Journal of the American Board of Family Medicine最新文献_第7页

Rural Family Physicians Are More Likely to Collaborate with Multisector Community Organizations. 农村家庭医生更有可能与多部门社区组织合作。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2024.240104R1

Haritomane Brillakis, Sarah Fleischer, Rachel Hogg-Graham, Lars E Peterson

引用次数: 0

Doxycycline Post-Exposure Prophylaxis (doxy-PEP) for the Prevention of Bacterial Sexually Transmitted Infections for Men Who Have Sex with Men and Transgender Women. 多西环素暴露后预防（doxy-PEP）对男男性行为者和变性女性细菌性传播感染的预防作用

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2024.240225R0

Bryce A Ringwald

引用次数: 0

Food Insecurity Is Associated with Vitamin B12 Deficiency: The All of Us Database. 食物不安全与维生素B12缺乏有关：我们所有人的数据库。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2023.230454R1

Daniel J Parente

{"title":"Food Insecurity Is Associated with Vitamin B12 Deficiency: The All of Us Database.","authors":"Daniel J Parente","doi":"10.3122/jabfm.2023.230454R1","DOIUrl":"10.3122/jabfm.2023.230454R1","url":null,"abstract":"Background: Vitamin B12 is an essential micronutrient obtained from dietary sources, but there is a paucity of information about how food security contributes to risk of vitamin B12 deficiency.Methods: I used multivariable logistic regression controlling for age, sex, and metformin exposure using the multicenter, United States National Institutes of Health All of Us precision medicine database. I included all adult participants 18 to 88 years old in the All of Us database who answered the social determinants of health survey and had a vitamin B12 measurement within 1 year of the survey.Results: 8,989 participants with median age 65.9 years (Q1 53.0, Q3 73.7), who were predominantly female (63.2%), White-identifying (87.4%), and not Hispanic or Latino (93.4%) were included. 9.8% of participants reported experience of food insecurity, and 12.9% reported worry about food insecurity. 15.1% had metformin exposures. Vitamin B12 levels less than 300 pg/mL were associated with experiencing food insecurity (multivariable OR [mOR] 1.24, 95% CI 1.01-1.51, P = .037). Age (mOR 0.92 per decade), and male biological sex (mOR 1.16) were also both associated with vitamin B12 deficiency, but I did not detect an effect due to metformin exposure (mOR 1.05, 95% CI 0.88-1.25, P = .59).Conclusions: Vitamin B12 deficiency is associated with food insecurity in United States adults enrolled in the NIH All of Us database. Future analyses designed to infer causality are warranted.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S156-S163"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701957","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}

引用次数: 0

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion. 减少宫内节育器插入疼痛和焦虑的实用建议。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2024.240079R1

Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen

{"title":"Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion.","authors":"Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen","doi":"10.3122/jabfm.2024.240079R1","DOIUrl":"10.3122/jabfm.2024.240079R1","url":null,"abstract":"Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.Methods: A literature review was conducted on PubMed by searching the terms \"IUD insertion\", \"pain management\", \"anxiety\", \"gynecologic procedures\". The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians' Strength of Recommendation Taxonomy (SORT) scale.Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, \"verbal analgesia\", lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1150-1155"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674871","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}

引用次数: 0

Patient-Reported Leg Cramp Treatments and Their Effectiveness. 患者报告的腿部痉挛治疗及其疗效。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2023.230310R1

Birgit Khandalavala, Jenenne Geske, Morgan Karloff

{"title":"Patient-Reported Leg Cramp Treatments and Their Effectiveness.","authors":"Birgit Khandalavala, Jenenne Geske, Morgan Karloff","doi":"10.3122/jabfm.2023.230310R1","DOIUrl":"10.3122/jabfm.2023.230310R1","url":null,"abstract":"Background: Leg cramps are common and distressing to patients who report using many treatment options, some of which have potential for significant adverse effects. Such treatments are often underreported to their clinicians, and additional sources for information are sought. Our study investigates patient-reported treatment choices and treatment helpfulness for leg cramp symptom relief, as well as their use of the Internet to identify treatments.Methods: A newly developed cross-sectional survey was administered in Midwest primary care clinics.Results: Of 714 survey respondents, 365 reported experiencing leg cramps and are included in our report. The mean age of our participants was 52.2 years (SD = 16.7). The sample was 70.4% female, 90.2% white, and 71.5% rural. Pharmacological treatment options for leg cramps were cited less frequently than nonpharmacological treatments. The most common and helpful pharmacologic interventions were over-the-counter analgesics. Nonpharmacologic treatments included massage, stretching, and walking. Of patients who experienced leg cramps, 30.8% (n = 100) reported looking up treatments on the Internet. The most popular interventions found on the Internet were hydration with either water or electrolyte drinks, potassium, magnesium, and massage of the affected muscle.Conclusions: Patients with leg cramps use a variety of treatment options. Many nonpharmacological treatment options are at least somewhat beneficial, which thus present less estimated risk with more benefit. Nearly one-third of patients with leg cramps could be at potential risk of medication adverse events, particularly from over-the-counter analgesics. The use of the Internet could be seen as being problematic in nearly the same proportion.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1123-1129"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674830","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}

引用次数: 0

Diabetes Monitoring in Foreign-Born and US-Born Latino Adults in US Community Health Centers. 美国社区卫生中心对外国出生和美国出生的拉丁裔成年人的糖尿病监测

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2024.240107R1

Roopradha Datta, Jennifer A Lucas, Miguel Marino, Danielle M Crookes, Benjamin Aceves, David Ezekiel-Herrera, Andrew Bazemore, John D Heintzman

{"title":"Diabetes Monitoring in Foreign-Born and US-Born Latino Adults in US Community Health Centers.","authors":"Roopradha Datta, Jennifer A Lucas, Miguel Marino, Danielle M Crookes, Benjamin Aceves, David Ezekiel-Herrera, Andrew Bazemore, John D Heintzman","doi":"10.3122/jabfm.2024.240107R1","DOIUrl":"10.3122/jabfm.2024.240107R1","url":null,"abstract":"Introduction: The Latino population is the largest ethnic group in the United States and has a higher prevalence of diabetes mellitus than non-Latino Whites. The objective of this article is to assess if glycohemoglobin (HbA1c) monitoring rates vary across Latino patients by subgroup and nativity compared with their non-Latino White counterparts.Methods: Our sample included 43,593 adults (18 to 79 years) with Type-2 diabetes extracted from electronic health record (EHR) data from Community Health Centers (CHCs) across 16 US states, linked with neighborhood-level Latino subgroup data within the study period 2012 to 2020. The outcome was number of HbA1c monitoring tests per year. The main independent variable was self-reported ethnicity/nativity (eg, Mexican-born, US-born Latino, etc.) or for those with no EHR-recorded country of birth.Results: Compared with non-Latino White people with diabetes, US-born Latinos with diabetes had an 11% higher rate of receiving HbA1c monitoring; no foreign-born Latinos had monitoring rates that differed significantly from non-Latino Whites. Latinos with no country of birth recorded and living in high percent Mexican neighborhood had 22% higher rates of receiving HbA1c monitoring. Those living in high percent Dominican, Guatemalan and Honduran neighborhoods also had greater rates of HbA1c monitoring compared with non-Latino White patients.Conclusions: It could be beneficial for clinics to inquire about nativity and subgroup information of their Latino patients, so as to customize the treatment plan and better understand utilization patterns common in their communities.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1095-1102"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674790","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}

引用次数: 0

Primary Health Care As a Common Good. 作为共同利益的初级保健。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2023.230430R1

Rebecca S Etz, Kurt C Stange

引用次数: 0

Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests. 与心脏负荷试验完成相关的社会人口学和临床因素的意义

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2024.240067R1

Maelys J Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera, Russell S Phillips

{"title":"Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests.","authors":"Maelys J Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera, Russell S Phillips","doi":"10.3122/jabfm.2024.240067R1","DOIUrl":"10.3122/jabfm.2024.240067R1","url":null,"abstract":"Background: Though cardiac stress tests have long been the standard of care for initial evaluation of cardiac symptoms, our institution, along with others, has noted high rates of incomplete tests.Objective: To identify sociodemographic factors associated with the completion of cardiac stress tests and to assess the value of completed tests.Design & participants: We conducted a retrospective chart review evaluating 150 patients with cardiac stress tests orders placed in 1 urban hospital-based primary care practice from 1/1/2018-12/31/2021.Main measures: Our primary outcome was the completion of the stress test. We examined rates of completion based on sociodemographic factors including age, gender, race, language, and social vulnerability, markers of chronic illness, risk of atherosclerotic cardiovascular disease, and pretest probability of coronary artery disease.Key results: In a multivariable adjusted model, female gender (OR:0.43 [0.18-1.00]), Black race (OR:0.26 [0.11-0.61]), and dyslipidemia (OR:0.27 [0.090-0.78]) were associated with lower test completion rates. We found no relationship between the likelihood of test completion and pretest probability. In an analysis of tests with low pretest probability, 100% of low-risk stress tests were negative; had any of those tests been positive the highest positive predictive value would have been 25%.Conclusions: Test completion rates were significantly lower for individuals with female gender, Black race, and a diagnosis of dyslipidemia, highlighting inequities in the completion rates for a potentially lifesaving test. In addition, a substantial number of ordered tests were low risk and low value, highlighting areas of opportunity by advancing the value of cardiovascular care delivered.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1088-1094"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674818","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}

引用次数: 0

Primary Care's Essential Role in Advancing Health Equity. 初级保健在促进健康平等中的重要作用。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2023.230423R0

Diane R Rittenhouse, Ann S O'Malley

引用次数: 0

Clinician and Staff Perspectives on a Social Drivers of Health Program Implementation. 临床医生和工作人员对健康计划实施的社会驱动因素的看法。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-11-01 DOI: 10.3122/jabfm.2023.230316R2

Stacie M Vilendrer, Samuel C Thomas, Kim Brunisholz, Grace Ann Kumar, Ishita Singh, Nancy Song, Raj Srivastava, Sara J Singer

{"title":"Clinician and Staff Perspectives on a Social Drivers of Health Program Implementation.","authors":"Stacie M Vilendrer, Samuel C Thomas, Kim Brunisholz, Grace Ann Kumar, Ishita Singh, Nancy Song, Raj Srivastava, Sara J Singer","doi":"10.3122/jabfm.2023.230316R2","DOIUrl":"10.3122/jabfm.2023.230316R2","url":null,"abstract":"Introduction: Health systems are increasingly pursuing efforts to screen for and address social drivers of health (SDOH), the nonmedical factors that contribute to health outcomes and inequities. A large integrated health system (Intermountain Health) launched a program in 2019 to universally screen for and address SDOH.Methods: Five primary care clinics within Intermountain were purposefully chosen for diversity of setting and practice type (family medicine and pediatric). We conducted 20 semistructured interviews with frontline clinicians and staff from 7/1/2020 to 9/1/2020 to explore attitudes related to feasibility, workflow processes, and facilitators and barriers to successful implementation. We conducted an inductive-deductive analysis to identify key themes and best practices.Results: Five clinics conducted 16,659 SDOH patient screenings from 12/1/2019 to 11/30/2020 (705 to 7,723 screens per clinic with rates ranging from 7.4% to 52.8% per clinic). Respondent perspectives about the program were mixed. Dominant implementation barriers included staff time constraints, limited availability of social services, and reduced morale. Key facilitators included triage protocols for positive screens independent of the primary care clinician, standardizing previsit digital screening, and instilling a culture of shared ownership through education and team SDOH-focused huddles.Conclusions: This evaluation of an early systemwide SDOH program implementation called into question the feasibility of universal screening in primary care given staff time constraints and social service availability. Future investigations should explore the impact of targeted screening approaches in diverse clinical settings and quantifying trade offs between SDOH programs and other clinical and organizational priorities.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1103-1122"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674784","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}

引用次数: 0