Long COVID affects a substantial portion of the U.S. population. The emergence of the Omicron variant and persistent sociodemographic disparities may contribute to temporal and regional variation in long COVID risk. However, such spatiotemporal variation and related social determinants remain poorly characterized. This study aimed to examine spatiotemporal patterns of county-level long COVID incidence and to identify sociodemographic factors associated with these patterns before and after the emergence of the Omicron variant. This retrospective study utilized data from the National COVID Cohort Collaborative (N3C), covering 5,652,474 COVID-19 cases from 2020 to 2024 and 41,694 long COVID cases across 1063 U.S. counties from 2021 to 2024. Temporal patterns of long COVID were analyzed before and after the Omicron variant's emergence, and spatial patterns were assessed using Moran's I and Getis statistics. Bayesian spatial random effect models were employed to evaluate the associations between long COVID incidence and sociodemographic factors such as economic vulnerability, healthcare access, and mobility. Among 4,070,879 COVID-19 cases analyzed, quarterly long COVID incidence ranged from 0.015% to 14.29%. Before the emergence of the Omicron variant, incidence was 204 cases per 10,000 COVID-19 cases, compared with 248 cases per 10,000 COVID-19 cases after Omicron emergence (p < 0.001). Based on the Local Moran's I statistic, 48.8% (328 of 673) of counties showed significant spatial correlation (p < 0.05) after Omicron's emergence, up from 43.5% (293 of 673) prior. High-risk areas became more concentrated in inland regions, while low-risk areas clustered along the East Coast. Long COVID incidence was significantly associated with economic vulnerability, limited healthcare access, and mobility constraints, with these sociodemographic disparities consistently driving its spatial disparities over time. Subregional analyses revealed distinct regional differences in social drivers. These findings highlight pronounced spatiotemporal and regional disparities in long COVID incidence across the United States. Targeted public health interventions, particularly in economically and geographically vulnerable regions, are essential to ensure equitable access to diagnosis, care, and resource allocation. National Center for Advancing Translational Sciences; National Institutes of Health; National Science Foundation.

Chronic hepatitis B (CHB) and hepatitis D (CHD) remain global health challenges, where sustained care engagement, treatment adherence and regular monitoring are essential but often limited by stigma and healthcare access. Digital health tools offer new opportunities to bridge these gaps. This study aimed to adapt the NORA mobile health app for CHB and CHD patients and evaluate its real-world utility in improving knowledge, adherence, communication and quality of life. We conducted a prospective, comparative study (February 2022-April 2024) including adult CHB (HBsAg-positive, HBeAg-negative) or CHD (anti-HDV or HDV-RNA-positive) patients with mobile access and Spanish proficiency. The app offered educational content, medication reminders, quality-of-life questionnaires (CLDQ, FACIT-F, EQ-5D-5L), a chat function and a knowledge test. Sociodemographic, clinical and usage data were analysed. Of 406 patients evaluated (356 CHB, 50 CHD), 277 CHB and 41 CHD patients were eligible. Participation was high (CHB: 88.4%; CHD: 90.2%), with active use in 48.1% and 70.3%, respectively. App users were more often male and Caucasian, and CHD users more frequently had detectable HDV-RNA. Patients with inactive HBV infection were less likely to use the app over the medium term (OR = 0.462, p = 0.003), and those who did use the app missed fewer clinic visits than nonusers (8.4% vs. 18.1%; OR = 0.41, p = 0.016). Among users, 85 were on antiviral therapy, 67% used the medication reminder, and chat use was higher in CHD and in treated patients (p = 0.004). High adherence (68% CHB, 84% CHD) and knowledge gains were observed, particularly in CHB with higher education. CHD patients showed worse baseline quality of life and greater declines over time. This first real-world study of a tailored mobile health (mHealth) app for CHB and CHD showed improved patient knowledge, adherence, communication and quality-of-life monitoring, with greater engagement in patients with advanced disease.

• Youth leaving foster care in the Deep South experience barriers to accessing healthcare. • Common barriers to healthcare access include mistrust, concern over cost, and lack of knowledge. • Unique to this Deep South study, ineffective healthcare guidance and policy limit access to care. • Guidance for healthcare professionals, agencies, policymakers is offered to ease barriers. Youth leaving foster care face significant challenges accessing healthcare due to frequent placement changes, fluctuating health insurance eligibility, and inconsistent adult guidance during the transition into adulthood. Concerns over health care access are intensified among youth leaving care because of the significant prevalence of behavioral and medical disabilities. Studies exploring specific psychosocial (e.g. , stigma) and structural (e.g. , systemic bias/racism) barriers to healthcare access within racially diverse, urban, and rural communities are crucial to improving health equity. Set against a backdrop of long-standing concerns over health access in the Deep South, this exploratory study provides a foundational understanding of barriers to healthcare access for youth leaving care with disabilities in the Southeastern United States. Ten in-depth semi-structured focus groups were conducted across three locations with distinct stakeholder populations, including youth leaving care with diagnosed disabilities ( n = 12), caregivers of youth ( n = 29), and child welfare professionals serving youth ( n = 37). Themes illustrate several factors challenging healthcare access for youth leaving care with disabilities, including (1) mistrust of healthcare, (2) concerns over cost, (3) insufficient learning opportunities, (4) conflicting and ineffective healthcare guidance, and (5) child welfare policies and practices limiting access to care. Given the limited literature describing challenges to healthcare access among youth with disabilities leaving care in the Deep South, this study contributes valuable insights to inform the development and implementation of regionally tailored strategies to promote healthcare access among this population.

Global breast cancer incidence, mortality, and survival among indigenous women: A systematic review and meta-analysis.

Asia faces a rising diabetes burden, with significant subregional variations. This study analyses trends from 1990 to 2021 and projects future burdens to guide targeted interventions. Using data from the Global Burden of Disease Study 2021, we assessed type 2 diabetes cases, deaths, disability-adjusted life-years (DALYs) and age-standardized rates across 35 Asian countries/regions. Decomposition analysis identified burden drivers, and the Bayesian Age-Period-Cohort (BAPC) model predicted trends. From 1990 to 2021, Asia witnessed a substantial increase in the burden of type 2 diabetes, with Central Asia having the fastest-growing age-standardized incidence rate (ASIR) at estimated annual percentage change (EAPC) of 2.82. South Asia faced the heaviest burden, with 410,254 diabetes-related deaths and 16,851,968 DALYs in 2021. The age-standardized mortality rate (ASMR) was highest in Southeast Asia at 27.84 per 100,000. Key drivers included population growth, ageing and epidemiological changes, particularly in South Asia, with projections indicating continued increases in diabetes burden in South and Central Asia. Asia's diabetes burden has continued to increase, driven by population growth, ageing and epidemiological shifts. Targeted prevention, healthcare access and ageing policies are critical, especially in high-burden regions like South and Central Asia.

Using human-centered design to explore telemedicine to improve healthcare engagement among individuals transitioning from prison to community in Malaysia.

Glycaemic control remains central in type 2 diabetes mellitus management: key learnings from the latest International Diabetes Federation guidelines.

The Indonesia pre-eclampsia study (INAPRES): Pregnancy outcomes in pregnancy with pre-eclampsia in Indonesia.

Neurobiological, molecular, and systemic mechanisms of exercise in the treatment of mental health disorders.

Antidepressant (AD) discontinuation care asks for tailored support and alignment with patients' expectations, needs and wishes. However, studies on patients' experiences and perspectives regarding the contribution of the pharmacist to AD discontinuation care are limited. The aim was to gain a deeper understanding of patients' perspectives regarding guidance during AD discontinuation and patients' views on the contribution of the pharmacist. A qualitative, explorative study was conducted with 15 semistructured face-to-face and video call interviews. Inclusion criteria were age ≥ 18 years and current or past use of ADs. The audiotapes were transcribed verbatim, coded and analysed by two researchers. The following four themes were identified: (1) experiences with ad use and discontinuation, (2) attitudes and behaviour towards AD discontinuation, (3) expectations and perceptions towards AD discontinuation and (4) needs regarding AD discontinuation. False beliefs about ADs and past negative experiences with AD discontinuation shape beliefs of patients that amount to a reluctance to discontinue ADs. The most urgent needs of patients were timely receiving guidance, including clear and relevant information from accessible, knowledgeable and trustable healthcare providers (HCPs). Pharmacists' easy accessibility, pharmacotherapeutic knowledge, expertise and capabilities should be put to use, as they may help meeting patients' needs on AD discontinuation.

Although the recent proliferation of telemental health care has transformed delivery of outpatient mental health care for many patients, little is known about population-level access to telehealth, hybrid, and in-person outpatient mental health care in the US. The objective of this report is to characterize patterns of all telehealth, hybrid, and all in-person outpatient mental health care by US adults. An analysis is presented of 2021-2022 Medical Expenditure Panel Survey data (n=39,561) focusing on annual percentages of adults receiving all telehealth, hybrid, and all in-person outpatient mental health care. Results are presented overall and stratified by sociodemographic characteristics. Differences are reported in average marginal estimates from logistic regressions for each sociodemographic characteristic controlling for age group, sex, and psychological distress (Kessler-6). Approximately 12.0% of adults annually received outpatient mental health care, including 3.3% all telemental health care, 2.6% hybrid, and 6.1% all in-person mental health care. After controlling for age, sex, and distress, unemployed adults 65 years of age or younger were less likely than employed adults to receive all mental health care (-1.0 percentage points, 95% CI: -1.6 to -0.4), and uninsured individuals were less likely than those with private insurance (-2.8 percentage points, 95% CI: -3.6 to -1.9). By contrast, college graduates were 3.2 percentage points (95% CI: 2.3-4.0) more likely than those with less than a high school diploma, higher-income individuals were 1.6 percentage points (95% CI: 0.8-2.30) more likely than those below the poverty level, and urban residents were 1.9 percentage points (95% CI: 1.1-2.7) more likely than rural residents to receive all telemental health care. These national patterns highlight differences in US telemental health care access across employment, education, income, insurance, and geographic groups.

To examine how mis- and disinformation about the Public Charge Ground of Inadmissibility final rule ("public charge rule") influences health care access for Latino immigrants in California as seen through the perspectives of leaders in health-serving organizations. This qualitative study included semi-structured interviews with healthcare and community-based organizational leaders serving Latino immigrants in California. Viswanath etal.'s structural influence model of communication and equity guided the analyses and interpretation of the findings. Between May 2024 and April 2025, primary data were collected from 31 organizations, resulting in 32 semi-structured interviews with 38 participants. Interviews were conducted via Zoom and transcribed verbatim. Researchers coded the data based on recurring themes using Dedoose software. Participants identified the public charge rule as a significant barrier to health care access for Latino immigrants. The policy has discouraged many Latinos from accessing public benefits, particularly the state's Medicaid and Supplemental Nutrition Assistance Program. In addition, immigrants' trusted sources of information (e.g., family, friends, and attorneys) were often misinformed about the policy, which amplified confusion and fear. Organizations respond by providing accurate information and connecting individuals with reliable resources to clarify that using public benefits would not necessarily result in being classified as a public charge. However, most efforts focused on education rather than directly countering mis- and disinformation. Healthcare and community-based organizations offer unique perspectives as trusted intermediaries who help Latino immigrant families navigate health care and public benefits. Their close daily interactions reveal how misinformation about the public charge rule deters families from accessing essential services and makes it more challenging for organizations to fulfill their missions. These insights underscore the need for culturally responsive outreach and policy solutions that address information gaps and the climate of fear affecting community health.

School-based health centers (SBHCs) and other school-based clinics (OSBCs) reduce health care access barriers and support positive outcomes in disadvantaged children by providing primary medical care and other services, respectively. This study describes California SBHCs and OSBCs and identifies school characteristics associated with access. Databases on California SBHCs, OSBCs, and schools were compiled. Descriptive statistics characterize the number of clinics and services offered from 2011 to 2023. Multivariable logistic regression models estimate associations between school characteristics and SBHC/OSBC access in 2023. Between 2011and 2023, the SBHCs increased from 124 to 186, and services became more comprehensive. OSBCs increased from 18 to 104, with most offering mental health services. SBHC access was more likely in schools with a larger share of students who were English Learners and "other" as their race and ethnicity; high schools; and in large cities. OSBC access was more likely in schools with a larger share of English Learner students and in cities. SBHCs and OSBCs expanded and largely served disadvantaged schools, which may promote health and academic equity.

Young people living with Long Covid face challenges accessing health care and social support. Previous qualitative research in the UK has described the 'invalidation' of Long Covid illness experience. It has been said that there is a 'double invisibility' produced by narratives that minimise the effects of Covid-19 among young people, which combine with a generalised lack of awareness of Long Covid itself. In this analysis, we look beyond the well-documented networks of online self-help and advocacy to trace how young people navigate, connect and maintain multi-sited alternative care networks to manage their everyday experiences of Long Covid. We draw on the analysis of qualitative interviews with 54 young people aged 15-25 with long-term health impacts from Covid-19, of whom 30 also participated in follow-up interviews. The sample includes young people with multiple genders, who identify with a range of ethnic identities, and who have experience of neurodiversity or additional disabilities. Interview transcripts were analysed to identify key themes, in collaboration with a group of peer researchers who are co-authors on this study. We find that the informal networks that are navigated and created by young people play a vital role, but that they are also fragile. We present our findings across four themes-how informal networks afford young people validation in different ways; the material differences informal networks bring to young people's lives; the work that young people do to build and maintain these networks; and the fragility of support networks. We show that informal networks are not simply identified and found, but that they are 'made to work' by young people who do the work that brings informal networks together and that holds them in place. We conclude that there is a need to strengthen the vital work of informal care that is done by young people, but that alternative care networks should not be seen simply as a means of 'filling the gaps' of inadequate care. There is a need to build infrastructures that properly integrate formal with informal care in direct response to young people's experiences of Long Covid. This qualitative study was undertaken in close collaboration with community partners and co-produced with young people affected by Long Covid, using participatory methods. Young people affected by Long Covid were involved in a series of consultations, workshops and meetings focused on the analysis of data and their development into project outputs, including as authors of this paper.

Despite significant literature on access to, and utilisation of, health care, less attention has been given to the agency of rural service users to use, or not use, health services. This paper aims to understand the decisions of residents from two rural communities to use, or not use, health services. Participants were recruited from Neighbourhood Houses in two rural communities in northern Victoria, Australia, located relatively close to a regional centre. Twenty participants with significant socioeconomic needs were included. The study used a qualitative design and constructivist paradigm to undertake semi-structured interviews which were analysed thematically. Three types of decisions to access health services were identified. First, regular users prioritised their health, valued health care, and usually had a trusted healthcare navigator. Second, sometimes users identified barriers to accessing services, primarily not having a trusted GP and cost. Third, avoiders of health services suggested they did not prioritise their own health, it was easier to not attend, they did not believe health services led to better health outcomes, and poverty or other social issues prevented use. Some respondents moved between the three types, being regular users for children and when they had a trusted GP, and sometimes users for themselves or when barriers arose. This study identified the strong role of GPs and the relational aspects of accessing and utilising health care. It calls for stronger engagement with disadvantaged rural residents to build trust in health care among those avoiding health services.

Enhancing outcomes for geriatric patients with evaluation of the social determinants of health.

People with diabetes may be more vulnerable to temperature extremes due to impaired thermoregulation and higher prevalence of comorbidities, but evidence is limited. We aimed to compare short-term effects of extreme heat and cold on all-cause emergency hospital admissions in Germany among people with and without diabetes. We applied space- and time-stratified conditional quasi-Poisson regression with distributed lag non-linear models (up to 21 days) to estimate short-term effects of daily average temperature. We chose the reference temperature (20 °C) such that it approximates the minimum morbidity temperature in most subgroups. Analyses were stratified by sex, age, and diabetes status using data from all emergency hospital admissions in Germany, 2005-2022 (N = 132,243,083) at the level of 400 administrative districts, enabling an ecological study. Both heat and cold increased hospital admissions. Heat-related relative risks (RR) were broadly similar between people with and without diabetes. Considering all ages, heat-related RRs (95% confidence interval) were 1.03 (1.03-1.04), 1.07 (1.00-1.13), and 1.02 (1.01-1.03) in males without, with type 1, and with type 2 diabetes. Age-specific RRs for heat and cold were similar between people without and with type 2 diabetes but higher for type 1 diabetes in some subgroups; e.g. cold-related RRs were 1.13 (1.12-1.15) and 1.51 (1.14-2.01) in men aged ≥80 years without and with type 1 diabetes. Contrary to prior hypotheses, diabetes was not associated with greater vulnerability. This may reflect good healthcare access and increased awareness of heat and cold-related risks among people with diabetes. Nevertheless, given the higher baseline risk of hospital admission in diabetes, similar RR may still translate into larger absolute effects of extreme temperatures. Hence, clinical practice and policies aimed at mitigating temperature-related effects should continue to consider diabetes as a potential vulnerability factor. None.

Explainable machine learning framework based on blood biomarkers and routine health information for assistive diagnosis and risk stratification of acute myocardial infarction.

MedQA-MA: A Moroccan Arabic medical question-answering dataset for virtual healthcare assistants and large language models.

To develop and evaluate an automated system for identifying healthcare barriers focusing on transportation issues in veterans' clinical notes using large language models (LLMs) and to assess the impact of different prompting strategies on classification performance and explanation consistency. We developed a hybrid system combining pattern matching for templated notes with LLM analysis for free-text notes. Using 2000 manually annotated clinical notes, we compared four prompting strategies (dual-role short, dual-role long, analysis-first, analysis-only) across Mistral-7B and Llama-3.1 models. We evaluated classification performance using standard metrics and assessed explanation consistency through embedding similarity analysis. The analysis-first strategy achieved superior performance, with Mistral-7B reaching an F1 score of 0.914, outperforming traditional machine learning approaches (GBM: 0.786, BERT: 0.811). LLMs demonstrated higher explanation consistency within models (mean cosine similarity 0.887-0.908) compared to cross-model similarities (0.767-0.872). Pattern matching successfully handled 6.7% of templated notes deterministically. Mistral-7B showed greater internal consistency but higher abstention rates compared to Llama-3.1. Requiring LLMs to analyze evidence before classification improves both accuracy and explanation consistency for identifying transportation barriers in clinical notes. This approach enables automated barrier detection at scale while providing clinically relevant explanations, supporting both population-level healthcare planning and individual patient care decisions.