, particularly in regions with inadequate water sanitation. In August 2024, an outbreak of acute gastroenteritis was reported from Malangam, Bandipora, with multiple admissions at Sher-i-Kashmir Institute of Medical Sciences, Soura. An outbreak investigation was conducted to identify the source, epidemiological characteristics, and risk factors associated with the outbreak. To investigate the cases of acute diarrheal illness reporting to tertiary care hospital and determine the potential risk factors, and provide recommendations for specific prevention and control. A cross-sectional epidemiological study. Pre-designed, pre-tested epidemiological case sheet was used. The cases were contacted in person wherever possible, and those cases that were not available in person were contacted telephonically, while case interviews were conducted for all of them. A total of 117 cases were diagnosed with acute diarrheal illness during the study period. Female patients were more in number. It was found that the mean age of the cases was 45 years, with a standard deviation of &#xb1;21.8 years, indicating a wide age distribution among patients. The occupational profile of patients indicated that homemakers were the most affected group. Among the admitted cases, around one-third of patients (29.1%) were residents of Srinagar district. The primary source of drinking water for the majority of the cases (62.4%) was piped water, followed by spring water which accounted for 37.6% of cases. The majority of patients experienced multiple episodes of vomiting and diarrhoea. A total of 13 deaths were recorded during the study period. The investigation indicated that the outbreak was waterborne due to untreated water. Strengthening sanitation infrastructure and promoting safe water practices are essential to prevent future outbreaks.

Developmental delay refers to children who experience significant variation in the achievement of expected milestones for their actual or adjusted age. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. Caregivers of these children feel stressed and limit their participation in society. This study was designed to assess the parental stress experienced by caregivers, their social participation, and the coping strategies they adopt. An observational study was carried out on 100 caregivers of children with developmental delay who were enrolled in a rural rehabilitation center. Caregivers were interviewed and assessed for stress, coping strategies, and social participation using specific questionnaires. The mean age of the caregivers was 32.9 &#xb1; 7.76 years, and mainly women (64%). The age of the children ranged from 8 months to 18 years, and most were boys (57%). The proportion of total parental stress was 34%, with the "dysfunctional interaction" subscale at 63%, "parental distress" at 49%, and the "difficult child" subscale at 4%. Only 35% of the participants had no participation restriction, and a significant association between parental distress and social participation was noted (P = 0.004). Though the caregivers used all forms of coping strategies, caregivers with stress used the "avoidant emotional" strategy more compared to those without stress (mean score: 2 &#xb1; 0.41 vs 1.65 &#xb1; 0.34; P < 0.0001). Caregivers without stress mainly adopted the "problem-focused" coping strategy (mean score: 3.19 &#xb1; 0.54 vs 2.86 &#xb1; 0.62; P < 0.0001).

BackgroundPre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) transmission, particularly for individuals at increased risk. However, uptake and long-term adherence remain challenging, with limited data on pharmacies beyond pilot studies. This study explored how psychological, social, and structural factors shape perceptions of HIV risk and influence PrEP adherence, using the Tripartite Risk Perception (TRIRISK) model, Protection Motivation Theory, and the Theory of Planned Behavior.MethodsA qualitative design using in-depth interviews (IDIs) was conducted pre-implementation (May 2023) and during implementation (April-July 2024) of pharmacy-based PrEP services. Participants were adults (18+years) accessing pharmacy-based PrEP services in Gauteng and the Western Cape, South Africa. Data were analyzed thematically using Excel and MAXQDA, guided by the integrated behavioral frameworks.ResultsA total of 99 IDIs were conducted, 30 in 2023, 69 in 2024. Through the TRIRISK model, this study found that decisions to start or continue PrEP were shaped by perceived vulnerability to HIV, awareness of risky sexual behaviors, mistrust of partners, and emotional experiences like fear and trauma. The PMT further highlighted how emotional triggers, along with perceived severity and coping efficacy, affected motivation to initiate or continue PrEP. The TPB helped explain how subjective norms, such as stigma and social judgment, and perceived behavioral control, shaped by access, convenience, and privacy, impacted adherence.ConclusionIntegrated behavioral frameworks offer critical insights into PrEP-related decision making. Interventions, including pharmacy-based PrEP models, should address emotional barriers, such as stigma-sensitive messaging, strengthening social support, and reducing structural inequalities. HIV Risk Perception and PrEP UsePre-exposure prophylaxis (PrEP) is a highly effective medicine that helps prevent human immunodeficiency virus (HIV). However, not everyone who needs PrEP uses it effectively. In South Africa, PrEP is being offered in some pharmacies to make it easier to access compared to most public clinic settings. This study looked at what people think and feel about their risk of getting HIV, and how those thoughts shape their decision to take PrEP. We interviewed 2 groups of pharmacy clients at different stages of implementation: one group before pharmacy-based PrEP was rolled out, and another group during implementation after PrEP had been initiated. We used 3 behavioral theories to understand how people assess their risk and make decisions about PrEP use. We found that people were more likely to start PrEP when they felt personally at risk of HIV, for example due to a partner's unfaithfulness or past traumatic experiences. Support from peers, privacy at the pharmacy, and easy access made it easier to keep using PrEP. However, stigma, travel, and life challenges like family responsibilities often made it harder to continue. This study shows that providing PrEP through pharmacies can work well, but emotional, social, and structural barriers must be addressed. PrEP programs should include supportive messaging, flexible access options, and tools that help people stay on PrEP even when life gets difficult.

The aim of our study was to understand how routine pharmacy practice was impacted during the COVID-19 pandemic and the consequences for patient access. Community pharmacists are among the most accessible primary care providers, playing a vital role in primary care access for patients. During the COVID-19 pandemic, community pharmacists took on numerous additional roles to support safe primary care access. As health systems are in the latter stages of recovery from the pandemic, understanding how the pandemic impacted routine community pharmacy practice and the repercussions for post-pandemic practice is important. Between September 2020 and January 2021, we interviewed 11 pharmacists working in community pharmacies in Nova Scotia, Canada. We thematically analyzed qualitative data pertaining to pharmacists' perceptions of pandemic impacts on providers, patients, and pharmacy practice. The COVID-19 pandemic greatly impacted community pharmacy practice, patients, and community pharmacists. Participants recommended maintaining some of the community pharmacy practice changes and suggested that continuing to expand the scope of practice for pharmacists is essential to meeting population health needs moving forward. Pharmacists recognize and are willing to maintain the essential roles they have assumed in facilitating patient access to primary care. Decision-makers should consider providing the necessary supports (e.g., communication software) and funding support to enable the full scope of community pharmacist practice.

Diabetes is a noncommunicable disease that requires constant self-management and support systems. Managing diabetes can be stressful due to various restrictions and necessary activities for self-care. Diabetes-related stigma can lead to delays in diagnosis, treatment, and management activities. Therefore, there is a need to assess the stigma associated with diabetes. This study assessed the stigma associated with type 2 diabetes mellitus (T2DM) and established the association between diabetes-related stigma, self-management of diabetes, family support for diabetes, and glycemic control. This is a cross-sectional hospital-based study. Three hundred patients of T2DM attending the Medicine and Diabetic Outpatient Department were selected, and the interviewer administered the questionnaire after obtaining informed written consent. The patients' glucose control, treatment received, presence of complications and comorbidities, and regular follow-up visits to the hospital were assessed using their OP cards from the MRD. Data were analyzed using SPSS and JAMOVI software. The study population had a mean age of 57 &#xb1; 9 years, with men and women participating at similar rates. Approximately 53% of the study population had not achieved glycemic control. Structural equation modeling showed significant negative associations between diabetes-related stigma and glycemic control, negative associations between family support and stigma, and positive associations between family support and self-management as well as between self-management and glycemic control. In patients of T2DM with uncontrolled blood sugar, there is a need to address stigma associated with the disease as a part of individual assessment.

India continues to struggle with a deep-rooted preference for sons, reflected in the declining sex ratio at birth (SRB). Rajasthan, with a child sex ratio of 883 girls per 1,000 boys, remains one of the worst-affected states. To curb sex-selective practices, the Government of India enacted the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, and the Government of Rajasthan introduced the Mukhbir Yojana in 2015. The frontline health workers (FHWs), including ASHAs and ANMs, are vital for community mobilization, yet their perspectives on these interventions remain understudied. To assess the awareness of FHWs regarding the PCPNDT Act and Mukhbir Yojana in Jodhpur, Rajasthan, and to explore challenges faced in their implementation. A sequential exploratory mixed-methods study was conducted from July-September 2022 across rural and urban Jodhpur. Six focus group discussions and one key informant interview provided qualitative insights, followed by a quantitative survey among 213 randomly selected FHWs. Data were analyzed using thematic analysis and SPSS v23.0, with odds ratios calculated for urban-rural comparisons. Out of the 213 participants, 64.7% were ASHAs and 35.3% were ANMs, with a median age of 38 years. Most (93.8%) were aware of the PCPNDT Act, though only two-thirds had received training. Awareness of the Mukhbir Yojana was significantly lower (50.2%), and just 23% reported departmental training. Urban FHWs had higher odds of training and awareness compared to rural counterparts. Key challenges included discreet sex-selective practices, lack of training, weak law enforcement, and hesitancy of FHWs to act as informers. Despite these barriers, 94.3% expressed willingness to spread awareness about the schemes. FHWs demonstrated strong awareness of the PCPNDT Act but limited knowledge and training regarding the Mukhbir Yojana. Deep-rooted son preference and weak enforcement mechanisms continue to challenge implementation. Strengthening recurrent training, ensuring confidentiality for informers, and fostering community advocacy are critical to curb sex-selective practices.

Adolescent substance use and substance use disorders are significant public health issues. Our goal was to evaluate the association between adolescent substance use, detected via blood alcohol levels and urine drug screens, and trauma-related outcomes at a Level I pediatric trauma center. Most of the literature is focused on adult trauma patients with limited data in the pediatrics. In this retrospective cohort study, we analyzed data from adolescent trauma patients 13-17 years of age presenting to a Level I pediatric trauma emergency department (ED). Demographic data, Injury Severity Score (ISS), intensive care unit (ICU) admission, hospital length of stay (LOS), and ED disposition were extracted from the Pennsylvania Trauma Systems Foundation Database Collection System, which includes comprehensive information on demographics, clinical characteristics, and outcomes of trauma patients. These data were compared between patients whose alcohol levels and urine drug screening were positive and negative. Our primary outcome measures were ISS and LOS in the hospital and ICU. Our secondary outcome measures were need for surgery, mortality, and disposition from the ED. Specific substances, including tetrahydrocannabinol (THC), benzodiazepines, and opioids, were further analyzed as drugs associated with these outcomes. We performed multivariate regression models to identify independent associations of blood alcohol levels or urine drug screen positivity with trauma severity and ICU admissions. Among 405 adolescents who had toxicology testing done, 11/286 (3.8%) tested positive for alcohol, while 95/377 (25.2%) had positive urine drug screens predominantly for THC (19.9% of the 95 who had a positive screen). Blood alcohol level-positive patients demonstrated significantly lower ISS (P < .001), shorter ICU stays (P. < .01), and shorter overall hospital stays (P< .01) compared to blood alcohol level-negative patients. Conversely, benzodiazepine positivity was strongly associated with higher ISS, increased ICU admissions, and prolonged hospitalization stays. Multivariate analysis showed that older age was associated with increased ISS (&#x3b2; = 0.30 per year, P < .06) and ICU admission (OR 1.16, 95% CI, 1.04-1.28, P < .01). Blood alcohol level and most urine drug screen results were not independently associated with primary outcomes of ISS and LOS in the hospital and ICU, although benzodiazepine positivity was strongly associated with increased ISS (P < .001) and ICU admission (OR &#x2248; 30, P < .001). Adolescent trauma patients who were positive for benzodiazepines were associated with significantly worse outcomes, emphasizing the need for targeted screening and intervention strategies. Alcohol positivity was paradoxically associated with less severe trauma presentations. These findings highlight the complexity of substance use on adolescent trauma and underscore the importance of nuanced clinical assessments and targeted interventions addressing both substance use and underlying sociodemographic vulnerabilities.

Acute Encephalitis Syndrome (AES) has been a serious public health concern in India. Choosing uncertified medical practitioners (UMPs) for AES treatment significantly delays presentation at proper healthcare facilities, leading to poor outcomes in pediatric AES cases. This study elucidates the socio-economic, demographic, and behavioral determinants influencing treatment-seeking behaviors among parents or caregivers of pediatric AES patients. This Cross-sectional study was conducted from July to December 2023. Data related to socioeconomic and demographic characteristics, point of contact for seeking the treatment, and factors associated with it, were collected from the parents and caregivers of confirmed AES pediatric patients. Continuous variables were reported as Mean (SD) and/or Median (IQR). Categorical variables were reported as numbers and percentages. Bivariate and multivariable logistic regressions were used to study the relationship between binary dependent variables and categorical independent variables. The first choice for treatment was UMPs in 55/91 (60.4%) cases. Distance of government healthcare facilities 36/49 (73.5%), availability of UMPs near home 39/45 (86.7%), and no awareness about the disease and its treatment 32/49 (65.3%) were key contributors to choosing UMPs. Patient &#x2265;12 years of age [AOR. (95% C.I.), P] = [4.1 (1.9, 17.8), 0.06]; rural resident [1.4 (0.3, 6.2), 0.68]; from upper lower class [5.6 (0.2, 127.2), 0.27] had higher odds of choosing UMPs. We found significant involvement of UMPs in the treatment of pediatric AES patients causing adverse health outcomes. There is an urgent need to strengthen peripheral public health facilities and increase awareness of AES prevention and treatment among the community and healthcare providers.

This systematic review evaluated the effects of postnatal care (PNC) interventions provided to mothers delivering in hospitals or health centers in India, compared to alternative interventions or usual care, on maternal and neonatal health outcomes over the first year after discharge. We searched seven electronic databases for eligible quantitative and qualitative studies published between January 2000 and December 2024. Study selection, data management, and data synthesis were protocol-driven (PROSPERO-CRD42024554919). After screening 1212 records retrieved, we included only two nonrandomized interventional studies reported in five publications. We assessed the risk of bias using the ROBINS-I assessment tool and reported results following the synthesis without meta-analysis (SWiM) guidelines. One study, reported in four publications, evaluated the Companion Care Programme (CCP), a structured, predischarge, postnatal educational and skills-building package incorporating evidence-based PNC interventions for mothers and family members to improve newborn care, followed by postdischarge support, compared to preintervention usual care. Moderate certainty evidence from a sample of 133,733 mothers from 28 public hospitals across four Indian states demonstrated that CCP reduced the risk of neonatal deaths by 18% (95% CI 7 to 29%). Outpatient visits increased by 27% (95% CI 1 to 47%), but readmissions reduced by 56% (95% CI 39 to 66%), maternal complications reduced by 12% (95% CI 3 to 21%), and neonatal complications by 16% (95% CI 9 to 14%). The effects on exclusive breastfeeding rates were less certain with the CCP, and with a video-based breastfeeding educational program added to standard lactational counseling, versus only lactational counseling.

The association between breast cancer diagnosis and treatment and the risk of incident ischemic stroke remains unclear. We investigated ischemic stroke risk among breast cancer survivors and evaluated associations by age, follow-up duration, and type of cancer treatment. We conducted a nationwide, retrospective, matched cohort study using the Korean National Health Insurance Service database. Women aged 18 years and older with newly diagnosed breast cancer who underwent breast cancer surgery between January 2010 and December 2016 and had no prior stroke were identified. Each was matched 1:3 by birth year to cancer-free women. The primary outcome was first ischemic stroke, defined as hospitalization with International Classification of Disease, Tenth Revision codes I63/I64 plus inpatient brain CT or MRI. Subdistribution hazard ratios (sHRs) and 95% CIs were estimated using Fine-Gray models that accounted for death as a competing risk and adjusted for sociodemographic factors and cardiovascular and non-CV comorbidities. We analyzed 107,606 breast cancer surgery survivors (mean age, 50.0 years) and 322,818 matched cancer-free women. Over a mean 7.2-year follow-up, ischemic stroke occurred in 1,155 survivors (1.07%). Stroke risk was elevated shortly after breast cancer diagnosis (1-year sHR 1.59; 95% CI 1.34-1.89; 3-year sHR 1.17; 95% CI 1.05-1.30) compared with cancer-free women, with stronger associations at 3 and 6 months after diagnosis across all age groups. Over the long term, survivors had a slightly lower risk of stroke (sHR 0.94; 95% CI 0.88-1.00), and in a 1-year landmark analysis including only event-free individuals, the risk was lower (sHR 0.87, 95% CI 0.81-0.93). Among survivors, anthracycline use (sHR 1.25) and combined tamoxifen-aromatase inhibitor therapy (sHR 1.49) were associated with increased risk of stroke, whereas radiation therapy was associated with decreased risk (sHR 0.84). These associations attenuated and became nonsignificant beyond 1 year. Stroke risk was also higher among survivors with low income, hypertension, diabetes, or current smoking. The association between breast cancer and ischemic stroke risk is time dependent, with a short-term increase after diagnosis and treatment followed by a gradual decline over time. These findings highlight the need for proactive stroke risk management, including early CV assessment and ongoing monitoring for thromboembolic events during survivorship.