Patient care in radiation oncology is challenging. Interface problems can arise, particularly when transitioning from the inpatient to home environment. Inpatients' perception of safety regarding the upcoming discharge and their satisfaction with care were addressed in the project. "Bridging the gaps" was an optional course for medical students in their 5th year. The study consisted of two arms-one with ahome visit by medical students and the other without such avisit. Before discharge, inpatient radiation oncology patients were offered ahome visit by medical students. Asurvey was conducted before (time point1) and 3-5days after discharge (time point2) using questionnaires concerning satisfaction with care, current health status, and perception of safety. Outcome changes between time points1 and2 in both groups (with vs. without home visit) were compared. Atotal of 60patients were interviewed. Patients which received ahome visit expressed improved perception of safety after discharge, whereas patients without ahome visit showed decreased perception of safety (p = 0.024 for group-difference). Both groups showed ahigh level of satisfaction with care, which varied between the time points. In patients without ahome visit, satisfaction decreased significantly after discharge, whereas satisfaction slightly increased in patients with ahome visit (p = 0.001 for group-difference). Radiation oncology patients may benefit from home visits by increasing their perception of safety. Continuation and expansion of the project could strengthen the role of radiation oncology in the cross-sectoral care system.

Globally, Public Health Nurses (PHNs) play a central role in disease prevention and health promotion. In Sri Lanka, the PHN service, discontinued in the 1980s, was reintroduced in 2018. However, a standardised framework for defining, implementing, and documenting their roles and services is still lacking, despite record-keeping being vital for evaluating service delivery. This study aimed to describe the duties performed by Sri Lankan PHNs. A descriptive cross-sectional study was conducted among the PHNs working in 08 provinces in Sri Lanka during October 2024. Data collection was performed using a pre-tested, validated, self-administered questionnaire, and the results were analysed descriptively. Of 171 eligible PHNs, 127 responded (74.3%). Within the month, almost all (99.2%) delivered NCD prevention, running 1,183 screening clinics (median 8 per nurse) and registering 10,822 people (median 71 per nurse). In palliative care, 94% conducted 1,518 home visits (median 8), commonly providing catheter care (76.4%), wound care (59.8%), and NG feeding (48.8%). For geriatric services, 74.8% of patients received home-based care (744 visits), and their blood pressure was monitored (1,371 instances) and blood sugar levels checked (1,275 instances). Health promotion was universal, with 85% of the population contributing to mental healthcare. Although 83.5% of PHNs had attended in pain management, only 41.7% assessed pain, and 37.8% administered prescribed analgesics. Disaster management (4.7%) and research engagement (13.4%) were limited. Service volumes varied by district, with higher pain-management activity in Nuwara Eliya and Ratnapura. Female PHNs more often attended bereavement sessions and mental healthcare (p = 0.036; p = 0.025), while older age correlated with longer travel for mobile clinics (rs=0.201) and more elderly home visits (rs=0.220). PHNs in Sri Lanka make strong contributions to NCD prevention, health promotion, and palliative care, with additional roles in elderly and mental healthcare. Yet, their involvement in pain management, disaster response, and research remains limited. Clearer role definitions, more PHN recruitments, targeted capacity building, and a workforce need assessment are essential to maximise their impact on community health.

Abstract Background During the period September to December 2024 an individual GPwSI was working across specialist palliative care (0.2WTE) and acute frailty (0.6WTE) concurrently within the same Trust. To allow Specialist Palliative Care consultants to concentrate on ward/inpatient/complex cases, the GPwSI saw a variety of patients where the CNS felt a doctor was needed with unclear or undifferentiated problems. Method We analysed the case mix and outcomes of 38 cases seen, demonstrating that cross-speciality working has positive outcomes for doctors, patients and services and reduces acute admissions. Results Of the 38 cases analysed, 71% were home visits (patient’s usual place of residence), 24% originated as cases identified as needed cross-specialty input whilst the GPwSI was working in ED/SDEC, and 5% were at the hospice/telephone. Over a third (34%) of patient contacts involved patients with non-cancer or frailty related symptoms. Outcomes of the visits varied widely—some were advice only, in two cases GPwSI and CNS administered anticipatory medications, most were referred on to other services e.g. Rapid Response, hospice inpatient unit, Frailty SDEC (Same Day Emergency Care). Patients were seen within 1–2 days on Frailty SDEC by the Frailty team (including GPwSI) for presentations that would otherwise likely have resulted in ED attendances or hospital admissions. At least 37% (up to 50%) of these contacts resulted in >1 ED attendances/admissions avoided through cross-specialty/sector working—some were seen multiple times in Frailty SDEC for follow up and prevention of crises. Presentations included deranged electrolytes, anaemia, infection, ascites. The 24% of cases seen in ED also involved more direct and rapid input from palliative care including inpatient hospice. Conclusion This cross specialty integrated method of working was highly successful in admission avoidance in those approaching the end of life, achievement of patient goals (PPC/PPD) and patient satisfaction. Staff also reported high impact of this way cross-sector working.

Abstract Introduction Frail older adults are often discharged from hospital with complex needs into community care services. Without senior clinical oversight, many experience fragmented care, delayed reviews, inappropriate care planning, and avoidable readmissions. This project evaluated the impact of introducing clinical leadership into a care provider pathway designed to deliver short-term, post-discharge domiciliary care. Methods Over 11 weeks, 51 patients were supported, 43 of whom were on the care provider pathway. Using the Plan-Do-Study-Act (PDSA) framework, the project identified inefficiencies and tested solutions. Interventions included senior clinician-led home visits, MDT support, care plan reviews, and collaboration with community therapy and social care teams. Data was collected on care package changes, hospital length of stay, and therapy involvement. Results Key issues included: lack of formal policy for the pathway, no senior clinical oversight, unregistered care staff making key decisions, and poor end-of-life planning. Outcomes from clinical leadership interventions included: 12% of patients had reduced care packages prior to discharge; 24% had reduced care needs once home. Estimated 476 care hours released per week. Approximate cost saving of £7000 per week. Senior clinician home visits proved the most impactful, enabling timely assessments, realistic care decisions, reduced dependence on social care, and improved patient experience. MDT engagement and end-of-life care planning also improved significantly. Conclusions Introducing senior clinical leadership to the care provider pathway significantly improved patient flow, care quality, and resource use. A 12-month Band 7/8 leadership role is recommended, jointly funded by acute, community, and social care partners, to oversee and define this pathway. This approach offers a sustainable model to manage complex discharges for frail patients while reducing system strain and supporting better outcomes.

Older adults are more likely than younger people to have multiple chronic health conditions and increased health and/or social needs. As older people generally prefer living at home in the community as they age and residential care can be expensive, there is a need for effective alternatives to residential care in the community.The objective of this review was to synthesize evidence about programs aimed at enabling older people with ongoing health and social care needs to remain in the community. This review followed the JBI methodology for systematic reviews of effectiveness. Included studies reported on complex, multifactorial interventions that were based in the community and included more than one type of service.Six databases and gray literature were searched for published and unpublished research. Titles and abstracts, and full-text selections were screened by two or more reviewers and assessed for methodological quality using JBI critical appraisal tools.Results related to quality of life and healthcare outcomes were extracted. Fifty-five full text articles, reporting on 51 unique complex interventions, were included in the review. Studies were predominantly randomized controlled trials (n=24) and quasi-experimental studies (n=23), with five cohort and three case series studies included. The overall quality of the included studies was moderate. Key characteristics of the interventions included case management, care planning, a comprehensive assessment, and in-home visits. Comparative meta-analyses were completed for five of the outcomes (hospital admission, emergency department visits, long-term care use, primary care use and quality of life). The results showed effects in the direction of interventions for the number of hospital admissions and LTC use, however, none of the meta-analyses were statistically significant. There is little agreement about the effectiveness of complex interventions on quality of life and health system outcomes. Jurisdictional differences may make the integration of literature reporting on such interventions particularly difficult. There is an ongoing need to understand what helps older people with complex needs live well in the community and what level of health system engagement is optimal. PROSPERO reference number CRD42022324061.

In the Danish healthcare system, primary care for the growing population of older adults is provided by around 1600 independently owned general practices with a high degree of autonomy in service delivery. to investigate practice-level variation in consultation frequencies for older adults in Denmark and its association with practice-level factors, after adjustment for patient characteristics. Register-based nationwide cohort study of all Danish residents aged≥75 years listed with a general practice in 2017-2021. The practices' consultation frequencies were analysed using zero-inflated Poisson regression adjusted for patient population factors. Funnel plots assessed variation in consultations. Multinomial logistic regression was used for analysing associations between practice factors and exhibiting systematic variation in consultation frequency. In 2017, the study included 468 679 older adults, rising to 569 457 in 2021. In 2021, the average consultation frequency was 10, comprising 3.7 face-to-face, 3.3 telephone, 2.2 e-mail, 0.61 home visit, and 0.38 chronic care review consultations. After adjusting for the practices' patient population, 4% to 9% of general practices showed greater variation in consultation frequency than could be explained by chance. No practice-level factors: number of general practitioners, their age, sex, or years since specialist qualification, were associated with providing more consultations than expected. The systematic variation in consultation frequencies between practices is notable. Further studies should explore the potential consequences for patients registered with a general practice exhibiting consultation frequencies that differ significantly from other practices beyond what could be explained by chance.

There is substantial evidence that programs that build parents' abilities to support early learning benefit children's development. Evidence is needed on how to integrate and scale these programs within government services. To determine whether a parenting program implemented by government primary health care services and combining in-person and remote delivery benefits children's development and parenting attitudes and behaviors. In this single-blind randomized clinical trial, enrollment began in July 2022 in primary health care centers in Jamaica. The intervention was phased in from September 2022 to August 2023 and lasted 8 months. Data collection ended in April 2024. Families with children aged 3 to 28 months from communities served by the centers were identified by health staff. Following eligibility checks and informed consent, families were randomly assigned to intervention or waiting list control. The intervention aimed to strengthen parents' skills in helping their child learn through play and responsive interactions. Community health workers used a curriculum with age-appropriate play and language activities and made fortnightly contacts with families, alternating between home visits and telephone calls. Child development was measured with the Griffiths Mental Development Scales and parenting behaviors (involvement, responsivity, acceptance, and learning materials) with the Home Observation for Measurement of the Environment (HOME). Effect size (ES) was calculated by dividing the regression coefficient by the pooled-sample SD. A total of 627 children were enrolled (311 intervention and 316 control; 322 [51.4%] male). At follow-up, 491 children (78.3%) were assessed, 237 (76.2%) of those in the intervention group and 254 (80.4%) in the control group. Children's mean (SD) age at follow-up was 27.0 (5.8) months in the control and 27.0 (6.1) months in the intervention group. A total of 393 mothers (62.7%) had completed secondary school. There were no significant differences in follow-up rate or characteristics between groups. Intention-to-treat multivariate regression analyses with inverse probability weights showed benefits for children's overall developmental quotient (ES, 0.17 SD; 95% CI, 0.01-0.33 SD), fine motor ability score (ES, 0.19 SD; 95% CI, 0.03-0.36 SD), and parent behaviors (HOME score ES, 0.25 SD; 95% CI, 0.08-0.41 SD). In this randomized clinical trial of a parenting program delivered through primary health care, the intervention benefited child development and parenting. Findings suggest combining in-person and remote methods may be a useful strategy for scaling. ISRCTN Registry Identifier: ISRCTN11059214.

Communicating effectively with women experiencing socioeconomic vulnerability during the perinatal period: A systematic review.

HF is the most common reason for hospital admission and readmission of older adults and those readmitted within 30 days have a higher mortality rate at 6 months. The transition from hospital to community has been identified as a vulnerable time when patients must assume responsibility for their own care. No one strategy has been found to reduce 30-day readmissions or 6-month mortality rates. The Heart Failure Nurse Navigator (HFNN) is a home health registered nurse with specialized training in HF care. In this IRB-approved study, an HFNN visited intervention group participants once in the hospital, followed by weekly home visits for 1 month. Control group participants received usual care, with discharge teaching by nursing and follow-up with their provider. The qualitative research question was "What are the perceptions of older adults (≥65) with a diagnosis of HF who transition from hospital to home regarding care received from a Heart Failure Nurse Navigator?" Qualitative data were transcribed verbatim, then key thoughts and concepts were identified and organized into similar categories. Two main categories emerged: Personal Clarification of Patient Education, especially related to diet, exercise, and medications, and Feelings of Support, Reassurance, and Safety. Meeting the HFNN in the hospital was the beginning of the caring relationship that continued through the home visits. As the caring relationship developed, the HFNN, patient, and family determined together what mattered most during this crucial transition. Providing specialized HF instruction to home health nurses may give them a stronger base from which to offer comprehensive education, support, and reassurance to patients with HF.

This qualitative phenomenological study examined the teaching experiences of 10 volunteer teachers in Tabaco City Division with at least two years of experience, selected for their willingness to participate. Through in-depth interviews, it addressed four research questions: teaching experiences, strategies employed, personal and professional insights gained, and a proposed development plan. Teaching experiences revealed three themes: supportive yet resource-limited environments from partner schools and the Local Government Unit providing essential resources; parental barriers due to program unawareness, work issues, and health concerns, addressed through committed home visitations fostering school-home partnerships; and adaptive responses to learners' needs including reading difficulties, low confidence, bullying, health issues, and unsupportive homes via differentiated instruction and personal funding for necessities. Witnessing learner growth brought deep fulfillment. Volunteer teachers used student-centered strategies focused on creativity, differentiation, and engagement despite challenges like irregular compensation forcing personal spending, material shortages, poor weather-exposed facilities, student absences, and diverse behaviors. Resilience stemmed from learner progress and community support. Insights showed personal growth in empathy, patience, and resilience, and professional gains in time management, organization, leadership, self-confidence, creativity, and purpose. Suggestions included regular stipends for expenses, sufficient facilities and resources, greater community and parental involvement with counseling, program awareness, safety during visits, and seminars on inclusive education. Advice to future volunteers stressed patience, dedication, passion, love, and care. A development plan was proposed to tackle these challenges. The program builds resilient educators and learner progress, requiring enhanced stakeholder collaboration for sustainability.

eHealth literacy is important for older adults to be able to seek and evaluate online health information. However, there is a scarcity of large-scale data on their eHealth literacy levels, particularly among the oldest older individuals (aged >75 years) in unique, high-income Asian regions such as Hong Kong. A comprehensive understanding of how eHealth literacy is associated with specific health behaviors, mental well-being, and physical health outcomes in this population is lacking. This study aims to assess the level of eHealth literacy and its associations with health behaviors and health-related outcomes among older adults in Hong Kong. We conducted a cross-sectional analysis of baseline data from the Generations Connect Project. This is an ongoing large-scale community-based project, where we trained university students to conduct home visits and assess the health status of older adults (N=6704) in Hong Kong. eHealth literacy was measured using the eHealth Literacy Scale (eHEALS; score: 8-40). Health behavior measurements included physical activity levels (metabolic equivalent of task minutes per week) and smoking, drinking, and eating habits. Mental well-being was measured using the World Health Organization-Five Well-Being Index (percentage score: 0-100) and UCLA 3-item Loneliness Scale (score: 3-9). Physical health was assessed on the basis of self-reported medical diagnosis of noncommunicable diseases (yes/no), including hypertension, diabetes, cardiovascular disease, and stroke. Adjusted unstandardized coefficients (b) and odds ratios (ORs) were calculated to determine the associations between variables. Among the 6704 participants (mean age 77.8, SD 7.0 years), the mean eHEALS score was 18.2 (SD 10.2), and 44.1% (2897/6566) of the participants had inadequate eHealth literacy (score: 8-15.99). Increasing age (adjusted b -0.32, 95% CI -0.35 to -0.28; P<.001), support from the Comprehensive Social Security Assistance Scheme (adjusted b -1.49, 95% CI -2.04 to -0.95; P<.001), and living in public housing (adjusted b -1.60, 95% CI -2.69 to -0.50; P=.004) were associated with a lower eHEALS score. Participants with moderate eHealth literacy (score: 24-31.99) were less likely to be current smokers (adjusted OR 0.60, 95% CI 0.38-0.95; P=.04), more physically active (adjusted b 39.83, 95% CI 2.04-77.62; P=.04), more likely to be community health center members (adjusted OR 1.52, 95% CI 1.30-1.77; P<.001) and to have healthy diets (adjusted b 0.034, 95% CI 0.006-0.063; P=.04), and less likely to have a medical diagnosis of diabetes (adjusted OR 0.73, 95% CI 0.62-0.85; P<.001). Moreover, they had a higher score on the World Health Organization-Five Well-being Index (adjusted b 2.89, 95% CI 1.42-4.36; P<.001) and a lower score on the UCLA 3-item Loneliness Scale (adjusted b -0.26, 95% CI -0.37 to -0.15; P<.001). The level of eHealth literacy was low among older adults in Hong Kong. eHealth literacy was associated with positive health behaviors and health-related outcomes. Interventions are warranted to boost their eHealth literacy in the future.

ABSTRACT Home care has been associated with time pressure and extensive waiting times, affecting care users’ ability to manage their daily activities. In 2023, one Swedish municipality started offering ‘video visits’ to complement home visits. However, little is known about the implications of this type of digital technology for care users’ waiting experiences. This article aims to understand how care users experience time in relation to home care and what implications video visits have for their experiences of time. This article is based on a qualitative interview study with 19 care users, aged 70 to 90+, who received video visits. Theoretical perspectives on uncertainty, temporal orders, and waiting have been used to analyse the empirical material. Results show how care users raised two concerns with the physical homecare: 1) care staff were seldom on time, and 2) there were too many new and different care staff. However, video visits were experienced to be punctual and offer staff continuity. Results show that video visits can reduce wait time in home care. However, it depends on how the digital technology is used, how the work is organized and performed, and how tasks are prioritized in relation to other tasks. The uncertainty that arises from waiting for home care negatively affects care users’ wellbeing, which is why it is important to find ways to make home care more predictable.

Introduction: The COVID-19 pandemic has had a substantial impact on informal working mothers, who struggle to balance employment and childcare amid limited resources. These challenges have increased food insecurity and obesogenic behaviour, affecting their dietary intake. This study examined the association between food insecurity and obesogenic behaviour in informal working mothers in peri-urban and rural areas, focusing on their dietary patterns during the post-pandemic era. Method: This cross-sectional study was conducted in peri-urban and rural areas of Indonesia between November and December 2022. A total of 143 informal working mothers with children under five were recruited through consecutive sampling; data collection was carried out via home visits. Household food insecurity and obesogenic behaviour were assessed using validated questionnaires, while dietary intake was assessed using dietary recalls, with statistical analysis performed using multinomial logistic regression analysis. Results: Obesogenic behaviour was more prevalent in rural areas (59.1%), while food insecurity with hunger was more prevalent in periurban areas (60.5%). Obesogenic behaviour had no significant association with dietary intake. Regression analysis showed that food insecurity with hunger had lower odds of high protein intake (OR=0.30, p=0.038) and high carbohydrate intake (OR=0.26, p=0.024). The model suggested that additional social, economic, and environmental factors likely contributed to dietary differences. Conclusion: Household food insecurity was higher in peri-urban areas and significantly associated with energy, protein, and carbohydrate intakes, while obesogenic behaviour showed no significant link to dietary intake. Ensuring food security in families with informal working mothers requires comprehensive efforts.

Most minority populations in Europe generally exhibit lower childhood vaccine uptake compared with the general population. Improving uptake in these populations requires contextually tailored interventions. We conducted a realist review to identify interventions effective at improving measles, mumps and rubella (MMR) and human papillomavirus (HPV) vaccine uptake among underserved communities. We searched MEDLINE, EMBASE, CINAHL, Cochrane and ProQuest for English language publications from 2005 to 2022. Following title and abstract screening, full texts were assessed for relevance. Grey literature and reference lists were also examined. Data extraction and analysis were performed independently by two reviewers. Programme theories were generated from included articles and data extraction focusing on context-mechanism-outcome configurations. Of 1942 screened titles, 87 studies underwent full-text review of which 34 met inclusion criteria. 10 primary intervention categories were identified: parental and youth education; clinical outreach; data infrastructure/quality improvement; health provider training; school-based education; digital technology for patients; cash incentives; home visits; comic books; community leaders' education; and consent policy changes. Analysis highlighting contextual factors enabling or hindering each intervention category's success was conducted. Multicomponent strategies proved the most effective, with strongest evidence supporting home visits, parental and youth education, school-based programmes, data infrastructure and quality improvement and healthcare provider training. Moderate evidence supported reminders/recall strategies, comic books and consent policy changes, while digital technology for patients and cash incentives showed limited effectiveness. Importantly, there is no one-size-fits-all solution. Policymakers and practitioners should tailor and adapt interventions to the unique cultural, social and economic contexts of each group to ensure success. CRD42021268068.

BackgroundThe high incidence of Drug-Related Problems (DRPs), including medication adherence among patients with chronic diseases, especially during no direct monitoring by health workers, becomes a challenge to therapy success. Home Medication Review (HMR) is an alternative solution in primary healthcare services to avoid further complications.ObjectiveThis study aimed to analyze DRPs, their affecting factors, and DRP interventions for patients with chronic diseases in primary health centers (Puskesmas) through HMR.MethodsA quantitative, cross-sectional observational study using purposive sampling was conducted in several Puskesmas in Yogyakarta from February to May 2023. The collaborative HMR involved healthcare providers at each Puskesmas. DRPs were assessed based on observations and semi-structured interviews. The DRP classification followed PCNE V9.1, and medication adherence was measured using both pill counts and self-report via the MARS-10 questionnaire. Data were analyzed using SPSS 25.0 to perform logistic regression with a 95% confidence level.ResultsA total of 544 patients, comprising 269 adults and 275 older patients, were involved. Older patients experienced more DRPs than the adults (94.2% vs 84.8%). The most DRP experienced by both age groups was ineffective therapies, with the two most frequent causes being related to patient factors. Among the adults, hypertension comorbidity, number of medications, and BMI factors were associated with DRPs (p < 0.05). In contrast, no factors correlated with DRPs in the older patients. There was fair agreement between pill count and MARS-10 regarding medication adherence for both adults and older patients (kappa coefficients of 0.298 and 0.355, respectively).ConclusionPatients in primary health facilities with hypertension and using at least three medications have over a three-fold increased risk of experiencing DRPs. Healthcare providers, including pharmacists, nurses, and physicians, should collaborate to identify medication-related issues and provide personalized advice and management plans to enhance medication adherence. This study highlights the need for a standardized, structured HMR program, not merely as a patient home visit but also to better control chronic diseases.

To investigate international evidence on home visits and parenting interventions delivered by nurses and midwives and to identify core components, such as intervention content, programme characteristics, contextual factors and implementation elements shared by effective interventions. Scoping Review. Nine academic databases and grey literature were searched between June and August 2024 for studies published between 2020 and 2024. Screening and data extraction were independently conducted by two reviewers using covidence. The intervention characteristics were described using the TIDieR framework, and the content was analysed thematically. Of the 3217 screened studies, 23 met the inclusion criteria. The studies employed various designs, including RCTs, quasi-experimental, cohort, cross-sectional, register-based and single-case experimental studies. Interventions were typically guided by theories of human ecology, attachment and self-efficacy. Most used structured materials and were delivered via face-to-face home visits by trained nurses, starting during pregnancy and continuing for up to 2 years. Visits ranged from weekly to monthly, mainly to family homes. Interventions were often tailored to family needs and cultural contexts. Five core themes emerged: (1) parenting education, (2) maternal and infant health, (3) mental health and psychosocial support, (4) community connections and (5) cultural sensitivity. Effective interventions should be early, structured and tailored. Integrating parenting education, health, mental well-being and cultural sensitivity improves outcomes and scalable family care practices. Findings highlight the need for structured training and support for nurses and midwives. Integrating these interventions into routine services, with attention paid to equity and proportionate universalism, can enhance family outcomes. This review addressed the lack of clarity regarding what makes nurse- or midwife-led interventions effective. It identified key components that support child and family well-being and offers guidance for designing scalable, evidence-based interventions in maternal and child health services. The EQUATOR guidelines for PRISMA were met. No patient or public contributions.

Association of oil spill-related volatile organic compound exposure with CVD-related biomarkers in the Gulf Long-term Follow-up Study.

Extreme heat poses substantial health risks to older adults. Medicaid home visits in the weeks preceding such events may alleviate these risks. To assess whether receiving regular Medicaid home visits prior to extreme heat events is associated with reduced emergency department (ED) visits during extreme heat. This cohort study used claims and weather data. The changes in daily ED visits during and up to 2 days after extreme heat events were compared between dual-eligible enrollees who received weekly home visits in the preceding month (treatment group) and those who did not (comparison group). Participants included dual-eligible enrollees aged 65 years or older who received at least 1 Medicaid home visit in 2018 or 2019 in zip code tabulation areas (ZCTAs) across the US that experienced at least 1 extreme heat event between May and October in 2018 and 2019. Data were analyzed from June 2024 to October 2025. An extreme heat day was defined at the ZCTA level as a day when the maximum temperature exceeded 90 °F and was at least the 97th percentile for the same day of the year from 2006 to 2017. Consecutive extreme heat days were grouped into extreme heat events when they lasted 1 to 5 days. Daily ED visits per 1000 enrollees. Our sample included 597 388 dual-eligible enrollees (mean [SD] age, 77.2 [8.2] years; 423 474 female [70.9%]). During extreme heat, daily ED visits per 1000 enrollees increased by 1.29 (95% CI, 1.22 to 1.37) for those who received regular home visits in the preceding month and by 1.25 (95% CI, 1.19 to 1.31) for those who did not, a nonsignificant difference of 0.05 (95% CI, -0.04 to 0.14) between the 2 groups. Similar patterns in stratified analyses were found by climate region and among those with heat-sensitive chronic conditions. In this cohort study of community-dwelling dual-eligible enrollees, regular Medicaid home visits prior to heat events were not associated with changes in ED visits during extreme heat. This finding suggests that while regular home visits may not have reduced ED visits during heat events, they could have helped facilitate timely care-seeking when heat-related symptoms arose.

IntroductionThis study is a part of a series of studies on a health and social care home-visit program in Sweden called Grow Safely. The program aimed to reduce health disparities in underprivileged areas. The current study evaluated home visits from Child Health Care and dental services that took place when the children were 8 months old and illuminated their parents’ experiences of the home visits from both pediatric nurses and dental nurses.MethodsInterviews were conducted with 18 first-time families after they received the home visits. The interviews were analyzed using Burnard’s approach to content analysis. Ethical approval from the Regional Ethical Committee in Lund, Sweden, was obtained before the study was conducted.ResultsThe results included three categories. The parents appreciated the home visits since both they and their baby felt comfortable and secure during the visits. They found the information about their child’s development and the advice on good oral health valuable. They also valued the tailored information on how to ensure that their home was safe and secure for the child.ConclusionThe first-time parents appreciated the extended home visits when the baby was 8 months old. Further studies are needed in order to evaluate the effect of these visits on oral health.

The postpartum period entails physical, emotional and social changes, and municipalities are well placed to provide support. We conducted a systematic review of municipal initiatives for postpartum women by searching PubMed and Web of Science (10 January-8 February 2024). Of 147 records, 13 studies met the inclusion criteria. Reported actions clustered around: prevention of postpartum depression (routine screening, counselling, referral-often via home visits); targeted programs for vulnerable groups; measures to improve accessibility (transport vouchers, e-health/teleconsultation); social protection/insurance; multi-actor collaborations; and home-visiting schemes. Across settings, municipal engagement was associated with earlier detection of depressive symptoms, increased use of maternal services, longer exclusive breastfeeding, and gains in maternal empowerment. Evidence favors integrated approaches that combine health and social support and prioritize equity. Local governments should expand home visits, embed screening and referral in essential services, address transport and insurance barriers, and partner with community and NGO actors to tailor support to context.