Moving from urbanised settings to rural frontier border zones exposes stark inequities in access and disease patterns. In geographically isolated areas, primary health care is often delivered with limited referral capacity and long travel times to secondary care.This practice-based reflection describes two family physicians’ work in a rural border region where the nearest hospital is approximately 45-60 minutes away. To reduce access barriers, a multi-component primary care response was implemented: (1) mobile outreach to remote villages for systematic immunisation and screening; (2) contact tracing and community education for tularemia and scabies, together with periodic maintenance of natural water reservoirs; (3) multidisciplinary brucellosis prevention counselling, including dietitian-led education on safer dairy production; and (4) adapted protocols for populations facing accessibility barriers in local institutional settings. Measurable outcomes were not collected through a formal study design; reflections are grounded in routine service delivery and public health actions.Frontier primary care requires (a) proactive outreach models, (b) culturally sensitive risk communication for blood-borne and zoonotic exposures, and (c) structured communication pathways for populations with diverse ethno-cultural backgrounds. Future work should add simple indicators (coverage, recall, timeliness, adherence) to evaluate impact without increasing workload.Zoonoses (brucellosis, tularemia) and scabies dominated clinical priorities and were amplified by untreated water use and livestock-dependent livelihoods. Socio-economic vulnerabilities and religious rituals involving blood-borne risks necessitated a culturally sensitive “One Health” approach. Language barriers among populations with diverse ethno-cultural backgrounds further compromised diagnostic accuracy and treatment adherence.Border/frontier practice highlights that health equity depends on mobile health capacity and multidisciplinary, context-adapted primary care pathways.

Planetary health is an evidence-based scientific field that focuses on the links between changes in ecosystems and biodiversity caused by human activities and their impact on the health of living beings and the planet. XXX has set up a working group on planetary health in XXX. Among the topics addressed, one focused on the development of a summary document for patients about the first 1,000 days. This period extends from the beginning of conception, i.e. the meeting of the sperm and the egg, until the child is 2 years old.This is a qualitative study carried out by a working group of general practitioners, combining a narrative review of the literature and discussions within the working group. The final document is the result of a consensus reached by the group, based on the most recent scientific evidence.The perinatal period is a key time for parents who want the best for their child and are motivated to make healthy, sustainable choices that will benefit as many people as possible. It is important to maintain these healthy behaviours. This comprehensive guide provides the best possible support for future families.Training on environmental issues remains marginal in medical curricula, despite its significant impact on our current and future practices. This document contributes to continuing education and the general practitioner's understanding of global health through co-benefits.This guide is fully in line with the preventive role of general practitioners. It provides simple and useful advice tailored to patients to improve their health throughout the perinatal period while preserving global health and biodiversity.

As climate change progresses, heatwaves are becoming more frequent worldwide, and increase the risk for morbidity and mortality. Individuals with chronic conditions are particularly vulnerable to adverse effects of heat. Primary care can play an important role in preventing and mitigating these effects.Our study aimed to identify and describe systematically developed, implemented and evaluated interventions in primary care to address adverse effects of heat in individuals with chronic conditions.We conducted a scoping review based on a systematic search in Medline, EMBASE, CENTRAL, and LILACS and the trial registers ClinicalTrials.gov, ICTRP, ISRCTN, and OSF. Each record was screened by two researchers. Records assessed as relevant in title-abstract-screening by at least one researcher were included in full-text screening, in which consensus was required. Articles were eligible if they focused on (1) chronic conditions, (2) adverse effects of heat, (3) interventions addressing these effects, and (4) examined effects on health outcomes. Studies (a) with a secondary study design, (b) without adult participants, and (c) without relation to primary care were excluded.The search identified 10 557 articles and 159 study registrations. The full texts of 44 manuscripts were assessed. Nine manuscripts describing eight completed and one ongoing study were included. Between 2007 and 2023, two studies were conducted in Australia and the USA, respectively, and one each in China, France, Germany, and Russia.We identified some promising approaches. Two interventions aimed to improve heat-related health education. Of two studies aiming to monitor and advise patients during heatwaves, one evaluated patient-related health outcomes. Two studies developed screening tools for vulnerable patients. And two studies focused on rather specific drugs of limited importance for patients with chronic diseases. All evaluation studies reported positive effects. This demonstrates that primary care might be an effective setting for addressing adverse effects of heat.The current state of evidence is alarming. In the last twenty years, only eight studies on interventions in this context have been completed, of which five evaluated health outcomes, and only two were in an experimental design. Further research is needed to determine which approaches are most promising in this context.

Pregnant women and foetuses are particularly vulnerable to environmental pollutants, including industrial chemicals and pesticides, which have been linked to congenital anomalies, endocrine disruption and neurodevelopmental disorders. However environmental health training among primary care providers remains limited, which could affect the quality of information provided during antenatal care.The aim is to assess the information and counselling provided to pregnant women regarding environmental exposures, and to explore the knowledge, attitudes, and perceived barriers of healthcare professionals.A cross-sectional survey was conducted in 2024 among general practitioners, gynaecologists and midwives working in northern France. A total of 1,352 questionnaires were distributed (498 to general practitioners, 254 to gynaecologists, and 600 to midwives) by email and post. The questionnaire was developed and validated by a multidisciplinary scientific committee.A total of 136 professionals responded: 67 general practitioners, 26 gynaecologists and 43 midwives. Most were women (68%) and aged 31–45 years (56%). Overall, 65% of respondents had received no training in environmental health, although 86% expressed a willingness to address environmental risks in consultations while 53% did not know how to integrate such counselling into routine care.          Dietary advice was the most frequently provided (57% always, 32% sometimes), whereas discussions on cooking and reheating methods (55% never), cosmetics and hygiene products (59% never), and household products including pesticides or fragranced products (55% never) were largely absent. Discussion on indoor air quality and nursery preparation were inconsistent. The main barriers reported were a lack of time, insufficient knowledge, and limited resources to support patient guidance.Although limited by a low response rate and self-reported data, the findings highlight a clear gap between healthcare professionals’ motivation and their ability to translate environmental health knowledge into routine prenatal counselling. Inconsistent practices across professions suggest structural rather than individual barriers, particularly related to training and availability of practical tools.Despite high perceived relevance healthcare professionals insufficiently inform pregnant women about environmental exposures. Strengthening environmental health training and developing accessible counselling tools could support the integration of preventive messages into routine prenatal care.

Urban areas and XXX foothills in XXX are increasingly experiencing health impacts from extreme heat events. Although XXX are typically associated with cooler climates, climate change have contributed to rising temperatures making extreme heat an emerging public health concern.The objective of this study is to explore the intersection of health impacts of extreme heat and preparedness of XXX’s healthcare system.A mixed-method approach was employed, combining survey and semi-structured interviews with 35 Family Physicians working in urban hospitals. The survey explored their experiences in managing heat-related health conditions during the 2025 summer heatwave, while the interviews assessed institutional preparedness by reviewing availability of protocols, staff training and response mechanisms for heat related illnesses.Family Physicians reported an increasing number of cases of heat exhaustion, dehydration, heatstroke and cardiovascular events particularly among the elderly, outdoor workers and individuals with co-morbidities during the 2025 summer heatwave. Despite these growing health risks, healthcare systems remain underprepared. Family physicians reported lack of heat-specific training, limited awareness of heat action plans and inadequate resources for managing heat-related emergencies. Healthcare infrastructures in XXX lack heat resilient design and effective cooling systems, limiting their ability to safeguard patients and staff during extreme heat events.Extreme heat is becoming an increasingly significant health threat in regions traditionally considered climatically cold. Rise in heat-related illnesses during the 2025 summer heatwave reported by Family Physicians indicate that vulnerable populations such as the elderly, outdoor workers and people with chronic conditions are experiencing substantial health burdens. The reported lack of heat-specific clinical training, limited awareness on heat action plans and inadequate cooling facilities highlight critical gaps in health-system preparedness. Strengthening clinician capacity, implementing structured heat-health protocols and improving infrastructure resilience are critical in ensuring effective health systems response to future heatwaves.This study highlights the urgent need to integrate heat-health risk assessment into urban health planning in the XXX. Capacity building of clinicians through climate change focused training, heat-health awareness campaigns and comprehensive heat action plans within healthcare systems are critical steps in mitigating the health impacts of extreme heat in XXX health systems.

Due to climate change, mitigating adverse effects of heat has become an important aim of healthcare professionals. However, little is known about the effectiveness of protective behaviour.Our study analysed how primary care patients with chronic diseases from Germany and Northern Italy protected themselves from adverse effects of heat and how effective their respective behaviour was.Prospective cohort study based on an online survey and gridded hourly temperature data from ERA5-Land. Sociodemographic data and participants’ intentions to protect themselves were reported at baseline. Health complaints were measured by limitations in usual activities due to 14 specific symptoms on the warmest days of each week. At the same time, the actual protective behaviour was reported. Data were analysed by mixed-effects multivariable linear regression analyses.Our data set included 1,276 observations of 176 individuals. Response rate was 31.2%. Participants’ mean age was 59.9 years (standard deviation, SD: 14.2), 94 participants (53.4%) were female and 52 (29.6%) lived in Italy. Participants from Germany reported a stronger intention to protect themselves (22.8, SD: 4.1 vs. 21.0, SD: 5.1 in Italy, p=0.019), but there were no differences in the summary score of the actual behaviour during warmer days (11.1, SD: 4.0 vs. 11.2, SD: 4.2, p=0.556). There were no differences in adverse effects of heat between Germany and Italy (0.88, 95% confidence interval, CI: -2.14/0.37, p=0.166). The intention to protect themselves was not associated with symptom burden (0.04, 95% CI: -0.09/0.16, p=0.555), but there was an association with the actual behaviour. Specifically, sufficient fluid intake was associated with less adverse effects of heat (-0.50, 95% CI: -0.80/-0.21, p=0.001), and avoiding sun and heat (0.26, 95% CI: 0.08/0.44, p=0.005 to 0.29, 95% CI: 0.05/0.53, p=0.020), cooling down (0.49, 95% CI: 0.15/0.84, p=0.005), and avoiding physical activity (0.48, 95% CI: 0.27/0.68, p<0.001) were associated with more adverse effects.Except for fluid intake, benefits of protective behaviour could not be demonstrated. One reason could be a close interrelation between increasing symptom burden and behavioural adaptations.Still, more data on the effectiveness of protective behaviour are needed. Future studies should evaluate these effects in an experimental design.

Local environmental pollution from industrial activities and hazardous substances represents a significant but often underestimated public health threat. These exposures can generate acute concern within affected communities, particularly when health effects are uncertain, delayed, or difficult to attribute to a single pollutant. Media coverage may amplify fear and stress, underscoring the need for clear and transparent risk communication.This systematic review evaluates strategies for communicating health risks of local pollution, focusing on their impact on public knowledge, stress, and fear.We performed a mixed-methods systematic review across PubMed, Embase, Cochrane, Scopus, and PsycArticles, supplemented by reference and citation tracking. Eligible studies included quantitative and qualitative designs examining populations exposed to localized chemical or air pollutants. Outcomes assessed were changes in knowledge, behavior, stress, or fear following communication strategies. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. Quantitative data were synthesized through random-effects meta-analysis where feasible, and qualitative findings were analyzed using thematic synthesis, with confidence in results evaluated using GRADE and CERQual.69 Articles were used in this systematic review. 39 Contained only quantitative data, 20 only qualitative data and 10 were mixed method studies. Effective strategies empowered communities with concrete actions to reduce exposure, involved residents in communication processes, acknowledged stress, and addressed scientific uncertainty using accessible language without minimizing concerns. Training healthcare professionals, particularly general practitioners, supported integration of risk communication into community health. Distrust toward industry and government was common but might be mitigated through openness and involvement of trusted local figures.Local pollution poses substantial risks to public health and often generates distress within affected communities. Well-designed communication can transform this distress into empowerment, enabling residents to engage in exposure avoidance, remediation, and dissemination of accurate information. Involving healthcare providers strengthens community trust, while evidence from this review can guide policymakers in developing practical communication guidelines for local pollution events, fostering resilience and confidence at the community level.When confronted with local pollution, the public often turns to general practitioners for guidance on health effects. Without clear communication guidelines, practitioners may be ill-equipped to respond. Evidence-based guidance can better support them in informing patients.