Evaluating a psychoeducational program for patients with depressive symptoms in general practices: A randomized controlled trial.

Oral health is an important aspect of overall well-being, especially for frail older people, who are increasingly ageing in place. As this population with associated complex health care needs grows, integrated and collaborative oral health care becomes more urgent. Despite its importance, oral health is often overlooked in both practice and policy. This study aims to identify barriers and facilitators at the micro, meso, and macro levels to improve interprofessional collaboration for oral health care of frail, community-dwelling older people. This qualitative study was conducted in the Netherlands and comprised two data collection methods: six semistructured interviews and five discipline-specific focus group discussions, involving a total of 38 health care professionals. Each focus group consisted of professionals from a single discipline, including oral health care professionals, general practitioners, home care professionals, pharmacists, and public health professionals. Participants represented health care professionals both within nationally recognized integrated geriatric care networks and those not yet participating in such networks. Data were analysed inductively using thematic analysis in Atlas.ti. At the micro level, barriers included limited awareness, knowledge, and prioritization of oral health, unclear responsibilities, time constraints, and inconsistent referral pathways. At the meso level, participants reported insufficient standardized protocols, lack of interprofessional education, and poor digital integration of medical record systems. At the macro level, key issues were inadequate funding and reimbursement, fragmented policies, and limited support for home-based oral care. Facilitators at the micro and meso level included raising awareness and interprofessional education, practical tools and clear referral pathways, improved ICT systems, and appointing regional coordinators to strengthen multidisciplinary collaboration. At the macro level, national guidance and structural financial incentives were viewed as crucial for sustainable integration. In conclusion, this study, identified critical barriers and facilitators for effective interprofessional collaboration and better oral health care for community-dwelling frail older people at the micro, meso, and macro levels. Improvement requires increasing awareness and education among professionals, better integration of oral health care in multidisciplinary care networks, shared electronic medical record systems, and adequate reimbursement. These findings should inform guidelines and be validated through implementation studies.

Men's involvement in contraception: a qualitative study exploring the perceptions and practices of general practitioners in France.

Personal involvement and a holistic assessment: Patients and relatives' experiences of a geriatric outpatient assessment during temporary stay in a community rehabilitation facility - A descriptive qualitative study.

To investigate changes in the prevalence of chronic pain (CP), high-impact chronic pain (HICP), and musculoskeletal health (MSK-HQ scores) before and after the COVID-19 pandemic. Longitudinal cross-sectional study using data from two population-based surveys conducted in 2016/17 (PRELIM) and 2022/23 (MIDAS-POP). Adults aged 35 and over registered with general practices in the West Midlands, UK, completed questionnaires including CP, HICP, and MSK-HQ. Entropy balancing was applied to match respondents across survey years on age, sex, deprivation, and ethnicity. Logistic and linear regressions estimated odds ratios (ORs) and mean differences. Subgroup analyses tested for interactions, and E-values were calculated to assess robustness to unmeasured confounding. CP prevalence increased from 35.6% in 2016/17 to 42.9% in 2022/23 (OR 1.36, 95% CI 1.22 to 1.51), and HICP from 15.5% to 22.4% (OR 1.57, 1.38 to 1.80). MSK-HQ scores among people with CP declined from 32.4 to 23.1, exceeding the minimal important change. Increases were more marked among women and people aged 35-54. Differences by deprivation and ethnicity were observed, although subgroup estimates for ethnicity should be interpreted cautiously due to small sample sizes. E-values suggested that the associations were moderately robust to unmeasured confounding. Chronic pain prevalence and its burden have increased since the COVID-19 pandemic, alongside declines in musculoskeletal health. While some of this may reflect residual confounding, the findings underscore the need for targeted pain prevention and management strategies, particularly for working-age adults and underserved groups.

Guidelines recommend a corticosteroid injection or exercise therapy for shoulder pain in primary care, but long-term comparative studies are lacking. To examine the effectiveness of a corticosteroid injection versus physiotherapist-led exercise therapy over 12 months in patients with shoulder pain presenting in primary care. A pragmatic randomized controlled trial. Patients with a new episode of shoulder pain were included and randomly allocated to a corticosteroid injection or 12 sessions of physiotherapist-led exercise therapy. Questionnaires were administered at baseline, 6 weeks, 3, 6, 9 and 12 months. The primary outcome was pain and function measured with the Shoulder Pain and Disability Index (SPADI) over 12 months. 99 patients were included in the injection group and 101 in the exercise therapy group. Side effects were reported in 25% of the exercise therapy group and 7% of the injection group. At 12 months follow-up, the exercise therapy group showed a statistically significantly greater improvement of SPADI-score (mean difference=8·5, 95% CI=1·2 to 15·8) compared to the injection group. This was also seen at 6 months (mean difference=9·6, 95% CI=2·3 to 16·9) and 9 months (mean difference=7·9, 95% CI=0·4 to 15·4). The injection group showed a statistically significantly greater improvement of SPADI-score at 6 weeks (mean difference=-7·7, 95% CI=-14·9 to -0·6). There is an indication that treatment with exercise therapy gives statistically significant better SPADI-scores over 12 months follow-up. However, wide confidence intervals indicate uncertainty in the effect estimates. The Netherlands Trial Registry (NL-OMON52854).

Serological signals of past dengue exposure in general practice in southern mainland France.

Reproducing real-world clinical prediction models using the DIVE platform: A comparative validation study across three chronic diseases.

To examine the impact of different telehealth modes on therapeutic alliance between student health practitioners and patients in a student-led telehealth clinic, and to compare patient reports of therapeutic alliance with that previously published. Telehealth sessions between student health practitioners and patients were delivered via video, telephone, or a combination. 299 (n) patient and student pairings reported therapeutic alliance using a modified Working Alliance Inventory for General Practice. Linear regressions and t-tests were conducted. The 299 pairings identified that therapeutic alliance can be developed and maintained in this context. Telephone based approaches yielded higher patient scores for the bond and goal domains. Students provided lower scores than patients across all domains and telehealth modes. Patients reported higher scores than those from a previously published study. Telephone interactions may yield greater therapeutic alliance than video conference or mixed approaches. Therapeutic alliance can successfully be developed in the context of a student-led telehealth clinic. To consider how student-led clinics may become part of health service provision since patient ratings of students and general health practitioners is comparable.

In the ESPEN SIG meetings the similarities and differences between cachexia and disease-related malnutrition (DRM) were previously analyzed, as well as the role of inflammation in DRM. In the years 2023-2025, the SIG moving forward emphasized the relevance of the evolution of the cachexia definition and the advantage of considering DRM with chronic inflammation and cachexia as synonyms. We focused on the evidence regarding: i) the impact of DRM phenotypes and grade of inflammation on the efficacy of nutritional treatments, ii) the distinction between cachexia and end-of-life conditions, and iii) the identification of the barriers, facilitators and solutions for the implementation of the DRM definition among experts and non-experts in the field of nutrition. We underlined the importance of phenotyping those patients with DRM with inflammation to identify the most appropriate nutritional and metabolic interventions. Based on the role of inflammation in chronic and acute diseases, we discussed the impact of inflammation on the effectiveness of nutritional interventions. We discussed the differences between DRM with inflammation/cachexia and "end-of-life" conditions and the limited evidence on the efficacy of nutritional therapies in a palliative setting. Finally, the SIG discussed the barriers to the implementation of the concept of DRM, and suggested solutions. We emphasize the need for primary care training programs, to identify and address DRM early, and advocate for evidence-based interdisciplinary treatment strategies. The SIG recommends to enhance primary care nutritional and dietetic services, to support general practitioners and improve patient care through increased healthcare system engagement in clinical nutrition.

Adequacy of pharmacological prescriptions in women with postmenopausal osteoporosis attended in a Primary Care center

Influenza and influenza-like illness (ILI) place a heavy burden on UK healthcare. Vaccination programmes are shown to be effective but impeded by socioeconomic and demographic inequalities in uptake and outcomes. This paper examines why some neighbourhoods show atypical patterns of vaccination and illness beyond just deprivation. Electronic health records covering influenza seasons between 2018 and 19 to 2023-24 were used to explore trends in influenza vaccination and ILI among adults aged 50+ years. Multi-level negative binomial regression models were used to examine how vaccination uptake and neighbourhood-level deprivation were associated with ILI admissions, as well as to identify outlier neighbourhoods, which were further profiled. Most ILI hospital admissions occurred among adults aged 75+. Higher vaccination coverage was linked to fewer admissions, although this association weakened after adjusting for neighbourhood deprivation, which itself showed a strong social gradient with more deprived areas experiencing two to three times higher admission rates. Vaccination uptake was consistently lower in more deprived areas, with the steepest declines in uptake seen in younger age groups during 2023-24. The temporary provision of universal access of vaccinations for the 50-64 age group between 2020 and 21 and 2022-23 was associated with the largest increases in the least deprived areas. Additional neighbourhood factors predicted little of the residual variation in ILI beyond deprivation, though communal establishments, distance to nearest general practice and older housing showed some associations. Reducing influenza harms will require both boosting vaccination uptake in disadvantaged communities and addressing the wider structural determinants of health.

Objective Polymyalgia rheumatica (PMR) is diagnosed in both primary and secondary healthcare. However, general practitioners (GPs) do not report diagnostic codes to national health registers, limiting the representation of primary healthcare patients in register-based studies. We estimated the positive predictive value (PPV) of a register-based algorithm for identifying patients with PMR across healthcare sectors in Denmark. Method Potential patients were aged ≥50 years between 2003 and 2024. In primary healthcare, potential patients were identified by a first-time prescription of prednisolone/prednisone (PDN) issued by a GP and ≥375 mg PDN redeemed within 1 month. If other diagnoses, treated with PDN, were registered within 3 months of identification, patients were excluded. In secondary healthcare, potential patients were identified by a PMR diagnosis code in the Danish National Patient Registry (DNPR). Diagnoses were confirmed through chart review: in primary healthcare by GPs, and in secondary healthcare at two secondary hospitals and one tertiary hospital in Central Denmark Region (2013–2024). We estimated PPV with 95% confidence intervals (CIs) using the exact binomial method. Results PMR diagnoses were confirmed in 62% (95% CI 54–69) of patients in primary care, and 89% (95% CI 84–93) in secondary care. Among primary care patients redeeming 1000–2000 mg PDN within 2 months following diagnosis, PPV was 84% (95% CI 76–90). Among secondary care patients redeeming PDN within 2 months of diagnosis, PPV was 91% (95% CI 86–94). Conclusion The algorithm provides a robust framework for register-based epidemiological studies of patients with PMR.

ABSTRACT Background To create a workforce fit for 21st century healthcare, the importance of integrating more primary care teaching into the medical undergraduate curriculum has been repeatedly highlighted; yet has been slow to realise. Aim To explore the lived experience of educators working together to integrate teaching at the primary-secondary care (PSC) interface and identify facilitators and barriers to achieving change. Method A constructivist research philosophy using qualitative methodology explored the experiences of educators involved in integrating general practice teaching into the undergraduate curriculum. Purposive sampling identified suitable primary, secondary care and pre-clinical educators who consented to semi-structured interviews remotely via Microsoft Teams. Transcripts were coded using qualitative data analysis software and themes generated through iterative and inductive analysis. Results Ten educators (5 General Practitioners, 3 Hospital Consultants, 2 Pre-Clinical) took part. Four main themes emerged: (i) The sociocultural context, (ii) Understanding the interface, (iii) Tensions at the primary/secondary care interface, (iv) Challenges in managing educational change. Although supporting the rational for change, a strong sense of loss of traditional teaching formats, lack of communication, and misunderstandings related to clinical work and differentiating between generalist and specialist roles were found. Conclusion This study is unique in revealing a complex educational landscape, with many interconnected factors to consider if general practice is to be better integrated into the undergraduate curriculum. Hidden medical education sociocultural themes require further exploratory study in terms of both interface working and curriculum development.

Understanding general practice veterinarians' confidence in identifying and treating avian influenza.

Non-ambulatory tetraparesis or tetraplegia in cats may constitute a diagnostic challenge for general practitioners. Therefore, this study aimed to evaluate if clinical variables from signalment, history, clinical examination and basic ancillary tests are associated with underlying diagnoses in cats with non-ambulatory tetraparesis or tetraplegia. This was a retrospective single-centre study of cases presented between 2010 and 2023. Information on disease onset, progression, neurological and physical examination findings and ancillary tests was analysed across all diagnoses. Diagnostic categories comprising five or more cases were carried forward to univariate and/or multivariable analyses. Eighty-one cats were included, with 82.7% of cases represented by six conditions: polyneuropathy (PN; n = 26), ischaemic myelopathy (IM; n = 15), spinal cord neoplasia (n = 8), feline infectious peritonitis (n = 7), intracranial neoplasia (n = 6) and spinal cord contusion (n = 5). On multivariable analysis, an age of below 3 years, progressive presentation, normal mentation, reduced spinal reflexes in the thoracic limbs and normal blood tests were statistically associated with PN. Age between 6 and 9 years or older than 9 years and peracute onset of clinical signs were associated with IM. This was a retrospective study with limited multivariable analysis in certain diagnostic categories. Furthermore, the study included only referral cases, which may not represent the animal population seen by general practitioners. PN and IM were the most common causes for non-ambulatory tetraparesis or tetraplegia in this population of cats. Attention to the neurological examination and easy to identify clinical features can be used to determine the most likely differential diagnoses and assist general practitioners in the formulation of a diagnostic plan.

Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidance directly or through general practitioners. In contrast, BreastScreen Aotearoa (BSA) does not currently notify breast density to women, resulting in limited awareness and raising concerns relating to equitable care, patient autonomy in decision making, trust in health professionals and uncertainty regarding clinical pathways. Although the recent Health New Zealand - Te Whatu Ora technical review provides a comprehensive evidence summary and identifies areas for further investigation, policy progression has not occurred as anticipated. An implementation timeline, governance responsibility, communication planning and culturally responsive approach have not yet been specified. Although emerging evidence suggests that artificial intelligence may offer more consistent and reproducible breast density assessment than radiologists, planning for its integration has not been outlined. Research from the comparable settings suggests that misunderstanding, rather than notification itself, drives anxiety. This highlights the importance of communication design, health literacy considerations and primary care readiness. Ethical considerations around transparency and informed decision making remain relevant for screening equity. Addressing the implementation barriers is now crucial, and a coordinated and equity-driven approach is required to inform future policy on breast density notification.

This study assessed resident psychiatrist clinical confidence regarding women's mental health (WMH) topics and interest in receiving WMH education. The authors analyzed cross-sectional survey data from 152 Postgraduate year (PGY) 1-4 Residents in U.S. Adult Psychiatry Residency Training Programs between 12/3/2024-5/29/2025. Relative within-individual confidence in perinatal-focused WMH practice compared to general practice was assessed using paired Wilcoxon signed rank tests. Predictors of the relative confidence gap between perinatal and general practice were evaluated using multiple regression analyses. Resident interest in WMH education and preferred educational interventions was summarized using descriptive statistics. Residents were significantly less confident prescribing to pregnant and lactating individuals and counseling patients about risks and benefits of treatment in pregnancy and lactation compared to general practice (all p < 0.001). More self-reported WMH didactic hours attenuated the confidence gap for perinatal prescribing and counseling during pregnancy and lactation. The majority (62.5%) were not confident they would receive adequate WMH exposure by the end of residency, including 58.8% of PGY-4 residents. All (100%) expressed support for formal requirements for WMH education during residency. Residents were most interested in additional interactive WMH didactics (78.3%), followed by additional clinical electives (75.7%) or a national or program-specific women's mental health track (65.8%). Many residents are not getting the WMH training they need to serve women across the lifespan. When they do get it, it increases their self-efficacy to provide WMH care. Residents need and are recommending more WMH training so they can provide adequate mental health care to women across the lifespan.

The S3 Guideline provides evidence- and consensus-based recommendations for the structured follow-up care of adult patients after lung transplantation. Its goal is to standardize long-term management in order to optimize survival, functional status, and quality of life. The guideline is addressed to professionals in pulmonology, internal medicine, surgery, and general practice, as well as to transplant centers and inpatient institutions in the German-speaking countries of Germany, Austria, and Switzerland. The guideline is led by the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP).Methodologically, it is based on systematic literature searches and GRADE-based evidence assessment, combined with the development of an interdisciplinary and multiprofessional consensus involving patient representatives.The guideline emphasizes lifelong, individualized follow-up care founded on close cooperation between transplant centers, community physicians, and patients. Core topics include immunosuppression - specifically the selection, combination, and monitoring of calcineurin inhibitors, antimetabolites, and mTOR inhibitors - as well as strategies to minimize adverse effects and nephrotoxicity.Additional key areas are the prevention and management of infections, including the prophylaxis of opportunistic infections (such as CMV, Aspergillus, and Pneumocystis jirovecii), and vaccination strategies. The guideline also provides recommendations for standardized patient monitoring through bronchoscopy, biopsy, and spirometry within structured follow-up intervals and preventive examinations.Further topics include acute cellular rejection, non-adherence, chronic graft dysfunction, and comorbidities such as diabetes, chronic kidney disease, osteoporosis, and tumor prevention.

Increased healthcare use precedes classical multiple sclerosis (MS) symptom onset. Limited evidence exists on sex and age variation. We assessed physician visit patterns pre-MS onset by sex and age. Using data from British Columbia, Canada, we compared annual physician visit rates (overall, by reason and specialty) in the 15 years before the neurologist-determined MS symptom onset date (index) and a matched non-MS cohort, stratified by sex and age (<30, 30-49, ≥50). We included 2038 MS and 10 182 non-MS persons (74% female). Mean age (years) at index was 37.6 (females) and 38.7 (males). Compared with matched non-MS persons, females with MS showed earlier and more consistent elevations in physician visits (years -14 to -1), while males had sporadic elevations (years -5, -3 and -1). Females also had longer periods of elevated rate ratios (RRs) for ill-defined signs/symptoms (years -15 to -1), mental disorders (years -14 to -1 except year -7) and musculoskeletal conditions (years -6 to -1). Females exhibited sustained elevated visits by specialty, including general practice (all years; RR ≥1.1), psychiatry (years -12 to -1 except -8 to -6; RRs ≥1.6) and ophthalmology (years -9 to -1 except -2; RRs ≥1.4). Compared with matched non-MS counterparts, those aged 30-49 years had sustained higher RRs for psychiatry visits (years -12 to -1 except -8 and -6; RRs ≥1.9) and ophthalmology (years -9 to -1; RRs ≥1.4). Other age groups had fewer elevated RRs preindex. Across comparisons, RRs were of similar magnitude across sex and age groups. Sex-specific and age-specific differences in physician visits extended up to 15 years pre-MS onset, suggesting a durable prodromal signature, most evident in females and those aged 30-49 years.