Home-based primary care has been suggested to reduce emergency department visits among vulnerable older adults but how it should be organised to achieve this effect is unclear. This study aimed to increase the understanding of how older adults receiving home-based primary care and their family caregivers’ experience care during the period prior to an emergency department visit and to identify components of home-based primary care delivery that could help reduce such visits.

Qualitative study using semi-structured interviews with older adults receiving home-based primary care who had recently visited the emergency department, along with their family caregivers. Interviews were analysed using inductive thematic analysis.

Interviews were conducted in the homes of informants receiving home-based primary care in Region Stockholm, Sweden, 2022–2023.

Fourteen adults aged ≥65 years receiving home-based primary care who had visited an emergency department within the past 3 months were interviewed; seven interviews also included a family member.

An overarching theme, Trust as a prerequisite for timely emergency assessments in home-based primary care, describes how patient trust–in home-based primary care in general and in specific individual healthcare professionals–seems important in reducing emergency department visits, especially when patients experience symptoms of uncertain urgency or gradual onset. Four subthemes describe how primary care may build trust: through (1) access to care, (2) medical competence, (3) respect and relationship and (4) coordination and teamwork.

Trust in both home-based primary care in general and in individual healthcare professionals is crucial in reducing emergency department visits among older adults receiving home-based primary care. Trust may be strengthened by accessible and competent care, familiarity with both general practitioners and the responsible nurse and working as a collaborative team.

Adolescent-onset type 2 diabetes (T2D) has increased in prevalence in recent decades. However, the efficacy of preventative interventions targeting health behaviours is limited, and key developmental factors that may influence effectiveness, such as executive functioning (EF) and stress, are often overlooked. Within-person fluctuations in EF and stress are linked to the adoption and maintenance of physical activity, a critical component of T2D prevention, yet little is known about the between- and within-person temporal variability of these constructs or their relationship with physical activity in adolescents at risk for T2D. Ecological momentary assessment (EMA) is ideal to capture these processes in real-time to inform intervention development and personalisation.

We will enrol a subset of participants from a larger intervention study involving assigned-female-at-birth adolescents aged 12–17 years, with elevated depression symptoms (CES-D≥21) and T2D risk (BMI≥85th percentile) and diabetes family history. Prior to the intervention, a minimum of 50 participants will complete a 7-day EMA protocol consisting of repeated daily gamified EF assessments and brief surveys about EF, stress and physical activity. Participants will simultaneously wear an activity monitor to provide objective measures of physical activity. Recruitment began in Spring 2024 and is ongoing. Multilevel models will be used to separate between- and within-person variability and to estimate short-term lagged within-person associations between EF/stress and subsequent physical activity across 15–60 min windows. Primary analyses are planned for Winter 2026.

The Colorado Multiple Institutional Review Board approved this study (COMIRB#22-0180). Findings will be disseminated in peer-reviewed journals and conference presentations.

NCT05543083.

Older adults with multiple long-term conditions account for a large share of emergency department (ED) visits and up to 25% may be avoidable. Efforts to reduce such visits show mixed results, likely due to multiple caregivers and limited adaptation to local contexts. We explored factors contributing to avoidable ED visits as reported by multiple care providers, focusing on modifiable factors of importance in the design of a sustainable primary care (PC) intervention.

Web-based survey conducted across six in- and outpatient healthcare providers in Stockholm, Sweden: ED, geriatrics, ambulance services, advanced home-based healthcare, PC and home healthcare (both within and outside regular working hours). Closed-ended questions were analysed descriptively and open-ended questions using qualitative content analysis.

A total of 100 healthcare professionals (nurse assistants, registered nurses and physicians) with at least 6 months of working experience.

All providers considered potentially avoidable ED visits a major concern, with home care workers seen as the main initiators of ED referrals. One overarching theme was generated—medical and psychosocial complexities in the assessment of older patients with multiple long-term conditions—and four categories of contributing factors: (1) insufficient access to health and social care, (2) poor communication and cooperation, (3) deficient professional competence and geriatric knowledge and (4) unclear responsibility and fragmented care. Five providers highlighted limited access to care as the most demanding concern while PC noted poor communication.

An intervention should combine enhanced home-based care, better collaboration across providers, direct geriatric admissions and targeted training for home care workers. Accounting for differences in provider perspectives in intervention design may enhance feasibility and acceptability.

Symptoms of post-traumatic stress disorder (PTSD) are prevalent in primary care (PC). Therapeutic needs are not always met. In the multicentred, randomised-controlled PTSD after Intensive Care Unit Survival (PICTURE) trial, patients with mild to moderate symptoms of PTSD following intensive care received a short-term intervention based on narrative exposure therapy (NET-PC) by their general practitioner (GP).

To explore the acceptance of NET-PC by participating GPs.

We conducted semi-structured telephone interviews with GPs who had performed NET-PC within the PICTURE trial. The interview guide was based on the Theoretical Framework of Acceptance. The interviews were recorded, transcribed and analysed using qualitative content analysis.

We analysed 15 telephone interviews averaging 51 min in length. The interviews revealed varying perceptions of the frequency and relevance of mild to moderate symptoms of PTSD. Those who saw it as relevant were ready to implement NET-PC despite its high organisational and time commitment. Challenges arose from GPs’ lack of experience with psychotherapeutic interventions, including dealing with strong emotional reactions from patients, and from the difficulty of scheduling longer consultations into routine practice. Suggested support included validated screening tools, training opportunities and psychotherapeutic supervision. Furthermore, NET-PC should only be offered at the GPs’ discretion.

From the interviewees’ perspective, NET-PC is feasible for use in general practice. The identified challenges could be addressed by enhanced training and supervision and adequate funding for consultations. A NET-based intervention may be feasible in general practice for patients suffering from mild to moderate symptoms of PTSD after intensive care.

NCT03315390.

Effective support for patients with advanced cancer and their relatives requires addressing individual needs, preferences and wishes, with communication as a central component. However, discussions about end-of-life issues are often perceived as difficult, and communication needs frequently remain unmet. While past interventions have primarily targeted healthcare professionals, evidence suggests that directly involving patients can have positive effects. eHealth solutions offer a promising approach to facilitate access to information, support communication and promote patient engagement. Building on this, we developed a web-based application (ASTENZ) and are now evaluating its feasibility, usability and acceptability in a pilot study.

A single-centre, randomised, controlled, two-arm trial with mixed-methods elements will be conducted to assess the feasibility of app usage and the study design. A realist approach will guide the study, with quantitative data complemented by qualitative interviews. Patients aged >18 years with advanced cancer and/or their relatives will be recruited from the interdisciplinary ambulatory chemotherapy unit, the palliative care unit and the dermatology cancer unit at the University Hospital of Marburg, Germany. Sample size calculations indicate a total of n=171 participants (114 patients, 57 relatives), randomly assigned in a 2:1 ratio to the intervention group (using the ASTENZ app) or control group (treatment as usual). Control group participants will receive app access after the survey period. Both groups will be assessed at 4 and 8 weeks. Primary outcomes: feasibility, usability and acceptability; secondary outcomes: knowledge on end-of-life topics, confidence, readiness for end-of-life conversations, functionality, anxiety and depression, psychosocial distress, technical data and number of consultations. Primary analyses will be descriptive. Trial status: recruitment is planned to start on 12 February 2026.

The study was approved by the Ethics Committee for Human Research at Philipps University Marburg (ref. 25–292 BO) and preregistered in the German Clinical Trials Register (DRKS00037577). All materials and procedures were reviewed and approved by the ethics committee, and written informed consent will be obtained prior to inclusion. Study results will be published in peer-reviewed journals, presented at conferences and used to inform the design of a future effectiveness trial, with potential options for wider app dissemination.

DRKS00037577.

Diabetes is a major global public health challenge, with rapidly rising incidence, particularly in low- and middle-income countries. Physical activity is a well-established protective factor against type 2 diabetes (T2DM); however, the population-level impact of realistic modest increases in physical activity remains unclear.

To estimate the burden of T2DM attributable to physical inactivity in Brazil and project the impact of modest increases in physical activity.

We calculated the population attributable fractions (PAFs) and economic costs of diabetes due to physical inactivity in Brazil. We estimated the incidence of T2DM from 2026 to 2050 using data from the National Health Survey (2013 and 2019) and the Global Burden of Disease Study. The relative risk of incident diabetes across the physical activity continuum was extracted from a previous meta-analysis. We modelled scenarios simulating gradual increases in leisure-time physical activity (LTPA) and resistance exercise (RE) and projected economic impacts through 2050.

From 2026 to 2050, 11.7% (95% uncertainty interval, UI 9.5% to 14.1%) of incident T2DM cases in Brazil (~3.7 million) might be attributable to physical inactivity, with higher PAFs among adults with lower education (PAF: 13.7%; 95% UI 11.1% to 16.4%) and in Mixed Race (12%; 95% UI 9.6% to 14.3%) and Black (11.9%; 95% UI 9.5% to 14.2%) populations. In a nonlinear dose-response association, increasing LTPA by 10, 20 or 30 min/day among inactive individuals could prevent 7.0% (2.20 million), 12.9% (4.05 million) and 16.0% (5.02 million) of incident cases, respectively, by 2050. For RE, the same daily increases could prevent 12.0% (3.80 million), 18.7% (5.87 million) and 22.5% (7.07 million) of cases. These increments could significantly reduce healthcare costs, starting at R$1.9 billion for the 10 min LTPA scenario, with the greatest impact observed from RE.

Promoting small increases in physical activity could yield substantial health and economic benefits. Equitable public health strategies are essential to address disparities and halt the growing burden of diabetes in Brazil.

Wounds are one of the most common causes of emergency department visits. Their care often involves stitches, a potentially painful and stressful procedure. Pain and stress management is usually based on local anaesthesia, which is not always optimal. Medical hypnosis may offer a non-pharmacological alternative. Heart rate variability is a pain-free, easy-to-use and objective biomarker of stress. This study aims to assess the benefit of hypnosis on stress and pain during stitching using a randomised controlled trial.

This is a single-centre, randomised controlled trial in an emergency department in Clermont-Ferrand. Patients consulting for suturable wounds will be randomised into two groups: with or without medical hypnosis. Measurements will include questionnaires, heart rate variability, physical activity levels and blood biomarkers. The primary outcome is heart rate variability during the procedure. Data will be analysed with intention-to-treat and per-protocol approaches, with p

The study has received approval from the Ethics Committee Sud-Méditerranée III, France, and is registered on ClinicalTrials.gov. Written informed consent will be obtained from all participants. Results will be published in a peer-reviewed journal.

NCT06497712.

To examine primary care contacts among individuals with eating disorders (EDs) and assess differences across diagnoses and ethnic backgrounds.

Matched cohort study using retrospective primary care data.

Primary care electronic health records from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) covering 1 January 2010 to 31 December 2023.

46 473 individuals aged 18–65 years, with a recorded ED diagnosis or a referral to ED services, matched by age, sex and practice location (ratio 1:3) to 145 286 individuals without an ED.

The primary outcome was the number of primary care contacts in 24 months prior to ED diagnosis or referral to ED specialist service. Secondary outcomes examined whether ethnicity impacted likelihood of referral to specialist ED services.

Most individuals had a diagnosis of anorexia nervosa (43.0%), followed by bulimia nervosa (13.8%) and other specified feeding and ED (6.6%). 40.6% were aged 18–25 years, 79.5% were female and ethnicity was predominantly White (83.7%), with smaller proportions Asian (6.3%) and Black (3.4%). Compared with non-ED controls, cases had approximately double the rate of primary care contacts (incidence rate ratio (IRR)=1.96, 95% CI 1.94 to 1.98). Elevated contact rates were observed across all ED diagnostic groups, with IRRs ranging from 1.78 (95% CI 1.75 to 1.82) for anorexia nervosa to 2.45 (95% CI 2.09 to 2.88) for avoidant/restrictive food intake disorder (all p

There is a need to increase ED awareness within minoritised communities, alongside culturally inclusive primary care adaptations to support help-seeking for EDs. Targeted education for clinicians and patients in primary care may also improve screening and recognition of EDs across diverse presentations and communities, facilitating access to timely, evidence-based care.

The dataset from this study is held securely at the Medicines and Healthcare products Regulatory Agency. Access may be granted on completing a data request. The CPRD Ethnicity Record sources underlying data from HES and primary care data copyright 2025, re-used with the permission of The Health & Social Care Information Centre.

Postoperative neuropsychological disorders including delirium, cognitive dysfunction and emotional distress are common after cardiac surgery and are linked to reduced quality of life, morbidity and mortality. Reliable preoperative risk factors remain difficult to identify. This study investigates stress-related parameters as predictors of postoperative neuropsychological disorders in patients undergoing cardiac surgery.

In this prospective study, 240 patients undergoing elective cardiac surgery (coronary artery bypass grafting: n=120, aortic valve replacement: n=120) with extracorporeal circulation at the Kerckhoff-Clinic Bad Nauheim (Germany) will be enrolled. Preoperative stress factors will be assessed using measures of stress-related personality traits, perceived stress, anxiety, depression, salivary cortisol and heart rate variability. Postoperative neuropsychological disorders will be evaluated through diagnosis of delirium in both the intensive care unit and on the standard ward. Additional neurocognitive dysfunctions and emotional distress will be assessed at hospital discharge and 3 months postoperatively, with corresponding preoperative baseline measurements.

If stress measures prove to be predictive, they may enhance understanding of postoperative neurocognitive and emotional disorders and facilitate the development of risk stratification algorithms, enabling more effective preventive strategies for high-risk patients.

The study was approved by the Ethics Committee of Justus Liebig University Giessen (Ref.: 54/24) and is conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from the patients. Results will be disseminated through peer-reviewed publications and scientific conferences.

Prospectively registered with the German Clinical Trials Register (DRKS00035318).