This study aimed to explore how individuals with complex multimorbidity perceive and experience the management of their health in everyday life and healthcare encounters.

Patients with two or more health conditions may be challenging for general practitioners (GPs) who must provide adequate treatment(-s) in a healthcare system structured mainly around single-disease models. For patients, the lived experience of this multimorbidity can be demanding, as it often involves managing multiple appointments, medications, and medical advice alongside everyday life. This situation may be particularly challenging for patients who live with multiple physical and mental health conditions.

Semi-structured individual interviews with eight individuals with complex multimorbidity living in Denmark. Analysis was guided by thematic analysis.

The analysis resulted in two main themes. First, ‘Multiple diagnoses – not multimorbidity’ describes how the participants did not expect overall continuity across diagnoses but appreciated recognition of the cumulative burden of multimorbidity. They expected continuity within each speciality and developed agentic strategies to achieve this. Some were successful; others were not. Second, ‘Managing treatment and illness in everyday life’ describes how the participants navigated tensions between medical recommendations and personal priorities as they deliberately pursued valued activities at the expense of their long- or short-term health. A professional lifeline, was a significant support for the participant. This person was often the GP. These findings underscore the active role of patients and the GP’s role in recognizing their resources to develop patient-centred care that is responsive to and realistic for the individual patient.

Although adolescent depression has been linked to individual chronic conditions, its broader role in shaping multimorbidity risk remains understudied.

A total of 87,562 UK Biobank participants were included, of whom 18,851 had documented adolescent depression. Cox proportional hazards models were applied to evaluate associations between adolescent depression and 24 chronic diseases, followed by stratified analyses by sex and age. Two-sample Mendelian randomization (MR) was then conducted to infer causality for diseases showing significant associations. Genomic colocalization analyses were performed using relevant GWAS data to identify shared causal variants. Mediation analyses were performed to detect possible mediating factors, including the frailty index, KDM biological age acceleration, allostatic load and 30 circulating biomarkers.

Adolescent depression was associated with elevated risk for 12 chronic diseases, with strongest associations for hypothyroidism (HR = 1.29 [1.18–1.42]), diabetes (HR = 1.25 [1.13–1.38]) and chronic obstructive pulmonary disease (COPD) (HR = 1.74 [1.50–2.01]). Risks were notably higher among females and younger adults. MR confirmed likely causal relationships for hypothyroidism (OR = 1.45 [1.03–2.05]), diabetes (OR = 1.01 [1.01–1.02]) and COPD (OR = 1.04 [1.02–1.06]). Genomic colocalization revealed a shared genetic signal at the CDSN/PSORS1C1 locus between adolescent depression and hypothyroidism. Mediation analyses revealed disease-specific pathways: creatinine for hypothyroidism, testosterone for diabetes, KDM biological ageing for COPD and frailty index across all three conditions.

Adolescent depression confers systemic vulnerability through genetic and metabolic mechanisms, with amplified risks in females and individuals aged ≤55 years. These findings support early, integrated interventions to mitigate long-term multimorbidity.

This article reports on the feasibility, acceptability of a trial design and results of ¡Coma, Muévase y Viva!, an adapted version of the Eat, Move, Live! Curriculum, a 10-week diet and lifestyle change intervention for low-income Latina and Indigenous Mexican women in rural Inland Southern California.

A pilot randomised intervention and wait-list controlled parallel trial.

Latina and Indigenous Mexican women participated in ¡Coma, Muévase y Viva!, the adapted version of the curriculum customised for Spanish speakers with a focus on health literacy, cultural norms and values, and delivered by community health workers/promotoras.

Participants were randomised into the intervention (n 19) or wait-list control (n 16). Most were Latino (88 %), mothers (75 %) and foreign-born (87 %).

The adapted intervention was feasible and acceptable with 87·5 % of participants retained at three months. The intervention was delivered with high fidelity. Intervention compared to control participants reported success with predetermined prioritised goals (OR = 0·25, 95 % CI: 0·06, 0·99, P = 0·03) and showed a greater likelihood of cooking healthier food (OR = 4·87, 95 % CI: 1·04, 22·90, P = 0·05), enjoyment of cooking healthy meals (OR = 3·94, 95 % CI: 0·87, 17·92, P = 0·08) and doing physical activities (OR = 5·30, 95 % CI: 1·16, 24·24, P = 0·03). Healthy eating and physical activity as primary outcomes indicated the intervention group was more likely to eat healthy and be active (OR = 2·08, 95 % CI: 1·12, 3·89, P = 0·02).

The adapted intervention was feasible and acceptable and indicated an effect on dietary and lifestyle behaviour change with significant changes in meeting desired goals and engaging in healthy eating and physical activity.

Conducting health systems assessments helps highlight weaknesses and strengths to be explored to improve care delivery. The Assessment of Chronic Illness Care (ACIC) considers the perspective of professionals who work in the care-providing institution. Its structure comprises seven dimensions that provide specific data about the care offered. Objectives: (1) evaluate the institutional capacity for Type 2 Diabetes Mellitus (T2DM) management in the interior of the State of Amazonas from the perspective of health professionals; (2) verify the association between socio-educational, work and geographic location variables with the dimensions of the ACIC.

A cross-sectional study carried out between October 2020 and December 2022 in 36 Primary Health Units (PHUs) of the seven cities of the Amazonas, totaling 230 participants. Excel 2019 and R (4.2.1) were used for data analysis. The association between independent variables and ACIC dimensions was analyzed using multiple logistic regression analysis.

The PHUs in the rural Amazonas have the basic capacity to care for patients with T2DM. Analysis of each dimension of the ACIC demonstrated that geographic location was the most relevant factor, showing an association with all instrument dimensions.

Socioeducational variables showed an association with the dimensions of Decision Support, Design of the Service Delivery System, Clinical Information System, and Integration of components of the Care Model for Chronic Conditions. Work-related variables, on the other hand, were associated with the dimensions of Organization of Health Care, Community Resources, Support for Self-Management and Integration of the components of the Chronic Conditions Care Model.

To understand patterns of cannabis use and self-management experiences in patients with chronic disease during the post-legalization period in Thailand and to quantify such experiences and perceptions.

Patients with chronic disease are a population in which disease self-management is potentially involved with the use of complementary and alternative medicines (CAMs). The recent changes in cannabis regulation in Thailand have allowed retail selling and home cultivation. Cannabis is a medicinal herb in many traditional Thai recipes and is often adopted as a CAM in the chronic disease population. The adoption of cannabis products as part of CAM could lead to changes in chronic disease outcomes.

Exploratory-sequential mixed methods were used in this study. A descriptive qualitative study was conducted to acquire a basic understanding of the patients’ experiences. Semi-structured in-depth interviews were conducted, and thematic analysis was applied. Subsequently, a cross-sectional study was conducted to quantify the patterns of cannabis use and self-management experience in patients with diabetes and/or hypertension.

Eleven patients were interviewed, and 124 patients participated in the cross-sectional study. Most of the participants were male, married, and identified as Buddhist. Many patients believed that cannabis could improve their health, while fewer considered it a threat to their health. In general, the patients viewed cannabis as a way to enhance their quality of life and treat chronic diseases. Some patients embraced the principles of CAM. They primarily used cannabis tea daily to manage diabetes or hypertension, with their approaches being more complementary than alternative. However, only one-third (34.7%) were aware of potential drug interactions with their concurrent medications.

To evaluate the indications, outcomes, and recurrence rates of elective paediatric functional endoscopic sinus surgery at a tertiary centre, and to highlight the continued importance of multidisciplinary management.

A retrospective review included 65 patients (age range 5–17 years) undergoing elective paediatric functional endoscopic sinus surgery from January 2017 to December 2024. Data on demographics, surgical details, additional procedures, and revision rates were collected. Logistic regression identified predictors of revision.

Chronic rhinosinusitis was the most common indication (45/65), with 62 per cent requiring polypectomy and 84 per cent undergoing middle meatal antrostomy. Fifteen percent had cystic fibrosis; cystic fibrosis status significantly predicted revision (odds ratio 8.5, p = 0.007). A multidisciplinary approach was crucial for the 20 per cent needing additional procedures. No major complications were reported.

Paediatric functional endoscopic sinus surgery is safe and effective for paediatric sinonasal disease, particularly where balloon sinuplasty is insufficient for polyposis. Multicentre collaborations will help refine selection criteria and enhance long-term outcomes.

Treatment interruptions in disaster victims are concerning, owing to an increase in natural disasters and the growing elderly population with chronic conditions. This study examined the temporal trends in treatment interruptions among victims of 2 recent major heavy rain disasters in Japan: West Japan heavy rain in 2018 and Kumamoto heavy rain in 2020.

Data for this study were derived from the national standardized medical data collection system called the “Japan Surveillance in Post-Extreme Emergencies and Disasters.” Joinpoint regression analysis was performed to examine the daily trends in treatment interruptions reported soon after each disaster onset.

A total of 144 and 87 treatment interruption cases were observed in the heavily affected areas of the West Japan heavy rain in 2018 and Kumamoto heavy rain in 2020, respectively. In both disasters, a high number of treatment interruption cases were observed on the first day after the disaster. Joinpoint regression analysis showed that trends in the percentage of treatment interruptions differed between the 2 disasters at different disaster scales.

The findings suggest the importance of a prompt response to treatment interruptions in the immediate aftermath of a disaster and consideration of the specific characteristics of the disaster when planning for disaster preparedness and response.

This constructivist grounded theory study aimed to (1) explore patients’ experiences of and roles in interprofessional collaborative practice for chronic conditions in primary care and (2) consider the relevance and alignment of an existing theoretical framework on patients’ roles and based on the experiences of patient advocates.

High-quality management of chronic conditions requires an interprofessional collaborative practice model of care considering an individual’s mental, physical, and social health situation. Patients’ experiences of this model in the primary care setting are relatively unknown.

A constructivist grounded theory approach was taken. Interview data were collected from primary care patients with chronic conditions across Australia in August 2020 – February 2022. Interviews were recorded, transcribed verbatim, and thematically analysed by (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation, and (5) theme and sub-theme development. Themes and sub-themes were mapped against an existing theoretical framework to expand and confirm the results from a previous study with a similar research aim.

Twenty adults with chronic conditions spanning physical disability, diabetes, heart disease, cancer, autoimmune, and mental health conditions participated. Two themes were developed: (1) Adapting to Change with two sub-themes describing how patients adapt to interprofessional team care and (2) Shifting across the spectrum of roles, with five sub-themes outlining the roles patients enact while receiving care. The findings suggest that patients’ roles are highly variable and fluid in interprofessional collaborative practice, and further work is recommended to develop a resource to support greater patient engagement in interprofessional collaborative practice.

Adolescents with cancer often experience significant symptom burden and aggressive treatment near end-of-life. Increased adolescent involvement in care and decision-making may benefit health outcomes. Limited research has examined factors associated with adolescents’ involvement in care in the context of advanced disease. Thus, we examined the impact of background factors and decision-making perceptions on both adolescents’ involvement in care and their desired change in involvement.

Adolescents with advanced cancer (<60% survival or refractory/relapsed disease), ages 10–23 (n = 41; Mage = 15.37), were recruited approximately 1 month after diagnosis to complete measures of decision-making perceptions and their family role. Hierarchical regressions examined the contributions of background factors and decision-making perceptions to adolescents’ frequency and desired involvement in their care. Qualitative interviews regarding decision-making were analyzed using deductive analysis.

The model examining frequency of involvement in care was significant, F(5,34) = 3.12, p = .02, R2 = .31. Older age was the only significant predictor (β = .13, p = .003). The model examining desired involvement was non-significant, F(5,34) = 2.22, p = .075. Qualitative analysis indicated that (1) older adolescents have more involvement in decision-making, (2) collaborative decision-making occurred between the adolescent and extended family, and (3) adolescents trusted others to make decisions. Integration of qualitative and quantitative data revealed congruence in findings.

Adolescents with advanced cancer, who consider how decisions directly impact them and prefer greater autonomy, may be more involved in their medical care. Research is needed to identify other longitudinal predictors of decision-making and involvement in care. Providers should consider encouraging families to communicate their preferences and engage in shared decision-making.

Over 90% of children with CHD survive into adulthood and require lifelong cardiology care. Delays in care predispose patients to cardiac complications. We sought to determine the time interval to accessing adult CHD care beyond what was recommended by the referring paediatric cardiologist (excess time) and determine risk factors for prolonged excess time.

Retrospective cohort study including all patients in the province of Alberta, Canada, age 16–18 years at their last paediatric cardiology visit, with moderate or complex lesions. Excess time between paediatric and adult care was defined as the interval (months) between the final paediatric visit and the first adult visit, minus the recommended interval between these appointments. Patients whose first adult CHD appointment occurred earlier than the recommended interval were assigned an excess time of zero.

We included 286 patients (66% male, mean age 17.6 years). Mean excess time was 7.9 ± 15.9 months. Twenty-nine (10%) had an excess time > 24 months. Not having a pacemaker (p = 0.03) and not needing cardiac medications at transfer (p = 0.02) were risk factors for excess time >3 months. Excess time was not influenced by CHD complexity.

The mean delay to first adult CHD appointment was almost 8 months longer than recommended by referring paediatric cardiologists. Not having a pacemaker and not needing cardiac medication(s) were risk factors for excess time > 3 months. Greater outpatient resources are required to accommodate the growing number of adult CHD survivors.

To evaluate the impact of Hurricanes Irma and Maria on 3 major chronic diseases in Puerto Rico.

San Juan Overweight Adults Longitudinal study participants were re-evaluated after Hurricanes Irma and Maria (May 2019–July 2020) for the Preparedness to Reduce Exposures and Diseases Post-hurricanes and Augment Resilience study. This study compared the prevalence and incidence of asthma, depression, and hypertension within the same 364 individuals over time.

Asthma and depression prevalence and incidence did not change significantly after the hurricanes. The prevalence of hypertension increased significantly after the hurricanes (OR = 2.2, 95% CI: 1.2, 3.9). The incidence of hypertension after the hurricanes (IR = 9.0, 95% CI: 6.5, 12.4) increased significantly compared to before the hurricanes (IR = 6.1, 95% CI: 4.5, 8.0) (age-adjusted incidence rate ratio [aIRR] = 1.4, 95% CI: 4.5, 8.0) for similar time periods.

Hurricanes Irma and Maria were associated with a significant increase in the prevalence and incidence of hypertension in this study population. Contrary to expectations, no significant increases were observed in depression and asthma prevalence after the hurricanes. Results from this study can inform better strategies to prevent and manage hypertension in the population affected by a hurricane.

This study evaluated the relationship between frontal pain as a symptom in chronic frontal sinusitis and radiological and endoscopic findings, quality of life and disease severity. The aim was to determine its utility as a marker in chronic frontal sinusitis and in surgical decision-making.

This was a prospective study of 51 consecutive patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Patients ranked their frontal pain score on a numerical rating scale from 0 to 10. Facial pain or pressure, Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation score, Lund–Mackay score and modified Lund–Kennedy score were also collated. Statistical analysis was performed using analysis of variance and Pearson correlation coefficient.

Frontal pain scores were low and demonstrated no correlation with the extent of frontal sinus disease radiologically or the severity of overall sinus disease endoscopically. Higher frontal pain scores significantly correlated with poorer quality-of-life.

This study does not support the use of frontal pain as a sensitive or specific marker of chronic frontal sinus disease.