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Provides abstracts of published medical research. Studies include "Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes," "Emergency Treatment of Young People Following Deliberate Self-harm," "The Relation Between Pulse Pressure and Cardiovascular Mortality in 12763 Middle-age Men From Various Parts of the World: A 25-Year Follow-up of the Seven Countries Study," "High Attributable Risk of Elevated C-Reactive Protein Level to Conventional Coronary Heart Disease Risk Factors: The Third National Health and Nutrition Examination Survey," "Continued Decline in Blood Lead Levels Among Adults in the United States: The National Health and Nutrition Examination Surveys," and "Complications After Photodynamic Therapy."

Background: This study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records., Methods: A cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5-11 years and 6 months-4 years cohorts. Chi square or Fisher's exact test was used where appropriate., Results: Across both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child's race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5-11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038)., Conclusions: This study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker., (© 2024. The Author(s).)

Competing Interests: Conflict-of-Interest Disclosures: None to disclose.

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

Given the role opioid overprescribing has played in the current overdose crisis, reducing the supply of prescription opioids available for misuse has gained widespread support. Prescription monitoring programs (PMPs) have been identified as a tool for achieving this goal, but little is known about how to promote PMP use to prescribers. This paper describes the process of developing a health communication campaign to support the adoption of the Texas PMP. After formative research, message development and concept testing, a range of campaign concepts and messages were tested and final recommendations determined. The messages and lessons learned have utility beyond Texas.

All people in the United States deserve the same level of public health protection, making it crucial that every health department across the country has a core set of foundational capabilities. Current research indicates an annual cost of $32 per person to support the foundational public health capabilities needed to promote and protect health for everyone across the nation. Yet national investment in public health capabilities is currently about $19 per person, leaving a $13-per-person gap in annual spending.To "create the conditions in which people can be as healthy as possible" and to protect national security, this gap must be filled. The Public Health Leadership Forum convened national experts in the public health, public policy, and other partner sectors to develop options for long-term, sustainable financing. The group aligned around core principles and criteria necessary to establish a sustainable financing structure.Informed by the work of the expert panel, the authors recommend a Public Health Infrastructure Fund for state, territorial, local, and tribal governmental public health, that would provide $4.5 billion of new, permanent resources needed to fully support core public health foundational capabilities.

Ensuring the conditions for all people to be healthy, though always the core mission of public health, has evolved in approaches in response to the changing epidemiology and challenges. In the Public Health 3.0 era, multisectorial efforts are essential in addressing not only infectious or noncommunicable diseases but also upstream social determinants of health. In this article, we argue that actionable, geographically granular, and timely intelligence is an essential infrastructure for the protection of our health today. Even though local and state efforts are key, there are substantial federal roles in accelerating data access, connecting existing data systems, providing guidance, incentivizing nonproprietary analytic tools, and coordinating measures that matter most.

Objectives: To evaluate the reported amount of 14 vitamins and 10 minerals in over-the-counter (OTC) and prescription (Rx) prenatal multivitamins and minerals (PMVMs) and compare them with the Health and Medicine Division (HMD) of the National Academies recommended dietary allowances (RDAs) and tolerable upper intake levels for intake., Design: Observational convenience sample of supplemental facts labels on OTC and Rx PMVMs identified and evaluated from online retailers, grocery stores, and pharmacies., Setting and Participants: Not applicable., Outcome Measures: Reported vitamin and mineral amounts in PMVMs were compared with HMD RDAs to determine whether PMVMs could correct RDA deficiencies in the average pregnant woman's diet. Reported vitamin and mineral amounts were compared in OTC and Rx PMVMs and to HMD upper intake levels., Results: One hundred sixty-three OTC and 88 Rx PMVMs were evaluated. The average pregnant woman in the United States is deficient in many vitamins and minerals from food intake alone. Over 80% of OTC and Rx PMVMs would correct the RDA deficit for vitamin B6, folic acid, vitamin C, vitamin E, and iron. Over 90% of OTC products would correct the deficit for vitamin A and zinc; however, 47% and 74% of Rx products would correct for those deficits, respectively. Approximately 73% of OTC and 60% of Rx PMVMs corrected calcium deficit, and 33% of OTC and 24% of Rx PMVMs corrected vitamin D deficit. A minority of PMVMs corrected deficits for magnesium and choline. OTC products have significantly more of each vitamin compared with Rx, with several exceptions including: iron, folic acid, copper, and vitamin B6., Conclusion: Most pregnant women take PMVMs. If pregnant women are not consuming enough essential micronutrients from diet, it is possible that PMVMs will provide adequate amounts; however, this depends on the specific vitamin or mineral. There is notable variation between Rx and OTC PMVM options., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations.

Objectives: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors., Design: Cross-sectional., Setting: Chronic Renal Insufficiency Cohort Study., Participants: Eight hundred twenty-five adults aged 55 and older with CKD., Measurements: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m(2)) was estimated using the four-variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score < or =1 standard deviations from the mean)., Results: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1-3.9), naming (AOR=1.9, 95% CI=1.0-3.3), attention (AOR=2.4, 95% CI=1.3-4.5), executive function (AOR=2.5, 95% CI=1.9-4.4), and delayed memory (AOR=1.5, 95% CI=0.9-2.6) but not on category fluency (AOR=1.1, 95% CI=0.6-2.0) than those with mild to moderate CKD (eGFR 45-59)., Conclusion: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.

Background: The field of hospital medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities and barriers posed to hospital medicine's development as an academic field in internal medicine., Objective: To develop consensus around key areas limiting or facilitating hospital medicine's development as an academic discipline., Design: Consensus format conference of key stakeholders in academic hospital medicine., Results: The Consensus Group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderate non-teaching roles, and demands to perform non-clinical duties (such as quality improvement) not generally viewed as academic pursuits. The Consensus Group developed recommendations for addressing these concerns, specifically 1) characterizing the 'optimal' job description for an academic hospitalist, 2) developing better local and at-a-distance opportunities for training academic hospitalists in key aspects of early career success, 3) advocacy for development of fellows and junior faculty researchers in hospital medicine. Fostering academic hospital medicine will help address these issues more effectively and will help the field while also attracting the next generation of generalists needed to care for an increasingly complex inpatient population.

Research has revealed significant variation in both the quality of clinical care and the health status of populations. We conducted a study to determine if variations in the quality of clinical care can be quantitatively linked to variations in health status, at the patient and the population level. This study, conducted at health facilities in four municipalities in Macedonia, collected cross-sectional data on (1) structural measures (such as infrastructure, facilities, equipment and costs) and the quality of clinical care provided by physicians (as measured by clinical vignettes); (2) detailed health and socioeconomic status information on patients using the facilities; and (3) nearly the same information on a random sample of adults in each municipality. Data were collected from a total of 57 facilities, 273 physicians, 1451 patients, and 1627 adults from the general population. The main outcome measure was health status, based on self-reported health surveys. Objective health measures were obtained to control for preexisting conditions. The main explanatory variable was quality of clinical care, based on physicians' clinical vignette scores. Structural measures were included in our model but had a more distal relationship to health status. We found that quality of care strongly predicted self-reported health status of patients using the facilities even after controlling for other factors (p < .05). Quality of care was also associated with higher health status for the population living in the surrounding community, regardless of utilization (p < .05). This linkage between quality of clinical care and health suggests that policies that improve clinical practice have the potential to improve population health more rapidly than other interventions.

Background: Reliable approaches for measuring antihypertensive medication compliance in the outpatient setting are not readily available. The objective of the current study was to determine the reliability of the Hill-Bone Compliance Scale among elderly hypertensive patients., Methods: We conducted a cross-sectional survey of community-dwelling patients attending the hypertension section of the Internal Medicine Clinic in a large multispecialty group practice. Participants (n=239) completed a self-administered questionnaire consisting of demographic questions and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, which includes a nine-item medication compliance subscale., Results: The mean age of respondents was 69 years; 51% of patients were men, 73% were white, 86% had at least a high school education, and 61% were married. The Cronbach alpha was 0.68 for the medication compliance subscale. All nine items of the medication compliance subscale maintained higher correlations with their own subscale total than with the salt intake and appointment keeping subscale totals. After adjusting for other demographic variables, the odds ratio (95% confidence interval) of perfect medication compliance as reported on the medication compliance subscale was 1.71 (0.95-3.07) for participants 65 years of age and older versus those younger than 65 years of age, 2.53 (1.37-4.66) for whites versus nonwhites, 1.27 (0.73-2.20) for males versus females, 1.30 (0.73-2.29) for married versus unmarried participants, and 1.63 (0.74-3.62) for those with at least a high school education versus those with less education., Conclusion: The medication compliance subscale of the Hill-Bone Compliance Scale appears reliable and may be a useful tool for detecting noncompliant patients in outpatient settings.

Background: The proportion of older individuals infected with the human immunodeficiency virus (HIV) is rising., Methods: We performed a retrospective case-control study of 58 patients more than 60 years old at the time of diagnosis of HIV infection and compared them with 232 controls (matched by CD4+ lymphocyte count). Clinical and demographic data were obtained from the Adult Spectrum of Diseases (ASD) database at the Medical Center of Louisiana., Results: Patients in the older age group were more likely to be male and African American or Hispanic. The most common risk factor for acquisition of HIV infection among the patients was homosexual contact (53%). Disease staging was similar in both groups as determined by CD4+ lymphocyte counts and history of opportunistic infections. There was no difference in the use of antiretroviral therapy. In a Cox proportional hazard model and regression models, age > or = 60 years was associated with shorter survival., Conclusion: Patients who are older than 60 years at the time of diagnosis of HIV infection have a shorter survival than younger patients.

Background: Recent shifts in reimbursement toward capitation makes appointment availability a significant resource and stimulates us to understand primary care physician (hereafter referred to as "provider") behavior concerning appointment assignment. The results of prior studies suggest significant provider variability in this area., Objective: To examine the influences on assigning patient revisit intervals in the ambulatory setting., Methods: Survey regarding general care issues of hypothetical diabetic and hypertensive patients seen in an ambulatory setting was given to 62 providers in the Internal Medicine Program at the Tulane University Internal Medicine Residency Program and outpatient clinics, New Orleans, La. Measurements evaluated included survey responses for demographics (sex, year of birth, year of graduation from medical school, and level of training) and practice style (decision to change therapy, order tests, and recommended return appointment interval in weeks) variables., Results: The response rate was 89% (56 providers). Most respondents were men (n = 39). Wide variation was noted in assignment of reappointment interval with mean return intervals for the scenarios ranging from 2.2 to 20.5 weeks. Significant influences on provider practice included patient stability (P<.001), the decision to change therapy (P = .001), and the decision to order tests (P = .001). All correlated with an earlier return appointment. Some providers exhibited test-ordering tendencies across scenarios. Sex was a significant provider independent variable and was not influenced by other study variables. Female providers assigned earlier reappointment intervals for their patients., Conclusions: Wide variation exists among practitioners with similar training background and practice setting. As expected, patient stability was a major determinant of assigned return interval. Test-ordering behaviors may consume appointments inappropriately and may be a productive area for efforts to reduce provider variability. The influence of the provider's sex on scheduling follow-up appointments warrants further investigation.