Objective Multicenter evidence comparing health literacy across Spanish autonomous communities in primary care remains scarce. We aimed to describe health literacy among adults attending scheduled nursing consultations and explore sociodemographic, clinical, and territorial differences. Methods Multicenter cross-sectional study in primary care health centers of six Spanish autonomous communities, conducted between June 2025 and January 2026. Adults aged 18–75 years (n = 980) completed the 16-item European Health Literacy Survey Questionnaire, Ponte a 100 lifestyle questionnaire, and 13-item Orientation to Life Questionnaire. Non-parametric tests and multiple linear regression were used. Results Among 920 participants with valid scores, 62.50% presented sufficient health literacy and 37.50% problematic or inadequate health literacy. Health literacy was largely homogeneous across sociodemographic groups. Older age was weakly associated with lower health literacy, whereas chronic disease and sense of coherence were associated with higher health literacy; lifestyle was not retained. Participants from Castilla-La Mancha and Castilla y León showed slightly lower adjusted health literacy scores. The model explained 9.50% of health literacy variability. Conclusions Sufficient health literacy predominated, but more than one third of participants had limited health literacy, and territorial differences were small. Contextual and healthcare-related factors may shape health literacy beyond individual characteristics.
Objectives Maternal and neonatal disorders remain leading causes of death and disability, this study analyzes its trends, risks, and projects future burdens. Methods We collected the age-standardized rates for incidence, prevalence, mortality, disability-adjusted life years, and years lived with disability from the GBD database between 1990 and 2023. Joinpoint regression estimated average annual percentage changes. Age-period-cohort models decomposed independent effects of age, period, and birth cohort. Autoregressive integrated moving average models projected trends. Results From 1990 to 2023, age-standardized mortality rates in China declining, outpacing the G20 average. However, age-standardized years lived with disability rates rose persistently in both China (0.97%) and the G20 (1.45%). Age-period-cohort analysis identified the highest incidence in women aged 25–29 years, and in newborns<5 years old; although attributable mortality fell by 97.5% in China, attributable years lived with disability decreased by only 18.3%. The fitted model projects an increase in China's age-standardized incidence rates (1065.11 per 100,000), whereas G20 is expected to decline. Conclusions Despite remarkable mortality reductions, the persistent rise in disability—driven largely by survival of high-risk neonates and environmental risks—signals an urgent need for integrated health system strategies, and build rehabilitation planning capacity.
The United States continues to face a persistent maternal mortality crisis, underscoring the need to explore innovative approaches to prevention that extend beyond traditional clinical care. Mental health and substance use disorders are among the leading causes of preventable maternal deaths, particularly during the postpartum period when clinical perinatal care ends. Community-based workers—including community health workers, doulas, peer support specialists, and patient navigators—may address gaps in maternal healthcare by responding to social determinants of health, connecting patients with community resources, and supporting engagement with healthcare and behavioral health services. This commentary explores opportunities to integrate community-based workers into perinatal care and highlights their potential roles in addressing mental health and substance use, navigating social and structural barriers, and strengthening continuity of support throughout pregnancy and the postpartum period. The commentary also highlights the importance of investing in the community-based workforce and developing partnerships between community-based workers and perinatal providers. Rather than replacing physicians, community-based workers may complement clinical care by addressing needs that extend beyond the traditional scope of medical practice and expanding the reach of maternal healthcare.
