BACKGROUND AND OBJECTIVES:Diagnoses of attention deficit hyperactivity disorder (ADHD) in Australian children are increasing, and assessment wait times remain long. Expanding diagnosis and management to upskilled general practitioners (GPs) has been proposed, but evidence is limited. To describe the referral pathways, wait times and medication outcomes in the first 207 children diagnosed with ADHD in 2023-26 by four GPs trained in ADHD management in Nepean Blue Mountains Local Health District, New South Wales. METHOD:Prospective cohort study evaluating an integrated model of ADHD care delivered in two general practices. GPs diagnosed 207 children aged 4-17 years, mean age 11 years (112 boys, 91 girls, 4 non-binary).   RESULTS: The majority of participants (57%) were referred by GPs from other practices. Median time to first appointment was 3 weeks. Of 121 children currently stabilised on medication, 118 were prescribed stimulants. Among 85 with serial teacher ratings, inattention hyperactivity with aggression (IOWA Conners) scores improved significantly (P<0.001). Five children were referred to other specialists (paediatrics/psychiatry).   DISCUSSION: These preliminary findings suggest that trained GPs might deliver timely and effective ADHD care in primary care settings.

BACKGROUND:Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes mellitus (T2DM) and detection of CVD risk is a key part of routine care. Slow walking speed is strongly correlated with CVD events in the general population. AIM:To see whether there is an association between reduced walking speed and increased CVD incidence in people with T2DM. DESIGN & SETTING:Systematic review of studies of people with T2DM. METHOD:We searched studies in which usual walking speed was recorded, and participants were followed up for subsequent fatal and non-fatal cardiovascular events. PubMed Central, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched in December 2024. Studies were screened by two independent reviewers. Studies reporting walking speed or comparable indices and CVD outcomes in T2DM were included. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity of study populations prevented meta-analysis. RESULTS:Out of 1281 studies identified, 53 full texts were retrieved and four were included, which were all of good quality. These involved 132 967 individuals with diabetes from the USA, the UK, and Japan. Mean study follow-up was 3-14 years. All four studies assessed walking speed by self-reported questionnaire and reported significant associations between reduced walking speed and increased CVD risk with risk or hazard ratios ranging from 1.18-5.88 (P<0.001-0.0001). CONCLUSION:This is the first systematic review to indicate an association between reduced walking speed and increased CVD incidence in T2DM. This association is seen across diverse populations and settings. Further research in T2DM could explore whether increasing walking speed reduces CVD risk.

BackgroundVaccination during pregnancy is crucial for safeguarding maternal and neonatal health, but vaccination rates remain suboptimal, especially in women from Black and Asian ethnic minorities. We explored the perspectives and decision-making processes of pregnant women regarding uptake of the three recommended vaccines in pregnancy: Influenza, Pertussis (whooping cough) and COVID-19. We also explored women's attitudes to taking part in vaccine trials during pregnancy and the use of artificial intelligence (AI) to obtain information on vaccines.MethodsIn 2023, we conducted in-depth telephone interviews with ethnically diverse pregnant women in the Greater London area using convenience and snowball sampling. The interviews focused on participants' views on vaccination during pregnancy, participation in vaccine trials, information-seeking behaviours, and attitudes to emerging technologies for health information. Interviews were transcribed verbatim and thematically analysed. The data collection and analysis were conducted alongside the iterative development of the topic guide and coding framework, with key themes emerging through collaborative team discussions.ResultsTwenty one pregnant women aged 20-39 were interviewed of whom 67% were from ethnic minorities and 29% were from migrant backgrounds. Half the participants (53%) reported hesitancy towards at least one of the vaccines. The analysis revealed several themes: concerns about vaccine safety, particularly regarding newer vaccines due to lack of long-term data; reliance on healthcare professionals for guidance, balanced with personal research; and a strong desire for clear and comprehensive information specifically tailored to pregnant women. Pregnant women reported insufficient information, explanation, or recommendation by midwives. Additionally, there was widespread refusal regarding participation in vaccine trials; and mixed responses to the use of AI (such as chatbots) for obtaining vaccine information.ConclusionsPregnant women's vaccination decisions are complex and require clear, unambiguous communication from healthcare providers, especially midwives, to address their specific concerns. Although information obtained via AI can be useful, responses were mixed.

Vaccination during pregnancy is crucial due to increased maternal vulnerability to infectious diseases. However, uptake of recommended vaccines (influenza, pertussis, COVID-19) remains suboptimal, particularly among disadvantaged groups. This qualitative study explored healthcare professionals' (HCPs) perspectives, selected purposively, on factors influencing maternal vaccination in London. Data from a workshop transcript and an online quality improvement survey involving 15 GPs, two midwives, two obstetricians and one pharmacist were thematically analysed. HCPs highlighted that pregnant women perceive the benefits of pertussis vaccination more positively than other vaccines. Clear, consistent communication and integrating vaccinations into routine antenatal care were identified as essential for improving accessibility and convenience. The critical role of midwives influencing vaccination decisions was emphasised. While recognising the potential of AI-based technologies to disseminate vaccine information, concerns were raised about trust, digital literacy and information quality, highlighting the need for tailored, reliable strategies to boost maternal vaccination rates and improve health outcomes.

Recommended vaccinations during pregnancy are safe and can prevent serious illness in both pregnant women and newborns. Despite this, uptake remains low in England. We explored maternal vaccination services at selected maternity sites in London and Liverpool, focusing on service delivery, vaccination recording and midwife training. Services included walk-in vaccination clinics, nurse-led rather than midwife-led vaccination, telephone and text reminders with links to online vaccination booking, multilingual leaflets, posters and digital apps with vaccine information links. However, practical barriers persist. These include poor integration between maternity and primary care data systems for recording vaccinations, limited and inconsistent midwife training, and logistical constraints on vaccine administration. Midwives reported difficulties accessing electronic vaccine records, and vaccination discussions with patients were often absent, particularly in group models of antenatal care. System-level improvements such as integrated data access, protected training time, clear documentation protocols and tailored outreach are needed to strengthen maternal vaccination services.

BackgroundDigital tools that enable patients to submit information before consultations, such as Accurx and eConsult, are increasingly used in general practice. These systems aim to streamline workflows, improve documentation, and optimize consultation efficiency. However, evidence about their implementation, impact on health inequalities, and health care outcomes remains limited and fragmented. ObjectiveThis study aims to map and synthesize the evidence on digital tools used for preconsultation information sharing in family or general practice. MethodsThis scoping review will follow the Joanna Briggs Institute framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were conducted on May 12, 2025, in MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and the Cochrane Library. Gray literature will be identified via Google Scholar and the National Health Service or government websites. Eligible studies will describe or evaluate digital tools used to collect information from patients before general practice consultations. Two independent reviewers will conduct screening and data extraction. Data will be analyzed using narrative synthesis. ResultsDatabase searches identified 6991 records, with 4536 (64.88%) remaining after deduplication. Screening began in June 2025. Full-text screening was completed in November 2025, with data extraction and synthesis planned for completion by February 2026. Results will be submitted for publication in early 2026. ConclusionsThis review will summarize evidence concerning the use of digital tools for preconsultation information sharing in general practice. Findings will inform implementation, research priorities, and service improvement in digitally supported care. International Registered Report Identifier (IRRID)DERR1-10.2196/82649

The UK is experiencing a sharp increase in rates of whooping cough (pertussis), with confirmed cases in England climbing rapidly from 858 in 2023 to reach 2793 in just the first three months of 2024. 1 In that period alone, whooping cough claimed the lives of five infants-a tragic and preventable outcome. 1 The rise in cases may reflect the cyclical nature of pertussis, 2 but it also underscores a worrying decline in vaccine uptake during pregnancy. 3 We urgently need to increase maternal vaccination rates and protect newborns who are too young to be vaccinated.Maternal vaccination is 97% effective against infant death from pertussis. 4 5Despite these benefits, pertussis vaccination coverage in pregnancy has fallen from 70% in September 2017 to just 58% in September 2023. 6Pertussis vaccine uptake is even lower in London, with coverage of only 36% from October to December 2023. 6Historically, pertussis vaccination uptake has been significantly lower in England's deprived regions and among ethnic minorities, particularly black and South Asian women, than among white women. 7e phenomenon referred to as "vaccine hesitancy" is defined as the "delay in acceptance or refusal of safe vaccines despite the availability of vaccine services."It stems from complex cultural and context specific factors that vary by time, place, and vaccine type, influenced by issues such as confidence, communication, complacency, convenience, and sociodemographic contexts. 8Misinformation and conspiracy theories, often amplified by social media, further compound vaccine hesitancy. 9Although widely used, the term "vaccine hesitancy" may not fully capture the breadth of determinants that can lead to delay or refusal of vaccinations.Additionally, structural issues such as health inequalities, socioeconomic disadvantages, systemic racism, and barriers to access are critical factors that undermine vaccine confidence and uptake.

Introduction Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and the USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis/whooping cough and COVID-19 during pregnancy and identify possible strategies to increase vaccination rates. Methods We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research. Results Out of 2681 articles screened, 28 studies (n = 1573 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety and efficacy, lack of knowledge about vaccines’ benefits and necessity, fear of adverse effects on the foetus or mother and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear communication on the benefits and safety of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, and clear and consistent communication about vaccines addressing pregnant women’s concerns. Conclusion This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Recommendation from a healthcare provider can play a significant role in promoting vaccine uptake, as can clear risk/benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.

INTRODUCTION:Implementing artificial intelligence (AI) in healthcare, particularly in primary care settings, raises crucial questions about practical challenges and opportunities. This study aimed to explore the perspectives of general practitioners (GPs) on the impact of AI in primary care. METHODS:A convenience sampling method was employed, involving a hybrid workshop with 12 GPs and 4 GP registrars. Verbal consent was obtained, and the workshop was audio recorded. Thematic analysis was conducted on the recorded data and contemporaneous notes to identify key themes. RESULTS:The workshop took place in 2023 and included 16 GPs aged 30 to 72 of diverse backgrounds and expertise. Most (93%) were female, and five (31%) self-identified as ethnic minorities. Thematic analysis identified two key themes related to AI in primary care: the potential benefits (such as help with diagnosis and risk assessment) and the associated concerns and challenges. Sub-themes included anxieties about diagnostic accuracy, AI errors, industry influence, and overcoming integration resistance. GPs also worried about increased workload, particularly extra, unnecessary patient tests, the lack of evidence base for AI programmes or accountability of AI systems and appropriateness of AI algorithms for different population groups. Participants emphasised the importance of transparency, trust-building, and research rigour to evaluate the effectiveness and safety of AI systems in healthcare. CONCLUSION:The findings suggest that GPs recognise the potential of AI in primary care but raise important concerns regarding evidence base, accountability, bias and workload. The participants emphasised the need for rigorous evaluation of AI technologies. Further research and collaboration between healthcare professionals, policymakers, and technology organisations are essential to navigating these challenges and harnessing the full potential of AI.

ObjectiveTo explore the feasibility of a future trial to investigate whether encouraging use of the free NHS smartphone app Active10 increases brisk walking and reduces blood pressure (BP) in postnatal mothers who had hypertensive disorders of pregnancy (HDP). Design3-month feasibility study. SettingLondon maternity unit. Population21 women with HDP. MethodsAt recruitment we recorded initial (booking) clinic BP and asked participants to complete a questionnaire. Two months after delivery all participants were sent (by post/email/WhatsApp) a "Just Walk It" leaflet encouraging them to download the Active10 app and walk briskly for at least 10 minutes/day. This was backed by a telephone call after 2-weeks. Assessments were repeated 3-months later, and included telephone interviews about the acceptability and use of Active10. Main outcome measuresWere recruitment rate, follow-up rate and acceptability/use of Active10. ResultsOf 28 women approached, 21 (75%, 95% CI 55.1-89.3%) agreed to participate. Age range was 21-46 years and five (24%) self-identified as black ethnicity. One woman dropped out of the study, and one became ill. The remaining participants (90%, 19/21, 95% CI 69.6-98.8%) were followed up after 3-months. Ninety-five percent (18/19) downloaded the Active10 app and 74% (14/19) continued using it at 3-months, averaging 27-minutes brisk walking/day according to Active10 weekly screenshots. Comments included: "Brilliant app", "Really motivates me". Mean BP was 130/81mmHg at booking and 124/80mmHg at 3-months follow-up. ConclusionsThe Active10 app was acceptable to postnatal women after HDP and may have increased minutes of brisk walking. A future trial could explore whether this simple, low-cost intervention could reduce long-term BP in this vulnerable group.

BACKGROUND:Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS:We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS:From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations. CONCLUSIONS:Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.

This letter to the editor is on the original article by Heydenrijk‐Kikkert et al. on pages 1493–1500 of this issue.