Family Medicine and Community Health最新文献

Objective: Predictors of prognosis are necessary for use in routine clinical practice for older patients with pneumonia, given the ageing of the population. Recently, the National Early Warning Score (NEWS), a comprehensive predictor of severity that consists solely of physiological indicators, has been proposed to predict the prognosis of pneumonia. The neutrophil/lymphocyte ratio (NLR) is a simple index of inflammation that may also be predictive of pneumonia. In the present study, we aimed to determine whether NEWS or a combination of NEWS and NLR predicts mortality in older patients with pneumonia.

Design: A retrospective cohort study.

Setting: A general hospital in Japan.

Participants: We collected data from patients aged ≥65 years with pneumonia who were admitted between 2018 and 2020 (n=282; age=85.3 (7.9)). Data regarding vital signs, demographics and the length of hospital stay, in addition to the NEWS and NLR, were extracted from the participants' electronic medical records.

Intervention: The utility of the combination of NEWS and NLR was assessed using NEWS×NLR and NEWS+NLR.

Main outcome measures: Their predictive ability for 30-day mortality as the primary outcome was assessed using receiver operating characteristic (ROC) curve analysis.

Results: According to the NEWS classification, 80 (28.3%), 64 (22.7%) and 138 (48.9%) of the participants were at low, medium and high risk of mortality, respectively. The 30-day mortality for the entire cohort was 9.2% (n=26), and the mortality rate increased with the NEWS classification: low, 1.3%; medium, 7.8%; and high, 14.5%. The NLRs were 6.0 (4.2-9.8), 6.8 (4.8-10.4) and 14.6 (9.4-22.2), respectively (p<0.001). The areas under the ROC curves for 30-day mortality were 0.73 for the NEWS score, 0.84 for NEWS×NLR and 0.83 for NEWS+NLR, indicating that the combinations represent superior predictors of mortality to the NEWS alone. NEWS×NLR and NEWS+NLR tended to have better sensitivity, accuracy, positive predictive value and negative predictive value than NEWS alone (p=0.06).

Conclusions: A combination of the NEWS and NLR (NEWS×NLR or NEWS+NLR) may be superior to the NEWS alone for the prediction of 30-day mortality in older patients with pneumonia. However, further validation of these combinations for use in the prediction of prognosis is required.

Family physicians provide comprehensive care for the community and are an integral part of the healthcare system. Canada is experiencing a shortage of family physicians, driven in part by overbearing expectations of family physicians, limited support and resources, antiquated physician compensation, and high clinic operating costs. An additional factor contributing to this scarcity is the shortage of medical school and family medicine residency spots, which have not kept pace with population demand. We analysed and compared data on provincial populations and numbers of physicians, residency spots and medical school seats across Canada. Family physician shortages are the highest in the territories (>55%), Quebec (21.5%) and British Columbia (17.7%). Among the provinces, Ontario, Manitoba, Saskatchewan and British Columbia have the fewest family physicians per 100 000 persons in the population. Among the provinces that offer medical education, British Columbia and Ontario have the fewest medical school seats per population, while Quebec has the most. British Columbia has the smallest medical class size and the least number of family medicine residency spots as a function of population, and one of the highest percentages of provincial residents without family doctors. Paradoxically, Quebec has a relatively large medical class size and a high number of family medicine residency spots as a function of population, but also one of the highest percentages of provincial residents without family doctors. Possible strategies to improve the current shortage include encouraging Canadian medical students and international medical graduates to consider family medicine, and reducing administrative burdens for current physicians. Other steps include creating a national data framework, understanding physician needs to guide effective policy changes, increasing seats in medical schools and family residency programmes, providing financial incentives and facilitating entry into family medicine for international medical graduates.

Introduction: Country of birth/nativity information may be crucial to understanding health equity in Latino populations and is routinely called for in health services literature assessing cardiovascular disease and risk, but is not thought to co-occur with longitudinal, objective health information such as that found in electronic health records (EHRs).

Methods: We used a multistate network of community health centres to describe the extent to which country of birth is recorded in EHRs in Latinos, and to describe demographic features and cardiovascular risk profiles by country of birth. We compared geographical/demographic/clinical characteristics, from 2012 to 2020 (9 years of data), of 914 495 Latinos recorded as US-born, non-US-born and without a country of birth recorded. We also described the state in which these data were collected.

Results: Country of birth was collected for 127 138 Latinos in 782 clinics in 22 states. Compared with those with a country of birth recorded, Latinos without this record were more often uninsured and less often preferred Spanish. While covariate adjusted prevalence of heart disease and risk factors were similar between the three groups, when results were disaggregated to five specific Latin countries (Mexico, Guatemala, Dominican Republic, Cuba, El Salvador), significant variation was observed, especially in diabetes, hypertension and hyperlipidaemia.

Conclusions: In a multistate network, thousands of non-US-born, US-born and patients without a country of birth recorded had differing demographic characteristics, but clinical variation was not observed until data was disaggregated into specific country of origin. State policies that enhance the safety of immigrant populations may enhance the collection of health equity related data. Rigorous and effective health equity research using Latino country of birth information paired with longitudinal healthcare information found in EHRs might have significant potential for aiding clinical and public health practice, but it depends on increased, widespread and accurate availability of this information, co-occurring with other robust demographic and clinical data nativity.

Universal access to health information is a human right and essential to achieving universal health coverage and the other health-related targets of the sustainable development goals. The COVID-19 pandemic has further highlighted the importance of trustworthy sources of health information that are accessible to all people, easily understood and acted on. WHO has developed Your life, your health: Tips and information for health and wellbeing, as a new digital resource for the general public which makes trustworthy health information understandable, accessible and actionable. It provides basic information on important topics, skills and rights related to health and well-being. For those who want to learn more, in-depth information can be accessed through links to WHO videos, infographics and fact sheets. Towards ensuring access to universal health information, this resource was developed using a structured method to: (1) synthesise evidence-based guidance, prioritising public-oriented content, including related rights and skills; (2) develop messages and graphics to be accessible, understandable and actionable for all people based on health literacy principles; (3) engage with experts and other stakeholders to refine messages and message delivery; (4) build a digital resource and test content to obtain feedback from a range of potential users and (5) adapt and co-develop the resource based on feedback and new evidence going forward. As with all WHO global information resources, Your life, your health can be adapted to different contexts. We invite feedback on how the resource can be used, refined and further co-developed to meet people's health information needs.

Objective: There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk.

Design: A retrospective cross-sectional study.

Setting: Data from the Canadian Longitudinal Study on Aging (CLSA).

Participants: 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA.

Results: CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk.

Conclusions: Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.

Objective: We performed a segmentation analysis of the unvaccinated adult US population to identify sociodemographic and psychographic characteristics of those who were vaccine accepting, vaccine unsure and vaccine averse.

Design: Cross-sectional.

Setting: Nationally representative, web-based survey.

Participants: 211 303 participants aged ≥18 years were asked in the Household Pulse Survey conducted during 1 December 2021 to 7 February 2022, whether they had ever received a COVID-19 vaccine. Those answering 'No' were asked their receptivity to the vaccine and their responses were categorised as vaccine averse, unsure and accepting. Adjusted prevalence ratios (APR) were calculated in separate multivariable Poisson regression models to evaluate the correlation of the three vaccine dispositions.

Results: Overall, 15.2% of US adults were unvaccinated during 1 December 2021 to 7 February 2022, ranging from 5.8% in District of Columbia to 29.0% in Wyoming. Of the entire unvaccinated population nationwide, 51.0% were vaccine averse, 35.0% vaccine unsure and 14.0% vaccine accepting. The likelihood of vaccine aversion was higher among those self-employed (APR=1.11, 95% CI 1.02 to 1.22) or working in a private company (APR=1.09, 95% CI 1.01 to 1.17) than those unemployed; living in a detached, single-family house than in a multiunit apartment (APR=1.15, 95% CI 1.04 to 1.26); and insured by Veterans Affairs/Tricare than uninsured (APR=1.22, 95% CI 1.01 to 1.47). Reasons for having not yet received a vaccine differed among those vaccine accepting, unsure and averse. The percentage reporting logistical or access-related barriers to getting a vaccine (eg, difficulty getting a vaccine, or perceived cost of the vaccine) was relatively higher than those vaccine accepting. Those vaccine unsure reported the highest prevalence of barriers related to perceived safety/effectiveness, including wanting to 'wait and see' if the vaccines were safe (45.2%) and uncertainty whether the vaccines would be effective in protecting them from COVID-19 (29.6%). Those vaccine averse reported the highest prevalence for barriers pertaining to lack of trust in the government or in the vaccines (50.1% and 57.5% respectively), the perception that COVID-19 was not that big of a threat (32.2%) and the perception that they did not need a vaccine (42.3%).

Conclusions: The unvaccinated segment of the population is not a monolith, and a substantial segment may still get vaccinated if constraining factors are adequately addressed.

Negotiating a resource package as a potential new department chair is common practice in academic medicine. The foundations for this negotiation include the historical presence of the department in relation to the broader institution, projections for future growth, accounting for mission/vision, resource needs (space, personnel, finances, etc), faculty and staff development, and external partnerships within and outside the institution. Despite similarities in this process across departments, many nuances influence the development of a specific new chair package, such as, department size; desires, perspectives and talents of the incoming chair, the department faculty, the medical school and dean; prevailing agendas and mission imperatives; and the overall priorities of the institution. With strategy and forethought, a new chair package can promote a successful chair tenure and departmental growth. Assembled through the Association of Departments of Family Medicine with input from several dozen department chairs and senior leaders, this is intended to serve as a practical guide to new chair packages for chair candidates.

Given the increase in pornography use among adolescents over the years, we discuss the impact of its use on sexual health development as well as the role of primary care providers (PCPs) in assessing use and providing sexual health education. While pornography use is often viewed negatively, it is important to develop unbiased understanding of the use in order to provide non-judgemental, adolescent-focused and educational care. As PCPs are often the first point of contact when adolescents experience medical and behavioural health concerns, it is essential for them to be equipped to screen for pornography use effectively, create a confidential and comfortable environment to talk about pornography use and sexuality, and be informed of ways to promote open discussion between youth and parents. In addition to PCP involvement, parental collaboration, knowledge and comfortability with discussing pornography use with their child are powerful tools in understanding and navigating pornography use in this population. This special communication seeks to provide an objective view of adolescents' pornography use, guidelines for screening of pornography use and ways to facilitate conversations about the use between adolescents and caregivers.

Objective: Artificial intelligence (AI) will have a significant impact on healthcare over the coming decade. At the same time, health inequity remains one of the biggest challenges. Primary care is both a driver and a mitigator of health inequities and with AI gaining traction in primary care, there is a need for a holistic understanding of how AI affect health inequities, through the act of providing care and through potential system effects. This paper presents a systematic scoping review of the ways AI implementation in primary care may impact health inequity.

Design: Following a systematic scoping review approach, we searched for literature related to AI, health inequity, and implementation challenges of AI in primary care. In addition, articles from primary exploratory searches were added, and through reference screening.The results were thematically summarised and used to produce both a narrative and conceptual model for the mechanisms by which social determinants of health and AI in primary care could interact to either improve or worsen health inequities.Two public advisors were involved in the review process.

Eligibility criteria: Peer-reviewed publications and grey literature in English and Scandinavian languages.

Information sources: PubMed, SCOPUS and JSTOR.

Results: A total of 1529 publications were identified, of which 86 met the inclusion criteria. The findings were summarised under six different domains, covering both positive and negative effects: (1) access, (2) trust, (3) dehumanisation, (4) agency for self-care, (5) algorithmic bias and (6) external effects. The five first domains cover aspects of the interface between the patient and the primary care system, while the last domain covers care system-wide and societal effects of AI in primary care. A graphical model has been produced to illustrate this. Community involvement throughout the whole process of designing and implementing of AI in primary care was a common suggestion to mitigate the potential negative effects of AI.

Conclusion: AI has the potential to affect health inequities through a multitude of ways, both directly in the patient consultation and through transformative system effects. This review summarises these effects from a system tive and provides a base for future research into responsible implementation.