Purpose This study aims to explore mental health professionals’ perspectives on caring for individuals diagnosed with schizophrenia in Bogotá, Colombia. It aims to understand challenges and experiences related to healthcare access, social inclusion, recovery and quality of life. The study identifies barriers and facilitators in professional management and provides insights for improving comprehensive care and social integration for this population. Design/methodology/approach A qualitative study with a concurrent nested design was conducted, emphasizing the qualitative component. Semistructured interviews were held with 25 purposively selected mental health professionals to ensure diversity in therapeutic approaches. Thematic analysis was applied to identify recurring patterns, experiences and perceptions regarding clinical care, rehabilitation, social inclusion and challenges faced by both patients and professionals. Findings Patients face barriers such as limited access to specialized services, medication delays, shortage of trained professionals, social stigma and exclusion from education and work. Professionals emphasize the importance of early diagnosis, combined pharmacological and psychosocial interventions and empathetic, patient-centered care. Social and family support, public education and inclusive policies are crucial for improving outcomes and quality of life. Research limitations/implications This study is limited to professionals in Bogotá, which may reduce generalizability. Future research should include multiple regions, patients and caregivers, and assess interventions addressing access, stigma and social inclusion. Practical implications Enhancing healthcare infrastructure, community-based programs, professional training, interdisciplinary collaboration and integrated care can improve schizophrenia management. Social implications Reducing stigma, promoting public education and supporting inclusive policies in education and employment foster social integration and equity. Strengthening family and community support networks can enhance patient outcomes. Originality/value This study provides in-depth insights from professionals on schizophrenia care in Colombia, integrating clinical, social and policy perspectives to guide interventions, policy and education strategies for improved care and inclusion.

The progressive incorporation of artificial intelligence (AI), neurotechnologies, and biomarkers into psychiatric practice has opened a field of profound clinical, diagnostic, and epistemological transformations. From the use of machine learning algorithms to predict hospitalizations for schizophrenia to the identification of functional biomarkers through neuroimaging, digital sensors, and explainable artificial intelligence, contemporary psychiatry is moving toward more precise and objectified models of psychological suffering. However, this technological shift raises substantial questions about the limits of neurobiological reductionism, the clinical interpretation of data, the ethics of algorithmic diagnosis, and the role of subjectivity in mental health care.

Pain management after hip fracture surgery is particularly challenging because clinicians must simultaneously minimize prolonged opioid exposure while ensuring effective recovery in this vulnerable patient population. We sought to compare persistent postoperative opioid use across a matched group of patients with femoral neck fracture treated with either total hip arthroplasty (THA) or hemiarthroplasty and to describe the association between patient characteristics and opioid use. Routinely collected health care databases were linked at ICES to create a population-based cohort of patients aged 66 years or older in Ontario, Canada, who underwent THA or hemiarthroplasty for a femoral neck fracture between 2002 and 2016. We used propensity-score matching to balance potential confounders. We quantified and compared persistent postoperative opioid use between treatment groups using survival analysis. The full cohort consisted of 45 119 patients, of whom 41 247 (91.4%) were treated with hemiarthroplasty and 3872 (8.6%) were treated with THA. More than half (n = 25 168, 55.8%) of patients had not filled an opioid prescription in the year before hip fracture and were considered naive to opioids. Overall, 5958 (23.7%) opioid-naive patients filled at least 1 opioid prescription between 90 days and 1 year after hip fracture. All eligible patients who underwent THA were matched 1:2 to hemiarthroplasty patients (matched cohort n = 6492). There was no statistically significant difference in persistent postoperative opioid use between treatment groups (relative risk 1.06, 95% confidence interval 0.96 to 1.17). Patients living in long-term care or requiring home care services and patients with a high comorbidity burden were more likely to use opioid medication, before and after hip fracture. Persistent opioid use is common after both THA and hemiarthroplasty for hip fracture. Patients with higher health care needs before fracture and higher comorbidity burden were more likely to persistently use postoperative opioids.

The article is devoted to the formation of state policy in the field of religions and churches and the construction of a partnership model of state-confessional relations. It provides a concise definition of the concept of a “secular state” and presents a classification of models of state-confessional relations. The article argues that state-confessional relations are shaped by historical confessional and national legal traditions, as well as the participation of religious organisations in the state-building processes of each individual country. Special attention is given to the role of the All-Ukrainian Council of Churches and Religious Organisations in fostering interfaith dialogue and the establishing state-confessional relations in Ukraine. The article also mentions the draft Concept of Relations between the State and the Church in Ukraine and notes the lack of direct state financial support for churches. The current state of state-religious relations in the spheres of education, health care and defence is described, as well as the participation of the All-Ukrainian Council of Churches and Religious Organisations in the formation of these relations

The COVID-19 pandemic has a lasting impact on health care utilization, as both the acute infection and post COVID condition (PCC) can lead to increased demand for medical services due to ongoing symptoms. The aim of this study is to systematically examine health care utilization among individuals after acute SARS-CoV-2 infection in Bavaria, Germany, with a particular focus on PCC. The study combines claims data analysis with qualitative interviews to improve the understanding of objective care pathways and patients' subjective experiences within the health care system. The research project 'SOLongCOVID' employs a mixed-methods design consisting of two subprojects: (1) a retrospective cohort study using claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB) to analyze care pathways through state sequence analysis, (2) a qualitative study based on semistructured interviews and focus groups with patients with PCC concerning their subjective care experiences. A synthesis process involving a focus group discussion will combine the information from the two subprojects, providing a comprehensive understanding of the care processes of patients with PCC. The study was funded by the German Federal Joint Committee Innovation Fund in October 2024. Statutory health insurance claims data cover the period from 2019 to 2022, and qualitative interview data collection is planned from May 2025 to August 2026. As of manuscript submission, study preparation and ethics approvals have been completed, and 14 participants have been recruited for the qualitative interviews. Study findings are anticipated to be published from July 2026 to August 2027. The results are expected to enhance the understanding of existing barriers and challenges and to support evidence-based recommendations for improving care pathways for patients with specific care needs.

The California Advancing and Innovating Medi-Cal (CalAIM) initiative supports Enhanced Care Management (ECM) for high-need pediatric populations but published evidence of the impact of ECM in pediatric populations is lacking. We evaluated a novel multidisciplinary care model (Pair Team) for delivering ECM services, focusing on implementation and early outcomes for children and adolescents enrolled in California's Medicaid program (Medi-Cal). We conducted a retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents who enrolled in Pair Team's program between July 2022 and November 2024. Program engagement, health care engagement, and depressive symptoms were assessed using program data, electronic health records, and prescription data. The main cohort included 1294 enrollees with 12 months of follow-up data (mean age 8.9 years, 50.3% (651/1294) female, 81.8% (1058/1294) experiencing homelessness). Members averaged 2.8 interactions per month with care team members over the first 3 months and 57.1% (851/1491) were still enrolled at 12 months. In the year prior to enrollment compared to the year postenrollment, the prevalence of an asthma diagnosis increased from 7.8% to 10.0% (P=.005), outpatient visits increased 7% (rate ratio, RR=1.07, P<.001), emergency department visits decreased 9% (RR=0.91, P=.002), and antibiotic prescriptions increased 41% (RR=1.41, P=.001). For those with depressive symptoms at enrollment, mean PHQ-9 score decreased from 15.4 (SD 4.7) to 10.2 (SD 6.8) after 3 months (P<.001). An innovative ECM program successfully engaged with and retained high-need pediatric Medicaid patients. Program members had higher engagement with other health care in the year following enrollment, and depressive symptoms improved. These results highlight the potential for this model to improve outcomes for the highest-need pediatric Medicaid patients.

Formative evaluation is widely used in implementation science to anticipate barriers and facilitators prior to the deployment of health technologies, typically relying on stakeholders' reported beliefs collected before real-world exposure. This approach has proven informative for many digital health tools; however, its application to immersive and embodied technologies such as extended reality (XR) warrants closer scrutiny. Most XR interventions in health care are delivered through head-mounted displays, which depend on spatial perception and sensorimotor engagement. Several implementation-relevant properties, including comfort, perceived intrusiveness, safety, and workflow disruption, often become apparent only through direct interaction. At the same time, large segments of the health care workforce remain XR-naive, such that preuse judgments are frequently shaped by anticipation rather than experience. Drawing on concepts from implementation science, grounded cognition, and human-computer interaction, this Viewpoint examines a plausible interpretive problem in XR adoption and argues that perception-based formative evaluation, when applied through frameworks developed for screen-based technologies, may misclassify barriers and facilitators. Rather than questioning formative evaluation as a methodological approach, we identify a boundary condition for its interpretability in experience-dependent technologies and propose a pragmatic refinement: incorporating brief experiential familiarization before eliciting stakeholder perceptions to strengthen early-stage assessment and improve alignment with real-world implementation decisions.

The lack of a comprehensive population-level study evaluating the association of marginalization markers with concussion presentation limits opportunities for health care system improvements. To describe the association of socioeconomic measures of disparity with location of concussion presentation and follow-up rates. This population-based cohort study used linked administrative databases to assess patients with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) concussion diagnosis codes at emergency department (ED) or outpatient clinics in Ontario, Canada, from April 1, 2010, to March 31, 2023. Data analysis was performed from March 1, 2025, to February 8, 2026. Patient-level exposures were age, sex, immigrant status, presence of family physician, and rurality. Neighborhood-level exposures were income quintile, Ontario Marginalization (ON-Marg) Material Resource Index (access to basic material needs, such as percentage of unemployment), Household and Dwelling Index (accommodation type, such as percentage living alone), and Racialized and Newcomer Populations Index (such as percentage of recent immigrants or those who identify as a visible minority group) within 4 different age groups (<18, 18-39, 40-64, and ≥65 years). Location of initial visit (ED vs outpatient, including urgent care, walk-in, primary care, and specialty clinic) and presence of outpatient follow-up visit at 30 days or less. Overall, 674 629 patients were evaluated (356 842 [52.9%] female; mean [SD] age, 32.8 [22.0] years). Marginalization measures were higher for patients first presenting to EDs vs outpatient via the ON-Marg Material Resources Index (57 043 [20.4%] vs 56 856 [14.4%]; difference, 6.2 [95% CI, 6.0-6.3] percentage points), rurality (47 356 [16.9%] vs 35 521 [9.0%]; difference, 7.9 [95% CI, 7.8-8.1] percentage points), and presence of a family physician (264 179 [94.4%] vs 388 346 [98.3%]; difference, -3.9 [95% CI, -3.8 to -4.0] percentage points). In modeling, having a family physician was associated with first seeking care in EDs (18-39 years: odds ratio [OR], 4.71; 95% CI, 4.41-5.03), as was living in rural areas (18-39 years: OR, 1.56; 95% CI, 1.51-1.62). Follow-up rates at 30 days or earlier were lower for patients first seen in EDs (24 307 [8.7%]) vs outpatient (110 821 [28.1%]). In regression analysis assessing variables associated with follow-up, first being seen in EDs (aged 65 years: OR, 0.21; 95% CI, 0.19-0.22), not possessing a family physician (aged ≥65 years: OR, 0.29; 95% CI, 0.19-0.46), and being in the most marginalized quintile for ON-Marg Material Resources (aged ≥65 years: OR, 0.74; 95% CI, 0.65-0.84) were all significantly associated with not completing a follow-up visit. In this cohort study of patients with concussion treated in Ontario, Canada, those with higher marginalization markers were more likely to first seek care in EDs and have lower follow-up rates. These findings emphasize the importance of expanding health care system-wide resources, including primary care access and telemedicine, and enhancing resources for ED clinicians to optimize concussion care.

Near miss events can reveal system problems before patients are harmed, but current reviews are inconsistent and often rely on simple counts that are distorted by patient volume and reporting culture. Consequently, leaders cannot tell whether a rise in reports means that safety is getting worse or that staff are reporting more, and current systems are not strong enough to clearly separate real safety risks from random variation. This study developed a 3-level near miss framework (NM³), a conceptual framework that converts descriptive near miss data into decision-grade intelligence through a structured, evidence-based process, including baseline measurement and advanced interpretation and governance. NM³ was developed to provide decision-grade analytics for acute inpatient hospital settings. The framework was designed as a maturity model, progressing from baseline measurement to advanced interpretation. It integrates standardized definitions, rate calculations, statistical process control, severity weighting, and learning metrics. Level 1 establishes an organizational baseline through near miss rates per 1000 patient-days and near miss-to-harm ratios monitored with control charts. Level 2 introduces domain-specific denominators and unit-level charts to detect local variation. Level 3 applies severity weighting to generate a Near Miss Index; incorporates learning yields at 90 and 180 days; and triangulates near miss trends with harm events, exposure, reporting volume, and culture measures. A synthetic example demonstrates how the framework converts raw reports into stable rates, weighted indices, and learning metrics. NM³ provides a structured pathway for organizations to strengthen near miss analytics. By progressing through maturity levels, leaders can improve the interpretation of safety signals, prioritize high-consequence risks, and integrate near miss reporting into governance.

Rural hospitals are essential access points for healthcare delivery in the United States, yet they continue to experience disproportionate rates of closure and service disruption that threaten community health, economic stability, and equity. This rapid systematic review synthesizes recent peer-reviewed evidence examining rural hospital closures and service disruptions, with emphasis on financial, policy, workforce, and performance-related factors and their downstream impacts. Guided by PRISMA methodology, four databases were searched for U.S.-based studies published between January 2024 and June 2025. Following screening and consensus-based review, 59 articles met inclusion criteria. Across studies, financial vulnerability, characterized by revenue instability, low patient volumes, unfavorable payer mix, and reliance on non-operating revenue, emerged as a dominant precursor to closure and service reductions. Policy context, particularly Medicaid expansion status, telehealth and broadband infrastructure, and reimbursement adequacy, strongly shaped hospital sustainability. Closures and service disruptions were consistently associated with increased travel distances, reduced access to maternal, surgical, mental health, and chronic care services, higher prices at surviving hospitals, and increased strain on remaining providers. Workforce shortages further compounded these challenges. Collectively, findings demonstrate that rural hospital closures reflect interconnected structural weaknesses rather than isolated organizational failure. Coordinated policy action, targeted financial stabilization, workforce development, and technology-enabled care models are necessary to mitigate continued erosion of rural healthcare access.

ABSTRACT In‐service training for school staff, generally referred to as professional development (PD), may bolster a school's capacity for implementing school mental health (SMH) services. However, not all PD results in knowledge or behavior change. In one model of PD, Project Extension for Community Healthcare Outcomes (ECHO), participants collaborate with each other and a panel of SMH experts on case consultation and didactics. Although ECHO has shown to have positive effects on school staff's knowledge and self‐efficacy to implement SMH, the effects of ECHO may differ depending on participants' professional background or prior experiences. To test this hypothesis, the current study explored whether role, years of experience, and pre‐test levels of school mental health professional (SMHP) skills predicted key SMH competencies (i.e., clinical self‐efficacy, supervisory self‐efficacy, multicultural skills and knowledge, knowledge of evidence‐based practices, and interprofessional collaboration) at post‐test among SMHPs ( N = 47) who participated in ECHO‐based PD. The results indicated that school counselors reported greater clinical self‐efficacy and multicultural skills post‐ECHO compared to other SMHPs, controlling for baseline scores. Knowledge of evidence‐based practices was greater for school psychologists post‐ECHO compared to school counselors, controlling for baseline scores. Years of experience did not significantly predict any outcome measures. The findings suggest that SMHPs may benefit differently from ECHO training based on role. Researchers and educational leaders may wish to consider further developing ECHO to be accessible and relevant to various school‐based professions.

Given the increasing prevalence of depression and anxiety disorders and enduring barriers to care, there is a critical need for alternative treatment options. Generative artificial intelligence (AI) chatbots show promise for increasing access to mental health care, though more direct research is needed to establish their efficacy. This pilot study aimed to test the efficacy of a generative mental health chatbot rooted in solution-focused therapy compared to the general-purpose ChatGPT and an assessment-only control (AOC) group on depression, anxiety, and well-being. A total of 185 English-speaking adults were recruited online and randomly assigned to one of three groups: AI therapy, ChatGPT, or AOC. Of these, 147 eligible participants filled out a pretreatment assessment. Over a 3-week period, the AI therapy group (n=44) was instructed to complete 3 structured, fully automated app-based sessions per week (9 total), while the ChatGPT group (n=60) was instructed to engage in 9 unstructured conversations with ChatGPT (GPT-4o-based models). The control group (n=43) received no intervention. In the AI therapy group, 39% (n=17) completed all sessions, as did 62% (n=38) of those in the ChatGPT group. Primary outcome measures, self-assessed online at baseline and postintervention, included the Patient Health Questionnaire-9 (PHQ-9), Overall Depression Severity and Impairment Scale (ODSIS) (depression), 7-item Generalized Anxiety Disorder Scale (anxiety), and World Health Organization Well-Being Index (5-item version) (well-being). Linear mixed effects models were used for data analysis. Compared to AOC, both the AI therapy group (d=-0.47; P=.01) and the ChatGPT group (d=-0.44; P=.02) demonstrated significant reductions in depression scores measured by PHQ-9. The AI therapy group showed nonsignificant reductions in anxiety (d=-0.37; P=.11) and ODSIS depression scores (d=-0.25; P=.22) and an increase in well-being (d=0.12; P=.53) compared to AOC. Similarly, a nonsignificant reduction in anxiety (d=-0.27; P=.22) and ODSIS depression scores (d=-0.12; P=.53) and an increase in well-being (d=0.20; P=.29) were observed in the ChatGPT group compared to AOC. The AI therapy group did not significantly outperform the ChatGPT group on any outcomes (PHQ-9: b=-0.19; d=0.03; P=.87; 7-item Generalized Anxiety Disorder Scale: b=-0.57; d=-0.11; P=.62; ODSIS: b=-0.59; d=-0.13; P=.50; and WHO: b=-0.38; d=-0.07; P=.69). Both the structured generative AI chatbot and ChatGPT showed a significant reduction in depression scores compared to the control group. No significant effects were observed across other outcomes, although descriptive trends indicated improvements in anxiety. While the AI therapy group showed descriptively better outcomes for depression and anxiety, differences between groups were not significant. A larger sample and longer intervention may be needed for the emerging trends to yield clinically meaningful effect sizes.

The United States Leads the Globe in Venture Capital Funding for Orthopaedic Surgery

Nurses have a key role in prevention of Surgical Site Infections (SSIs) through provision of evidence-based care and ensuring patient safety; despite this, existing studies indicate unsatisfactory standards of nursing practice. This is further aggravated by low awareness, implementation and adherence to SSI prevention guidelines across various health care settings globally. In Kenya, the burden of SSIs was estimated at between 20% to 30% affecting patient safety, cost of surgical treatment, duration of hospitalization and mortality in severe cases. Mbagathi and Mama Lucy hospitals are major referral facilities in Nairobi County facing a similar burden of SSIs. The two hospitals had inconsistent standards of nursing practice in prevention of SSIs compromising the quality of surgical care. This was a pre-test post-test nonequivalent groups quasi-experimental study design that was conducted over a duration of 9 months. The study intervention was utilization of the world health organization SSI prevention guidelines by nurses working at Mbagathi hospital while the control was ongoing routine care at Mama Lucy hospital. The primary outcome variable was nursing practice in prevention of SSIs. The study involved a total of 126 nurses with a sample size of 63 participants from each of the hospitals. The ethical approval reference was NACOSTI/P/24/35347. Informed consent for participants ensured before data collection. Simple random sampling was used and data collected through questionnaires and observation checklists. Data was analysed using chi square and fishers test to compare practice between the two hospitals. Mann-Whitney U test was used to evaluate the effect of the intervention and control on the overall nursing practice. Implementation of the SSI care guidelines checklist led to improved nursing practice in prevention of SSIs compared to routine care (p=0.0041). The SSI care bundle checklist is therefore recommended for implementation to improve the quality and safety of surgical care.

Abstract Preventive health care remains underutilized in India despite its proven benefits in reducing morbidity, mortality, and healthcare costs. With rising chronic diseases such as diabetes and cardiovascular conditions, the urgency for proactive health management has never been higher. Yet, societal apathy, lack of awareness, infrastructural gaps, and low perceived value hinder its adoption. Many prefer curative over preventive care, viewing regular checkups as unnecessary unless symptomatic. The undervaluation of Preventive and Social Medicine (PSM) (Syn. Community Medicine) within medical education and society further compounds the issue, discouraging future healthcare professionals from pursuing this specialty. Complex health systems, cost concerns, and limited motivation also prevent timely screenings and lifestyle modifications. A shift toward preventive-focused public policies, stronger health insurance integration, better public awareness, and greater recognition of PSM professionals is imperative. India must reorient its healthcare paradigm – valuing prevention as much as cure – to safeguard public health and ensure sustainable outcomes.

The Veterans Health Administration (VHA) aims to improve patient safety by becoming a high reliability organization (HRO), which requires a culture of continuous quality improvement (CQI). Despite national HRO emphasis, conditions supporting or hindering frontline staff engagement in CQI efforts, especially skill development, are not well understood. We conducted semistructured interviews at VHA sites participating in one of 3 randomized trials to improve clinical outcomes by engaging staff in quality improvement (QI). We conducted interviews with primary care and mental health staff and leaders to assess local context, including barriers and facilitators to engaging in QI training and initiatives. Interviews were coded using the updated Consolidated Framework for Implementation Research and analyzed for cross-cutting themes. Analysis of 56 interviews revealed that despite high-level leadership support for HRO principles, including patient safety, most sites lacked adequate infrastructure and leadership engagement necessary to support participation in QI training and projects. Barriers included limited time, unclear direction, burnout, and lingering COVID-19 pandemic effects. These challenges often prevented staff from developing foundational QI skills critical for entering a positive feedback loop of engagement and empowerment. Opportunities for improvement varied based on leadership style, team cohesion, role clarity, and location. To advance as HROs, health systems must go beyond high-level endorsement and invest in skill development and provide protected time to enable local leaders and frontline providers to do QI. Future work should explore how leaders can create sustainable conditions for improvement efforts and better align system-level goals with local realities.

Blood group incompatibility, particularly ABO and Rhesus (Rh) systems, remains a major contributor to maternal and neonatal morbidity, especially in settings with limited access to preventive care. This study aimed to assess the knowledge, attitude, and practice of women of reproductive age regarding blood group and Rh factor, as well as awareness of associated risks and preventive measures such as anti-D prophylaxis. A descriptive cross-sectional study was conducted among 450 women aged 15–49 years attending primary health care centres in Basra city over a six-month period. Data were collected through structured face-to-face interviews using a pretested questionnaire covering sociodemographic characteristics and knowledge, attitude, and practice domains. The mean age of participants was 30.28 ± 7.84 years, with the majority being married housewives and having primary or intermediate education. Most women (85.1%) were aware of their blood group and Rh status, and 72.6% knew their husbands’ status; however, only 4.4% actively sought this information. Although 80.4% and 80.9% of participants recognized the risks of ABO incompatibility and Rh isoimmunisation respectively, accurate knowledge was limited, with only 8.4% demonstrating correct understanding of ABO-related risks. Awareness of anti-D was moderate (55.6%), but correct knowledge regarding its timing and indication was low, with only 6.1% identifying appropriate use. Family and relatives were the predominant sources of information. Significant associations were observed between knowledge and both age and marital status. In conclusion, despite relatively high awareness levels, substantial gaps exist in accurate knowledge and practical application, highlighting the need for targeted health education and improved counselling services.

Introduction. Uncontrolled hypertension remains a leading cause of preventable cardiovascular morbidity and mortality. Despite frequent clinic visits, timely follow-up for elevated blood pressure (BP) is often inconsistent, delaying medication adjustments. At the University of Kansas School of Medicine Center for Health Care (CHC) Internal Medicine Clinic, BP rechecks were often delayed for months after medication changes, contributing to suboptimal control. To address this gap, we implemented a standardized two-week BP recheck workflow supported by provider education, nursing engagement, and home BP monitoring. The aim was to improve timely BP rechecks and achieve a clinic-wide BP control rate at or above the 75th national percentile. Methods. This quality improvement initiative was implemented from August 2023 to March 2024, with outcomes tracked longitudinally. A standardized hypertension follow-up and medication titration workflow, modeled after Kaiser Northern California guidelines, was introduced. Clinicians documented BP targets and follow-up plans. Patients with repeated BP &gt;130/80 mmHg were offered self-measured BP (SMBP) monitoring, using shared decision-making to determine home or nursing follow-up. Participants received education, BP logs, and instructions, and BP readings were documented in REDCap® or the patient portal. Educational sessions reinforced workflow consistency and care coordination. Results. Same-visit and two-week BP rechecks showed modest improvement (14% and 4%, respectively), but hypertension control improved substantially, increasing from 66% in 2023 to 76% by October 2025, exceeding the national average of 62%. Improvements correlated with ongoing staff education and reinforcement of the standardized workflow. Conclusions. A standardized, team-based workflow incorporating home BP monitoring and a structured treatment algorithm improved BP control, demonstrating a scalable model for chronic disease management.

Mobile health (mHealth), and specifically smartphone apps, have grown exponentially in both functionality and accessibility and are becoming an important component of health care. Research exploring the use of mHealth for managing or treating chronic diseases, such as cancer, has shown promising effects. Yet, comparatively little work has examined how such technologies can enhance exercise interventions for young people with cancer. To optimize the effectiveness of mHealth in these contexts, it is essential to build a stronger evidence base on user experience. This study aimed to investigate how healthy children and young people engaged with an augmented reality (AR) app developed specifically for children and young people undergoing cancer treatment, and to identify design features that may support engagement and behavior change in the intended clinical population. School and university students, aged 8-21 years, were eligible to participate in the study. Practical workshops allowed participants to engage with the AR exercise app before taking part in focus groups to explore user experiences. Data were analyzed using qualitative content analysis, which also involved a critical friend approach using 2 researchers (HM and KS). Suggested improvements were mapped against the motivational affordances' taxonomy. A total of 39 participants aged 8-21 years took part in the focus group study. Participants found the demonstrations and varied exercises useful but expressed some concerns regarding data safety and functionality of the novel AR avatar. It was proposed that additional educational components, challenges, and rewards, as well as a customizable avatar, social support features, and audio instructions for a more inclusive design would be desirable and could enhance user experience. When mapped against the motivational affordances taxonomy, the suggested improvements aligned primarily with mechanisms of user education, challenges, feedback, cooperation, and comparison. This study provides an understanding of how apps that prescribe exercise can be optimized to enhance motivation and user experience. By assessing feedback and suggestions for improvements, the findings highlight key design features that may support engagement. While this initial work focused on healthy, age-matched participants, further evidence specifically in children and young people with a childhood cancer diagnosis is needed.

Although early diagnosis improves long-term outcomes, patients with juvenile idiopathic arthritis (JIA) often experience prolonged, circuitous paths to diagnosis. To inform diagnostic improvement, we sought to characterize health care utilization in the year preceding diagnosis. We identified 10,021 patients with an incident diagnosis of JIA and 20,042 age- and sex-matched healthy controls in the Merative MarketScan administrative datasets (2014-2022). Using negative binomial or hurdle models, we calculated incidence rate ratios (IRRs) comparing outpatient, inpatient, and emergency department or urgent care (ED/UC) utilization between patients with JIA and controls. In the year before diagnosis, patients with JIA had significantly increased health care utilization compared to controls (IRR 2.55 [95% confidence interval (CI) 2.49-2.62], P < 0.001). Accounting for sex, age, and insurance, utilization was increased across care settings: outpatient (IRR 2.56 [95% CI 2.49-2.62], P < 0.001), inpatient (IRR 2.00 [95% CI 1.48-2.71], P < 0.001), and ED/UC encounters (IRR 1.76 [95% CI 1.67-1.86], P < 0.001). The most common visits by patients with JIA preceding diagnosis were to a general practitioner (91.8%), ED/UC (47.0%), and orthopedist (22.9%). Health care utilization increased as the index date approached. In patients insured by Medicaid, ED/UC care was more frequent (odds ratio 2.05 [95% CI 1.89-2.23]) and orthopedic care less frequent (odds ratio 0.27 [95% CI 0.24-0.34]) than in patients with commercial insurance. In the year before diagnosis, children with JIA have significantly higher health care utilization compared to healthy peers. There are differences in the patterns of utilization in patients with Medicaid versus commercial insurance. There may be opportunities for earlier identification of JIA in primary care, orthopedics, and ED/UC.