Search

Purpose: Rates of loneliness and obesity have increased in recent decades. Loneliness and obesity independently have been found to be risk factors for negative physical and mental health outcomes. This study examined the rates and interrelationships of loneliness, body mass index (BMI), and health care utilization in a primary care setting. Methods: A cross-sectional survey of adult patients presenting for outpatient care at 7 family medicine clinical practices in Pennsylvania was conducted. Survey questions included self-reported measures of loneliness, height/weight, number of health care visits, and potential confounders (eg, sociodemographic variables, health status). Bivariate and multivariable linear regression models were used to analyze associations among loneliness, BMI, and health care utilization. Results: In all, 464 eligible patients returned surveys for an overall response rate of 26%. Mean (standard deviation) loneliness score was 4.2 (1.7), mean BMI was 30.4 (7.6), and mean number of visits in year prior was 2.7 (3.6). On bivariate analysis, BMI was positively associated with loneliness (effect estimate: 0.50; P = 0.03). On multivariable analysis, BMI was negatively associated with attending religious services and self-reported physical health and positively associated with self-reported mental health (P < 0.05 for all), but not associated with loneliness. While not associated with loneliness, health care utilization was negatively associated with Hispanic ethnicity, marital status, and self-reported physical health (P < 0.05 for all). Conclusions: Given the detrimental effects loneliness and obesity have on health outcomes, it might be prudent for health care providers to prioritize health concerns for their patients by assessing loneliness and counseling regarding associated risks, particularly in patients with obesity.

Context: As a result of the COVID-19 pandemic, interviews during the 2021 U.S. residency match were conducted virtually; a practice again recommended and repeated by many programs in 2022. The impact of transitioning to virtual interviews on match outcomes is not well studied. If not detrimental, continuing virtual interviewing in the future may be preferred by applicants and programs. Objective: To evaluate the impact of virtual interviews by comparing a baseline of in- person resident interviewing outcomes from 2016-2019 to virtual interviewing outcomes using data from the 2020-2022 virtual interview seasons in three Family Medicine (FM) residency programs. Study Design and Analysis: Retrospective cross-sectional analysis of National Residency Matching Program[R] data between 2016-2022. Aggregate in-person data (2016-2019) was compared to aggregate virtual data (2020-2022) for each program using chi-square, Fisher Exact test or 2-tailed t-tests to 95% confidence. Setting or Dataset: Three Pennsylvania FM residency programs affiliated with Penn State Health (PSH): the M.S. Hershey Medical center in Hershey, a three-year University-based program; the Mount Nittany Medical Center in State College, a three-year community-based university affiliated program; and Saint Joseph Hospital in Reading, a three-year community-based university affiliated program. Population Studied: FM residency applicants at three programs affiliated with PSH. Intervention/Instrument: Retrospective chart review. Outcome Measures: Fill rate, MD/DO ratio, average position on rank list, average distance from residency site to current and permanent address, and % URIM matched resident. Results: One program had significantly more unfilled positions during virtual recruitment (p=0.006); two had significant differences in the proportion of MD:DO matched applicants (p=0.001; p, Presenters Zakary Newberry, Karl Clebak, MD, MHA, FAAFP, Joseph Wiedemer, MD, FAAFP, Jessica Parascando, Alexis Reedy-Cooper, MD, MPH, Robert Lennon, MD, FAAFP, JD, JD, Huamei [...]

CONTEXT: Substance use disorders (SUDs) pose a significant risk to public health. While there are plenty of resources out there, getting them to the right people presents a challenge. Medicaid expansion has been shown to be beneficial (Kravitz-Wirtz et al., 2020), and our public perceptions can negatively impact victims of SUDs. Furthermore, SUDs have contributed to nearly one- million deaths in the US since 1999 (NCDAS, 2022). OBJECTIVE: To evaluate the impact of opioid use in Berks County, PA and assess the need for naloxone dispensing machines in areas of need (AON). STUDY DESIGN AND ANALYSIS: This study is a needs assessment involving the Penn State Health St. Joseph Family Medicine Residency. We identified several community partners within Berks County, PA to gather information regarding the need for naloxone dispensing machines. SETTING OR DATASET: Data was provided by Berks County on overdose (OD) death rates (Jan 2015-Dec 2021) and OD calls to 911 (Sept 2021-22) by location frequency. Additional information was obtained through interview with community partners involved with addiction treatment in Berks County. POPULATION STUDIED: The general population of Berks County. INTERVENTION/INSTRUMENT: Interpreting the data gathered to identify AON in Berks County. OUTCOME MEASURES: Berks County AON based on OD rates and 911 OD call locations. RESULTS: The Family Dollar at Penn St is the top location identified without naloxone at high risk for OD (9 fatal OD, 20 unconscious), with shopping centers being 31.67% of OD calls. Reading, PA totals over 50 OD calls, the next municipality less than 10. OD deaths per 100,000 Berks County residents by ethnicity (Jan 2015-Dec 2021) reveals that the White population OD rate increased from 19.0 to 34.1 while the Hispanic population OD rate increased from 17.3 to 40.2. The Black population OD rate peaked from 5.8 to 72.0 from 2015 to 2019 with a decline to 53.9 in 2020 and 2021. CONCLUSIONS: Now that St. Joseph has completed the part of identifying local AON, the next steps are to work with partners and researchers at Penn State College of Medicine to design a separate study involving the installation of naloxone dispensing machines. This will help determine whether access to these machines would improve outcomes amidst the opioid crisis., Presenters Ryan Liu, Alexis Reedy-Cooper, MD, MPH, Nathaniel Ohlinger, DO, [...]

Group medical visits (GMVs) for patients with chronic pain are becoming more accessible and have been shown to be successful in furthering patient education on multidisciplinary, nonopioid interventions. Unfortunately, evidence suggests that many group visit models lack sustainability due to recruitment issues and retention rates. Additionally, most of the studies surrounding GMVs are located in primarily urban health centers, potentially limiting their generalizability. This study aims to identify patient interest in and barriers to GMVs for chronic pain and to explore how chronic pain impacts daily lives for GMV content optimization in a nonurban population. Nineteen participants age 18 to 65 years participated in semistructured phone interviews to generate a thematic analysis. Participants received their care from family practitioners at a suburban multiclinic academic medical group and were being prescribed at least 50 morphine milligram equivalents (MME) at the time of recruitment. Analysis generated two themes: (1) Participants expressed specific interest in GMVs with few barriers identified, and (2) Pain has a negative impact on mental health and most aspects daily life, creating a foundation for discussion in GMVs. Findings support significant patient interest in group medical visits for chronic pain, but careful planning is necessary to address patient needs, expectations, and barriers in order to ensure GMV sustainability.

Approximately 7% of children in the United States younger than 18 years have a diagnosed eye disorder, and 1 in 4 children between two and 17 years of age wears glasses. Routine eye examinations during childhood can identify abnormalities necessitating referral to ophthalmology, which optimizes children's vision through the early diagnosis and treatment of abnormalities. The U.S. Preventive Services Task Force recommends vision screening at least once in children three to five years of age to detect amblyopia or its risk factors to improve visual acuity. The American Academy of Family Physicians supports this recommendation. The American Academy of Pediatrics recommends screening starting at three years of age and at regular intervals in childhood, and that instrument-based screening (e.g., photoscreening, autorefraction) is an alternative to vision charts for testing visual acuity in patients three to five years of age. Eye examinations include visual acuity testing, external examinations, assessing ocular alignment and pupillary response, and assessing for opacities with the red reflex examination. Common abnormalities include refractive errors, amblyopia (reduction in visual acuity in one eye not attributable to structural abnormality), and strabismus (misalignment of the eye). Rare diagnoses include retinoblastoma (often detectable through loss of red reflex), cataracts (detectable by an abnormal red reflex), and glaucoma (often manifests as light sensitivity with corneal cloudiness and enlargement). (Am Fam Physician. 2023; 108(1):40–50. Copyright © 2023 American Academy of Family Physicians.) Approximately 7% of children in the United States younger than 18 years have a diagnosed eye disorder, and 1 in 4 children between two and 17 years of age wears glasses. Routine eye examinations during childhood can identify abnormalities necessitating referral to ophthalmology, which optimizes children's vision through the early diagnosis and treatment of abnormalities. The U.S. Preventive Services Task Force recommends vision screening at least once in children three to five years of age to detect amblyopia or its risk factors to improve visual acuity. The American Academy of Family Physicians supports this recommendation. The American Academy of Pediatrics recommends screening starting at three years of age and at regular intervals in childhood, and that instrument-based screening (e.g., photoscreening, autorefraction) is an alternative to vision charts for testing visual acuity in patients three to five years of age. Eye examinations include visual acuity testing, external examinations, assessing ocular alignment and pupillary response, and assessing for opacities with the red reflex examination. Common abnormalities include refractive errors, amblyopia (reduction in visual acuity in one eye not attributable to structural abnormality), and strabismus (misalignment of the eye). Rare diagnoses include retinoblastoma (often detectable through loss of red reflex), cataracts (detectable by an abnormal red reflex), and glaucoma (often manifests as light sensitivity with corneal cloudiness and enlargement). [ABSTRACT FROM AUTHOR]

Does inhaled corticosteroid (ICS) monotherapy improve exacerbation outcomes in patients with stable chronic obstructive pulmonary disease (COPD)? [ABSTRACT FROM AUTHOR]

Is adding an antiplatelet agent for the treatment of deep venous thrombosis (DVT) safe and effective for preventing future complications? [ABSTRACT FROM AUTHOR]

The article presents a study which examined whether intravaginal antifungal is safe and effective as oral antifungals for the treatment of uncomplicated vulvovaginal candidiasis. Topics discussed include clinical characteristics of vulvovaginal candidiasis, clinical cure rates for patients using short-term courses of oral versus intravaginal antifungals, and guidelines from the U.S. Centers for Disease Control and Prevention.

The article offers information on patients at increased risk of developing type 2 diabetes mellitus, is metformin effective for the prevention or delay of diabetes onset and its associated complications. Topics include the patients who used metformin for one to 5 years were less likely to develop type 2 diabetes compared with patients has counseled on standard diet and exercise, and the development of type 2 diabetes in patients taking metformin has compared on intensive diet and exercise.