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

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

Psychological and mental states mediated the association between physical activity and self-rated health of Chinese centenarians.

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

Background: Telemedicine has emerged as a key digital healthcare platform, offering convenient access to medical services for the public. Despite its potential, widespread adoption remains hindered by lingering consumer skepticism. Objectives: The aim of this systematic review was to investigate the factors increasing telemedicine adoption across adult non-healthcare professionals. Materials and methods: This was a systematic review conducted of primary observational studies published between 2021 and 2025. Adhering to PRISMA guidelines, the authors systematically searched three online databases (PubMed, ProQuest, and Science Direct) and screened articles using the PRISMA Flow Chart to identify eligible studies based on predefined inclusion criteria. The Joanna Briggs Institute’s (JBI) critical assessment techniques were used to evaluate the quality of the research findings. Results: From the reviewed secondary data derived from primary studies, 22 original articles were selected for analysis. Four major themes emerged as drivers of telemedicine utilization, including: 1) socioeconomic-demographic, such as age, education, income, employment, marital status, and social influence, 2) user’s perceived benefits factors like perceived usefulness, benefits, ease of use, and trust, 3) health-related problems, such as frequent healthcare demands, caregiving responsibilities, having chronic disease, and mental health conditions, and 4) internal factors or technological factors of telemedicine systems: price, service, and system quality. Conclusion: In conclusion, telemedicine adoption is influenced by a multifaceted interplay of socioeconomic and demographic factors, a user’s perceived benefits, individual health needs, and systemic features.

Postpartum post-traumatic stress disorder and health service use: A longitudinal cohort study.

Reperfusion strategies for acute pulmonary embolism: Design and rationale of RECONNECT-PE-A living systematic review and meta-analysis.

Depopulation and healthcare service decline: Spatial evidence of a vicious cycle in South Korea

Effect of auriculotherapy on the management of anxiety in pregnant and postpartum women in health services: Scoping review.

Patients with heart failure often experience debilitating symptoms, including dyspnea, fatigue, and anxiety, symptoms that influence quality of life. Cardiac nurses play an essential role in palliative care for patients with heart failure by providing comprehensive disease management, self-care support, patient education, symptom monitoring, medication management, and psychosocial support. Evidence on cardiac nurses' perspectives on palliative care remains limited. This study examines the experiences of cardiac nurses in providing palliative care to patients with heart failure in the late palliative phase. A qualitative approach based on a phenomenological-hermeneutical methodology was used. Four focus group interviews were conducted with 18 cardiac nurses. The analysis was based on Kirsti Malterud's theory of systematic text condensation. The cardiac nurses regarded palliative care as a complex and demanding field, which made it challenging to define their care for patients with heart failure. The analysis identified three themes: 1) Identifying the level of treatment, 2) Finding room for the palliative care, acknowledging the patients' wishes, and 3) Organisation and support in palliative cardiac care. Cardiac nurses perceive palliative care for patients with heart failure as both challenging and frequently overlooked within cardiac care settings. The nurses often struggle to integrate and appropriately frame palliative care while respecting patients' wishes, which contributes to feelings of uncertainty and vulnerability. They highlight the critical need for systematic interdisciplinary collaboration to effectively support patients and their families throughout the palliative care process.

Resistance mechanisms and post-trastuzumab deruxtecan (T-DXd) strategies in HER2+ and HER2-low breast cancer: From biology to clinical practice.

Controlled medicines for children's medical needs: a review of the scope, determinants, and consequences of inequitable access.

Analysis of experience of the attendance by health professionals and health services of people with pluripathology

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

Teaming up for improved population health: A model for whole system integration.

Against the backdrop of global ageing, a growing empirical literature highlights associations between age-friendly environments (AFEs) and older adults' well-being. However, the evidence is difficult to cumulate because AFE measurement is fragmented, characterized by heterogeneous operational approaches and uneven domain coverage. Importantly, this measurement heterogeneity is not merely a methodological limitation; it acts as a structuring force that shapes inference, comparability, and policy learning across studies. This systematic review aims to map how AFEs are operationalized and how they are connected to older adults' well-being. Following PRISMA, four databases were searched to April 2025; 5305 records were screened, and 58 studies were included. We classified AFE measures as subjective (n = 37), objective (n = 11), and mixed (n = 10) and mapped indicators to the WHO Age-Friendly Cities and Communities (AFCC) domains. Our synthesis reveals that AFE measurement is skewed to physical domains, such as transportation, outdoor spaces and buildings, and health services, with social domains underspecified. Associations are often positive for features such as reliable public transport, proximate everyday services, and opportunities for social participation; however, magnitudes and even directions vary by context and by how AFEs are operationalized. We also observe non-linear patterns (for example, in street connectivity or greenness), and occasional negative associations, particularly in disadvantaged settings where higher service density may signal unmet need rather than support. Some of this heterogeneity likely reflects analytic choices, including denominator selection, buffer size and shape, and the omission of micro-scale features and barriers. We recommend a comprehensive AFE assessment that combines subjective and objective approaches, balances physical and social domains, and improves transparency on validity and cross-cultural equivalence. Emerging tools such as street-view imagery and other fine-scale urban data can help capture micro-spatial features with greater precision.

Doubts and disconnection: Police reflections on drug decriminalization in British Columbia in the first year of implementation.

Social vulnerability is likely to be predictive of how well individuals within regions are supported during adverse events such as natural disasters. We aimed to examine the association between social vulnerability and suicide to inform targeted suicide prevention strategies. We obtained region-level data on suicide counts and population estimates from the Australian Institute of Health and Welfare, and the same level of data on social vulnerability to health impacts of climate change. We performed adjusted negative binomial regression analysis to examine the associations of social vulnerability index (and the 14 social domains that comprise the index) with suicide. Greater social vulnerability was marginally associated with lower suicide rates at the population level (Incidence Rate Ratio [IRR] 0.99, 95% Confidence Interval [CI] 0.97-1.00). When social domains were modelled individually, increasing vulnerability related to three domains (income and employment, education and social development, communication and transport infrastructure) was associated with a higher suicide rate. Opposite patterns were observed for increasing vulnerability to the domains of household composition, natural and built environment, emergency services, health services, government services, housing precarity, and livelihood/occupation. Social vulnerability index misses indicators that are associated with suicide. Regions with greater social vulnerability experienced slightly lower suicide rates. However, regions with heightened vulnerability due to unemployment, low labour force participation, poverty, low school participation, low educational attainment, high income inequality, and inadequate access to communication and transport infrastructure had higher suicide rates, highlighting the need to address these population-level factors to reduce suicide.

Mast Cell Activation Syndrome and Mimickers.

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