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Background This study investigated patients’ attitudes about severe acute respiratory syndrome coronavirus 2 in rural Michigan. Despite increasing cases in rural communities across America, surveys have revealed that residents may feel less threatened by the virus compared to their urban counterparts. This difference in attitude and information appraisal can negatively affect rural health by discouraging coronavirus disease (COVID-19) preventative behaviors. Understanding social influences that contribute to the formation of opinions about the pandemic can help public health officials and clinicians better address rural health. Methodology This cross-sectional study surveyed 299 participants from three primary care clinics in Shiawassee County of Michigan during a seven-week interval. Statistical analysis, primarily through SAS version 9.4 (SAS Institute Inc., Cary, NC, USA), included descriptive statistics, multiple linear regression models, paired t-tests, and correlation coefficients. A p-value less than or equal to 0.05 was considered significant. Results Patients believed the risk COVID-19 posed to their family was significantly higher than the risk it posed to themselves (p < 0.001). Patients who reported that they would follow their provider’s advice for treatment of a non-COVID-19 medical illness were found to be more likely to follow a provider’s advice on COVID-19 (p < 0.001). However, patients overall were more agreeable with following provider advice for non-COVID-19 medical illnesses than they were for COVID-19 (p < 0.001). Conclusions As patients were more agreeable with following medical advice on chronic conditions than COVID-19, there may be extrinsic factors influencing patient views of COVID-19. Polarization of COVID-19 in the media has heavily influenced attitudes toward the virus in America. Initiatives to provide reliable patient education is key to encouraging constructive discussions and a healthy rural community. In a strong patient-provider relationship, primary care providers can share and encourage appropriate healthy behaviors regarding COVID-19, which have a direct impact on community health.

Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians. This study examines factors associated with family medicine residency match rates and the extent to which such factors differ across medical school settings.We combined data from a survey of 123 departments of family medicine with graduate placement rates reported to the American Academy of Family Physicians over a 2-year period. Chi-square/Fisher's Exact texts, t tests, and linear regression analyses were used to identify factors significantly associated with average match rate percentages.The resulting data set included 85% of the U.S. medical schools with Departments of Family Medicine that reported 2011 and 2012 residency match rates in family medicine. Match rates in family medicine were higher among graduates of public than private medical schools-11% versus 7%, respectively, t(92) = 4.00, p.001. Using a linear regression model and controlling for institutional type, the results indicated 2% higher match rates among schools with smaller annual clerkship enrollments (p = .03), 3% higher match rates among schools with clerkships lasting more than 3 to 4 weeks (p = .003), 3% higher match rates at schools with at least 1 family medicine faculty member in a senior leadership role (p = .04), and 8% lower match rates at private medical schools offering community medicine electives (p.001, R(2) = .48), F(6, 64) = 9.95, p.001. Three additional factors were less strongly related and varied by institutional type-informal mentoring, ambulatory primary care learning experiences, and institutional research focus. Insights: Educational opportunities associated with higher match rates in family medicine differ across private and public medical schools. Future research is needed to identify the qualitative aspects of educational programming that contribute to differences in match rates across institutional contexts. Results of this study should prove useful in mitigating physician shortages, particularly in primary care fields such as family medicine.

In 2006, the Association of American Medical Colleges recommended a 30% increase over 2002 enrollment in U.S. medical schools by the year 2016, particularly in areas with rapid population growth during the past 25 years or where the population was projected to grow rapidly in future years. Both MD-granting and DO-granting schools subsequently expanded enrollment. To examine the relationship between ongoing medical school expansion and state-level measures of population need and workforce capacity, the authors used established national health workforce and training site datasets to compare total medical school enrollment (2000-2010) with change in population, medical student retention in state (those returning to practice in the state where they graduated), and primary care supply.From 2000 to 2010, U.S. population increased 10% (median state population growth 7.4%). Median state total MD and DO medical school enrollment growth was 14.7%, with nine states increasing enrollment by more than 50%. Medical student retention rates varied from 9.8% to 67%. A wide variation in concordance and discordance between medical school enrollment to population growth and to medical student retention rates existed across states. States also demonstrated concordance or discordance between medical school enrollment and supply of primary care physicians.The authors recommend strategies for expansion that may help meet the population's need for primary care physicians and improved geographic distribution of specialties. Expansion of graduate medical education must also be aligned with population need, necessitating coordination of workforce planning.

Historically, cradleboards and other external pressure devices have been used to intentionally mold children's skulls into desirable shapes to signify high social status, ethnicity, or both. 1 In the last 10 years, several tertiary care centers in the United States have noticed a marked increase in the incidence of unintentionally flattened asymmetric infant skulls. 2,3 Multiple terms have been used to describe this posterior skull deformation: functional synostosis, 4 plagiocephaly without synostosis, 3 deformational plagiocephaly, 5 positional plagiocephaly, 6 lambdoid positional molding, 7 occipital plagiocephaly, 8 and positional skull deformity. 9 Whatever the term used, the infants all had varying degrees of unilateral occipital flattening, forehead protrusion, facial asymmetry, anteriorly displaced ears, and almost all slept on their backs. 2

Many women seek care for vulvar, vaginal, or pelvic complaints. Primary care providers should possess a solid understanding of the differential diagnosis and treatment of gynecologic infections. Many infections in the reproductive tract are sexually transmitted, whereas other common infections are attributable to an overgrowth of the normally present bacteria or yeast in the vagina. Presenting symptoms and signs are helpful in determining the source of infection, but often a battery of tests must be performed to make a definitive diagnosis.

To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women.Randomised, placebo controlled trial.Academic medical centre in an urban setting in New Zealand.1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo.Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death.Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49).Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.Australian Clinical Trials Registry ACTRN 012605000242628.

Fourth-generation quinolones, such as levofloxacin (Levofloxin) and gatifloxacin (Tequin), have become widely used in outpatient and inpatient settings. These quinolones add Gram-positive bacterial coverage and maintain the Gram-negative coverage of earlier quinolones. This broad-spectrum coverage