Family Medicine and Community Health最新文献

{"title":"Changes in family situation and concurrent changes in working life: a 15-year longitudinal analysis","authors":"Mo Wang, Pia Svedberg, Jurgita Narusyte, Annina Ropponen","doi":"10.1136/fmch-2023-002438","DOIUrl":"https://doi.org/10.1136/fmch-2023-002438","url":null,"abstract":"Objective Currently, little is known regarding changes in family situation with concurrent changes in working life. This study aimed to examine whether changes in family situation (based on living with children and/or marrying/divorcing) were associated with changes in working life and whether the associations were influenced by sex, genetics and early life environment. Design Prospective cohort study. Setting and participants Data from Swedish national registers of 16 410 twins were used. Fixed-effects logistic regression models assessing ORs with 95% CIs were applied to examine associations between changes in family situation and working life controlling for time-invariant effects and adjusted for covariates, and conditional models to account for confounding of genetics and early life environment. Results Changes in individuals life situation from being single and living without children to married and living with children were associated with transitioning from unsustainable (ie, having unemployment or sickness absence/disability pension) to sustainable working life (men: OR 2.40, 95% CI 2.26 to 2.56; women: OR 1.68, 95% CI 1.59 to 1.78). Changes from being married to single, in contrast, attenuated the likelihood of transitioning to a sustainable working life. Moreover, changes in men’s working life seem to be more dependent on changes in family situation compared with women. Genetic factors and early life environment play a role in the associations. Conclusions Family formation increases the likelihood of a more stable working life whereas divorce is a risk factor for work interruptions. Our study emphasises that family formation improves the work life situation and to a higher degree for men. Data may be obtained from a third party and are not publicly available.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forward from the Editor-in-Chief","authors":"Li Li","doi":"10.1136/fmch-2024-002868","DOIUrl":"https://doi.org/10.1136/fmch-2024-002868","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine VIII: clinical approaches","authors":"W. Ventres, Leslie A Stone, Lauren E Gibson-Oliver, Elizabeth Kyle Meehan, Mari A Ricker, David Loxterkamp, Stacy A. Ogbeide, Frank V. deGruy, Megan R Mahoney, Steven Lin, Clare MacRae, Stewart W Mercer","doi":"10.1136/fmch-2024-002795","DOIUrl":"https://doi.org/10.1136/fmch-2024-002795","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘VIII: clinical approaches’, authors address the following themes: ‘Evaluation, diagnosis and management I—toward a working diagnosis’, ‘Evaluation, diagnosis and management II—process steps’, ‘Interweaving integrative medicine and family medicine’, ‘Halfway—the art of clinical judgment’, ‘Seamless integration in family medicine—team-based care’, ‘Technology—uncovering stories from noise’ and ‘Caring for patients with multiple long-term conditions’. May readers recognise in these essays the uniqueness of a family medicine approach to care.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of conscious AI in primary healthcare.","authors":"Dorsai Ranjbari, Samira Abbasgholizadeh Rahimi","doi":"10.1136/fmch-2023-002625","DOIUrl":"10.1136/fmch-2023-002625","url":null,"abstract":"<p><p>The conversation about consciousness of artificial intelligence (AI) is an ongoing topic since 1950s. Despite the numerous applications of AI identified in healthcare and primary healthcare, little is known about how a conscious AI would reshape its use in this domain. While there is a wide range of ideas as to whether AI can or cannot possess consciousness, a prevailing theme in all arguments is uncertainty. Given this uncertainty and the high stakes associated with the use of AI in primary healthcare, it is imperative to be prepared for all scenarios including conscious AI systems being used for medical diagnosis, shared decision-making and resource management in the future. This commentary serves as an overview of some of the pertinent evidence supporting the use of AI in primary healthcare and proposes ideas as to how consciousnesses of AI can support or further complicate these applications. Given the scarcity of evidence on the association between consciousness of AI and its current state of use in primary healthcare, our commentary identifies some directions for future research in this area including assessing patients', healthcare workers' and policy-makers' attitudes towards consciousness of AI systems in primary healthcare settings.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care providers practice patterns regarding female pelvic floor disorders.","authors":"Anna Weimer, Jennifer L Hallock, Chi Chiung Grace Chen","doi":"10.1136/fmch-2023-002448","DOIUrl":"10.1136/fmch-2023-002448","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary care providers (PCPs) have a unique opportunity to increase treatment and provide appropriate referrals for these patients.</p><p><strong>Methods: </strong>An online survey was administered to PCPs to assess provider practices, knowledge, comfort managing and ease of referral for PFDs. Logistic regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest: discomfort with management and difficulty with referral of PFDs.</p><p><strong>Results: </strong>Of the 153 respondents to the survey, more felt comfortable managing stress urinary incontinence (SUI) and overactive bladder (OAB), compared with pelvic organ prolapse (POP) and faecal incontinence (FI) and were less likely to refer patients with urinary symptoms. Few providers elicited symptoms for POP and FI as compared with SUI and OAB. Provider variables that were significantly associated with discomfort with management varied by PFD, but tended to correlate with less exposure to PFDs (eg, those with fewer years of practice, and internal medicine and family physicians as compared with geriatricians); whereas the factors that were significantly associated with difficulty in referral, again varied by PFD, but were related to practice characteristics (eg, specialist network, type of practice, practice setting and quantity of patients).</p><p><strong>Conclusion: </strong>These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols, as well as collaboration with pelvic floor specialists to improve screening, treatment and referral for patients with PFDs.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twin studies as an innovative approach to address research questions in cancer care within primary care settings.","authors":"Monalisha Sahu","doi":"10.1136/fmch-2023-002623","DOIUrl":"10.1136/fmch-2023-002623","url":null,"abstract":"<p><p>This paper proposes the utilisation of twin studies as a novel and powerful methodological approach to investigate critical research questions pertaining to cancer prevention, screening, diagnosis, treatment and survivorship within primary care contexts. The inherent genetic similarity between monozygotic (MZ) (identical) twins provides a unique opportunity to disentangle genetic and environmental influences on cancer-related outcomes. MZ twins share virtually identical genetic makeup, offering a unique opportunity to discern the relative contributions of genetic and environmental factors to cancer-related outcomes. In contrast, dizygotic (DZ) twins, also known as fraternal twins, develop from two separate eggs fertilised by two different sperm and share on average 50% of their genetic material, the same level of genetic similarity found in non-twin siblings. Comparisons between MZ and DZ twins enable researchers to disentangle hereditary factors from shared environmental influences. This methodology has the potential to advance our understanding of the multifaceted interplay between genetic predisposition, lifestyle factors and healthcare interventions in the context of cancer care. This paper outlines the rationale, design considerations and potential applications of twin studies in primary care-based cancer research.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10862323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring conservative management for cervical intraepithelial neoplasia grade 2 in organised cervical cancer screening programmes: a multicentre study in Italy.","authors":"Silvia Gori, Helena Frayle, Alessio Pagan, Marika Soldà, Cesare Romagnolo, Egle Insacco, Licia Laurino, Mario Matteucci, Giuseppe Sordi, Enrico Busato, Manuel Zorzi, Tiziano Maggino, Annarosa Del Mistro","doi":"10.1136/fmch-2023-002595","DOIUrl":"10.1136/fmch-2023-002595","url":null,"abstract":"<p><p>Cervical intraepithelial neoplasia grade 2 (CIN2) lesions may regress spontaneously, offering an alternative to immediate treatment, especially for women of childbearing age (15-45 years).We conducted a prospective multicentre study on conservative CIN2 management, with semiannual follow-up visits over 24 months, biomarkers' investigation and treatment for progression to CIN3+ or CIN2 persistence for more than 12 months. Here, we assess women's willingness to participate and adherence to the study protocol.The study was set in population-based organised cervical cancer screening.From April 2019 to October 2021, 640 CIN2 cases were diagnosed in women aged 25-64 participating in the screening programmes.According to our predefined inclusion and exclusion criteria, 228 (35.6%) women were not eligible; 93 (22.6%) of the 412 eligible refused, and 319 (77.4%) were enrolled. Refusal for personal reasons (ie, desire to become pregnant, anxiety, difficulty in complying with the study protocol) and external barriers (ie, residence elsewhere and language problems) accounted for 71% and 17%, respectively. Only 9% expressed a preference for treatment. The primary ineligibility factor was the upper age limit of 45 years. After enrolment, 12 (4%) women without evidence of progression requested treatment, 125 (39%) were lost to follow-up (mostly after 6-12 months) and 182 (57%) remained compliant. Remarkably, 40% of enrolees did not fully adhere to the protocol, whereas only 5% (20/412) of the eligible women desired treatment.Our study demonstrates a good acceptance of conservative management for CIN2 lesions by the women, supporting its implementation within cervical screening programmes.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10840026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system","authors":"John Kevin Ong Dayao, Caroline E L Duffy, Amalia M Cristiano, Gene 'Rusty' Kallenberg, Sarah E Linke","doi":"10.1136/fmch-2023-002608","DOIUrl":"https://doi.org/10.1136/fmch-2023-002608","url":null,"abstract":"Objective Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data. Design This study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives. Setting Five primary care clinics within a large academic health system. Participants A total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews. Results Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%. Conclusion Overall, this study established EIM’s feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits. All data relevant to the study are included in the article or uploaded as supplemental information.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139665957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential applications and implications of large language models in primary care.","authors":"Albert Andrew","doi":"10.1136/fmch-2023-002602","DOIUrl":"10.1136/fmch-2023-002602","url":null,"abstract":"<p><p>The recent release of highly advanced generative artificial intelligence (AI) chatbots, including ChatGPT and Bard, which are powered by large language models (LLMs), has attracted growing mainstream interest over its diverse applications in clinical practice, including in health and healthcare. The potential applications of LLM-based programmes in the medical field range from assisting medical practitioners in improving their clinical decision-making and streamlining administrative paperwork to empowering patients to take charge of their own health. However, despite the broad range of benefits, the use of such AI tools also comes with several limitations and ethical concerns that warrant further consideration, encompassing issues related to privacy, data bias, and the accuracy and reliability of information generated by AI. The focus of prior research has primarily centred on the broad applications of LLMs in medicine. To the author's knowledge, this is, the first article that consolidates current and pertinent literature on LLMs to examine its potential in primary care. The objectives of this paper are not only to summarise the potential benefits, risks and challenges of using LLMs in primary care, but also to offer insights into considerations that primary care clinicians should take into account when deciding to adopt and integrate such technologies into their clinical practice.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Goal Attainment Scaling (GAS) in evaluating a multicomponent exercise programme for community-dwelling pre-frail older adults.","authors":"Juan Fang, Jianping Ren, Jinjing Wang, Xiantao Qiu, Shiyan Zhang, Shuang Yuan, Liangfeng Wu, Lin Xie, Le Yu","doi":"10.1136/fmch-2023-002410","DOIUrl":"10.1136/fmch-2023-002410","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the effectiveness of Goal Attainment Scaling (GAS) in assessing an intervention for pre-frail senior citizens. Additionally, the study aimed to explain how the GAS goals were established based on the International Classification of Functioning, Disability and Health (ICF) categories, including body function, activity and participation and environmental factors.</p><p><strong>Methods: </strong>In this study, 220 pre-frail older adults were randomly selected to participate in a controlled trial. The intervention group engaged in multicomponent exercise three times a week, once at a community health service location and twice at home. The control group received advice on physical activity but did not have supervised exercise. Participants in both groups selected individualised GAS goals from 23 goals developed based on ICF by focus group discussion. The study used generalised estimating equations to analyse the differences between the groups.</p><p><strong>Results: </strong>The study included 144 participants, 72 in the exercise group and 72 in the control group. The top three individualised goals for all participants were vestibular functions (53.5%), pain management (43.1%) and lifting and carrying objects (31.9%). Both groups saw a significant increase in GAS scores at week 8 and week 24 of the intervention (p<0.05), but the exercise group showed a more significant improvement (p<0.05). The participants living alone were associated with lower postintervention improvements in the GAS scores. In contrast, the participants who were using a smartphone were likely to get higher postintervention improvements in the GAS scores.</p><p><strong>Conclusions: </strong>GAS can be a valuable tool for setting and evaluating individualised and meaningful goals in body functions, activity and participation and environmental factors. The multicomponent exercise interventions can help pre-frail older adults achieve their expected goals as measured by the GAS.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10824033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}