Family Medicine and Community Health最新文献

{"title":"Interdisciplinary approaches to prescription management in older adults: a group-based analysis.","authors":"Gaël R C Libert, Nadine Kacenelenbogen, Hilde Stevens, Sandra De Breucker, Rachida Bensliman","doi":"10.1136/fmch-2025-003417","DOIUrl":"https://doi.org/10.1136/fmch-2025-003417","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care determinants for timely diagnosis of dementia.","authors":"Hannah Gulline, Sarah Carmody, Amelia Bevins, Mark Yates, Stephanie Daly, Dimity Pond, Stephanie Perin, Amy Brodtmann, Samantha Loi, Yen Ying Lim, Heather Macklin, Kevyn Morris, Scott Ayton, Darshini Ayton","doi":"10.1136/fmch-2026-004039","DOIUrl":"https://doi.org/10.1136/fmch-2026-004039","url":null,"abstract":"<p><strong>Objective: </strong>To identify actions of primary care physicians (PCPs) that influence referral to specialist assessment for dementia from the perspective of people with symptoms of dementia and/or their significant others.</p><p><strong>Design: </strong>A descriptive qualitative design was used, involving 33 semistructured interviews that explored presenting symptoms, consultations with health professionals, tests undertaken and challenges encountered while navigating the prediagnostic phase of dementia. Interview data were mapped deductively to the Candidacy Framework to examine engagement with PCPs and to identify participant-perceived actions that facilitated or impeded timely diagnosis.</p><p><strong>Setting: </strong>Online interviews were conducted between August 2022 and June 2023 with participants across Australia.</p><p><strong>Participants: </strong>Participants were 37 people who had navigated the dementia diagnosis process as a patient or significant other (partner/spouse, adult child, sibling or friend).</p><p><strong>Result: </strong>Successfully communicating concerns and asserting candidacy was described by participants as determining the diagnosis trajectory. Participants reflected that PCPs assessed available information to determine the need for specialist referral. Participants detailed that following PCP referral and support provision, diagnosis proceeded to a specialist. We also identified participant-reported system-level and PCP-related barriers to facilitating a timely diagnosis, including PCP time-constraints and workload-constraints, dementia-specific knowledge and referral pathway inconsistency. From participants' perspectives, access to a specialist referral and timely diagnosis was facilitated or impeded by an interplay of actions by people experiencing symptoms, significant others, and PCPs.</p><p><strong>Conclusions: </strong>Primary care barriers and enablers to timely diagnosis spanned across patient, significant other, PCP and system levels. Recommendations to provide timely, accurate and equitable dementia diagnoses include (1) Raise community awareness of dementia symptoms, helping people communicate their concerns effectively with their PCP; (2) Enhance PCP knowledge of dementia to improve their ability to refer and diagnose and (3) Develop clear diagnostic pathways to ensure that individuals receive the appropriate diagnosis and care they need.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116268","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":"Ultra-processed food consumption and risk of multiple chronic diseases among 8,819,894 adults from 51 prospective cohorts: a dose-response meta-analysis.","authors":"Xiao Liu, Shengwei Luo, Yunting Zeng, Nanqin Peng, Xinyi Chen, Jianan Tian, Ling Lin, Shan Zeng, Yewei Xie, Zexuan Wang, Jiaxue Xu, Lin Li, Deju Zhang, Wenli Gu, Xiang Gu, Jun Zhang, Menglu Liu, Yujie Zhao, Lihan Zhu, Mir Wajid Majeed, Zhiwei Yan, Wenting Wang, Peng Yu","doi":"10.1136/fmch-2026-003925","DOIUrl":"10.1136/fmch-2026-003925","url":null,"abstract":"<p><strong>Objective: </strong>The consumption of ultra-processed foods (UPFs) has increased globally. This study comprehensively investigated the impact of consuming UPFs on the risk of major chronic diseases in adults.</p><p><strong>Setting: </strong>A systematic search identified prospective cohort studies up to April 2026 on consumption of UPFs and major chronic outcomes. Consumption of UPFs was assessed by food frequency questionnaires (FFQs), 24-hour recalls, or dietary history.</p><p><strong>Participants: </strong>Adults (≥18 years) without restriction to specific clinical conditions at baseline.</p><p><strong>Results: </strong>Fifty-one prospective cohort studies involving 8 819 894 participants were included. Consumption of UPFs was associated with cardiovascular events (Hazard Ratio (HR) 1.24, 95% Confidence Interval (CI) 1.14 to 1.36), cancer (HR 1.12, 95% CI 1.04 to 1.21), obesity/overweight (HR 1.23, 95% CI 1.17 to 1.30), metabolic syndrome (MetS)/diabetes (HR 1.24, 95% CI 1.08 to 1.42), depression/anxiety (HR 1.27, 95% CI 1.15 to 1.40), digestive diseases (HR 1.31, 95% CI 1.16 to 1.48) and all-cause mortality (HR 1.18, 95% CI 1.10 to 1.26). Dose-response analyses showed each additional 100 g/day associated with higher risks of cardiovascular events (HR 1.14, 95% CI 1.06 to 1.22), cancer (HR 1.04, 95% CI 1.02 to 1.06), all-cause mortality (HR 1.03, 95% CI 1.02 to 1.05), and MetS/diabetes (HR 1.02, 95% CI 1.01 to 1.04).</p><p><strong>Conclusions: </strong>Consuming UPFs was associated with higher risks of multiple chronic diseases and all-cause mortality with low or moderate evidence. Reducing dietary intake of UPFs may therefore be relevant for chronic disease prevention.</p><p><strong>Prospero registration number: </strong>CRD42023421092.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 Suppl 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026220","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":"Psychotropic-associated sudden death: a multifactorial challenge.","authors":"Ana Beatriz Andrade, Anabela Pereira Neves, Rosa Henriques De Gouveia","doi":"10.1136/fmch-2026-004226","DOIUrl":"10.1136/fmch-2026-004226","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977850","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 of primary palliative care interventions across six sub-Saharan African countries: understanding contextual determinants and lessons learnt.","authors":"Anna Peeler, Oladayo Afolabi, Kennedy Nkhoma, Catherine Evans, Eve Namisango, Mary Abboah-Offei, Lindsay Farrant, Joy Hunter, Edwina Beryl Opare-Lokko, Adwoa Boamah Mensah, Maya Jane Bates, Dorothee van Breevoort, Duncan Kwaitana, Modai Mnenula, Dickson Chifamba, Lovemore Mupaza, Richard Harding","doi":"10.1136/fmch-2025-003490","DOIUrl":"10.1136/fmch-2025-003490","url":null,"abstract":"<p><strong>Objective: </strong>To synthesise five purposively selected service-level primary palliative care interventions in six sub-Saharan African countries to identify the contextual barriers and facilitators and the implementation strategies employed to address them.</p><p><strong>Setting: </strong>Primary palliative care studies that have taken place in sub-Saharan Africa in the last 5 years.</p><p><strong>Design: </strong>We used an implementation-focused formative evaluation design involving semi-structured interviews with every site lead (n=7) supplemented by a review of study-related documentation. Data were analysed using framework analysis underpinned by the relevant constructs of the Consolidated Framework for Implementation Research.</p><p><strong>Participants: </strong>Site leads from each of the five studies were interviewed.</p><p><strong>Results: </strong>Facilitators to implementing primary palliative care interventions included the following: (1) the relative advantage compared with standard care (ie, person-centred approach, expansion to those with non-cancer conditions), (2) primary care worker champions within sites, (3) broad sustained engagement with policymakers, managers, healthcare workers, patients and families and (4) availability of linked healthcare records. Barriers included the following: (1) inconsistent staffing and training needs for the diverse workforce, (2) fragmented referral pathways, (3) inconsistent national and local policies and (4) physical infrastructural limitations.</p><p><strong>Conclusion: </strong>Context-specific facilitators, barriers and recommendations should be considered to bolster the implementation process of future primary palliative care interventions. Advocacy is needed to ensure adequate investments in the design, equipping and staffing of primary healthcare in sub-Saharan Africa to properly support patients and their families.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945859","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":"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}