Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in children and adolescents, with symptoms often persisting into adulthood. We studied epidemiology and health care provision for ADHD in Germany by analyzing recent billing data. Anonymized billing data from 2017 to 2023 were examined. Patients with ≥ 2 outpatient or one inpatient ADHD diagnosis were included. Application of the inclusion and exclusion criteria yielded 78 919 ADHD cases for analysis. The administrative prevalence of ADHD in 2023 was 3.6% in children/adolescents and 0.6% in adults. In 2023, 40.9% of children and adolescents with ADHD received no treatment, 47.8% were treated with drugs alone, 4.2% were treated with psychotherapy alone, and 7.1% received multimodal therapy. 44.4% of adults with ADHD received no treatment, 38% were treated with drugs alone, 7.6% were treated with psychotherapy alone, and 10% received multimodal therapy. Over the period of observation, the prevalence of ADHD and the frequency of drug treatment, psychotherapy, and multimodal therapy rose slightly. This secondary data analysis characterizes the care of ADHD in Germany. In 2023, the administrative prevalence was much lower in adults than in children and adolescents. Over the period of observation, there was a continuous rise in the provision of psychotherapeutic services-especially behavioral therapy-while the percentage of patients treated with neither drugs nor psychotherapy fell; yet overall rates of treatment are still low, particularly for psychotherapy.

Most medical care for the approximately 14 million children and adolescents in Germany is provided on an outpatient basis, but data on the quality of care is lacking. We studied the quality of outpatient care for children and adolescents with common mental or physical conditions. In pediatric, general medical, and child/adolescent psychiatric practices in the German federal state of Hesse, patient records of children and adolescents diagnosed with attention deficit/hyperactivity disorder, depression, conduct disorder, asthma, atopic dermatitis, otitis media, or tonsillitis were randomly selected, and data were extracted for the calculation of quality indicators. The quality indicators had been generated before the start of the study with a modified RAND/UCLA method. The extracted data were used to determine the extent to which the quality indicators were fulfilled. Potential influencing factors were examined as well. Study registration: DRKS00022408. In the overall sample (1156 patients; 61.9% male, average age 11.9 years, 20 513 diagnostic/therapeutic episodes evaluated), 45.5% of quality indicators were met (mental disorders: 38.7%, physical diseases: 50.9%). The highest degree of adherence was found for tonsillitis (78.8%) and conduct disorders (72.5%), and the lowest for depressive disorders (21.2%) and asthma (34.0%). No consistent picture emerged with regard to the influencing factors examined. The quality of outpatient care for children and adolescents in Germany is-with limited comparability, because of methodological and health system factors-comparable to that in the USA and lower than that in Australia. Potential for improvement was identified for some disorders. The assessment of quality of care proved to be feasible; in future, this could be done routinely on the basis of electronic secondary data.

Migraine activity is shaped not only by the biological vulnerability but also by environmental factors that may influence susceptibility and contribute to fluctuations in migraine occurrence, although the evidence remains inconsistent. We aimed to evaluate the intermediate-term and short-term effects of environmental exposures on migraine activity and to examine a conceptual layered model comprising biological vulnerability, intermediate-term environmental modulators, and acute triggers. We conducted a population-based case-crossover study among patients with migraine identified from the Negev Migraine Cohort (2000-2023), using electronic medical records from Clalit Health Services and Soroka University Medical Center. Eligible participants were adult patients (≥18 years) residing in Be'er Sheva, Israel, with migraine diagnoses or triptan prescriptions. Daily exposure to air pollutants and meteorologic conditions were obtained from fixed monitoring stations. Outcomes were emergency migraine-related encounters as a marker of triggered events and quarterly triptan use as a marker for disease activity. Intermediate-term modulators were defined as weekly climatic conditions hypothesized to modify the short-term effects of daily exposures. Associations were evaluated using conditional logistic and Poisson regression. The analysis included 7,032 adult patients with migraine residing in Be'er Sheva. Short-term exposure to nitrogen dioxide (NO2) (odds ratio [OR] 1.41; 95% CI 1.13-1.77) and solar radiation (OR 1.23; 95% CI 1.07-1.42) was associated with an increased risk of emergency migraine-related encounters. Cumulative exposure to NO2 was associated with a higher triptan use (incidence rate ratio [IRR] 1.10; 95% CI 1.00-1.21), as was cumulative particulate matter ≤2.5 µm (PM2.5) exposure during the preceding quarter (IRR 1.09; 95% CI 1.00-1.19). Weekly climatic conditions modified short-term effects: high temperatures and low humidity during summer amplified NO2-related risk (OR 2.18; 95% CI 1.06-3.30), whereas cold and humid winter weeks intensified the effect of PM2.5 (OR 3.78; 95% CI 1.74-5.82). Short-term and cumulative exposure to ambient air pollution and climatic factors were associated with increased migraine activity. Although these findings support a layered model of environmental modulation of migraine activity, their generalizability is limited by the use of emergency health care encounters as a proxy outcome, underscoring the need for further research using complementary measures.

Objectives. To describe health care‒related educational divides in 2 dimensions-outpatient care utilization and medically preventable deaths-over the past 25 years. Methods. We examined education-based disparities in ambulatory care utilization by analyzing data on 476 277 respondents aged 25 years or older to the 1996-2022 US Medical Expenditure Panel Survey, and in deaths potentially preventable by medical care (defined by International Classification of Diseases, 10th Revision, code) from 26 092 720 death certificates of individuals aged 25 to 74 years in the United States from 2001 to 2023. Results. In 1996, the share of adults with zero provider visits was higher among those without (26.4%; 95% confidence interval [CI] = 25.3, 27.5) than with (20.2%; 95% CI = 18.5, 22.0) a bachelor's degree, a gap that widened to a nearly 2-fold difference by 2022; the gap in the proportion with no doctor visit also widened. Disparities in health care use were larger after adjustment for health factors. Separately, we observed large and growing education-based gaps in age-adjusted health care‒amenable mortality. Conclusions. Education-based disparities in ambulatory health care utilization have grown since 1996, as have medically preventable deaths. Public Health Implications. Improved health care access for less-educated Americans might help address widening disparities in ambulatory health care use and, potentially, health outcomes. (Am J Public Health. 2026;116(5):692-701. https://doi.org/10.2105/AJPH.2025.308373).

Positive and negative mental health care experiences among transgender and non-binary people in Canada.

Health Care Use for Pediatric Community Health Center Patients During Medicaid Coverage Unwinding.

Expanding whole health access for rural veterans with pain: Virtual hub-and-spoke models.

Clinical effectiveness and cost-effectiveness of primary community health care nurses: A meta-analysis.

In this paper, we provide the first, large-scale corpus-pragmatic analysis of mental health advice by social media influencers on TikTok. We identify advice-giving in large datasets focusing on if-conditionals as a specific form that allows us to analyse how the audience is positioned relative to a need and the solution which is then proposed. To identify the different ways in which mental health issues are presented, we use an adapted version of the ‘mental health quotient’ (Newson and Thiagarajan, 2020), as a linguistically informed framework for differentiating between lay discussions of mental health and those that invoke specific disorders. We sample a corpus of over 27,000 TikTok videos from 85 mental health influencers, using corpus-scale identification to extract and analyse if-conditionals produced by mental health professionals and wellness influencers. Our analysis of the protasis shows how these two types of influencers use prompts that share some similarities but also rely on fundamentally different models of healthcare. The relationship between these prompts and the information and recommendations in the apodosis show how health professionals rely on diagnostic information and therapeutic advice, while wellness influencers recommend embodied practice and products to treat mental health issues. These findings set out the distinctive ecosystem of healthcare which is emerging within the algorithmically driven contexts of sites like TikTok. • First study of mental health advice by health professionals and wellness influencers on TikTok • Analyses a dataset of 27,000 TikTok video voice-overs using corpus-pragmatic methods. • Identifies advice via if-conditionals to analyse audience positioning. • Adapts the Mental Health Quotient for linguistic analysis of prompts. • Findings reveal contrasting healthcare models circulating in TikTok's algorithmic feeds.

Mental health continuum of care for children and young people with adverse childhood experiences: A qualitative evidence synthesis.

Burden of chronic oral corticosteroids among adults with asthma in the United States.

Background: The COVID-19 pandemic has had a profound impact on health care systems worldwide, resulting in significant disruptions to routine medical and dental care. Dental prosthetic treatments are vital to maintaining functional and aesthetic aspects of oral health in geriatric patients. However, the decision-making process for initiating and completing such treatments can be influenced by various factors. Aim: To assess the effect of pandemic circumstances in determining the patient’s choice of the proposed prosthodontic treatment plan and factors that influence them to not accept the proposed treatment plan. Materials and Methods: This descriptive cross-sectional study randomly sampled 600 patients, assessing their acceptance of a proposed prosthodontic treatment plan during and after COVID-19. Descriptive statistics, including frequencies and percentages, were used. χ 2 tests compared explanatory variables, and cross-tabulation analysis evaluated decision-making factors influencing treatment acceptance or refusal. Results: During COVID-19, 79.3% of 300 respondents rejected the proposed treatment, while 20.7% accepted it. Post–COVID-19, 42.7% declined, and 57.4% accepted. Reasons for refusal included high costs, fear of infection, urgency for quick treatment, and dependency during COVID-19, among others, totaling 11 reasons for rejecting prosthetic treatment. Conclusions: This cross-sectional study underscores the impact of the COVID-19 pandemic on geriatric patients’ decision-making regarding dental prosthetic treatment. The findings highlight the need for national health care policies that ensure accessible, affordable, and timely prosthodontic care, especially during crises. Strengthening financial support and public health initiatives can enhance treatment acceptance rates.

Rural hospitals operate on thin margins, sustained largely by federal funding through Medicaid and bolstered by the Affordable Care Act premium subsidies. As these supports erode due to recent federal legislative changes through the One Big, Beautiful Bill Act and a failure of the U.S. Congress to renew Affordable Care Act monies, millions will lose affordable insurance. For anesthesiologists, these changes will translate into closed healthcare systems, cancelled cases, less coverage for medication-assisted treatment used in opioid use disorder, and shrinking surgical capacity. These changes will be disproportionately felt in rural America, where residents already faced disparities in health care. Protecting coverage and rural hospital funding is not just a matter of equity; it is central to maintaining safe, timely anesthesia care for millions of Americans.

Learning to navigate interprofessional boundaries in health care.

The ASCENT Consortium was funded by the National Institutes of Health (NIH) in August 2025 with the goal of advancing palliative care (PC) research, evidence, implementation and practice to improve care of persons with serious illness and those who care for them across the lifespan. ASCENT aims to: (1) Develop and coordinate the national scientific infrastructure and community needed to advance PC research, marshalling research expertise currently distributed across research centers and leveraging the impact of that expertise via partnership and collaboration. Partners include persons who have lived experiences with serious illness personally or as caregivers, practicing clinicians, patient advocacy organizations, professional organizations, community organizations, health care systems/settings/payers across the continuum of care and other NIH-funded consortia and networks. (2) Generate new PC research knowledge and methodologies, directly by conducting projects to establish new knowledge or methods that support the work of PC scientists. (3) Foster career development and impact of the PC scientist workforce by funding career development and pilot and exploratory awards, providing access to methodologic consultations and resources such as PC research methodology and career development curricula and facilitating mentoring. (4) Disseminate PC research findings and facilitate subsequent implementation via a multi-pronged approach, including providing resource libraries, guidance documents, best practices, training, and toolkits to facilitate collaboration and co-design with health system partners and relevant organizations. This article describes the goals, organization, resources, programs and activities of the ASCENT Consortium, intending to raise awareness about ASCENT and encourage engagement with, utilization of and collaboration with ASCENT.

Health care organization leaders are charged with patient safety, evidence-based practice, financial sustainability, capacity, and staff supervision in systems that are challenged by bureaucracy, fragmentation, mistrust, and limited interdisciplinary engagement. It is not known how leaders effectively address specific challenges of staff supervision, policies/mandates, difficult conversations, and staff burnout. This study collected strategies from high-performing leaders in the Veterans Health Administration to understand how they approach these challenges. Applying a positive deviance approach to examine organizational survey data across the entire administration, we first statistically identified Veterans Health Administration sites that, based on employee feedback, showed the greatest organizational health improvements from 2022. These sites' chiefs of staff (N = 24) were then interviewed about how they approached four specific challenges. Findings indicate commonalities across these leaders' best practices, including creating opportunities for dialogue, building a culture of learning and psychological safety, proactively addressing process improvements, supporting work-life balance, leading with grace and courage, and maximizing and protecting resources. Public sector health care leaders may benefit from this approach to learning from these highest performers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Inequities in health care as a reflection of inequities in society.

Previous randomized trials and real-world observational studies of electronic alerts for acute kidney injury (AKI) have yielded conflicting results. The applicability of trial findings to routine clinical practice is also contested. Despite this, AKI e-alerts remain widely implemented. Here, we used Regression Discontinuity Design (RDD) to evaluate the real-world causal effect of the nationwide AKI e-alert initiative in Wales. The study encompassed hospital and community-based systems serving 3.1 million adults (aged 18 years and older) residing in Wales, 2016-2020, following implementation of AKI e-alerts across all Welsh health boards, seven using passive alerts and one using interruptive alerts. We assessed outcomes across the e-alert threshold, including mortality, hospital admission/readmission, AKI severity and recovery, documentation of AKI, prescribing, and follow-up monitoring of proteinuria and blood pressure. Among 861,494 hospital and 354,505 community patient encounters, AKI alerts were triggered in 5.8% and 2.0% of cases respectively (mean age 64 years, 54% female). In both settings, AKI alerts led to no significant changes in mortality [complier average treatment effect +1.31% (95% Confidence Interval -3.07, 4.74); +2.07% (-3.44, 6.65)] or admissions/readmissions [+0.13% (-3.82, 4.21); +4.07% (-1.84, 8.27)]. AKI coding was infrequent across both settings. Alerts modestly increased hospital coding [+5.88% (2.22, 7.58)] but had minimal impact on primary care coding post discharge [+0.72% (-0.67, 1.30)] and led to only small improvements in proteinuria and blood pressure monitoring. Findings were consistent across passive and interruptive alert types, clinical settings and subgroups. We found no causal evidence that AKI e-alerts (specifically implemented at a 50% creatinine rise threshold) improved or worsened clinical outcomes in this nationwide real-world evaluation. Consistently poor outcomes, limited documentation and follow-up care, even in the presence of e-alerts, underscore the need for an improved clinical response to AKI.

As the U.S. population becomes increasingly diverse, the persistent underrepresentation of dark skin tones in nursing educational materials constitutes a critical concern. The foundational textbooks used in prelicensure nursing programs often fail to illustrate how clinical conditions present on darker skin, thereby undermining students' assessment and diagnostic competence and perpetuating health care disparities. This study aimed to evaluate how prelicensure nursing textbooks visually represent clinical conditions across diverse skin tones, with a focus on the extent to which dark skin tone images are included and the implications of this for diagnostic preparedness. This quantitative, image-based study analyzed photographic and graphic (drawn or computer-generated) images from 23 chapters in 13 widely used prelicensure nursing textbooks. Images were categorized by skin tone using the Fitzpatrick skin phototype scale and evaluated for the clear depiction of clinical conditions. Interrater reliability was assessed using Cohen κ, which yielded values between 0.78 and 1.00, indicating substantial to perfect agreement. Of the 1,116 images reviewed, only 7% depicted dark skin, while 76% depicted light skin. Of the 432 photographs representing clinical conditions, 10% featured dark skin. Graphic illustrations reflected even greater disparities, with only 2% showing dark skin. Conditions for which diagnosis relies heavily on visual assessment, such as cellulitis, melanoma, and allergic reactions, were rarely depicted on dark skin. Nearly half of all photographic images did not depict a discernible clinical condition. This study identifies a pervasive visual bias in nursing textbooks that privileges light skin as the clinical norm. The underrepresentation of dark skin perpetuates structural inequities in health care education and decreases nurses' ability to recognize clinical conditions across diverse populations. Nursing curricula must be intentionally revised to include clinically accurate imagery across all skin tones. Doing so warrants priority status as part of nurses' professional and ethical commitment to health equity and patient safety.

<h2>ABSTRACT</h2><h3>Background</h3> Globally, approximately 2 million stillbirths occur annually, and India accounts for the greatest number of stillbirths in the world. This study was conducted to evaluate stillbirths at the community level to understand the barriers/gaps in accessing optimal health care on time. <h3>Aim</h3> To understand the factors attributed to stillbirth by capturing the lived experience of the woman and her family members with stillbirth using the WHO verbal autopsy tool. <h3>Method</h3> ology: Population-based surveillance was done with the identification of all stillbirths that occurred either at home or in a health care facility in two districts of Haryana. This study employed a concurrent mixed-methods approach, combining quantitative (QUAN) and qualitative (QUAL) strategies to meet the objectives of the research. The quantitative data was collected using the WHO verbal autopsy tool, and for qualitative data, in-depth interviews were conducted to capture the lived experience. <h3>Results</h3> During the study period of four months, a total of 3651 births occurred, out of 3651 births, 66 were stillbirths (≥28 weeks of gestation) with a stillbirth rate of 18.0 per 1000 total births. Almost 2/3^rd of stillbirths were antepartum. None of the women had a delay 2 i.e., difficulty in reaching the health care facility. The main hurdle that came out predominantly was delay 1 (Perceiving own healthcare requirement) and delay 3 (Receiving adequate care). <h3>Conclusion</h3> Surveillance for stillbirths at the community level is feasible, and it can help capture the associated factors that are usually missed at the facility level of surveillance.