Family Medicine and Community Health最新文献

{"title":"Managing headache in primary care: choosing therapies that treat the whole patient.","authors":"Brian T Burroughs","doi":"10.1136/fmch-2026-004020","DOIUrl":"10.1136/fmch-2026-004020","url":null,"abstract":"<p><p>To provide a practical, comorbidity-aligned approach to headache management in primary care, emphasising therapies that can address headache and coexisting chronic conditions while reducing polypharmacy and medication interaction risk. Narrative clinical review using targeted literature searches and guideline synthesis. Contemporary clinical guidelines, systematic reviews, meta-analyses, randomised controlled trials and other clinically applicable evidence addressing the diagnosis and management of headache disorders in adults were prioritised. Evidence relevant to primary care, comorbidity-aligned treatment selection, non-pharmacologic interventions, medication-overuse headache and office-based procedures was emphasised. PubMed/MEDLINE and major headache guideline sources were searched through 7 August 2026. Reference lists of selected publications were also reviewed to identify additional clinically relevant evidence. Most headache disorders can be managed in primary care using a structured approach that confirms the headache phenotype, screens for secondary causes, identifies comorbidities and aligns treatment with the patient's broader clinical needs. Selecting therapies that benefit both headache and coexisting conditions may reduce medication burden and improve adherence and tolerability. Non-pharmacologic interventions and structured follow-up are important components of care. Recognition and management of medication overuse can improve outcomes, while selected office-based procedures may provide additional options when used with appropriate attention to evidence limitations, patient selection and clinician competence. Comorbidity-aligned headache care offers primary care clinicians a practical framework for individualising treatment, limiting unnecessary medication layering and integrating pharmacologic and non-pharmacologic strategies. This approach may improve headache outcomes while supporting management of the patient's overall health. This narrative review was not prospectively registered.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke incidence trends and the role of chronic disease management in a universal health coverage system: a retrospective observational study in Macao, 2019-2024.","authors":"Kwong Ho Tam, Hao Wan Chou, Wing Yi Kwong, Sao Kuan Lei, Wen Zeng, In Wong","doi":"10.1136/fmch-2026-004068","DOIUrl":"10.1136/fmch-2026-004068","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the temporal trend of stroke incidence from 2019 to 2024 in Macao and evaluate its relationship with hypertension (HTN) and type 2 diabetes mellitus (T2DM) management within a universal health coverage (UHC) system.</p><p><strong>Design: </strong>Retrospective observational study using routinely collected electronic health records.</p><p><strong>Setting: </strong>Macao Health Bureau's primary care system, which provides free, publicly funded community health services to all residents.</p><p><strong>Participants: </strong>Macao residents aged ≥15 years with a confirmed diagnosis of ischaemic or haemorrhagic stroke recorded in the Macao Health Bureau medical system between 1 January 2019 and 31 December 2024 (n=8265).</p><p><strong>Results: </strong>Age-standardised stroke incidence declined from 250.03 per 100 000 in 2019 to 219.95 per 100 000 in 2022, followed by a rebound in 2023-2024 which may partly reflect pandemic-related data entry delays. Over 88% of patients with pre-existing HTN or T2DM had documented healthcare follow-up in the year preceding their stroke. Stroke incidence among these high-risk patients declined and the interval from diagnosis to stroke onset lengthened significantly, yet a substantial stroke burden persisted.</p><p><strong>Conclusion: </strong>High healthcare engagement was associated with improved risk monitoring and delayed stroke onset. However, the persistent stroke burden suggests that achieving high coverage alone is not sufficient-ongoing quality improvement in chronic disease management is essential to translate engagement into better outcomes.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 Suppl 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insomnia and associated pharmacological prescription in the adult population in primary care in Central Catalonia from 2018 to 2024.","authors":"Berta Bertrans Vilaró, Queralt Miró Catalina, Josep Vidal-Alaball","doi":"10.1136/fmch-2026-004152","DOIUrl":"10.1136/fmch-2026-004152","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the prevalence, the annual rate of insomnia diagnosis and the associated pharmacological prescription in Central Catalonia during the 2018-2024 period.</p><p><strong>Design: </strong>Population-based retrospective observational study using collected electronic primary care health records (ECAP) from 2018 to 2024. Sociodemographic and clinical characteristics, insomnia prevalence, annual diagnosis rates and associated pharmacological prescribing patterns were analysed.</p><p><strong>Setting: </strong>Primary care centres in Central Catalonia, Spain.</p><p><strong>Participants: </strong>Adult population of Central Catalonia diagnosed with insomnia between 2018 and 2024.</p><p><strong>Results: </strong>The prevalence of insomnia increased by 43.4% during the study period, reaching 11.17% (95% CI 11.05 to 11.28) in 2024. The factors associated with higher prevalence were advanced age, female sex, residence in urban areas, polypharmacy and mental health comorbidity. The percentage of people with insomnia receiving pharmacological treatment increased from 47.88% (2018) to 55.11% (2024). Among patients receiving pharmacological treatment, anxiolytics were the most frequently prescribed medication class (36.68% in 2018 to 39.44% in 2024), followed by hypnotics and sedatives.</p><p><strong>Conclusion: </strong>The prevalence of insomnia and the use of pharmacological treatments among patients with insomnia-including anxiolytics, hypnotics and sedatives-have increased in recent years. These findings demonstrate the need to improve strategies in managing insomnia in primary care in order to promote the use of the first-line tool in the treatment of insomnia, cognitive behavioural therapy and thereby minimise pharmacological overprescription.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral artery disease in patients with persistent claudication after lumbar spine surgery: a primary care reassessment framework.","authors":"Joomong Park","doi":"10.1136/fmch-2026-004259","DOIUrl":"10.1136/fmch-2026-004259","url":null,"abstract":"<p><p>Persistent claudication after lumbar spinal surgery may reflect unrecognised peripheral artery disease (PAD) and delayed implementation of secondary cardiovascular prevention. Despite effective guideline-directed therapy, diagnostic and treatment gaps persist in routine practice. Vascular claudication may be under-recognised when exertional lower extremity symptoms are attributed solely to neurogenic causes such as lumbar spinal stenosis. Antiplatelet and statin therapy may be absent even in patients with established PAD, while symptomatic agents such as cilostazol are continued without concurrent secondary prevention. Clinical features supporting vascular rather than neurogenic claudication include reproducible claudication distance, calf-predominant exertional pain, pulse abnormalities, cool extremities and limited posture dependence. Ankle-brachial index (ABI) testing-performed either by Doppler or by validated automated oscillometric devices-provides a practical and guideline-supported first-line diagnostic tool in primary care, with toe-brachial index measurement reserved for patients with non-compressible vessels. This communication provides a primary care reassessment framework integrating symptom-pattern assessment, pulse examination, ABI testing, medication reconciliation and timely vascular referral to reduce diagnostic delay and close secondary prevention gaps in patients with persistent claudication after lumbar spinal surgery. This framework represents a pragmatic clinical approach derived from existing guidelines and observational data; it has not been prospectively validated.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of adverse childhood experiences, positive childhood experiences and adult protective and risk factors on health in a statewide representative sample.","authors":"Krista Kotz, Rachel Gilgoff, Jeffrey Gassen, Devika Bhushan, Jackson Schuetz, Wendy Barrera, David McClendon, George M Slavich","doi":"10.1136/fmch-2026-003963","DOIUrl":"10.1136/fmch-2026-003963","url":null,"abstract":"<p><strong>Objective: </strong>Adverse childhood experiences (ACEs), positive childhood experiences (PCEs) and adult protective and risk factors have each been associated with health outcomes but have rarely been examined together. We examined associations among ACEs, PCEs, adult protective and risk factors, and adult mental, behavioural, and physical health outcomes, including whether adult factors were independently associated with health after accounting for childhood experiences.</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Setting: </strong>California, USA.</p><p><strong>Participants: </strong>Data were analysed from 24 453 adults categorised into 5 age categories (18-25, 26-39, 40-54, 55-64 and ≥65 years) participating in the 2021 California Health Interview Survey, a statewide representative survey.</p><p><strong>Analysis: </strong>Outcomes included multiple mental, behavioural and physical health indicators, including composite measures of any physical condition and any mental/behavioural health condition. Weighted logistic regression models examined associations and interactions among ACEs, PCEs, adult protective and risk factors, and health outcomes, adjusting for age, gender and race/ethnicity. Additional models examined adult factors independent of ACEs and PCEs.</p><p><strong>Results: </strong>Greater ACE exposure was associated with higher odds of most poor health outcomes, whereas higher PCE exposure was generally associated with lower odds across mental, behavioural and physical health outcomes. Compared with individuals with high ACE exposure and low PCE exposure, progressively less ACE exposure was associated with progressively lower odds of any mental/behavioural health condition (moderate ACEs OR=0.59, 95% CI 0.50 to 0.70; no ACEs OR=0.30, 95% CI 0.24 to 0.37) and any physical condition (moderate ACEs OR=0.75, 95% CI 0.64 to 0.88; no ACEs OR=0.58, 95% CI 0.45 to 0.75). Adult protective and risk factors remained independently associated with health outcomes after accounting for ACEs and PCEs. Higher cumulative protective factor exposure was associated with lower odds of any mental/behavioural health condition (OR=0.49, 95% CI 0.42 to 0.57) and any physical condition (OR=0.63, 95% CI 0.53 to 0.74).</p><p><strong>Conclusions: </strong>Adult protective and risk factors were associated with health outcomes independent of ACEs and PCEs, extending prior ACE and PCE research beyond childhood experiences. Findings highlight the importance of healthcare and public health approaches that address both childhood and adult adversity and strengthen protective resources and supportive environments.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation outcomes from delivering 'acute-on-demand telehealth services' in primary care: a retrospective observational study.","authors":"Ngiap Chuan Tan, Shen Yi Dominic Lim, Win Yee Cheong, Yi Ling Eileen Koh, Chun-Yun Gary Kang, Jambay Dorji","doi":"10.1136/fmch-2026-003988","DOIUrl":"10.1136/fmch-2026-003988","url":null,"abstract":"<p><strong>Objectives: </strong>The retrospective component of this mixed method study leveraged implementation science to assess the execution of an acute-on-demand telehealth (AODTH) service pioneered in a Singapore public primary care institution using video consultation (VC) targeting the local multiethnic population.</p><p><strong>Design: </strong>A study was conducted using electronic medical records and AODTH service data from 2023 to 2024. The data were computed to determine the implementation outcomes based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: demographics of users (Reach); conversion to in-patient consultations (Effectiveness); AODTH uptake (Adoption); defaulters, post-VC referral to emergency or specialist outpatient services, medical certification (Implementation); purpose and service utility trend (Maintenance).Descriptive statistics, Pearson's χ² test and regression analyses were executed to report implementation outcomes and associated factors.</p><p><strong>Setting: </strong>Data were obtained from a primary care clinic (polyclinic) in eastern Singapore.</p><p><strong>Participants: </strong>AODTH users aged ≥18 years who used the service between 2023 and 2024 were included. No exclusion criteria were applied.</p><p><strong>Results: </strong>39 811 AODTH VCs were completed by 17 603 unique users, including 44.4% males and Chinese (59%) and Malay (24%) ethnicity. Senior adults aged 65 years and older represented only 2.5% of users and 1.2% of VCs. Monthly VC volumes in 2024 exceeded those in 2023, with some months recording nearly double the consultation numbers and surpassing 2500 VCs in the second half of 2024. Mean default (6.6%) and conversion (2.2%) rates showed a decreasing trend from 2023 to 2024. Referrals to emergency or specialist outpatient services constituted 5.6% of VCs. Acute medical conditions accounted for 82.7% of VCs, chronic disease management 12.4% and other reasons 4.9%, with upper respiratory tract infections comprising almost half of acute cases. Over half (50.9%) of consultations were not prescribed medications, of which 72.3% were issued sick leave. 81.3% of users had two or fewer sick leave issuances, including those with none.</p><p><strong>Conclusion: </strong>Although AODTH outreach to older adults was low, the service was effective for acute medical management with low in-person consultation conversion despite the lack of physical examination. The rising trends of AODTH users and VCs over 2 years reflect gradual service adoption, while low defaulter and referral rates reflect an appropriate implementation framework. Prevalent medical certification is likely the cornerstone to maintain AODTH service as a means for recovery from acute illnesses.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical accountability in fragmented primary care for older adults: a practical framework for minimal multidimensional assessment and targeted testing in community and home-based settings.","authors":"Joomong Park","doi":"10.1136/fmch-2026-004209","DOIUrl":"10.1136/fmch-2026-004209","url":null,"abstract":"<p><p>Fragmented care in older adults often results in duplicated testing, delayed decision-making and unclear clinical responsibility. These challenges are particularly pronounced in community and home-based primary care settings, where multiple providers contribute to care without formal coordination structures. Although comprehensive multidimensional geriatric evaluation is recommended, its complexity limits routine implementation. This article proposes a pragmatic framework integrating assessment of daily functioning, cognitive screening, mood assessment and mobility evaluation with targeted laboratory testing guided by clinical findings. A central principle of this model is clinical accountability, defined as the responsibility of the clinician who performs assessment and interprets findings to integrate diagnostic results into patient management and follow-up. In this framework, accountability refers specifically to responsibility for documenting findings, initiating appropriate follow-up evaluation and ensuring communication of clinically significant results. By linking brief multidimensional assessment, problem-oriented testing and explicit responsibility for follow-up, this practice-informed communication offers a pragmatic, adaptable approach for family physicians and community-based clinicians working in fragmented care environments. It is presented as a practice-informed proposal rather than a validated framework, consensus statement or guideline.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency taught me medicine: practice taught me everything else.","authors":"Dominika Jegen","doi":"10.1136/fmch-2026-004247","DOIUrl":"10.1136/fmch-2026-004247","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) tele-monitoring system in primary care as perceived by healthcare professionals using the CFIR framework.","authors":"Cia Sin Lee, Pei Pei Gong, Gerald Choon Huat Koh, Ngiap Chuan Tan","doi":"10.1136/fmch-2026-004076","DOIUrl":"10.1136/fmch-2026-004076","url":null,"abstract":"<p><strong>Objective: </strong>Telemedicine has been increasingly adopted post-COVID-19 to optimise chronic disease management, improving patient outcomes. The multi-component OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) tele-monitoring (TM) system yielded favourable health outcomes and was introduced in primary care nationwide in Singapore. This study aims to understand the factors associated with its implementation during the randomised controlled trial (RCT).</p><p><strong>Design: </strong>A qualitative study was conducted using individual semi-structured interviews. Data were transcribed, audited, coded and analysed using thematic analysis. The CFIR (Consolidated Framework for Implementation Research) framework, consisting of five domains (Intervention characteristic, Outer setting, Inner setting, Characteristics of individuals and Process), was adopted as the underpinning framework.</p><p><strong>Setting: </strong>Primary care setting in Singapore.</p><p><strong>Participant: </strong>Healthcare professionals involved in the care provided to patients enrolled in the OPTIMUM RCT.</p><p><strong>Results: </strong>TM facilitated behavioural change in patients, and its robust treatment algorithm allowed continuous monitoring and personalised advice. The associated external factors were manpower, costing and data security. Measures to mitigate internal risks included managing additional healthcare professionals' burden, reducing potential adverse events and addressing medicolegal risks related to TM. While TM enhanced provider satisfaction and the patient-healthcare professional relationship, strategies to enhance user experience and streamline the TM processes are required to improve its acceptance and adoption.</p><p><strong>Conclusion: </strong>The CFIR served as a useful framework to identify factors associated with successful implementation of an intervention in a real-world setting. Understanding these factors enables healthcare leaders to address the challenges before scaling up the intervention in routine clinical services.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 Suppl 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of radioactive iodine treatment with survivorship symptoms and primary care utilisation in women of reproductive age with thyroid cancer: a retrospective cohort study.","authors":"Priya Devanarayan, Meghan Hartman, Michael Partin","doi":"10.1136/fmch-2026-004118","DOIUrl":"10.1136/fmch-2026-004118","url":null,"abstract":"<p><strong>Objectives: </strong>Radioactive iodine (RAI) is commonly administered after thyroid cancer surgery and is generally considered low risk. Its use in women of reproductive age, however, is increasingly debated. Most research has focused on cancer outcomes, fertility or short-term psychological effects, with limited attention to symptoms relevant to primary care after treatment. Evidence describing post-treatment symptom burden, mental health outcomes and primary care utilisation in this population is limited. This study examines whether RAI treatment after thyroid cancer surgery in women of reproductive age is associated with an increase in disease-related symptom burden, new mental health diagnoses and greater primary care utilisation within the first year following treatment.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX database to compare adult women of reproductive age (18-49) with thyroid cancer who underwent thyroidectomy from 1 January 2000 to 1 January 2024 by RAI treatment status. Propensity score matching was performed to balance baseline demographic and clinical characteristics. Outcomes within 1 year included new diagnoses of fatigue and malaise, generalised anxiety disorder, depressive episodes, sleep disorders, cognitive symptoms, adjustment disorders and primary care utilisation. Standardised mean differences (SMD) compared baseline characteristics and risk differences with 95% CIs and risk ratios (RR) with 95% CIs compared outcomes between cohorts.</p><p><strong>Results: </strong>Before propensity score matching, patients receiving RAI had higher prevalence of obesity (SMD 0.269), hypertension (SMD 0.189), diabetes (SMD 0.127) and mental health conditions (SMD 0.370). After matching, 10 882 patients were analysed. RAI-treated patients experienced significantly higher rates of fatigue and malaise (RR 1.239, 95% CI 1.031 to 1.490; p=0.022), depressive episodes (RR 1.344, 95% CI 1.043 to 1.732; p=0.022), sleep disorders (RR 1.281, 95% CI 1.006 to 1.630; p=0.044) and primary care visits (RR 1.476, 95% CI 1.330 to 1.638; p<0.001).</p><p><strong>Conclusion: </strong>RAI treatment in women of reproductive age may be associated with increased symptom burden and primary care utilisation in the first year following thyroid cancer treatment. These findings underscore the importance of anticipatory guidance, symptom screening, coordinated survivorship care and further research to define optimal survivorship care pathways for this population.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}