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Patient safety events are among the top ten causes of death and disability worldwide, with most considered preventable, particularly in primary care. Digital interventions are increasingly used in primary care to improve patient safety, targeting errors and preventing adverse events. Evaluating their effectiveness and implementation is essential to inform clinical practice and policy. The study aims included a systematic review and meta-analysis of the effectiveness of digital patient safety interventions in primary care, comparing single and multicomponent interventions, identifying effective components, and exploring factors influencing their success. MEDLINE, EMBASE, and CENTRAL were searched from January 2001 to June 2025, restricted to English-language publications. This review followed PRISMA guidelines. Randomized controlled trials assessing digital interventions aimed at improving patient safety outcomes in primary care were included. Safety outcomes were grouped into medication safety and non-medication process measures, and adverse events. Two reviewers independently extracted and verified data and assessed risk of bias, resolving discrepancies by consensus. Random-effects meta-analysis was performed for predefined safety outcomes, and a narrative synthesis described implementation factors. Seventy-four randomized controlled trials (RCTs) were included. Meta-analysis demonstrated benefits for medication safety process measures (k = 54; Odds Ratio (OR) 1.46, 95% confidence interval (CI): 1.30-1.64), non-medication process measures (k = 40; OR 1.77, 95% CI: 1.56-2.01), and adverse events (k = 12; OR 1.17, 95% CI: 1.06-1.30). Overall, multicomponent interventions consistently showed greater improvements than single-component interventions. Interventions combining components of clinical decision support and audit and feedback were most effective for medication safety, while patient-facing components had greater impact on non-medication process measures. Results remained consistent in sensitivity analyses restricted to higher-quality RCTs. Effectiveness was likely influenced by implementation factors, including workflow integration and relational support. Digital interventions in primary care are associated with moderate improvements across multiple patient safety process measures. Multicomponent approaches appear most promising, with effectiveness potentially shaped by implementation, patient engagement and contextual factors. These findings support the broader adoption of well-designed, contextually adapted digital strategies to enhance patient safety and underscore the need for ongoing evaluation of the sociotechnical factors supporting delivery of these interventions.

Food and Nutrition Surveillance is a key strategy of Brazil's National Food and Nutrition Policy and plays a central role in the organization of nutritional actions in primary health care. Despite its strategic importance, food and nutrition surveillance implementation faces persistent challenges related to training gaps, funding discontinuities, and limited institutional support. This study assessed the organizational readiness of primary health care professionals for food and nutrition surveillance implementation via the Organizational Readiness for Implementing Change (ORIC) instrument. This cross-sectional study was conducted in Mato Grosso do Sul, Brazil, during a state-level permanent education event in 2023. Eighty-five primary health care professionals from 49 municipalities responded to the Brazilian version of the ORIC instrument, adapted for the food and nutrition surveillance context. ORIC measures two core constructs: change commitment and change efficacy. The statistical data were analyzed and compared with the readiness levels by professional category (frontline representation) and health macroregion. The mean ORIC score indicated neutral to moderate readiness across participants (commitment: 3.65; efficacy: 3.71 on a 5-point Likert scale). Nurses and physical education professionals exhibited the highest levels of readiness, surpassing the threshold of 4.0 in both domains. In contrast, nutritionists-despite being the professional group most directly associated with the food and nutrition surveillance-scored lower. Geographic disparities were also evident: professionals from the Eastern Border and Southern Cone regions reported greater readiness than those from the Central and Pantanal macroregions did. The findings reveal important gaps in organizational readiness for food and nutrition surveillance implementation in primary health care, particularly among nutritionists and in certain territories, suggesting limited engagement or perceived capacity to implement the policy. These results emphasize the need for regionally tailored strategies, stronger integration with permanent education initiatives, and institutional support mechanisms. The ORIC instrument proved to be a useful tool for assessing team-level readiness and guiding implementation efforts. Applying implementation science frameworks may help foster greater alignment between health professionals' practices and policy goals, ensuring more equitable and sustainable integration of food and nutrition surveillance in primary health care.

Obesity is a growing global health burden, previously with few effective treatments. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally approved for diabetes but are increasingly prescribed for treatment of overweight and obesity. The increasing expenditure has led to ethical debates surrounding the utilization of these drugs. Few studies have investigated the attitudes to GLP-1 RAs among prescribing physicians. This study aimed to assess the attitudes to GLP-1 RAs for treatment of overweight and obesity among Swedish primary care physicians. This was a cross-sectional survey with descriptive quantitative analysis and thematic analysis of free-text responses. A mix of multiple-choice questions and rating scales, including the Likert scale was employed. The study was conducted in October 2024 among physicians working in primary care in the Swedish regions of Gävleborg, Uppsala, Västernorrland, Västmanland and Örebro. The survey was distributed through the Drug and Therapeutics Committees (DTCs) in the regions. The 190 responses yielded a response rate of 28%. Of these, 163 responses could be included in the final analysis. Almost all respondents (98%) agreed that GLP-1 RAs are effective drugs for treating obesity, and 91% believed they will be important for obesity treatment in the future. Main identified barriers for prescribing GLP-1 RAs were high patient co-payment (69%) and low drug availability due to supply shortages at the time of conducting this survey (86%). Physicians working in primary care in Sweden consider GLP-1 RAs effective for treating obesity and believe these drugs will play an important role in obesity treatment in the future. These findings should be interpreted in the light of the low response rate and possible self-selection bias.

Influenza vaccination coverage in France remains suboptimal, with variability across population groups. We assessed demographic and behavioral determinants of influenza vaccination in the post-COVID-19 period among a primary care population in the Haute-Vienne department (Nouvelle-Aquitaine, France). We conducted a cross-sectional survey using an anonymous, self-administered questionnaire distributed to adults attending five general-practice sites between May and July 2023. The primary outcome was receipt of the 2022-2023 influenza vaccine. Candidate determinants included age, sex, municipality size, socio-professional category, eligibility criteria (age&#x2009;&#x2265;&#x2009;65 years, healthcare-worker status, chronic conditions, or pregnancy), prior influenza vaccination, number of COVID-19 vaccine doses received, and self-reported history of influenza infection. Associations were examined using chi-square tests, Cochran-Armitage trend tests, and univariate logistic regression. Two multivariable logistic regression models were then constructed: a demographic model including age, sex, municipality size, socio-professional category, and the presence of any comorbidity or pregnancy, and a behavioral model including prior influenza vaccination and COVID-19 vaccination status (&#x2265;&#x2009;3 doses vs.&#x2009;&#x2264;&#x2009;2 doses). Adjusted results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Among the 800 questionnaires distributed, 432 were returned (participation rate: 54%). Overall, 75.9% of participants met at least one eligibility criterion for influenza vaccination. Influenza vaccination coverage for the 2022-2023 season was 58.3% and differed by municipality size (38.8% in areas with fewer than 5,000 inhabitants; 59.2% in those with 5,000-10,000; and 64.3% in those with more than 10,000, p&#x2009;=&#x2009;0.0003) and increased with the regularity of prior influenza vaccination (6.7% among never vaccinated, 55.9% among occasional, and 96.6% among annually vaccinated, p&#x2009;<&#x2009;0.0001). Coverage was also associated with the number of COVID-19 vaccine doses received (p&#x2009;<&#x2009;0.0001). In the demographic model, age&#x2009;&#x2265;&#x2009;65 years was associated with higher vaccination uptake (aOR 8.55, 95% CI 1.88-61.73, p&#x2009;=&#x2009;0.012), whereas other demographic variables were not independently associated with vaccination uptake. In the behavioral model, prior influenza vaccination was strongly associated with vaccination uptake (aOR 16.20, 95% CI 7.21-36.41 for occasional vs. never and aOR 331.21, 95% CI 122.57-894.99 for annual vs. never; both p&#x2009;<&#x2009;0.001). Receipt of &#x2265;&#x2009;3 COVID-19 vaccine doses was also independently associated with vaccination uptake (aOR 2.64, 95% CI 1.01-6.89, p&#x2009;=&#x2009;0.047). In this primary care survey, influenza vaccination during the 2022-2023 season was primarily associated with prior influenza vaccination history, suggesting persistence of vaccination practices over time. Age&#x2009;&#x2265;&#x2009;65 years and receipt of &#x2265;&#x2009;3 COVID-19 vaccine doses were also independently associated with vaccination uptake, although to a lesser extent. Targeted strategies that reinforce continuity (annual reminders, vaccination offers during routine visits, and co-administration options) and encourage initiation among previously unvaccinated adults could help improve coverage. Not applicable.

Hospital referral in acute situations is a complex process with a significant impact on older adults. This study aims to explore the considerations of healthcare providers from both primary and secondary care when deciding whether or not to refer an older patient to the hospital in acute situations. By including perspectives of different health care providers, this study seeks to provide a more comprehensive understanding of the decision-making process. In February 2025, three online semi-structured focus group discussions were conducted with 16 primary and secondary healthcare providers. Three case studies (two hip fractures, one COPD exacerbation) guided the discussion. Data were analysed using a combination of inductive and deductive thematic analysis and were iteratively clustered and visualized around four key consideration factors. Twenty subthemes were identified and mapped onto four overarching main themes, corresponding to the four key consideration factors: patient-related (e.g. network, quality of life, patient and family preferences, emotional status and living situation), healthcare provider-related (e.g. professional attitude, collaboration and familiarity with patients), case-specific (e.g. age, medical history, activities of daily living (ADL) and mobility, cognitive functioning, frailty, prognosis, the acuity of situation, alternative treatment, and risk of complications) and structural factors (e.g. ability to arrange appropriate care and the patients' increasing care demand). Decision-making in hospital referrals is not determined solely by the acute condition, but is a complex and dynamic process. This highlights the importance of strengthening interprofessional communication and collaboration, addressing the shortages in the availability of appropriate patient care, and extending advance care planning (ACP) practices by involving family members to support more patient-centred referral decisions.

Germany faces a critical shortage of primary care physicians (PCPs). A protective factor against job turnover is the experience of meaningful work. While the presence of meaning fosters work engagement and well-being, its absence can lead to career exit. This qualitative study explores perceptions of meaningful and meaningless work among German PCPs to inform health policies and help minimize career exit. We implemented a qualitative study design, conducting online, one-on-one, semi-structured interviews with 24 PCPs practicing across Germany. Participants were recruited through purposive and snowball sampling to ensure a representative sample. We evaluated the data using reflexive thematic analysis. We generated five central themes. Meaning is derived from realizing professional identity through autonomous medical expertise (theme 1) and cultivating trust-based, long-term patient relationships on an equal footing (theme 2). Conversely, meaninglessness arises through unrealistic patient expectations and physicians' experiences of frustration (theme 3), and systemic devaluation through administrative burdens and inadequate compensation (theme 4). The resulting disillusionment (theme 5) increases the risk of career exit. Our findings show that the projected PCP shortage in Germany may stem in part from a "crisis of meaning". Current billing structures prioritize high-volume transactional encounters, which obstruct the very tasks that PCPs find meaningful. To ensure workforce stability, policy reforms must move beyond individual resilience and address these systemic drivers of meaninglessness.

China's long-term care insurance (LTCI) pilots aim to support older adults, but evidence on whether policy rollout is followed by reduced care gaps among functionally limited older adults remains limited. Using CHARLS 2011-2020, we included respondents aged 60 years or older at first observation and estimated a staggered difference-in-differences model comparing early-adopter pilot cities with never-pilot cities. The primary outcome was a severe care-gap proxy, defined as ADL/IADL difficulty with no help. This estimand describes care-gap trajectories among older adults with functional limitations, not effects among confirmed LTCI beneficiaries or formally eligible disabled older adults. We also examined whether estimates differed according to whether local policy texts explicitly included in-kind home- and community-based services (HCBS), including home-visit provision. In early-adopter pilot areas, adoption was associated with a higher severe care-gap proxy by 2020 (ATT 0.023; 95% CI 0.001-0.045). The proxy showed high specificity and positive predictive value but limited sensitivity against 2020 activity-level unmet-need items. Estimates were directionally larger in cities without explicit in-kind HCBS wording, and formal/community home-based care did not measurably expand over the same period. The observed 2020 pattern should be interpreted cautiously because pandemic disruption, measurement differences, attrition, and compositional shifts may have contributed. The findings support nursing-centered monitoring of severe care-gap indicators during policy rollout and more explicit attention to service activation pathways.

Although primary health care (PHC) is central to health system performance, effective facility-level management is a critical determinant of service quality, resource use, and improved health outcomes. We conducted a systematic review to synthesize evidence on interventions, implementation strategies, and outcomes aimed at strengthening PHC facility management in Sub-Saharan Africa (SSA). We conducted a systematic review using thematic synthesis. Eight electronic databases were searched for peer-reviewed studies and grey literature published between 2012 and 2022, focusing on interventions targeting PHC facility management in SSA. Implementation strategies were mapped to the thematic cluster areas of the Expert Recommendations for Implementing Change (ERIC) framework. Implementation outcomes were classified using Proctor's Implementation Outcome Framework, and management effectiveness domains were identified through thematic analysis. Of 3,752 studies screened, nine met the inclusion criteria. These studies represented six SSA countries: Botswana, Ethiopia, Kenya, South Africa, Tanzania, and Zambia. Four categories of intervention were identified: (1) training and capacity building programs, (2) peer-to-peer learning, (3) audit and feedback-based quality management systems, and (4) supportive supervision. These interventions were delivered through multiple implementation strategies, including training and education, coaching and mentoring, learning collaboratives, interactive continuous learning, and routine data monitoring. Acceptability was the most consistently reported implementation outcome. Improvements in management effectiveness were identified across four domains: financial management, organizational climate and culture, resource management and utilization, and human resource management. Five studies also reported intermediate service-level outcomes including improvements in maternal and child health indicators. Interventions aimed at strengthening PHC facility management in SSA primarily emphasize skill development, collaboration, and ongoing managerial support, typically delivered through multiple strategies. However, few studies have evaluated these interventions using rigorous experimental or pragmatic study designs. More robust implementation research is needed to identify effective strategies for strengthening PHC facility management and supporting the consistent implementation of national PHC guidelines.

Despite the importance of promoting healthy lifestyles in primary healthcare (PHC) to prevent non-communicable diseases, implementing and sustaining evidence-based health-promotion lifestyle practices remains challenging. This study aimed to evaluate the sustainability of uptake of a health-promoting practice using a 12-month multifaceted implementation intervention in a Swedish PHC setting. A non-randomized parallel group design was used to compare five PHC intervention centers and five matched control centers with respect to health-promotion activities registered in medical records at: 6 months pre-implementation, during a 12-month implementation phase, and a follow-up at 18 months (sustainability). The intervention centers received a multifaceted implementation intervention based on a leadership change model using internal and external facilitators. Uptake was analysed using negative binomial mixed-effects models with a log link, modelling monthly uptake rates with an offset for the number of visits. Time since intervention initiation and time since the post-implementation phase were modelled using restricted cubic splines, allowing intervention effects to vary over time. Models were adjusted for seasonality, secular trends, patient sex, and site pair, with site included as a random effect. Intervention effects were estimated as ratios of rate ratios with simultaneous 95% confidence intervals. The intervention centers successfully adopted and sustained the clinical intervention. At the 18-month follow-up, intervention centers sent out 7.2 times as many lifestyle screening forms compared with the control centers. The mean crude uptake difference was 43.6 and the relative rate was estimated at 2.23, indicating that patients at the intervention centers were more often asked about their lifestyle and more often received advice or consultative conversations about lifestyle changes. This multifaceted implementation intervention, focusing on leading change and facilitation in a routine clinical setting, increased the uptake of a health-promoting practice at the PHC intervention centers that was sustained over time. Health-promoting activities reached a larger proportion of patients in the intervention centers, indicating that the clinical intervention may work under routine conditions. These results are promising but need to be verified in larger randomized studies. In addition, differences between the intervention centers emphasize the need to explore the mechanisms of impact. This study was registered at ClinicalTrials.gov on 4 March 2021 (ref: NCT04799860).

Black women are under-represented in clinical research, contributing to persistent health inequities and undermining the validity and generalisability of research findings. Understanding facilitators and barriers to their research engagement is essential to addressing these challenges. This study aimed to identify and synthesise evidence on barriers and facilitators which influence Black women's participation in healthcare research, to inform inclusive recruitment strategies and equitable research designs. This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024587308). Findings were narratively synthesised using thematic analysis and discussed iteratively through Patient and Public Involvement. Five databases were searched (CINAHL, PsycInfo, Embase, MIDIRS, MEDLINE) for studies published since 2010. Papers in any language were screened for inclusion. Patient and Public Involvement members informed review objectives and data interpretation. Primary research studies reporting on Black women's experiences, attitudes, and facilitators/barriers to participating in any type of healthcare research. Studies were included if&#x2009;&#x2265;&#x2009;50% (to ensure primary representation) of the sample recruited were Black women. Seventy-two studies were included. Most were from America and spanned research areas relating to oncology, Human Immunodeficiency Virus (HIV), dementia, maternity, and general health. Five overarching themes identified how Black women's participation in healthcare research is shaped by a complexity of factors. These were mistrust, interpersonal experiences, altruism, self-interest, and low health/research literacy and awareness. Patient and Public Involvement consultations concurred that the findings aligned with a "bridge and barriers" analogy, illustrating how various factors can facilitate or prevent Black women from engaging with research opportunities. This provided a clear framework to guide culturally sensitive implementation for researchers, healthcare professionals, and policymakers. Inclusive strategies for recruiting Black women into research must focus on co-constructing a bridge between communities and research systems. This requires structural and systemic change in research delivery environments and ongoing collaborations with all stakeholders including Black women, healthcare system providers, and research teams. PROSPERO (CRD42024587308).

People with mobility impairments such as stroke survivors or people with spinal cord injury (SCI) receive ambulatory healthcare from several healthcare providers. The coordination of these providers is challenging because there are usually no team meetings or shared treatment protocols. To gain insights into the coordinative processes of ambulatory care, the information transfer between providers was explored. A cross-sectional network study was conducted in an urban community in the south-west of Germany. First, an exploratory internet search for local providers was conducted. Then, providers were asked to distribute a survey to their patients (stroke, SCI) to identify the provider network. This was followed by a survey of the providers named by the surveyed patients. Network analysis was applied to explore connections and network characteristics (density, centrality). Based on the patient survey (n&#x2009;=&#x2009;22), a total of 58 healthcare providers in the community were identified, 20 of whom took part in the provider survey. In the network identified, physiotherapists, general practitioners, occupational therapists, orthopaedic technicians, neurologists, speech therapists and neuropsychologists were connected by 251 ties. The network had a density of 0.152 and a centrality of 0.442. Inter-organizational information sharing was only mentioned for 12 connections between healthcare providers. Care coordination in the community was rated as medium. Network analysis provided insight into a local network of healthcare providers. The network is dominated by a few providers and all providers have a low degree of connectivity. This study found that sharing of patient's information between providers is rarely implemented.

Bellwether procedures-caesarean section, laparotomy, and open fracture management- are core indicators for monitoring safe, equitable, and affordable surgical care in a country. Although effective surgical care is essential for achieving universal health coverage and the Sustainable Development Goals, spending on surgical care leading catastrophic health expenditure among surgical patients, particularly low-income and middle-income countries (LMICs). This study assesses catastrophic health expenditure (CHE) associated with bellwether surgery to quantify financial risk and inform future equitable health financing reforms. A prospective institutional-based observational cohort study was conducted at Debre Tabor Specialized Hospital, South Gondar. Using systematic random sampling, 425 patients undergoing bellwether procedures were enrolled. Catastrophic expenditures assessed with the validated Financial Risk Protection tool developed by the Harvard Program in Global Surgery and Social Change. Categorical variables were compared using &#x3c7;&#xb2; tests, while continuous data were evaluated for normality with the Shapiro-Wilk test and histograms. Means (&#xb1;&#x2009;SD) and medians (&#xb1;&#x2009;IQR) were reported accordingly. Bivariable and multivariable binary logistic regression identified predictors, with adjusted odds ratios (95% CI); p&#x2009;<&#x2009;0.05 to declare statistical significance. A total of 425 patients undergoing bellwether procedures were included, representing all woredas and city administrations of South Gondar, Northwest Ethiopia. The median age was 36 years (IQR 24-52), and the majority were classified as ASA I/II. Emergency laparotomy accounted for the largest proportion of procedures (55.8%). Within the three-delay framework, the median duration of Delay 1 (care-seeking) was 12.0&#xa0;h (IQR 6-24). The overall postoperative complication rate was 21.3%, while in-hospital mortality was 0.9%. At the 10% threshold, catastrophic health expenditure (CHE) was observed in 76.0% of households lacking community-based insurance or free health initiatives. CHE at this threshold was significantly associated with referral delay (Delay 2; adjusted odds ratio [AOR] 1.06, 95% CI 1.01-1.10 per hour), emergency bone fixation (AOR 22.9, 95% CI 7.4-70.4), and emergency laparotomy (AOR 3.3, 95% CI 1.6-6.9). Approximately two-thirds of patients undergoing bellwether surgery experienced catastrophic health expenditure, declined to one-third among those enrolled in community-based or family health insurance. Catastrophic health expenditure was greatest with delayed presentation, rural residence, long travel distance, and prolonged hospital stay. Expanding insurance coverage, improving access, and integrating surgical services into primary health care are essential to achieve safe, timely, and affordable surgery in line with global targets.

General practitioners (GPs) are central to the treatment and management of injured workers. Australian workers' compensation funds GP consultations for work-related injuries. Almost all other GP consultations are subsidised by public healthcare insurance (Medicare Benefit Scheme). This study aimed to examine changes in publicly-insured GP consultations before and after injury for injured workers with long-duration claims, focusing on consultation duration types and GP-provided mental health and chronic diseases management plans. This retrospective cohort study using interrupted time series analysis included 3,755 injured workers and 10,113 community individuals with injury/index date between 2006 and 2016. We compared monthly changes in rates (per 1000 workers) of six GP consultation types for 12-month before and 24-months after injury. Acute and long-term changes were examined both overall (combining all consultation types) and separately by consultation type. Consultation types include four duration-based levels: A (0-6&#xa0;min), B (6-20&#xa0;min), C (20-40&#xa0;min), and D (40-60&#xa0;min), and two types describing mental health and chronic disease management plans. After injury, injured workers received an additional 1,600 Medicare-subsidised GP consultations per 1,000 workers per year compared to the community group. Post-injury, the largest increase in monthly consultation rates was observed for Level D consultations (IRR: 2.37, 95% CI: 1.35, 4.20), while the smallest increment was observed for Level B consultations (IRR: 1.45, 95% CI: 1.32, 1.59). Monthly GP mental health care and chronic disease development plan rates increased by 84% (IRR: 1.84, 95% CI: 1.17, 2.93) and 20% (IRR: 1.20, 95% CI: 0.78, 1.86) post injury, respectively; however, the monthly rates of these consultations were small (maximum 25/1000 workers) Following these initial increases immediately post-injury, monthly consultation rates decreased by 3% to 9% and by 24-months post-injury had returned to levels observed in the comparison group. All six types of publicly insured GP consultations increased temporarily in the initial months following injury, regardless of worker's compensation status. These consultations remained elevated above pre-injury levels for over 12 months, likely reflecting delayed claim acceptance or increased care needs. These findings highlight the need of a comprehensive, whole-person approach to recovery that addresses both immediate and broader healthcare needs.

The gait recovery process after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) is complex. However, systematic evidence regarding risk factors for delayed early postoperative gait recovery in patients with Crowe type I/II DDH remains limited. This retrospective study included 283 patients with Crowe type I/II DDH who underwent primary THA at our institution between January 2020 and December 2024. The primary outcome was delayed clinical gait recovery at 3 months after surgery, defined as persistent limping or Trendelenburg gait after full weight-bearing was permitted and/or a Harris Hip Score (HHS) limp subscore&#x2009;<&#x2009;11; this threshold indicates failure to reach the "no limp" score of 11 in the HHS limp subscore. Outcomes were independently adjudicated by two uniformly trained investigators, and inter-rater agreement was assessed using Cohen's kappa (&#x3ba;). Model 1 included age, bilateral DDH status, American Society of Anesthesiologists (ASA) physical status class II/III, symptom duration, preoperative HHS, preoperative need for a walking aid, preoperative Trendelenburg sign, Crowe classification, preoperative leg length discrepancy (LLD), operative time, and intraoperative blood loss. Model 2 further included postoperative residual LLD, height of the acetabular center of rotation, cup abduction angle, and femoral offset change. The primary analysis was based on multiple imputation by chained equations (MICE; 20 imputations), with sensitivity analyses using the unilateral DDH subgroup, complete cases, alternative outcome definitions, a parsimonious model, an all-prespecified-covariate model, collinearity testing between preoperative and postoperative LLD, and LLD threshold analyses. Delayed gait recovery at 3 months occurred in 92 patients (32.5%). Multivariable analysis (Model 1) showed that a positive preoperative Trendelenburg sign (odds ratio [OR]&#x2009;=&#x2009;2.87, 95% confidence interval [95% CI]: 1.55-5.31), Crowe type II (OR&#x2009;=&#x2009;2.15, 95% CI: 1.18-3.91), preoperative LLD (per 1-mm increase: OR&#x2009;=&#x2009;1.14, 95% CI: 1.03-1.26), age (per 1-year increase: OR&#x2009;=&#x2009;1.03, 95% CI: 1.01-1.05), and symptom duration (per 1-year increase: OR&#x2009;=&#x2009;1.03, 95% CI: 1.01-1.06) were independent risk factors for delayed gait recovery. The extended model (Model 2) showed that postoperative residual LLD was also independently associated with delayed gait recovery (per 1-mm increase: OR&#x2009;=&#x2009;1.20, 95% CI: 1.02-1.41), whereas height of the acetabular center of rotation, cup abduction angle, and femoral offset change showed no independent associations. Sensitivity analyses restricted to unilateral DDH and complete-case analyses were consistent with the primary analysis. In this predominantly female Chinese single-center cohort of patients with Crowe type I/II DDH undergoing primary THA, delayed clinical gait recovery at 3 months was not uncommon. Positive preoperative Trendelenburg sign, Crowe type II, greater preoperative LLD, older age, and longer symptom duration were independently associated with delayed early clinical gait recovery; postoperative residual LLD provided additional explanatory value in the extended model. These factors may help identify patients at higher risk of delayed early clinical gait recovery before surgery, but instrumented gait analysis was not performed in this study, and long-term three-dimensional gait-kinematic prognosis requires further validation. Not applicable.

Strong opioids are central to effective symptom control in palliative care. In cases of complex symptom burden, primary care teams frequently rely on palliative care consultation services (PCCSs) for expert guidance. This survey explored the recommendations issued by hospital-based PCCS teams regarding the use of strong opioids in patients with advanced disease (e.g. clinical indications, opioid agent). A closed online survey was conducted via the SoSci Survey platform. All PCCS teams registered with the German Association for Palliative Medicine were invited to participate in November 2024, with a reminder sent three weeks later. Thirty-nine PCCS teams participated (21 university hospitals, 18 general hospitals). All respondents agreed on the indication for strong opioids in cancer-related pain and dyspnea. Differences emerged regarding the use of opioids in patients with non-malignant conditions: although most PCCS considered opioids appropriate for dyspnea associated with pulmonary (n&#x2009;=&#x2009;37) or cardiac disease (n&#x2009;=&#x2009;33), non-cancer pain was less consistently endorsed (n&#x2009;=&#x2009;20). Hydromorphone and morphine were the most commonly used opioids (>&#x2009;30 services reporting frequent use), whereas the use of fentanyl, oxycodone, and buprenorphine varied widely across services. There is consensus regarding the use of opioids in patients with cancer-related pain and dyspnea. The differing approaches to their use for symptoms caused by non-malignant conditions suggest varying clinical interpretations and underscore the need for further research and clearer guidelines.

Primary burning mouth syndrome (BMS) is a chronic idiopathic orofacial pain condition characterized by persistent intraoral burning sensation in the absence of clinically evident mucosal lesions. Its pathophysiology is considered multifactorial, with neuropathic mechanisms playing a central role. Current treatments are constrained by systemic adverse effects. Modulation of the oral mucosal ionic microenvironment has been proposed as a potential local therapeutic strategy. This study aimed to evaluate the efficacy and safety of magnesium-calcium oral rinse(test oral rinse)in patients with primary BMS. In this randomized, double-blind, placebo-controlled trial, 116 adults with primary burning mouth syndrome (BMS) were assigned in a 1:1 ratio to receive magnesium-calcium oral rinse or placebo for 8 weeks. Participants rinsed 10 mL for 60 seconds three times daily. The primary outcome was change in burning pain intensity assessed using a Numeric Rating Scale (NRS). Secondary outcomes included the responder rate (&#x2265;2-point reduction in NRS), Oral Health Impact Profile-14 (OHIP-14), Xerostomia Inventory, Patient Global Impression of Change (PGIC), and safety assessments. At week 8, the active group showed significantly greater reduction in pain compared with placebo (mean difference, -1.7; 95% CI, -2.5 to -0.9; P<0.001). Responder rates were 62% versus 32% (P=0.001). Significant improvements were also observed in OHIP-14 and xerostomia scores. Adverse events were mild and comparable between groups. Magnesium-calcium oral rinse significantly reduced burning pain and improved oral health-related quality of life in patients with primary burning mouth syndrome, with a favorable safety profile. These findings support the potential role of mineral-ionic topical therapy in this condition. ClinicalTrials.gov NCT07564843, registered on 27 Abril 2026. Retrospectively registered.

Provision of adolescent-friendly Health services (AFHS) at lower primary health care centres (PHCs) is a core strategy for improving access and health outcomes of adolescents. In this study we assessed the health facility-based prevalence of repeat adolescent pregnancies and the capacity of PHCs (Health centres (HC) level III and IV) to provide AFHS in Uganda. We conducted a cross-sectional study between April and May 2023 involving 43 healthcare facilities (33 HC III and 10 HC IV) across 4 districts in Southwestern Uganda. Using pretested structured questionnaires, we interviewed the health facility in-charges or their delegates. We extracted the 6-month information from registers on: number of repeat adolescent pregnancies, post-abortion, and post-natal adolescents attending each facility. With a checklist, we assessed the availability of family planning materials/services and other medical equipment. Descriptive statistics were generated. Adolescent contributed 4.9%, 16.3% and 14.8% of all repeat pregnancy, post-abortion and post-natal consultations documented at all PHCs. We noted a low perinatal care staffing with the majority of HC IIIs lacking adolescent peer educators (n&#x2009;=&#x2009;34; 79%), and counsellors (n&#x2009;=&#x2009;26; 60.5%). The need for training in the provision of adolescent-friendly services, post-natal or post-abortion care in adolescents (>&#x2009;90%) was high. PHCs were inadequately supplied with equipment for post-abortion care and IUD insertion. Female and male sterilization and emergency contraception were less offered. Health workers were willing to give family planning to previously pregnant adolescents (90.7%), without parental consent (65.2%), but did not support contraceptive administration to adolescents who had formerly been pregnant in fear of promoting sexual promiscuity (41.9%). A quarter of the PHCs had a dedicated clinic for adolescents and had a day in the week for adolescent services. This study reveals major gaps in adolescent perinatal care in Southwestern Uganda, including limited peer educators, inadequate post-abortion care, and poor healthcare worker training. Strengthening services requires interactive, peer-based training and addressing staffing shortages through peer educators and community health workers. Equipping Health Centre IIIs to deliver comprehensive, adolescent-friendly care is essential to improving access and closing these critical service gaps.

Maternal age at childbirth shows a bimodal risk distribution worldwide. While adolescent pregnancy remains common in many areas, the rate of advanced maternal age is rising in high-income countries. Both extremes are associated with adverse outcomes through different pathways. This study tests the hypothesis that adolescent (<&#x2009;19 years) and older (>&#x2009;35 years) mothers face higher obstetric and neonatal risks than young adults (19-35 years), regardless of key confounders. A retrospective cohort study was conducted from 2019 to 2023 at a tertiary-care center. A total of 19,728 mother-neonate dyads were included and stratified by maternal age: adolescents (n&#x2009;=&#x2009;1,570), young adults (n&#x2009;=&#x2009;14,707), and older adults (n&#x2009;=&#x2009;3,451). We analyzed maternal demographics, antenatal care, and maternal-neonatal outcomes. Multivariable logistic regression was adjusted for confounders, including socioeconomic status, parity, prenatal care, and comorbidities. Primary outcomes included mode of delivery, preterm birth, low birth weight, preeclampsia, and neonatal intensive care unit (NICU) admission. Older adult mothers showed the highest adjusted risks: preeclampsia (aOR&#x2009;=&#x2009;3.15, 95% CI: 2.82-3.52), cesarean delivery (aOR&#x2009;=&#x2009;1.89, 1.72-2.08), and preterm birth (aOR&#x2009;=&#x2009;2.94, 2.68-3.22). Adolescent mothers had lower cesarean rates but significantly higher adjusted odds of low birth weight (aOR&#x2009;=&#x2009;1.72, 1.45-2.04) and preterm birth (aOR&#x2009;=&#x2009;1.48, 1.25-1.75). The likelihood of NICU admission increased for both groups. Socioeconomic disadvantage was most apparent among adolescents, while medical comorbidities characterized the older group. This study confirms a U-shaped risk curve, with both adolescent and advanced maternal ages remaining associated with increased risk after adjustment for measured confounders for adverse pregnancy outcomes. The findings highlight the need for specific, age-tailored clinical and public health strategies: targeted social support and early prenatal care for adolescents, and careful monitoring and management of medical comorbidities for older mothers.

Cervical cancer screening guidelines in the United States have evolved with the introduction of human papillomavirus (HPV)-based modalities, including co-testing in 2012 and primary HPV testing in 2018, in addition to Pap-only screening. However, adoption of these modalities in federally qualified health centers (FQHCs) has been underexplored. We examined longitudinal patterns of HPV-based cervical cancer screening adoption (e.g., proportion screened with co- and primary HPV testing) across three FQHC systems in Washington and Idaho and explored factors associated with receipt of HPV-based modalities. Using electronic health record data, we identified the first routine cervical cancer screening among 11,316 individuals from 2012-2022 across 25 clinics within three FQHCs. Screening modality at the screening was classified as Pap-only, co-testing, or primary HPV testing. We quantified the proportion of each screening modality by year and FQHC from 2012-2022 and used multivariable logistic regression to estimate associations of factors (age, race, ethnicity, rurality, insurance status, primary care visits, and FQHC) with HPV-based screening for 2012-2018 and 2018-2022 guideline periods. The proportion of up-to-date screening in 2022 was 34.0%, 22.7%, and 37.6% for FQHCs A, B, and C, respectively. Among individuals receiving their first routine screening from 2012-2022, 59.1% underwent Pap-only, 38.8% co-testing, and 2.0% primary HPV testing, respectively. Pap-only was nearly universal in 2012 but declined to 57.0% by 2022, while co-testing increased to 41.0%. Primary HPV testing remained&#x2009;<&#x2009;7.0% across all years and FQHCs. During the 2012-2018 guideline period, odds of co-testing (vs. Pap-only) were higher among Hispanic (aOR&#x2009;=&#x2009;1.56; 95% CI, 1.35-1.80) and Black (aOR&#x2009;=&#x2009;1.64; 95% CI, 1.18-2.28) individuals and screened at FQHC C (aOR&#x2009;=&#x2009;4.21; 95% CI, 3.41-5.22). Odds were lower among rural (aOR&#x2009;=&#x2009;0.20; 95% CI, 0.17-0.24) and uninsured patients (aOR&#x2009;=&#x2009;0.51; 95% CI, 0.44-0.58). From 2018-2022, odds of co-testing were higher among individuals aged 40-59 and Black, lower at FQHC B (aOR&#x2009;=&#x2009;0.48; 95% CI, 0.37-0.63), and higher at FQHC C (aOR&#x2009;=&#x2009;1.34; 95% CI, 1.06-1.68). Adoption of HPV-based screening modalities increased over time and varied by patients' rurality, race, and ethnicity. Lower adoption in some organizations may reflect limited capacity/resources for adopting newer screening modalities, which could impact equitable access to screening.