Family practice最新文献

Background: Invasive meningococcal disease (IMD) is a severe infectious disease. Although effective preventive and therapeutical strategies are available, the fatality rate remains high in the general population, with an occurrence of meningococcal-related severe sequelae involving 10-20% of survivors. Given the crucial role of general practitioners in recognizing and preventing IMD and its related sequelae, we aim to assess the burden of these conditions in primary care.

Methods: Using an Italian primary care database, the incidence rate of IMD was calculated in the period 2000-2019 by capturing the first diagnosis registered during follow-up. As far as meningococcal-related sequelae are concerned, we identified and clinically evaluated each potential sequela during the first 3 months, from 3 to 12 months, and up to 36 months.

Results: Among 508 patients diagnosed with IMD, 403 (incidence rate: 0.24 per 10,000 person-years) comprised those diagnosed with IMD in patients aged 15 years or older. We ascertained 104 sequelae (20.4%); 76% of them occurred in those aged 25 or older; 42, 27, and 35 were assessed as short-, medium-, or long-term sequelae, respectively. Overall, 4.7% of IMD patients reported physical sequelae, while 12.2% and 5.7% of patients reported neurological and psychological sequelae, respectively.

Conclusion: Our study showed that a substantial proportion of IMD and related sequelae occur in individuals aged over 25, with a non-negligible burden for healthcare systems. As for the paediatric population, effective communication on the relevance of meningococcal vaccination in adults should be proficiently fostered.

Purpose: There is limited evidence about whether a substance use disorder (SUD) is a barrier to breast cancer screening. Because SUDs are highly prevalent in the USA, it is important to establish whether this patient population is less likely to obtain screening.

Methods: This retrospective cohort study included 220 227 patients, with 209 132 having no SUD and 11 095 (5.0%) with SUD based on electronic health record data in a multi-state, Midwestern healthcare system (1 January 2018-31 December 2022). The outcome was the receipt of a mammogram in the 5-year follow-up period. Patients were women aged 40-69 years as of 1 January 2018, with ≥ 2 in-person primary care visits between 2018 and 2022. Covariates included demographics, health services utilization, and physical/psychiatric conditions.

Results: Mean age of the sample was 54.7 (± 8.3) years old. After controlling for confounding, women without any SUDs had more than twice the odds of mammogram receipt compared to those with stimulant use disorder (odds ratio [OR] 2.06; 95% confidence interval [CI]: 1.83-2.33). Women with no SUDs had 89% higher odds of mammogram receipt compared to those with opioid use disorder (OR 1.89; 95% CI: 1.76-2.03), followed by "other" SUDs (OR 1.86; 95% CI: 1.69-2.06), sedative use (OR 1.70; 95% CI: 1.43-2.04), cannabis use (OR 1.58; 95% CI: 1.44-1.74), and alcohol use disorders (OR 1.49; 95% CI: 1.41-1.58).

Conclusions: Despite the high prevalence of SUDs, evidence of preventive service delivery among individuals with SUDs is still lacking. Further research is needed to investigate other healthcare disparities in preventive service delivery among individuals with SUDs.

Objective: This study aimed to examine the effects of father involvement on father-infant bonding, postpartum depression in mothers, and quality of life.

Materials and methods: The research involved randomized, controlled experimental design and was conducted from September 2021 to June 2023 with 63 mothers and fathers (31 in the experimental group and 32 in the control group). Fathers in the experimental group were given infant care training within the first 1-4 h after birth. The fathers were called with telephone in the 2nd, 3rd, 4th, 8th, and 12th weeks and participation in infant care was monitored. Data were collected using Personal Information Forms for Mother-Father, Baby Care Participation Chart, the Father-Infant Attachment Scale (FIAS), the Edinburgh Postpartum Depression Scale (EPDS), and the Maternal-Postpartum Quality of Life Scale (MPQOLS). Data analysis was done with SPSS and t-test, Mann-Whitney U, and Cohen's d were used.

Results: Fathers in the experimental group displayed significantly higher mean FIAS scores (83.79 ± 5.89) and subscales compared to those in the control group (P < .05). Mothers in the experimental group exhibited lower mean EPDS scores in the 4th, 8th, and 12th weeks (2.74 ± 2.07; 1.71 ± 3.51; 1.71 ± 3.43), along with higher MPQOLS mean scores (26.46 ± 2.11; 27.62 ± 1.55; 27.83 ± 1.41), as compared to the control group, with these differences being statistically significant (P < .05).

Conclusion: Father involvement strengthens father-infant bonding, reduces maternal postnatal depression risk, and improves postnatal quality of life. Healthcare providers, in postpartum care settings, could integrate father-focused education and support into routine care protocols.

Clinical trial registration: This study was prospectively registered at NCT05588089.

Background: Postpartum depression is experienced by approximately 10% of women and affects the health and development of their children. Although it is recommended that all mothers have the opportunity for early detection and intervention for postpartum depression, it is unclear whether early postpartum check-ups help to reduce postpartum depression.

Objective: The aim of this study was to assess the effect of 2-week postpartum check-ups on screening positive for postpartum depression in Japan.

Methods: This was a population-based cohort study that used the administrative database of Tsuyama, Japan. Participants were women who received postpartum home visits from a public health nurse in Tsuyama during the fiscal years 2017-2019. Data were obtained on participant's attendance at a 2-week postpartum check-up and their responses on the Edinburgh Postpartum Depression Scale. Owing to the initiation of a publicly funded postpartum check-up programme, participants were pseudo-randomly assigned to receive/not receive a 2-week postpartum check-up. We conducted instrumental variable estimation to assess the causal effects of the check-up on screening positive for postpartum depression.

Results: The characteristics of the 1,382 participants did not differ by fiscal year of childbirth. We found a 6.7% (95% confidence interval 2.2-11.2) reduction in the prevalence of screening positive for postpartum depression as an effect of 2-week postpartum check-ups among women received 1-month postpartum home visits.

Conclusion: The results suggest that 2-week postpartum check-ups are effective in reducing the prevalence of screening positive for postpartum depression among 1-month postpartum women. Despite some limitations, early postpartum care could reduce postpartum depression.

Background: Defensive medicine, characterized by the avoidance of high-risk patients or the overuse of diagnostic and therapeutic interventions due to fear of litigation or complaints, poses significant challenges in primary care. Existing scales primarily focus on hospital settings, limiting their applicability to family physicians. This study aimed to develop and validate a scale tailored to measure defensive medicine behaviors in primary care contexts.

Methods: Scale development involved reviewing the literature, conducting focus group discussions with family physicians, and consulting with experts. An initial 37-item draft was pilot-tested for clarity, resulting in a refined instrument. Data were collected from family physicians in two phases: exploratory factor analysis (EFA) with 252 participants and confirmatory factor analysis with 266 participants. Criterion validity was assessed by correlating the new scale with a previously validated defensive medicine scale. Reliability was evaluated using Cronbach's alpha and McDonald's omega.

Results: EFA supported a five-factor structure: referral, complaint, e-report, verbal/physical violence, and interventional procedure dimensions. After item removal, the final 21-item scale demonstrated acceptable goodness-of-fit indices (χ²/df = 2.43, root mean square error of approximation (RMSEA) = 0.07, comparative-fit index (CFI) = 0.93). Criterion validity was evidenced by a moderate positive correlation (r = 0.350, P < .01) with an existing scale. Internal consistency was high, with both Cronbach's alpha and McDonald's omega at 0.92 for the total scale.

Conclusions: The Primary Care Defensive Medicine Practices Scale is a valid and reliable instrument specifically tailored for primary care settings. It offers a more nuanced understanding of defensive behaviors, guiding targeted interventions to enhance care quality, patient safety, and resource utilization.

Purpose: Japan has insufficient palliative care specialists, so there are calls for a palliative care consultation system to aid primary care physicians. Community-based palliative care may require clarification on the division of tasks and responsibilities. Primary care physicians' needs specific to palliative care are also ambiguous. We therefore aimed to elucidate the consultation needs of primary care physicians particular to palliative care in Japan.

Methods: This analysis of a nationwide observational study was conducted between December 2023 and January 2024. We sent questionnaires to 1,100 Japanese board-certified primary care physicians based on the Palliative Care Difficulties Scale (range: 1-4). Comparisons were made by unpaired Student's t test and with a multivariate linear regression model according to workplace type (clinics and hospitals).

Results: We obtained 548 replies (response rate: 50%), of which 540 had analyzable data. Primary care physicians in clinics required less consultation than those in hospitals on the choice of medication (P = .019), opioids switching (P = .018), prognosis estimates (P < .001), decision support (P = .016), and grief care (P = .009). Those in clinics were less likely to have palliative care support from non-physician palliative care specialists (P < .001) and information support (P = .003). In multivariable analysis, being a clinic-based physician was inversely associated with the functioning of a decision-making support counseling system (R2 = 0.527).

Conclusions: The specific consultation needs of primary care physicians in Japan specific to palliative care differ by workplace. Our data suggest the need for clear national-level supporting guidelines and training toward primary care physicians' involvement in palliative care and individualized end-of-life management.UMIN trial ID: UMIN000054985.

Background: Shoulder pain is common amongst adults, but little is known about patients' preferences.

Objective: The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care.

Methods: A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model.

Results: Three hundred and twelve participants completed the questionnaire with mean age of 52 ± 15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again.

Conclusion: This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before.

Background: There is a lack of evidence regarding the trajectories of type 2 diabetes until the first clinic visit, including the untreated period after diagnosis.

Objective: We aimed to determine the real-world history of type 2 diabetes until the first clinic visit, including the untreated duration, and to assess the effective timing of the therapeutic intervention.

Methods: A total of 23,622 nondiabetic Japanese workers with a mean (SD) age of 38.8 (11.5) years were retrospectively followed from 2008 to 2022 for annual health checkups. The trajectories of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body mass index (BMI) until the first clinic visit in diabetes individuals were determined. ROC analysis was performed to assess the contribution of each measure to the first visit.

Results: During a median follow-up of 12.0 years, 1,725 individuals developed type 2 diabetes, of whom 532 individuals visited clinics. HbA1c and FPG trajectories steeply rose in the year before the first clinic visit after their progressive upward trends. ROC analysis showed cutoff values for each measure. As the untreated duration increased, glycemia increased and BMI decreased among individuals who visited clinics.

Conclusions: To prevent the initial worsening of diabetes, early therapeutic intervention is necessary during the increasing trends before the steep rise in glycemia, regardless of the degree of obesity. HbA1c ≥6.5% (47.5 mmol/mol) and an HbA1c ≥0.2% (2.2 mmol/mol)/year increase may be an effective timing for therapeutic intervention.

Background: Multiple studies have shown that physical activity improves cancer survivorship, by decreasing risk of second primary cancers and chronic conditions. However, cancer survivor physical activity levels remain low. General practice presents more opportunities for lifestyle interventions, such as increasing physical activity. We conducted a realist review of physical activity interventions relevant to general practice.

Methods: A total of 9728 studies were obtained from a systematic search of the CINAHL, Embase, PsycINFO, PubMed, and SPORTDiscus databases from the inception of the electronic database to 21 June 2024. We focussed on intervention studies that improved physical activity among cancer survivors and were relevant to general practice. Data extraction focussed on: what makes physical activity interventions effective for cancer survivors (what works) and what factors promote physical activity for cancer survivors (for whom it works).

Results: Thirty-seven studies were used to generate themes on the components of physical activity interventions that are likely to work and for whom; these studies facilitated goal setting, action planning, self-monitoring, social support, and shaping of knowledge; through delivering tailored motivational support, evoking a teachable moment, and promoting the use of self-monitoring tools. Interventions that were cost-effective and easily implementable improved sustainability, deployability, and uptake by cancer survivors. Cancer survivor psychological and physical factors, such as baseline motivational levels and post-treatment symptoms, influenced the uptake of physical activity interventions.

Conclusion: Our realist review has highlighted opportunities for general practices to promote physical activity among cancer survivors through collaborative goal setting, action planning, self-monitoring, social support, and shaping of knowledge.

Background: The University of New Mexico School of Medicine established the combined baccalaureate/medical degree (BA/MD) program in response to critical physician shortages in New Mexico (NM). This 8-year program aims to improve health care in NM by expanding access to medical education for local students, particularly from rural and underserved communities and/or racial/ethnically underrepresented in medicine (URiM) in NM.

Objectives: To describe the BA/MD program's initial design, the impact of improvements on retention, and the outcomes in terms of physicians in practice, particularly in primary care specialties.

Methods: The study reviews the BA/MD program's progress from 2006 to 2023, focusing on curriculum and support enhancements. Retention rates and choice of primary care specialties were analyzed by geographic origin and racial/ethnic background.

Results: From 2006 to 2023, the program graduated 81 physicians, with 53 practicing in 10 of NM's 33 counties. Approximately two-thirds specialize in primary care, and a similar proportion are URiM. Students from 31 of NM's 33 counties were admitted, with two-thirds coming from outside the state's metropolitan area. Overall retention and retention across demographic groups improved significantly in the baccalaureate phase of the program due to changes in curriculum and support services.

Conclusions: The program has effectively addressed physician shortages in NM, particularly in rural and underserved areas. Its success in training and retaining physicians from diverse backgrounds, with a focus on primary care, is crucial for improving health care access in the state. Ongoing improvements in the program are essential to sustaining and enhancing these outcomes.