Preventive Care Research Articles

Illicit Fentanyl Use and Hepatitis C Virus Seroconversion Among People Who Inject Drugs in Tijuana and San Diego: Results From a Binational Cohort Study.

Illicitly manufactured fentanyl (IMF) increases overdose mortality, but its role in infectious disease transmission is unknown. We examined whether IMF use predicts hepatitis C virus (HCV) and human immunodeficiency virus (HIV) incidence among a cohort of people who inject drugs (PWID) in San Diego, California and Tijuana, Mexico. PWID were recruited during 2020-2022, undergoing semi-annual interviewer-administered surveys and HIV and HCV serological rapid tests through 2024. Cox regression was conducted to examine predictors of seroconversion considering self-reported IMF use as a 6-month lagged, time-dependent covariate. Of 398 PWID at baseline, 67% resided in San Diego, 70% were male, median age was 43 years, 42% reported receptive needle sharing, and 25% reported using IMF. HCV incidence was 14.26 per 100 person-years (95% confidence interval [CI]: 11.49-17.02), and HIV incidence was 1.29 (95% CI: .49-2.10). IMF was associated with HCV seroconversion, with a univariable hazard ratio (HR) of 1.64 (95% CI: 1.09-2.40), and multivariable HR of 1.57 (95% CI: 1.03-2.40). The direction of the relationship with HIV was similar, albeit not significant (HR 2.39; 95% CI: .66-8.64). We document a novel association between IMF and HCV seroconversion among PWID in Tijuana-San Diego. Few HIV seroconversions (n = 10) precluded our ability to assess if a similar relationship held for HIV. IMF's short half-life may destabilize PWID-increasing the need for repeat dosing and sharing smoking materials and syringes. New preventive care approaches may reduce HCV transmission in the fentanyl era.

Sharenting: characteristics and awareness of parents publishing sensitive content of their children on online platforms

BackgroundThe term “sharenting” describes the increasingly popular habit of parents to share photos, videos, or other information regarding their children on their social profiles, through online platforms. It is highly likely that many parents are posting content about their underage children online with little knowledge of the risks associated with this practice. This study aims to investigate whether variables such as parents’ age, gender, marital status, occupation and educational level influence the practice of sharing child-related content and the degree of awareness.MethodsWe performed a pilot cross-sectional study, based on an anonymous questionnaire. The questionnaire was administered to parents of underage children attending the pediatric outpatient clinic of the Umberto I Hospital, Sapienza University, in Rome, Italy, by researchers, through the google forms platform; qualitative variables were generated on excel sheets and a statistical analysis was performed on SPSS Ibm-statistics using the chi-square test.ResultsTwo hundred twenty-eight parents of children under 18 years of age completed the questionnaire (82% mothers, 18% fathers); 98% of the respondents used social media and 75% of them published their children’s related content online. Thirty-one percent of the compilers started their practice of sharenting in the first 6 months of life of their child. Our analysis showed that compared to parents who do not post online, parents who usually post online their children are significantly more likely to be partial employees or unemployed (p = 0,002), with lower educational level (p = 0,05), younger (less than 35 years of age (p = 0,01)) and have a higher number of followers (p < 0,001). Finally, 93% of the compilers were not aware of the current legislation and of the risks related to the practice of sharenting.ConclusionsPediatricians, healthcare assistants and preventive healthcare professionals should play a central role in alerting parents and families to the risks of sharenting; the results of our study could draw their attention to the increasing practice of sharenting and make healthcare professionals active part in the protection of children.

Knowledge, Attitudes, and Cultural Beliefs of Afghan Refugee Women Toward Gynecological Cancer: A Qualitative Study.

Gynecological cancers constitute an important global health problem with increasing incidence and prevalence. The aim of this study was to explain gynecologic cancer knowledge, attitudes, and cultural beliefs of Afghan refugee women living in Türkiye. This research was carried out as a descriptive phenomenological design for qualitative research. The study was conducted at the Refugee Support Center Association in Eskişehir, Türkiye, and data were collected between January and April 2023, guided by a semi-structured interview guide. Nineteen Afghan refugee women were interviewed. A purposive sampling method was used to recruit participants. Content analysis method was used for data analysis. Four overarching themes that described Afghan women's gynecologic cancer knowledge, attitudes, and cultural beliefs were identified: (a) limited awareness and knowledge of gynecological cancer among women, (b) women's attitudes toward gynecological cancers, (c) women's cultural beliefs regarding gynecological cancer, and (d) healthcare system factors. In line with the main themes, subthemes were created for each main theme. Afghan refugee women, who were in the double risk group as both women and refugees, had insufficient knowledge of gynecological cancers, and their cultural beliefs and attitudes played an essential role in their access to gynecological cancer-related preventive healthcare services. It is recommended that training be planned to increase the awareness and knowledge of Afghan women on gynecological cancers, considering their cultural characteristics.

Approach to the patient with Childhood Interstitial and Diffuse Lung Disease.

Childhood Interstitial and Diffuse Lung Disease (chILD) encompasses a group of rare, chronic lung disorders in infants and children with overlapping clinical features but diverse etiologies. The clinical presentation of chILD is of chronic or recurring respiratory signs and symptoms, often including increased work of breathing and hypoxia, with diffuse radiographic abnormalities on chest imaging. Recognition can be challenging since some clinical features overlap with those of more common pediatric respiratory diseases including asthma and recurrent viral infections, among others. chILD should be considered as an underlying diagnosis when a patient's respiratory symptoms seem disproportionate to the clinical scenario and/or persist. The diagnostic process involves multiple steps and is tailored to the individual patient. Nearly all children will undergo imaging and pulmonary function testing, many will undergo bronchoscopy with bronchoalveolar lavage, many will receive genetic testing, and some will require lung biopsy. Treatment includes preventive care, evaluation for comorbidities, pharmacotherapy according to diagnosis, and ongoing disease surveillance, including revisiting genetic and histopathologic results as new clinical information becomes available and as our understanding of these rare disorders improves. The purpose of this review is to provide a broad approach to the diagnosis and management of patients with chILD.

School Nurses' Perceived Role and Capacity to Support School Behavioral Health Programs in DC Public and Public Charter Schools.

School nurses (SNs) practicing in DC public and public charter schools were surveyed to assess their perceived role and self-reported preparation to provide behavioral health prevention, early identification, and treatment services in schools. A total of 154 SNs completed a questionnaire about their role in the delivery of behavioral health services and supports. SNs reported they are primarily involved in the identification and referral of students to other school behavioral health professionals. Respondents also reported a lack of training in behavioral health and a desire for more information on related programs and services. This study offers recommendations for educating future SNs and highlights how the DC School Health Services Program utilized study findings to build capacity for SNs employed in practice. This study can help tailor educational opportunities for SNs to maximize their role in school behavioral healthcare process flows and ultimately improve outcomes for students and families.

Synergistic impact of plasma albumin and cognitive function on all-cause mortality in Chinese older adults: a prospective cohort study.

Hypoalbuminemia and cognitive impairment (CI) each independently increase the mortality risk in older adults. However, these two geriatric syndromes can occur simultaneously. In community-dwelling older adults, is the combination of hypoalbuminemia and CI linked to a higher mortality risk than either condition alone? We aimed to investigate the association between plasma albumin, cognitive function, and their synergistic effect on mortality in Chinese community-dwelling older adults. Data from the Chinese Longitudinal Healthy Longevity Survey (2012) included 1,858 participants aged ≥65. Baseline assessments comprised albumin levels and cognitive status. All-cause mortality was confirmed through 2014-2018 surveys. Cox proportional hazards models assessed associations, and restricted cubic splines explored albumin-mortality relationship. During a median follow-up of 48.85 months, 921 deaths. Albumin≥35 g/L vs < 35g/L [HR: 1.33 (95%CI, 1.10, 1.62)] and CI vs normal cognition [HR: 1.69 (95%CI, 1.43, 1.99)] independently predicted mortality. A dose-response relationship with mortality was observed for albumin quartiles (p < 0.001). Each SD increase in MMSE or albumin correlated with 22% and 15% lower mortality risk, respectively. Combined hypoproteinemia and CI increased the mortality risk by 155%, with a notably higher risk in males, those aged <85 years, and individuals living in rural areas. Interaction effects of albumin and CI on mortality were observed (p < 0.001). In the single CI group, older adults had a 61% increased risk of mortality in the hypoproteinaemia group compared with the albumin-normal group. Restricted cubic spline revealed a reverse J-shaped association, particularly for participants without CI. For individuals with CI, albumin levels were inversely associated with mortality risk. Hypoproteinemia and CI, individually and combined, increased all-cause mortality risk in Chinese older adults, with stronger effects observed in males, younger older adults, and those living in rural areas. These findings emphasize the importance of targeted adjustments and early nutrition programs in health prevention and clinical care for older adults.

Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities.

Arthropod vectored diseases have been a major impediment to societal advancements globally. Strategies to mitigate transmission of these diseases include preventative care (e.g. vaccination), primary treatment and most notably, the suppression of vectors in both indoor and outdoor spaces. The outcomes of indoor vector control (IVC) strategies, such as long-lasting insecticide-treated nets (LLINs) and indoor residual sprays (IRSs), are heavily influenced by individual and community-level perceptions and acceptance. These perceptions, and therefore product acceptance, are largely influenced by the successful suppression of non-target nuisance pests such as bed bugs and cockroaches. Adoption and consistent use of LLINs and IRS is responsible for immense reductions in the prevalence and incidence of malaria. However, recent observations suggest that failed control of indoor pests, leading to product distrust and abandonment, may threaten vector control programme success and further derail already slowed progress towards malaria elimination. We review the evidence of the relationship between IVC and nuisance pests and discuss the dearth of research on this relationship. We make the case that the ancillary control of indoor nuisance and public health pests needs to be considered in the development and implementation of new technologies for malaria elimination.

Autism Among Adults with Down Syndrome: Prevalence, Medicaid Usage, and Co-Occurring Conditions.

Our objective was to examine occurrence of both conditions in Medicaid; and compare Medicaid service use and cost, and chronic conditions among adults with Down syndrome and autism to those with Down syndrome alone and those with autism alone. We used ICD9 and ICD10 codes in Medicaid claims and encounters from 2011 to 2019 to identify autism and Down syndrome in adults > 18 years. We then calculated costs, claims, hospitalizations, long term care days, and chronic conditions, and compared by group- autism alone, Down syndrome alone, Down syndrome + autism. Between 2011 and 2019, there were 519,450 adult Medicaid enrollees who met our criteria for autism (N = 396,426), Down syndrome (N = 116,422), or both Down syndrome and autism (N = 6,602). In 2011, 4.1% of enrollees with Down syndrome had co-occurring autism; by 2011 it was 6.6%. The autism group had the fewest claims and inpatient hospitalizations, followed by the Down syndrome group, then the Down syndrome + autism group. After age adjustment, those with Down syndrome alone and Down syndrome + autism had elevated prevalence of atrial fibrillation, dementia, heart failure, kidney disease, and obesity compared to the autism alone group. Both groups also had decreased occurrence of depression and hypertension compared to the autism alone group. Prevalence of autism is higher among people with Down syndrome than in peers. The increased costs and service use for those with both conditions highlight the extent to which this population need health care and signal the need for more effective preventative care and therapies.

Trauma, PTSD, and Self-Efficacy: Predictors of Cervical Cancer Screening in Sexual Violence Survivors.

Sexual violence is highly prevalent in the United States and is associated with a host of negative physical and mental health outcomes. Specifically, sexual violence is associated with increased rates of cervical cancer, one of the most common cancers found in women. Furthermore, sexual violence survivors report reduced participation in preventive healthcare behaviors (e.g., Pap tests) which may reduce individuals' risk of developing reproductive health conditions such as cancer. Sexual violence exposure is also associated with increased symptoms of posttraumatic stress disorder (PTSD) and reduced trauma-coping self-efficacy (TCSE), two factors that may impact trauma-exposed individuals' level of avoidance of cervical cancer screens. Current research on the connection between sexual violence and reproductive healthcare often fails to examine potential underlying mechanisms behind this association, nor does it account for confounding factors such as healthcare accessibility and need. Accordingly, the present study tested a proposed moderated mediation model to explore the association between sexual violence and cervical cancer screening participation, including analysis of the indirect effect of TCSE and potential moderation of this effect by PTSD symptoms. Participants were 554 participants who reported experiences of sexual violence on Amazon's Mechanical Turk. Severity of sexual violence was significantly associated with reduced likelihood of participation in recommended cervical cancer screening. TCSE did not mediate nor did PTSD moderate this association. Findings of this study suggest that individuals' reproductive healthcare behaviors are influenced by their experiences of sexual trauma, as well as by structural factors such as insurance and income. Limitations, directions for future research, and clinical implications of study findings are discussed.

Income inequality and healthcare utilization of the older adults-based on a study in three provinces and six cities in China.

The objective of this study is to gain a more nuanced understanding of the specific impact of income inequality on the utilization of healthcare services for older adults. Additionally, the study aims to elucidate the moderating and mediating roles of public transfer income and psychological health in this context. A systematic examination of the impact of income inequality on healthcare utilization among older adults was conducted through field questionnaire surveys in six cities across three major geographical regions (West, Central, and East). The analysis employed baseline regression, as well as mediating and moderating effect tests. First, there is a negative relationship between income inequality and the use of therapeutic healthcare services (β1 = -0.484, P < 0.01) and preventive healthcare services (β2 = -0.576, P < 0.01) by older adults. This relationship is more pronounced in the low- and medium-income groups as well as in the western region. The mediating effect of psychological state is significant (β3 = -0.331, P < 0.05, β4 = -0.331, P < 0.05). Public transfer income plays a significant role in regulation. The moderating effect of public transfer income on therapeutic services was more significant in low-income groups (β5 = 0.821, P < 0.01). The moderating effect of public transfer income on preventive services was more significant in middle-income groups (β6 = 0.833, P < 0.01). The study clearly demonstrates a significant negative correlation between income inequality and the utilization of healthcare services by older adults. Furthermore, the study reveals that this relationship is particularly pronounced among older adults in low- and medium-income and Western regions. This detailed analysis of regional and income level heterogeneity is of particular value in this field of research. Secondly, this study attempts to integrate the two pivotal dimensions of public transfer income and psychological state for the first time, elucidating their moderating and mediating roles in this relationship. The findings indicate that public transfer income serves as a moderating factor, exerting a notable "reordering effect" on income inequality and resulting in a "deprivation effect." Such factors may impede the utilization of medical services, potentially influencing the psychological state of older adults.

The future of preventive health care for people with intellectual disabilities in Australia: an analysis of the Disability Royal Commission’s approach, findings and recommendations

The Disability Royal Commission (the Commission) investigated many issues, one of which was whether people with cognitive disabilities, including people with intellectual disabilities, faced systemic neglect in the Australian health system. Using a method of co-design with people with intellectual disabilities, we analysed the Commission’s approach and recommendations about preventive health care. We identified how the Commission’s recommendations can inform the achievement of the National Preventive Health Strategy (the Strategy) for people with intellectual disabilities. We found that a strength of the Commission’s process was the multiple ways it inquired about the experience of accessing preventive health care. However, the inclusiveness of the invitations to participate in the Commission’s work and the location of the public hearings were limitations for key stakeholders. Our analysis also noted that the Commission’s public hearings focused on the supply side of healthcare access (health services) compared to the demand side of access (health users). This was a missed opportunity to learn from health users about their experiences. Two challenges to the implementation of the recommendations include the focus on cognitive disability instead of intellectual disability, and the focus on health care in general, rather than specifically on preventive health care. We also found that the Commission’s recommendations mainly relate to the leadership, governance and funding elements in the Strategy, with a few actions relevant to prevention, partnerships, information, research, surveillance and preparedness. It is important that all the elements required to mobilise prevention systems are considered and actioned to achieve the Strategy.

Emergency repairs downstream of earth and rockfill dams with water spring with indication of internal erosion

During periodic dam safety assessments, various anomalies are identified through field inspections, project documentation analysis, and structural behavior monitoring. These assessments aim to detect non-conformities, and engineering design firms propose technical solutions to address these issues. The primary goal of these reviews is to evaluate the overall state of conservation and structural safety, ensuring compliance with updated design criteria, revised standards, changing weather conditions, and technological advances. Dam renovations are crucial for enhancing operational capacity and preventive care. Implementing filtering materials within the dam's body establishes a drainage system to relieve internal pressures on the embankments and foundations. This prevents the washing away of soil particles due to internal erosion, known as "piping," a major cause of dam failures. Piping occurs when soil particles are displaced towards the outside of the embankment through the percolation process, particularly in the upstream area near the dam's base, where high hydraulic gradients and flows make it susceptible. This article presents a set of emergency or long-term solutions to address anomalies related to the onset of internal erosion in dams, with a focus on preventing piping. These solutions are vital for safeguarding the structural integrity and safety of these critical infrastructure components.

3D Simulation-Driven Design of a Microfluidic Immunosensor for Real-Time Monitoring of Sweat Biomarkers

This study presents the design and comprehensive 3D multiphysics simulation of a novel microfluidic immunosensor for non-invasive, real-time detection of pro-inflammatory biomarkers in human sweat. The patch-like device integrates magnetofluidic manipulation of antibody-functionalized magnetic nanoparticles (MNPs) with direct-field capacitive sensing (DF-CS). This unique combination enhances sensitivity, reduces parasitic capacitance, and enables a more compact design compared to traditional fringing-field approaches. A comprehensive 3D multiphysics simulation of the device, performed using COMSOL Multiphysics, demonstrates its operating principle by analyzing the sensor’s response to changes in the dielectric properties of the medium due to the presence of magnetic nanoparticles. The simulation reveals a sensitivity of 42.48% at 85% MNP occupancy within the detection zone, highlighting the sensor’s ability to detect variations in MNP concentration, and thus indirectly infer biomarker levels, with high precision. This innovative integration of magnetofluidic manipulation and DF-CS offers a promising new paradigm for continuous, non-invasive health monitoring, with potential applications in point-of-care diagnostics, personalized medicine, and preventive healthcare.

Knowledge of and Attitude Toward Preventive Care Among Iraqi Dentists and Senior Dental Students: A Cross-Sectional Study

Knowledge of and Attitude Toward Preventive Care Among Iraqi Dentists and Senior Dental Students: A Cross-Sectional Study

Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report.

Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.

Barriers and facilitators to implementation of the Ethiopian national cancer control plan strategies: Implications for cervical cancer services in Ethiopia.

Following an upsurge in cervical cancer incidence and mortality, Ethiopia developed its first National Cancer Control Plan (NCCP) to support efforts toward the prevention and control of cancer. The NCCP outlines strategies for reducing the incidence of cancer through prevention, screening, early diagnosis, treatment, and palliative care. This study examined barriers and facilitators to the implementation of the NCCP using a qualitative approach. The study entailed doing key informant interviews and reviewing secondary data. Using customized topic guidelines, fifteen interviews were conducted covering a wide range of topics, including political commitment, priority setting, interagency cooperation, the role of evidence, citizen empowerment, and incentives. All interviews were recorded (with consent), transcribed in Amharic, and then translated into English for thematic analysis. Review of secondary data focused on establishing the NCCP's implementation status for HPV vaccination, cervical cancer screening, and treatment, and strategic links to five other national policy documents centered on public awareness, cervical cancer services, HPV immunization, and sexually transmitted infections control. We found that in 2022, 55% of eligible Ethiopian women were screened for cervical cancer (against the annual target), with roughly half of those with a positive result receiving treatment. Overall, 900,000 (8.4%) of the 10.7 million eligible women in the country underwent screening. The study revealed inadequate implementation of the NCCP strategies toward achieving the WHO's 90-70-90 cervical cancer targets by 2030. A key positive strategy was the involvement of high-ranking government officials in the National Cancer Committee, which aided the NCCP implementation. On the other hand, inadequate political support, funding constraints, suboptimal public messaging, lack of incentives, and inadequate partnership arrangements emerged as important barriers. We recommend that decision-makers intensify coordinated efforts, prioritize dealing with identified challenges and optimizing facilitators, and mobilize additional resources to enhance cervical cancer services in Ethiopia.

Early Childhood Screening Practices and Barriers: A National Survey of Primary Care Pediatricians.

The American Academy of Pediatrics recommends screening during the first 3 years of life for developmental risk/delay, maternal depression, and social determinants of health (SDOH) using standardized tools. Adoption of these guidelines has been gradual, and barriers to screening are as varied as pediatric practices are themselves. We analyzed 2019 American Academy of Pediatrics Periodic Survey data. The survey included pediatricians' screening practices for developmental delay, maternal depression, and SDOH, and barriers to screening. We used Cochran's Q and McNemar's tests to compare barriers across topics, and χ2 tests and multivariable logistic regression to examine the relationship between barriers and screening practices. The survey response rate was 46.9% (n = 688). Most pediatricians reported screening/surveilling for developmental delay (98.1%), maternal depression (83.2%), and SDOH (76.7%), but fewer used standardized instruments to do so (59.0%, 44.9%, 12.6%, respectively). Those not screening/only surveilling for maternal depression were more likely to report that screening is not an appropriate role for the pediatrician and difficulty prioritizing time. For SDOH, those not screening/only surveilling were more likely to report instruments not available in the electronic health record, lack of knowledge regarding referral options, and lack of treatment options for positive screens. Rates of standardized screening, and barriers pediatricians encounter, have important implications for improving quality of early childhood preventive care. Opportunities include expanding the primary care team and integrating screening tools into the electronic health record. Programs to support social needs and maternal mental health could be strengthened to ensure robust referral options are available.

Evaluating the delivery of care by telemedicine for incarcerated people living with HIV: a cohort study

BackgroundThe use of telemedicine has grown significantly since the COVID-19 pandemic and has the potential to improve access to specialized care for otherwise underserved populations. Incarcerated people living with HIV (PLWH) could potentially benefit from expanded access to HIV care through telemedicine.MethodsAll PLWH who were incarcerated within the Tennessee Department of Corrections and received care through the HIV telemedicine clinic at Regional One Hospital between 5/1/2019 through 2/28/2022 were identified from the electronic health records (EHR). Demographics, laboratory data, vaccine history, and treatment outcomes were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions.ResultsOf the 283 incarcerated PLWH receiving care from this telemedicine clinic, 78% remained retained in care and 94% achieved or maintaining viral suppression at 12 months. Many preventative care measures remained unperformed or undocumented, including vaccinations and testing for concurrent sexually transmitted infections. There were 56 patients (20%) found to have chronic hepatitis C in this population, with 71% either cured or still on treatment in this study period.ConclusionsRetention in care and viral suppression rates were excellent among incarcerated PLWH receiving telemedicine care for their HIV. HIV related primary health care screenings and vaccinations, however, were less consistently documented and represent areas for improvement.

Comparing secondary prevention for patients with coronary heart disease and stroke attending Australian general practices: a cross-sectional study using nationwide electronic database

ObjectivesTo compare secondary prevention care for patients with coronary heart disease (CHD) and stroke, exploring particularly the influences due to frequency and regularity of primary care visits.SettingSecondary prevention for patients...

Addressing closed and limited enrolments in general practices in Aotearoa New Zealand: a mixed-methods study.

To ascertain the reasons for and impacts of closed books in general practices in Aotearoa New Zealand and report recommendations for mitigation. A mixed-methods approach was used. A first round of interviews with experts in the primary care sector was conducted, followed by a survey across general practices and, finally, a second round of interviews. Data reported here are qualitative data from the interviews and open-ended questions in the survey. Qualitative data were analysed using a general inductive approach. The key reasons for not enrolling new patients included workforce shortages, high workloads and staff burnout, funding issues, concerns about quality of care and insufficient physical space. These were exacerbated during the COVID-19 pandemic. The impacts included no access or delayed access to primary care, worsening health conditions, undiagnosed or untreated diseases and less or no access to preventive care. Recommendations included recruiting more staff including administrative staff, resolving the pay disparity between general practice and hospital staff, having a longer placement period for students in general practice, utilising a multidisciplinary workforce and revising the funding formula. There is an urgent need to resolve key issues so that general practices can accept all who wish to enrol.