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Presents letters to the editor referencing articles and topics discussed in previous issues of this journal. Discussion of ethics in managed care system; Comments on the article, related to onychomycosis; Remarks on the article "Antibiotics and Upper Respiratory Infection," which discussed the appropriateness of antibiotics.

Background: The Student Leadership Development Initiative was founded at the Medical College of Wisconsin to unite local physician leaders with Medical College of Wisconsin students to develop leadership skills and prepare for careers expanding beyond clinical practice., Methods: An anonymous survey was distributed to 246 current and past Student Leadership Development Initiative participants, probing confidence in leadership skills, professional goals, and the perceived importance of leadership training. Feedback interviews were also conducted., Results: Respondents reported improvement in areas such as compassion, leadership, and development of career goals. The perceived benefit for developing professional goals and compassion are positively related ( P  < 0.01) to the number of sessions attended., Discussion: Survey results highlight the importance of leadership training in medical education and suggest an integration strategy for a successful leadership training platform., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Medical student burnout has received increasing attention in recent years due to greater acceptance of psychological and emotional vulnerability in the health care profession. Given the significant investment of personal and financial resources in this demanding profession, continued evaluation of factors contributing to burnout in medical training is necessary. A midwestern medical college with a longstanding 4-year medical degree program created 2 regional campuses that utilize a calendar-efficient 3-year medical degree program. The objective in this study is to examine if medical student burnout scores are higher for students on the 3-year campuses and how that is affected by emotional intelligence., Methods: First- and second-year medical students voluntarily completed the Maslach Burnout Inventory for Students (scale: 1 = never, 7 = every day) and the Trait Emotional Intelligence Questionnaire (scale: 1 = completely disagree, 7 = completely agree). Multifactor analysis of variance assessed mean differences in burnout between campus and gender. Multivariate linear regressions were used for predicting burnout from emotional intelligence., Results: Three-year campus students reported significantly ( P <0.010) higher mean [SD] scores (8.3 [2.0]) than the 4-year campus students (7.4 [2.4]), and female students reported significantly ( P <0.049) higher scores (8.2 [2.0]) than male students (7.6 [2.4]). Five emotional intelligence facets were independently associated with increased burnout scores (R² = 0.26, P <0.001) but significantly varied with campus and gender., Conclusions: There were higher burnout scores in students studying on the two 3-year campuses compared to students on the traditional 4-year campus and higher scores for female students than male students. Different facets of emotional intelligence mitigated student burnout by campus and gender., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Background: In response to calls to increase class sizes, the Medical College of Wisconsin (MCW) opened two new 3-year community-based regional campuses in 2016 and 2017. The goal of this study was to analyze whether the applicants and accepted student pools differed for the school's 3-year and 4-year campuses., Methods: Deidentified data from Wisconsin applicants to MCW for the class enrolling in 2017 were categorized based on their preference for the Milwaukee or a regional campus. Applicants and admitted student data were compared on Medical College Admissions Test (MCAT) score, undergraduate school grade point average (GPA), sex, age, research intensity of their undergraduate school (Carnegie 1 classification vs all others) and Wisconsin county of residency., Results: Regional campus applicants were significantly older (24.6 vs 23.7, P = 0.023), more likely to reside in nonurban counties (33% vs 13%, < 0.001), attend nonresearch-intense undergraduate schools (65% vs 44%, P < 0.001) and had lower mean MCAT scores (d=0.77, P < .001) than applicants to the Milwaukee campus. Regression models indicated 4 applicant qualities were associated with a preference for 4-year (values > 1.0) or 3-year (values < 1.0) campus: graduation from a Carnegie 1 undergraduate school (OR = 1.626; 95% CI, 1.01 - 2.62), a higher age at the time of application (OR = 1.092; 95% CI, 1.01 - 1.18), total MCAT score (OR = 0.916; 95% CI, 0.89 - 0.95), and permanent residence in a rural Wisconsin county (OR = 0.349; 95% CI, 0.21 - 0.59). When we examined students who were accepted and matriculated as opposed to just applicants, regression models showed that students with higher ages were more likely to attend the 4-year campus (OR = 1.42; 95% CI, 1.15 - 1.76), while a higher total MCAT score (OR = 0.83; 95% CI, 0.76 - 0.91) and rural county residency (OR = 0.27; 95% CI, .1 - 0.73) were associated with atriculation to the 3-year regional campuses., Conclusions: These results indicate that the regional 3-year campus model is attracting and selecting students with some differences from those at MCW's 4-year campus. After adjusting for other characteristics, students matriculating to the regional 3-year campuses are nearly 4 times more likely to come from a rural county and have slightly higher MCAT scores., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Today's medical students are tomorrow's leaders. As leadership training becomes incorporated into undergraduate medical education, there is a need for validated educational models that are both effective and replicable., Methods: Between April 2017 and October 2017, groups of 15 to 20 medical students participated in sessions with an exemplary physician leader incorporating a guided interview format and discussion about her or his career. Prepared questions ensured leadership domains were covered. The program was evaluated using a post-session survey., Results: One hundred percent of survey respondents (N = 58) reported that the session was a good use of time. Seventy-eight percent felt more prepared to lead a team; 93% learned specific ways to improve their leadership skills., Discussion: This leadership program is a unique model to provide leadership education to medical students that is both effective and replicable., (Copyright© Wisconsin Medical Society.)

Purpose: Using a quasi-experimental approach, we examined student and faculty satisfaction with a mock residency interview program. We also examined whether self-selected participants had match rates that differed from nonparticipants., Methods: Interviews were arranged on a specified evening between students and a physician in the specialty to which the student wished to apply. Interviews were structured as similarly to residency interviews as possible, but included 10 minutes of verbal feedback and subsequent written feedback to all students. Students completed surveys indicating their satisfaction with the mock interview immediately following the interview and 5 months later (after their actual resident interviews). Faculty feedback to students and their satisfaction with the program also was collected. Out of 189 (55%) students in the senior class, 104 volunteered to participate., Results: Immediately following the mock interview, over 90% of students who participated either strongly agreed or agreed that the interview feedback was helpful, seemed realistic, and helped them identify strengths and weaknesses. Responses collected 5 months later were still favorable, but less positive. Faculty identified 7 students who they believed had poor interview techniques and an additional 13 who interviewers believed would be unlikely to match in their specialty. Final match results for the group participating in the mock interview showed a primary match rate of 99%, which was higher than students who did not participate (94%, P < .001)., Conclusion: In a self-selected group of students who chose to participate, mock interviews were useful in improving student match success compared to students who did not participate in the mock interview program. Because all students were not required to participate, it is unclear whether this tactic would be successful for all students.

Rhinosinusitis is one of the most common conditions seen by family physicians. Most cases are viral in nature and resolve spontaneously. When symptoms persist for 10 days or more or are accompanied by severe pain and fever, bacterial sinusitis may be present. Current guidelines recommend that acute bacterial sinusitis be treated with amoxicillin-clavulanate. Chronic bacterial sinusitis typically involves a change in the sinus ostia and microbiology. This rarely resolves with antibiotic treatment alone and often warrants surgical intervention. Fungal sinusitis is a rare condition seen more often in immunosuppressed individuals and manifests in severe symptoms along with possible neurologic findings., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

With the widespread use of vaccinations against Streptococcus pneumoniae, the frequency of acute otitis media (OM) has decreased significantly in recent years. Current management varies considerably in different countries, but there is consensus that most mild cases in children older than 6 months can be treated with observation and analgesics. When antibiotic therapy is indicated for children younger than 6 months or older children with severe or unrelenting symptoms, initial management with amoxicillin or amoxicillin-clavulanate is recommended. For children with recurrent OM or persistent serous OM, prophylactic antibiotic regimens appear to be effective. Insertion of tympanostomy tubes can be useful to prevent recurrences but confers little benefit on speech acquisition. Tonsillectomy and adenoidectomy yield minimal benefit for children with OM., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Oral cancers are uncommon in the United States. Risk factors for oral cancer include tobacco use, alcohol consumption, and high-risk oral human papillomavirus infection. Precancerous lesions, such as leukoplakia, may lead to oral cancers, but the majority of precancerous lesions never undergo malignant transformation. Management and prognosis for oral cancers vary widely depending on the site of the cancer. Lip cancers typically are detected early and have the greatest likelihood for cure and long-term patient survival. Cancers of the pharynx and tonsil have poor survival rates even when diagnosed in early stages. The best approach to preventing oral cancers is to control risk factors., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Background: Conflicting evidence exists about how patients would like their doctors to dress. This is complicated by new evidence showing elements of common physician attire (white coat or ties) can be contaminated with pathogens., Methods: We conducted a survey on a convenience sample of adult patients in three academic primary care offices in South Carolina and Ohio during the summer of 2010. The survey asked about patient preferences for physician attire and how their doctor usually dressed. After a brief statement regarding evidence of microbial contamination of coats and ties, the preferences were reexamined., Results: A total of 432 patients participated in the survey. No clear preference was stated by patients, and patients' initial preference was not closely related to their own physicians' customary attire. After reading the statement about microbial contamination, a significant percentage of patients changed their preference to select categories that did not include a tie or a white coat and tie. This information was associated with a large shift in preference to having physicians wear dress shirts and slacks with no tie (from 16% to 41%)., Conclusions: Patients in these three academic family medicine practices did not show any consistent preference for their physicians' attire. However, providing information about potential microbial contamination of clothing was associated with a shift in patient preferences for physicians not wearing a tie and a white coat.

Background and Objectives: Primary care research into post-traumatic stress disorder (PTSD) is less developed than primary care depression research. This study documents lifetime traumatic events and past month depression and PTSD in adult patients of a large family medicine residency practice., Methods: We used a telephone survey of 411 adult patients from a family medicine residency practice in the Southeastern United States. Standardized measures were used., Results: Seventy-nine percent of study enrollees completed the study. Women were significantly more likely than men to have been diagnosed with PTSD (35.8% versus 20.0%) or depression (36.1% versus 21.1%), with a high degree of diagnosis overlap (76.5%). Most adults (>90%) reported one or more traumatic events. Men reported more war zone/combat events; women reported more sexual victimization. More than 80% of patients thought family physicians should ask about traumatic events; only a minority recalled being asked (26.8% men, 43.6% women). Regression models determined that current depression and several traumatic events were significant correlates of current PTSD., Conclusions: Key gender differences in frequency of lifetime traumatic events, past month depression and PTSD, and patient attitudes about trauma questions existed. Current PTSD was best predicted by a combination of coexisting depression and traumatic events. Discussion explores training and practice implications.

Purpose: Although having a continuous relationship with a physician is a defining feature of primary care, few studies have evaluated the effect of this on chronic disease management. This aim of this study was to examine whether having a regular physician is associated with improvements in reaching treatment goals for patients with diabetes., Methods: Through the use of a diabetes registry, patients diagnosed with diabetes mellitus for a minimum of 6 months cared for in a large, single academic family medicine practice were compared based on whether they had a regular physician or not. The 2 groups were compared in the frequency in which they achieved goals for management of glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, and other aspects of diabetes care., Results: Patients with a regular provider were slightly older than those without a provider (57.5 years vs. 50.9 years; P = .002), but the gender distribution and percent who were smokers was the same. In assessing diabetes quality measures, patients with a regular provider had lower average levels of glycated hemoglobin (7.70 vs 8.53; P = .01), but no difference was noted in the percentage achieving a goal of < or =7.0. No differences were noted between the groups in either the average systolic or diastolic blood pressures or low-density lipoprotein cholesterol or in the percentages of patients achieving recognized goals for these measures. When examining other preventive services, patients with a regular provider were more likely to receive an influenza immunization within the last year (51.8% vs 35.6%; P = .02) but no more likely to receive a pneumococcal vaccine or take an aspirin each day., Conclusion: This study suggests that there are few benefits for patients with diabetes in having an established regular provider over having a regular place of service.

Background: Pregnant teens in the United States are at high risk for not obtaining prenatal care and for having low-birth weight deliveries. This observation suggests that significant cost savings might be realized if teens were able to obtain prenatal care in a timely fashion., Methods: To determine the optimal time for teens to start prenatal care, we conducted a cost-benefit analysis from the perspective of Medicaid, the predominant payer for pregnancy-related services for teens. Cost projections were based on current recommended prenatal care testing, the cost of vaginal and cesarean deliveries, and the estimated costs for care of the child in the first year of life. We then compared average cost per person and performed sensitivity analyses based on when prenatal care would have started., Results: Compared with no prenatal care, any prenatal care saves between $2,369 and $3,242 per person, depending on when care is initiated. All savings are related to reductions in the cost of caring for low-birth weight babies. We found no cost advantage to starting prenatal care earlier compared with later months., Conclusion: If prenatal care does reduce the rate of low-birth weight babies, prenatal care is cost beneficial. If a program was developed to improve access for teens and applied to all pregnant teens not in care by 6 months' gestation, the program would have to average $95 or less per person to be cost beneficial if it reduced the number of low-birth weight deliveries by 50%.

Purpose: To examine changes in the initiation of prenatal care by teenage girls in the United States between 1978 and 2003., Methods: Using birth certificate data collected by the National Center for Health Statistics from 1978, 1983, 1988, 1993, 1998, and 2003 we described initiation of prenatal care in preteens (aged 10-14 years), young adolescents (aged 15-16), and older adolescents (aged 17-19) by the trimester in which care began., Results: Although all three age groups showed trends toward earlier prenatal care, shifts to earlier prenatal care were mainly the result of more girls starting care in the first trimester and fewer in the second trimester. Younger teens were more likely to delay prenatal care or to receive no prenatal care for every year studied. Less education and prior births were also associated with increased likelihood of receiving delayed care., Conclusions: Shifts in timing of prenatal care initiation occurred in the U.S from 1978 to 2003. Much of the change corresponded to expanded eligibility in Medicaid coverage, suggesting that lack of health care coverage was a significant impediment to early prenatal care.

Background and Objectives: One factor cited for the decline of family physicians delivering babies is a lack of faculty role models during residency training. This study's purpose was to determine how many residency programs experience difficulty recruiting faculty who perform deliveries and whether financial or not financial compensation are associated with recruiting difficulties., Methods: Using an electronic questionnaire, we surveyed program directors of nonmilitary family medicine residencies in the United States, with a response rate of 60.7%., Results: Among residency programs who tried to recruit faculty with delivery skills, 58% stated that they have difficulties. Two program characteristics were associated with recruitment difficulties: the number of delivery providers among faculty and whether the residency program directors included delivery in their own practices. There were no statistically significant associations between recruiting difficulties and any type of financial reimbursement methods, but nonfinancial incentives were offered more often by programs that had no difficulty recruiting., Conclusions: More than half of all family medicine residency programs have difficulty recruiting faculty members to provide delivery training. Changing the type of financial compensation for faculty providing maternity care is not likely to assist in recruiting. However, we did find that programs without recruiting difficulties were more likely to offer nonfinancial incentives to faculty members who perform deliveries.

An increasing percentage of Internet users are seeking health information online. The purpose of our study was to determine the extent of Internet access and online health-seeking and the feasibility of implementing Internet services for our urban, residency-based practice. Using a self-administered survey, we obtained information on use of the Internet, demographics and socioeconomic profile, presence of a chronic medical condition and self-rated health from 300 consecutive patients. Complete surveys were obtained by 203 (68 percent). Responses were compared based on demographic, socioeconomic, and medical variables using Chi-square analysis. Results showed that our sample population tended to be under age 50, female, non-Hispanic Black, low income, and healthy. Seventy-seven percent of respondents had accessed the Internet at least once, 79 percent had used the Internet to find health-related information, 73 percent used the online information to make a health-related decision, 50 percent shared the information with their provider. In conclusion, we confirmed a high rate of Internet usage in our specific patient population, characterized by low socioeconomic status, low education level, and high minority percentages. Our patients not only access online health information, but also make changes based on this information, with only about half of all patients sharing this information with their physicians. It is unclear how this system of 'virtual medical care' influences overall patient health.

Objectives: To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003., Design: Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA., Setting: USA: ambulatory prescribing behaviour was derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey while hospitalizations in acute care hospitals were assessed in the National Hospital Discharge Survey., Participants: Adults 18-64 years old., Interventions: None., Main Outcome Measures: Proportion of visits for acute bronchitis/cough receiving a prescription for antibiotics and hospitalization for respiratory infections., Results: Ambulatory antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections exhibited non-linear patterns over the 8 year period. However, antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections had a weak/moderate negative association. For three of the seven yearly changes in prescribing and hospitalizations as one increased the other decreased (P<0.01)., Conclusions: Ambulatory antibiotic prescribing for respiratory tract infections was inversely associated with hospital admissions for respiratory tract infections.

Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.

The purpose of this study was to evaluate the accessibility and utility of a common Internet search strategy so physicians might provide this guidance to their patients seeking health information on chronic disease. We selected three common chronic diseases: diabetes, hypertension, and osteoarthritis. We then formulated basic questions from a patient perspective about diagnosis, treatment, and prognosis. A non-medical professional attempted to answer these questions by typing the disease name into the Google search engine. Focusing on the first ten web sites on the Google list was a successful strategy for finding sites that could answer the study questions (average of 61% of the time). The average number of clicks required to answer any question was 1.6. Web sites sponsored by government agencies (89% success) and hospitals (100% success) yielded answers to the questions more often than other sites. In conclusion, despite the multitude of web sites that appear when the name of a chronic disease is entered into a search engine, the top ten results are usually adequate to provide relevant information on common clinical questions to the average patient. Physicians can guide patients to relevant information by instructing them to type the name of the disease itself into a search engine and focusing on government and hospital-sponsored Web sites.

Objective: Cardiovascular disease has been reported to be more common in patients with elevated levels of TSH and with normal thyroxine levels, termed subclinical hypothyroidism (SCH). The aim of this study was to determine whether individuals with SCH were more likely than euthyroid controls to have elevations in inflammatory biomarkers that are associated with cardiac disease., Methods: From the National Health and Nutrition Examination Survey (NHANES) 1999-2002 data we identified respondents aged > or = 40 who met the laboratory criteria for SCH. We compared the average values and frequencies of elevated C-reactive protein (CRP) and homocysteine in the SCH individuals to those in euthyroid individuals. Results A total of 1608 individuals were included in the analysis of whom 45 (2.8%) met the criteria for SCH, with seven (15.6%) having TSH levels between 10 and 15 IU/l. We found no differences in median, mean or the percentage of elevated CRP or homocysteine in individuals with SCH compared to euthyroid controls. Linear regression models adjusting for age, gender, the presence of other cardiac risk factors, and whether the individual was using a cholesterol-lowering drug also failed to show any association between SCH and either high-sensitivity CRP (hsCRP) (P = 0.62) or homocysteine (P = 0.63) levels. When we examined the subset of people with TSH levels between 10 and 15 IU/l, we again found no difference in mean hsCRP or homocysteine compared to control., Conclusions: In this large population-based sample, hsCRP and homocysteine levels do not differ for individuals with SCH compared to euthyroid individuals. This suggests that cardiac inflammation is not greater in individuals with SCH.

Objective: Conflicting evidence has been reported about whether subclinical hypothyroidism (SCH) is associated with hyperlipidemia or cardiovascular disease. Thyroid peroxidase antibodies (TPOAb) are more common in persons with SCH. The purpose of this study was to evaluate whether the presence of (TPOAb) in people with SCH is associated with markers of cardiovascular disease., Design: Cross-sectional study using multivariate regression., Patients: Adults over age 40 who, in the National Health and Nutrition Examination Survey (NHANES) III, met the criteria for SCH (n = 188)., Measurements: Participants were stratified into TPOAb-negative (n = 82) and TPOAb-positive (n = 106) groups. Markers of cardiovascular disease risk were compared between the TPOAb-negative and TPOAb-positive groups. Multivariate regression models were performed to adjust for potential confounders., Results: In bivariate analyses, individuals with and without TPOAb had similar levels of triglycerides, high-density lipoprotein, low-density lipoprotein, total cholesterol and C-reactive protein. Homocysteine levels were higher in the patients without antibodies (P = 0.01). After adjusting for, age, gender, smoking, hypertension, diabetes and use of a lipid-lowering medication, however, no statistically significant relationships were found between the presence of TPOAb and any of the cardiovascular risk markers., Conclusions: The presence of thyroid peroxidase antibodies does not appear to correlate with cardiovascular disease risk in patients with subclinical hypothyroidism. This study does not support the measurement of TPOAb antibodies in SCH as a strategy for guiding treatment or assessment of cardiovascular disease risk.

Background and Objectives: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance., Methods: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile., Results: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars., Conclusions: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Objectives: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this study was to determine the availability of specialty HIV/AIDS services in long-term care facilities, and to determine differences in the availability of these services between rural and urban nursing homes., Methods: 1,423 nursing homes from the 1999 National Nursing Home Survey were stratified by rural/urban status and compared using chi2 analysis and logistic regression., Results: Less than 1% of surveyed nursing homes in the United States provided specialty HIV/AIDS services. While there was evidence that larger nursing homes are more likely to provide HIV/AIDS-related services, there were no significant differences between rural and urban nursing homes in the provision of specialty HIV/AIDS services., Conclusions: A vast majority of nursing homes in the United States do not provide any specialty areas for HIV/AIDS care. As our population ages and the life span of those diagnosed with HIV/AIDS continues to increase, nursing homes will begin to see patients diagnosed with HIV/ AIDS among those seeking care.

Objective: This study explored whether certain economic markers are associated with changes in the selection of primary care as a career., Methods: Using linear regression models, we examined whether economic factors in the United States could be used to predict the variability in US senior match rates in family medicine and three hospital-based specialties between 1978 and 2000., Results: A linear regression model using several economic indicators showed that public and private expenditures were associated with the US senior match rates in family medicine, anesthesia, and radiology. As private expenditures increased, the match rate for family medicine fell while the match rates for anesthesia and radiology increased. Increases in public expenditures were associated with increased family medicine match rates and declining match rates for the other two specialties. Increases in private spending resulted in average increases of 0.92% and 2.38% in the anesthesia and radiology match, respectively, with a drop in family medicine match rates of 1.36%. We found that for every 1% increase in public expenditures for health, family medicine match rates rise on average 1.39%, while anesthesia rates fall by 0.84% and radiology rates drop 2.16%., Conclusions: The amount of public and private funding for health care is associated with US senior match rates in family medicine, anesthesia, and radiology. Changes in these funding sources may predict future student specialty choice and could be used to plan residency match rates in disciplines such as family medicine.

Background: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency., Methods: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority., Results: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency., Conclusions: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.

Objectives: This study examined antimicrobial prescribing patterns for adults and children with bronchitis or upper respiratory infections (URIs) before and after release of nationally disseminated pediatric practice recommendations., Methods: Data from the 1993, 1995, 1997, and 1999 National Ambulatory Medical Care Survey were used to evaluate prescriptions for antimicrobials for URIs and bronchitis., Results: From 1993 to 1999, the proportion of children receiving antimicrobials after visits for URIs and bronchitis decreased. However, the use of broad-spectrum antimicrobials rose from 10.6% of bronchitis visits to 40.5%. Prescriptions of antimicrobials for adults with URIs or bronchitis showed a decrease between 1993 and 1999., Conclusions: Although antimicrobial prescribing for URIs and bronchitis has decreased for both children and adults, the prescribing of broad-spectrum antibiotics among children has shown a proportional rise.

Objective: This study assesses the attitudes of obstetricians about family physicians delivering babies., Methods: We performed a two-stage mail survey of physicians who self-reported their specialty as obstetrics- gynecology in the 2001 South Carolina Directory of Licensed Physicians. After excluding physicians who retired or moved, a response rate of 65% was obtained., Results: Fewer than half of the respondents (45%) supported family physicians providing pregnancy care. Obstetricians in favor of family physicians providing pregnancy care were more likely to work near a family physician who delivered babies, less likely to have been sued in the last 5 years, and more likely to be over age 60. Practice location (rural versus urban) did not predict support for family physicians participating in pregnancy care. Those obstetricians who supported family physicians participating in pregnancy care were comfortable with family physicians managing a wide range of common complications., Conclusions: Since fewer than half of obstetricians believe that family physicians should offer pregnancy care, family physicians may experience difficulty finding appropriate backup. Because older obstetricians were most likely to support family physicians, the retirement of these individuals from practice may create a problem for family physicians seeking obstetrical backup.

Background and Objectives: Balint seminars began in London in 1950 on a voluntary basis for general practitioners wishing to explore psychological problems in their practice. By 1964, there was a 36% early dropout rate among the 223 physicians who participated. This study sought to determine if those who leave Balint training during their residency, versus those who continue, have different psychological characteristics., Methods: A retrospective analysis of 206 Medical University of South Carolina family practice residents from 1982 to 1999 was completed. All residents participated in 6 months of required Balint training and then could leave the Balint group or continue for the remaining 2 years. We examined gender and personality attributes, comparing residents who completed 2 years of weekly Balint training and residents who left after 6 months. Personality attributes were measured with the Myers-Briggs Inventory, the Work Environmental Preference Schedule, the Internal-External Locus of Control, the Fundamental Interpersonal Relationship Orientation Behavior test, and the Personal Orientation Inventory., Results: A total of 132 residents completed 2 years of weekly Balint training, and 74 discontinued training after 6 months. Two-year attendees were significantly more intuitive on the Myers-Briggs Personality Inventory (MBTI). There were no significant differences on other MBTI items, nor were there significant differences in gender or in scores on the other psychological tests., Conclusions: Based on the rate of discontinuation of Balint training in our sample, Balint work does not appear to be suited to all physicians. With the exception of one MBTI characteristic, no significant differences could be demonstrated between those who did and did not continue participating. Further study is necessary to define other attributes characterizing Balint group attendees and nonattendees.

To determine if the timing of prenatal care is associated with low birth weight delivery after adjusting for sociodemographic and behavioral risk factors, we performed a retrospective cross-sectional study of singleton births to white (2,945,595) or African-American (552,068) women in the United States in 1996. When adjusted for race, maternal age, educational level attained, and the use of alcohol and tobacco during pregnancy, women beginning care in the 2nd (adjusted RR = 0.85; 95% CI: 0.83-0.86) and 3rd trimesters (RR = 0.87; 95% CI: 0.84-0.91) had a reduced risk of low birth weight compared to women beginning care in the 1st trimester. Our findings suggest that no benefit exists for early initiation of prenatal care for reducing the risk of low birth weight. Findings related to differences in low birth weight among women who start prenatal care later are likely due to sociodemographic differences that may influence access to early care.