Annals of Family Medicine最新文献

Family medicine is well-established in Israel and serves as the foundation of the Israeli health care system. On October 7, 2023, Israel experienced a profound shock and trauma when over 1,200 Israelis, including Jews, Christians, and Muslims of all ages, were brutally murdered, tortured, raped, burned alive, or taken hostage by Hamas terrorists from Gaza. This essay provides a contextual view from the vantage point of an Israeli family physician. It touches on the horror of the conflict while proposing that family physicians can stand as beacons of hope, offering healing and solace to all in need.Annals Early Access article.

Wars and conflicts appear to be a fact of life for populations across the globe, often in places where family medicine functions as the backbone of the health care system. In these situations, family physicians are frequently called on to serve in expanded roles and are witnesses to the enormous mental and physical suffering of individuals, families, communities, and populations. This article examines the lessons family medicine can learn from current wars and other terrible conflagrations.Annals Early Access article.

Providing care for families under occupation has always been marked by scarce resources and too many patients. The current war in Gaza has dramatically worsened conditions in the Occupied Territories of Palestine (OTP). A family physician and her team in the southern West Bank describe their own challenges and give voice to the physicians in the OTP they interviewed to better understand the professional and personal challenges of living and working during the uncertainty of war.Annals Early Access article.

This study investigates the well-being, resilience, and burnout of health care personnel treating evacuees with severe trauma following a major terrorist attack in southern Israel on October 7, 2023. Longitudinal trends and factors influencing personnel's emotional states are explored. Questionnaires from 129 health care personnel recruited from primary care clinics, including those serving evacuees exclusively, revealed significant correlations of self-efficacy and well-being with gender and religiosity, impacting burnout levels. Professional experience and exposure to traumatized evacuees were also linked to well-being. This research addresses a crucial gap in understanding personnel's emotional resilience and guiding interventions to enhance personnel well-being and improve patient care quality.Annals Early Access article.

Direct primary care (DPC) is a model of health care delivery that relies on membership fees for service; however, it has been criticized as potentially worsening the shortage of primary care physicians. We sought to compare the distribution of DPC practices in the United States to that of non-DPC primary care and assess the overlap with Health Resources and Services Administration designated health professional shortage areas (HPSAs). We mined data from publicly available sources on DPC practices, HPSAs, and other primary care physicians. We stratified analyses by degree of rurality and HPSA priority need scores. We found that DPC practices were less likely to be in HPSAs overall and less likely to be in a high-priority-need HPSA but more likely to be in a rural or partially rural HPSA compared to primary care physicians. There is ample opportunity to grow DPC presence in many HPSAs that remain underserved, especially high-priority HPSAs in urban areas.

Purpose: For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.

Methods: We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.

Results: A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (P < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.

Conclusions: For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.

Purpose: Infection with HIV remains a global health challenge, with >36.9 million individuals living with HIV in 2017. Despite efforts to increase HIV testing and treatment, traditional services have not effectively reached marginalized communities. The use of HIV self-testing (HIVST) offers a discreet and accessible alternative, potentially improving testing rates among at-risk populations including university students in Kenya.

Methods: We performed a cross-sectional analytical study using a multistage cluster sampling technique among undergraduate students at Kenyatta University. Clusters from various academic departments were randomly selected, and individual students were chosen for participation. Ethical approval was obtained from the Kenyatta University Ethics Review Committee and the National Commission for Science, Technology and Innovation. Participants were informed of the study's aims and their right to withdraw at any time. We collected data via questionnaires administered by trained enumerators.

Results: Participants' age averaged 21.1 years, with a majority being single, female, and full-time students. Substantial HIV knowledge was observed, and nearly one-half were aware of preexposure prophylaxis. Facility-based testing was prevalent, with significant preference for the OraQuick self-test kit among those who self-tested. Fear of positive results and stigma were primary barriers, whereas motivations for self-testing included routine use and protecting loved ones. Media exposure, especially the "Chukua Selfie" campaign, correlated with greater HIVST usage.

Conclusions: This study highlights the importance of school-based interventions and the critical role of academic institution support in HIV prevention. Participants' substantial knowledge of HIV contrasts with findings from other regions, underscoring the need for targeted education and safe-sex promotion. Addressing fear and stigma via comprehensive interventions is essential for improving HIVST uptake. Integrating HIVST into existing prevention programs can enhance HIV care frameworks in East Africa. Strategies to destigmatize HIV, ensure privacy in testing, and address misconceptions are vital for improving health outcomes among young individuals. Continuous efforts to strengthen self-testing programs are crucial to achieving global HIV targets.

Purpose: Efforts during the COVID-19 pandemic to address the health-related social needs (HRSN) of Medicare and Medicaid beneficiaries, such as food and housing, were insufficient. We examined HRSN data from the Accountable Health Communities study collected in Oregon to understand changes in these needs at the onset and during the first 2 years of the pandemic.

Methods: We conducted an interrupted time series analysis with data from 21,522 Medicare and Medicaid beneficiaries screened for overall HRSN between May 13, 2019 and December 24, 2021. Secondary interrupted time series analyses were conducted for each type of HRSN assessed with the Accountable Health Communities screening tool: food, housing, transportation, utilities, and interpersonal safety.

Results: The interrupted time series analysis indicated an abrupt 17.7-percentage point increase in overall HRSN around March 23, 2020, which did not significantly decline during the subsequent 2 years. Food, housing, and interpersonal safety needs increased by 16.5, 15.9, and 4.4 percentage points, respectively, with no significant decline thereafter. Transportation and utility needs increased by 7.2 and 7.5 percentage points, respectively, but decreased significantly after the start of the pandemic (decreasing by 0.2 and 0.1 percentage points each week, respectively).

Conclusions: The jump in HRSN following the start of the pandemic and the persistence of need, particularly in food and housing, highlight the importance of research to better understand which public health and health care interventions, investments, and policies effectively address HRSN.