Family Medicine and Community Health最新文献

{"title":"COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays.","authors":"Romain Lutaud, Sebastien Cortaredona, Lea Delorme, Patrick Peretti-Watel, Juliette Mirouse, Manon Borg, Lucie Cattaneo, Didier Thery, Gaetan Gentile, Christian Pradier, Touitou Irit, Philippe Brouqui, Sophie Tardieu, Michel Carles, Stéphanie Gentile","doi":"10.1136/fmch-2023-002447","DOIUrl":"10.1136/fmch-2023-002447","url":null,"abstract":"<p><strong>Objectives: </strong>To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes.</p><p><strong>Design: </strong>Cross-sectional online survey using life-event calendars.</p><p><strong>Setting: </strong>All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.</p><p><strong>Participants: </strong>312 patients responded to the survey.</p><p><strong>Main outcome measures: </strong>From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation.</p><p><strong>Results: </strong>Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.</p><p><strong>Conclusion and relevance: </strong>This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433052","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":"Assessing prognosis in depression: comparing perspectives of AI models, mental health professionals and the general public.","authors":"Zohar Elyoseph, Inbar Levkovich, Shiri Shinan-Altman","doi":"10.1136/fmch-2023-002583","DOIUrl":"10.1136/fmch-2023-002583","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives.</p><p><strong>Methods: </strong>Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression.</p><p><strong>Results: </strong>In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4.</p><p><strong>Conclusions: </strong>This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"12 Suppl 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418320","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":"Liver abnormalities following SARS-CoV-2 infection in children 1 to 10 years of age","authors":"Pauline Terebuh, Veronica R Olaker, Ellen K Kendall, David C Kaelber, Rong Xu, Pamela B Davis","doi":"10.1136/fmch-2023-002655","DOIUrl":"https://doi.org/10.1136/fmch-2023-002655","url":null,"abstract":"Objective Beginning in October 2021 in the USA and elsewhere, cases of severe paediatric hepatitis of unknown aetiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading aetiological suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. Design We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations. Results Compared with propensity score matched children with other respiratory infections, children aged 1–10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1–4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. Conclusion These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver. No data are available. We used a cloud-based database and cannot download the data set. In addition, the database is constantly being upgraded with new information, so the actual data from which the analysis was done will not be available at a subsequent time. That is why we indicate when the database was accessed and which specific data set was used. The EMR data are deidentified and so individual data cannot be made available to us or anyone else.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"10 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139556967","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":"Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: a national survey","authors":"Loai Albarqouni, Hannah Greenwood, Caroline Dowsett, Tammy Hoffmann, Rae Thomas, Paul Glasziou","doi":"10.1136/fmch-2023-002457","DOIUrl":"https://doi.org/10.1136/fmch-2023-002457","url":null,"abstract":"Background Many guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1) examine general practitioners’ (GPs’) knowledge, attitudes and practices for NDIs, including their use of the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI), and (2) identify factors influencing their use of NDIs and HANDI. Methods We conducted a web-based cross-sectional survey of practicing GP members in Australia during October–November 2022. The survey contained five sections: characteristics of GP; knowledge and use of NDIs; attitudes towards NDIs; barriers and enablers to using HANDI; and suggestions of NDIs and ideas to improve the uptake of NDIs in primary care. Results Of the 366 GPs who completed the survey, 242 (66%) were female, and 248 (74%) were ≥45 years old. One in three GPs reported that they regularly (‘always’) recommend NDIs to their patients when appropriate (34%), whereas one-third of GPs were unaware of HANDI (39%). GPs identified several factors that improve the uptake of HANDI, including ‘access and integration of HANDI in clinical practice’, ‘content and support to use in practice’ and ‘awareness and training’. Conclusions While many GPs are aware of the effectiveness of NDIs and often endorse their use, obstacles still prevent widespread adoption in primary care. The results of this survey can serve as a foundation for developing implementation strategies to improve the uptake of effective evidence-based NDIs in primary care. Data are available upon reasonable request. The authors had full access to all of the data in the study. Aggregated data that underlie the results reported in this article are available on request to the corresponding author.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"20 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412396","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":"Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention.","authors":"Priyanka Sharma, Divya Khanna, Satyajit Pradhan, Praveen Birur","doi":"10.1136/fmch-2023-002397","DOIUrl":"10.1136/fmch-2023-002397","url":null,"abstract":"<p><strong>Objective: </strong>Despite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for oral, breast and cervical cancer prevention in a rural community at the primary care level of Northern India and its policy implications.</p><p><strong>Design: </strong>This was a camp-based project conducted for 1 year, using oral visual examination, clinical breast examination and visual inspection of cervix by application of 5% acetic acid according to primary healthcare operational guidelines. During the project, screen-positive participants were followed through reverse navigation. Information about socio-demographic profile, clinical and behavioural history and screening were collected. Predictors for screen-positivity and follow-up compliance were identified through multivariable analysis.</p><p><strong>Settings: </strong>Based on the aim of project, one of the remotely located and low socioeconomic rural blocks, having 148 villages (estimated population of 254 285) in Varanasi district, India was selected as the service site. There is an established healthcare delivery and referral system as per the National Health Mission of Government of India. Oral, breast, gallbladder and cervical cancers are the leading cancers in the district.</p><p><strong>Participants: </strong>We invited all men and women aged 30-65 years residing in the selected block for the last 6 months for the screening camps. Unmarried women, women with active vaginal bleeding, those currently pregnant and those who have undergone hysterectomy were excluded from cervical cancer screening.</p><p><strong>Results: </strong>A total of 14 338 participants were screened through 190 camps and the majority (61.9%) were women. Hindu religion, tobacco use, intention to quit tobacco and presence of symptoms were significantly associated with screen-positivity. Nearly one-third (220; 30.1%) of the screened-positives complied with follow-up. Young age and illiteracy were significantly associated with lower compliance.</p><p><strong>Conclusion: </strong>Poor follow-up compliance, despite the availability of tertiary cancer care, patient navigation, free transportation and diagnostic services, calls for research to explore the role of contextual factors and develop pragmatic interventions to justify 'close the care gap'. Community cancer screening needs strengthening through cancer awareness, establishing referral system and integration with the National Tobacco Control and Cancer Registry Programmes.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 Suppl 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10729271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811467","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":"Should I take aspirin? A qualitative study on the implementation of a decision aid on taking aspirin for bowel cancer prevention.","authors":"Shakira Onwuka, Jennifer McIntosh, Lucy Boyd, Napin Karnchanachari, Finlay Macrae, George Fishman, Jon Emery","doi":"10.1136/fmch-2023-002423","DOIUrl":"10.1136/fmch-2023-002423","url":null,"abstract":"<p><strong>Objectives: </strong>Australian guidelines recommend 50-70 years consider taking aspirin to reduce their bowel cancer risk. We trialled a decision aid in general practice to facilitate the implementation of these guidelines into clinical practice. This publication reports on the qualitative results from the process evaluation of the trial. We aimed to explore general practitioners' (GPs) and their patients' approach to shared decision-making (SDM) about taking aspirin to prevent bowel cancer and how the decision aids were used in practice.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 17 participants who received the decision aid and 12 GPs who participated in the trial between June and November 2021. The interviews were coded inductively, and emerging themes were mapped onto the Revised Programme Theory for SDM.</p><p><strong>Results: </strong>The study highlighted the dynamics of SDM for taking aspirin to prevent bowel cancer. Some participants discussed the decision aid with their GPs as advised prior to taking aspirin, others either took aspirin or dismissed it outright without discussing it with their GPs. Notably, participants' trust in their GPs, and participants' diverse worldviews played pivotal roles in their decisions. Although the decision aid supported SDM for some, it was not always prioritised in a consultation. This was likely impacted during the trial period as the COVID-19 pandemic was the focus for general practice.</p><p><strong>Conclusion: </strong>In summary, this study illustrated the complexities of SDM through using a decision aid in general practice to implement the guidelines for low-dose aspirin to prevent bowel cancer. While the decision aid prompted some participants to speak to their GPs, they were also heavily influenced by their unwavering trust in the GPs and their different worldviews. In the face of the COVID-19 pandemic, SDM was not highly prioritised. This study provides insights into the implementation of guidelines into clinical practice and highlights the need for ongoing support and prioritisation of cancer prevention in general practice consultations.</p><p><strong>Trial registration number: </strong>ACTRN12620001003965.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 Suppl 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463297","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":"Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study.","authors":"Mingyue Li, Haoqing Tang, Huixian Zheng, Yiran Tian, Xiaoran Cheng, Haozhe Cheng, Xiaotian Zhang, Dan Hu, Xiaoyun Liu","doi":"10.1136/fmch-2023-002421","DOIUrl":"10.1136/fmch-2023-002421","url":null,"abstract":"<p><strong>Objective: </strong>Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China's national compulsory services programme (CSP).</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Health facilities in middle and western rural areas in China, 2015-2022.</p><p><strong>Participants: </strong>Cohorts of CSP graduates from 2015 to 2019 in four major medical universities.</p><p><strong>Main outcomes: </strong>Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year.</p><p><strong>Results: </strong>91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance-adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity-adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9-2.3 times more likely to report adequate facility support.</p><p><strong>Conclusion: </strong>GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487204","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":"Health-related quality of life among adolescents with type 1 diabetes since the second wave of the COVID-19 pandemic in Germany.","authors":"Juliane Regina Framme, Su-Jong Kim-Dorner, Bettina Heidtmann, Thomas Michael Kapellen, Karin Lange, Olga Kordonouri, Heike Saßmann","doi":"10.1136/fmch-2023-002415","DOIUrl":"10.1136/fmch-2023-002415","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children.</p><p><strong>Methods: </strong>A total of 445 adolescents (12-18 years) and 413 parents participated in an anonymous cross-sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parent-proxy report versions of the KIDSCREEN-10 index.</p><p><strong>Results: </strong>The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen's female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did.</p><p><strong>Conclusions: </strong>HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650154","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":"Service evaluation: identification of gaps in choking prevention advice for children in the South Coast of England, UK.","authors":"Saira Khan,&nbsp;Karen Patterson,&nbsp;Katy Fidler","doi":"10.1136/fmch-2022-001966","DOIUrl":"https://doi.org/10.1136/fmch-2022-001966","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Choking, also known as foreign body airway obstruction, is the blockage of respiration by a foreign body in the airway including the trachea, hypopharynx and pharynx. Among young children, choking is one of the leading causes of death among unintentional injuries, thus making it a significant public health issue. Children under 5 have the highest risk of choking compared with other children and adults. In 2016, of the approximately 1900 choking episodes resulting in emergency calls in London, 40% were for children under 5. Common items that children may choke on include food, toys and coins. Round objects that can adapt to the shape of a child’s airway are most likely to cause complete obstruction of the airways such as grapes, peanuts and hard sweets. To reduce the incidence of these events, choking prevention advice for parents/ caregivers is critical. One study showed that parents who lacked awareness of food choking hazards were more likely to give foods to their children that increase choking risk. Conversely, studies conducted in Israel and Crete showed a decline in choking cases in children after implementing educational choking prevention programmes. Healthcare professionals (HCPs) such as general practitioners (GPs), paediatric nurses and health visitors play a significant role in providing choking prevention advice to parents/caregivers. Examples of choking prevention advice recommended by the Child Accident Prevention Trust are shown in box 1. During their professional training, these HCPs have typically received choking prevention and management teaching. However, in clinical practice, it is unclear how routinely these roles are being carried out. Aims and objectives Our service evaluation had a primary objective to identify the type of HCPs providing choking prevention advice and how consistently this advice was delivered. Secondary objectives included assessing the use of choking prevention resources by HCPs and determining where HCPs think choking prevention advice is best placed.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/11/fmch-2022-001966.PMC10565162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215453","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":"Association of COVID-19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study.","authors":"Lindsey Wang, Pamela B Davis, Nathan Berger, David C Kaelber, Nora Volkow, Rong Xu","doi":"10.1136/fmch-2023-002456","DOIUrl":"10.1136/fmch-2023-002456","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus (RSV) infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA.</p><p><strong>Design: </strong>This is a retrospective population-based cohort study. Five outcomes were examined, including overall RSV infection, positive lab test-confirmed RSV infection, clinically diagnosed RSV diseases, RSV-associated bronchiolitis and unspecified bronchiolitis. Risk ratio (RR) and 95% CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts.</p><p><strong>Setting: </strong>Nationwide multicentre database of electronic health records (EHRs) of 61.4 million patients in the USA including 1.7 million children 0-5 years of age, which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals, primary care and specialty treatment providers.</p><p><strong>Participants: </strong>The study population consisted of 228 940 children of 0-5 years with no prior RSV infection who had medical encounters in October 2022. Findings were replicated in a separate study population of 370 919 children of 0-5 years with no prior RSV infection who had medical encounters in July 2021-August 2021 during a non-overlapping time period.</p><p><strong>Results: </strong>For the 2022 study population (average age 2.4 years, 46.8% girls, 61% white, 16% black), the risk for incident RSV infection during October 2022<b>-</b>December 2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (RR 1.40, 95% CI 1.27 to 1.55); and among children aged 0<b>-</b>1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR 1.40, 95% CI 1.21 to 1.62). For the 2021 study population (average age 2.2 years, 46% girls, 57% white, 20% black), the risk for incident RSV infection during July 2021<b>-</b>December 2021 was 4.85% for children with prior COVID-19 infection, higher than 3.68% for the matched children without COVID-19 (RR 1.32, 95% CI 1.12 to 1.56); and 7.30% for children aged 0<b>-</b>1 year with prior COVID-19 infection, higher than 4.98% for matched children without (RR 1.47, 95% CI 1.18 to 1.82).</p><p><strong>Conclusion: </strong>COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022. Similar findings were replicated for a study population of children aged 0-5 years in 2021. Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/27/fmch-2023-002456.PMC10582888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215451","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}