Attention Deficit Hyperactivity Disorder (ADHD) is a common condition in children and youth, with varying levels of primary care involvement across countries. Primary care involvement in ADHD diagnosis and management has the potential to improve efficiency, cost-effectiveness and equity for ADHD care.This study examined policies with respect to primary care physicians (PCPs) ability to diagnose and prescribe ADHD medications and analyzed ADHD-related visits to primary care amongst 5-19 year olds across nine INTRePID countries: Australia, Brazil, Canada, Indonesia, Mexico, Norway, Peru, Sweden, and the US.A document review and key informant survey was conducted in PCPs in each country. ADHD-related visit rates (2018–2023) were calculated as a percentage of total visits. Negative binomial regression estimated rate ratios (RRs, 95% CI) across Pre-pandemic (2018–2019), Pandemic (2020–2021), and Recovery (2022–2023) periods, adjusting for sex, seasonality, and offsetting by total visits. Sex-specific RRs were derived from stratified analysis.The ability for PCPs involvement in ADHD varied by country, with Canada and the US having full abilities, Australia recently introducing reforms, and all other countries having significant restrictions. Overall, North America had the highest ADHD-related visit rates: US (8.15%), Mexico (1.99%), and Canada (1.31%), while Indonesia had the lowest (0.03%). During the pandemic, rates increased in all countries with significant increases ranging from rate ratio (RR) 1.87; (95% CI: 1.61–2.17) to RR:1.16; (95% CI: 1.05–1.27) compared to the pre-pandemic. Rates remained higher than in the pre-pandemic during the recovery period in all countries, although differences were non-significant in Indonesia and Mexico. Across all countries, visit rates were 1.66 to 5.86 times higher in males than females. However, relative increases during the pandemic and recovery periods were more pronounced in females in over half of the countries.ADHD-related primary care visits varied across countries, likely reflecting differences in care models and cultural factors. However rates increased over time, particularly among females in all countries.Better integration of ADHD care in primary care could help reduce care gaps globally.

The implementation of a Mortality Committee at CAP of Barcelona represents an innovative initiative within the field of primary care, aimed at improving care quality and clinical safety through the systematic analysis of death cases. Although mortality committees are a well-established practice in hospital settings, their application in a primary care centre is still uncommon, which gives the project a clearly distinctive and pioneering value within the primary care network. • To systematically review and analyze the deaths registered within the scope of the Primary Care Centre (CAP). • To identify opportunities for improvement in clinical practice and continuity of care. • To promote a culture of patient safety and shared learning within the healthcare team. • To generate recommendations to optimize care pathways and coordination with other levels of healthcare. • To monitor the implementation of adopted measures.• Each selected case will be presented anonymously and structured according to a standard template (clinical summary, social context, chronology, critical points, reflections). • The analysis will follow a qualitative, non-punitive review model, based on continuous learning and improvement. • The conclusions will focus on: o Identifying contributory factors (clinical, organizational, communicative, social). o Proposing concrete and feasible improvement actions. o Sharing identified good practices.Sixty successful cases from the last three months were reviewed. The mean patient age was 80 years. Sixty percent had not attended the Primary Care Centre in the preceding three months, and 50% were not correctly classified as PCC-MACA. Ninety percent had an individualized care plan, while 40% had made two emergency department visits in recent years. None had received a condolence or support communication, and 90% of records showed incomplete coding of successful outcomes.Overall, this proposal represents a step forward in organizational innovation and the culture of quality in primary care, with the potential to be replicated in other centers across the network, strengthening CAP BCN commitment to excellence, humanization, and the continuous improvement of health services.Represents a cultural shift and a new way of working within primary care quality standards. It should be  mandatory committee across all primary care services in Europe

Non-pharmaceutical interventions (NPIs) were implemented worldwide to limit the spread of COVID-19. While effective in reducing transmission, concerns emerged about their effects on mental health. In low-income countries, impacts may be especially severe due to limited mental healthcare. However, evidence on mental health impacts of NPIs in these countries remains scarce.To investigate the association between NPI stringency and anxiety in XXXX countries during the COVID-19 pandemic, to explore the differential effects of specific NPIs across population groups.Data were extracted from the Life with Corona XXXX survey, a cross-sectional phone survey conducted throughout 2021 in XXXX, XXXX, XXXX, and XXXX (24,000 observations). Adult participants were randomly selected from pre-existing databases, using stratified random sampling by age, gender and residence. Survey data were combined with policy data from the Oxford COVID-19 Government Response Tracker. Anxiety symptoms were assessed using the GAD-7 scale. Multivariable logistic regression models and interaction analyses were performed, including country- and month-fixed effects.Higher policy stringency was associated with increased odds of anxiety symptoms (OR= 1.15, 95% CI: 1.11–1.20). Among specific policies, school closures (OR= 1.70, 95% CI: 1.54–1.87) and public transport closures (OR= 2.15, 95% CI: 1.83–2.54) showed the strongest associations with anxiety. Interaction analyses revealed that women, adults over 25, and individuals from higher socioeconomic groups were more affected by school closures, while men, adults under 25 or over 55, and those from the highest socioeconomic group were more affected by transport restrictions.This study is the first to examine the mental health impact of different NPIs across XXXX. Its large sample and consistent findings across sensitivity analyses strengthen the robustness of the findings. However, aggregated NPI data and the cross-sectional design limit causal inference. The association between NPIs and anxiety likely reflects multiple pathways, including economic hardship, reduced mobility, domestic tensions, and social isolation.Integrating mental health considerations into public health preparedness and policy design is essential to ensure equitable and effective responses in future health crises. For general practitioners, awareness of anxiety linked to restrictive policies is essential, as they are often the first point of contact for distressed patients.

Financial incentives and information provision are common strategies to improve quality of care. Because they are often applied together, it has been difficult to distinguish their individual effects. In Catalonia (Spain), both have been used in the public health system for nearly 20 years, but many quality indicators have plateaued. This study aims to identify the specific impact of financial incentives and information provision on quality of care.To evaluate the impact of removing financial incentives and information provision via an online platform on primary care quality indicators.An unblinded cluster randomized controlled trial is being conducted with 63 primary care practices and 1,433 professionals (GPs and nurses). They were randomized into three groups: (1) control, unchanged; (2) removal of financial incentives for 7 quality-of-care indicators; and (3) removal of both financial incentives and information for those indicators. The primary endpoint is the monthly result for the seven indicators; secondary variables include PCP, professional and patient characteristics. Mixed models will be used to compare the intervention effects among groups. Results are monitored weekly from February to December 2025.As of November 2025, incentive removal caused significant reductions in 3/7 indicators: 2.7% drop for arterial pressure (AP) control in diabetic patients, 4.1% for AP control in chronic renal failure, and 6.3% for inhaler technique verification. Removing information significantly reduced inhaler technique verification results (extending to a 14.5% drop), AP control in ischemic heart disease (7.3% drop) and diagnostic adequacy of hypertension (11.9% drop); the latter two were not affected by incentive removal alone. AP control and treatment adequacy in hypertense patients were unaffected by the interventions. Final results will be presented at the congress.The varied effects across indicators suggest that some professional practices are well established and less dependent on external support, while others rely more on financial or informational reinforcement. Tailoring quality improvement strategies to the maturity and nature of each indicator may enhance their long-term effectiveness.We identified the distinct effects of information and financial incentives to guide the design of more efficient and sustainable quality improvement initiatives in primary care.

Environmental stressors, such as heat stress, low air quality, traffic noise and the absence of green spaces are adversely associated with public health. Understanding these associations at a local level is crucial for monitoring health impacts and evaluating policy decisions related to environmental health. Primary care health data offer several advantages in this aspect, as they can detect more subtle and earlier health impacts, allow long-term monitoring of environmental health and involve a generalist approach, containing a wide range of health impacts while also considering the patient’s social context.In this paper, we explore whether routinely collected primary care morbidity data can be linked with environmental data, the methods used, the possibilities of this linked dataset and its strengths and limitations.Intego, a Flemish primary care morbidity registry containing medical and demographic information from general practitioners’ electronic health records, was linked to several environmental stressors at the home address of a patient. Data on temperature, humidity, air pollutants, traffic, noise levels and green spaces were retrieved from several Flemish and Belgian data sources.The resulting dataset, “Intego-MGZ”, includes information on environmental stressors for 318,835 patients after the last linkage, in addition to demographic and primary care health data. This dataset enables comprehensive environmental health analyses.With this dataset, we will be able to perform elaborate analyses to better understand the impact of environmental stressors on public health. Furthermore, possible health effects of mitigating policy decisions can be monitored. Future linkages can be performed periodically to track long-term environmental health trends in Flanders.The methods described in this article stress the importance of general practitioner data in environmental health research. As a first point of contact for many patients experiencing early symptoms due to environmental factors, general practitioners play a crucial role in environmental health research and adaptation strategies.

The National Dengue Prevention and Control Strategy (2019–2023) was developed to strengthen disease surveillance and community engagement. Despite this, recurrent outbreaks indicate ongoing operational shortcomings. Health officials serve as the vital link between national policy and grassroots implementation; however, empirical evidence describing their knowledge, attitudes, and practices (KAP) remains limited. Understanding these dimensions is crucial for translating policy into effective local action.To assess the knowledge, attitudes, and practices of health officials regarding national dengue prevention strategies and to identify determinants influencing their field-level implementation capacity.A descriptive cross-sectional mixed-methods study was conducted among 80 health officials, including Medical Officers, Public Health Inspectors, Field Workers, and administrative personnel from regional and national health institutions. A WHO-adapted and locally validated KAP questionnaire was administered using stratified random sampling according to professional category, with systematic replacements for non-respondents. Additionally, ten key informant interviews were conducted with purposively selected program stakeholders. Quantitative data were analyzed using descriptive statistics, one-way ANOVA, and chi-square tests, while qualitative data underwent thematic content analysis.Adequate knowledge (≥4/5) was demonstrated by 27.5% of participants, 51.3% expressed favorable attitudes (≥20/25), and only 11.3% reported good preventive practices (≥20/28). Knowledge and practice varied significantly by job category (p = 0.007 and p = 0.006), whereas attitudes did not (p = 0.080). No significant correlations were observed between KAP scores and years of service (r = 0.18, p = 0.115) or sex (t(57) = 1.53, p = 0.131). Qualitative findings highlighted gaps in timely resource mobilization, intersectoral collaboration, role-specific training, and integration of surveillance systems.Despite a comprehensive national strategy, frontline health officials showed low knowledge and practice levels, with disparities across professional categories. Systemic factors—such as delayed resources, weak intersectoral coordination, and insufficient role-specific training—appear to drive these gaps more than individual characteristics. Strengthening communication pathways, ensuring equitable resource allocation, and implementing targeted capacity-building initiatives are essential to enhance translation of policy into effective field-level dengue control.Bridging operational gaps through structured training, timely resource distribution, and improved coordination is critical to improve dengue prevention performance and achieve sustainable outcomes in Sri Lanka.

The Reproductive and Child Health (RCH) Programme launched in 1997, aims to reduce maternal, infant, and child mortality by improving healthcare access in rural areas. Key components include prenatal care, safe delivery, postnatal services, immunization, nutrition, adolescent health, family planning, and empowering women through reproductive health awareness and services.To examine the urban-rural disparity in the maternal and child health input, its utilization, and output during NFHS –1 and NFHS-5.This study analyzed data from NFHS-I (1992–93) and NFHS-V (2019–21), covering 89,777 and 7,24,115 women respectively, using bivariate analysis and chi-square tests.India made significant progress in reproductive and child health, especially in rural areas between 1992–93 and 2019–21. Improvements were seen in antenatal care, immunization, institutional deliveries, and contraceptive use. Maternal education emerged as a strong predictor of better health outcomes. Scheduled castes and tribes saw notable gains, while socio-religious groups showed varied progress. Mortality rates declined across all groups, with sharper drops in rural areas. Chi-square analysis confirmed strong links between socio-economic factors and improved health service utilization and outcomes.India witnessed significant improvements in reproductive and child health across urban and rural areas, though notable disparities remain. Antenatal care, institutional deliveries, immunization, and treatment for childhood illnesses improved, with rural areas showing higher percentage gains. Yet, urban areas retained higher absolute service utilization. Gaps in full immunization and antenatal visits narrowed considerably. Maternal education emerged as the strongest determinant of improved outcomes, alongside caste, residence, and birth order. Mortality rates declined across all demographics, especially in rural areas. Chi-square analysis confirmed strong associations between socio-economic factors and health outcomes, stressing the need for equitable healthcare access.India saw major improvements in reproductive and child health, though urban-rural disparities persist between 1992–93 and 2019–21. Rural areas recorded larger relative gains in institutional deliveries and contraceptive use, yet urban areas remained ahead overall. Maternal education strongly influenced positive health outcomes. Socio-demographic factors like caste, religion, and residence showed significant associations with health indicators. Addressing these disparities requires targeted interventions, improved rural outreach, and inclusive health policies to ensure equitable healthcare access for all population groups in India.