Notes

Brand-new style combines natural replies, PML-NB formation, epigenetic control and also reactivation coming from latency.
2% (
<.001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candidates. Overall, 71.5% of patients contacted felt their referral was appropriate.

An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.
An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.
We undertook a study to examine national trends in potentially preventable hospitalizations-those for ambulatory care-sensitive conditions that could have been avoided if patients had timely access to primary care-across 3,200 counties and various subpopulations of older adults in the United States.

We used 2010-2014 Medicare claims data to examine trends in potentially preventable hospitalizations among beneficiaries aged 65 years and older and developed heat maps to examine county-level variation. We used a generalized estimating equation and adjusted the model for demographics, comorbidities, dual eligibility (Medicare and Medicaid), ZIP code-level income, and county-level number of primary care physicians and hospitals.

Across the 3,200 study counties, potentially preventable hospitalizations decreased in 327 counties, increased in 123 counties, and did not change in the rest. At the population level, the adjusted rate of potentially preventable hospitalizations declined by 3.45 percentage points frons, dually eligible patients and Black and Hispanic patients continued to have substantially higher rates compared with non-dually eligible and White patients, respectively.
To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries.

Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services' 8-state Multi-Payer Advanced Primary Care Practice demonstration.

Six activities were associated with lower spending or utilization. Use of a registry to identify and remind patients due for preventive services was associated with all 4 of our outcome measures total spending was $69.77 less per beneficiary per month (PBPM) (
= 0.00); acute-care hospital spending was $36.62 less PBPM (
= 0.00); there were 6.78 fewer hospital admissions per 1,000 beneficiaries per quarter (P1KBPQ) (
= 0.003); and 11.05 fewer emergency department (ED) visits P1KBPQ (
= 0.05). Using a patient registry for pre-visit planning and clinician reminders was associated with $29.31 lower total spending PBPM (
= 0.05). Selleckchem NSC 641530 Engaging patients with chronic conditions in goal setting and action planning was associated with 4.62 fewer hospital admissions P1KBPQ (
= 0.01) and 11.53 fewer ED visits P1KBPQ (
= 0.00). Monitoring patients during hospital stays was associated with $22.06 lower hospital spending PBPM (
= 0.03). Developing referral protocols with commonly referred-to clinicians was associated with 11.62 fewer ED visits P1KBPQ (
= 0.00). Using quality improvement approaches was associated with 13.47 fewer ED visits P1KBPQ (
=0.00).

Practices seeking to deliver more efficient care may benefit from implementing these 6 activities.
Practices seeking to deliver more efficient care may benefit from implementing these 6 activities.
Studies conducted in medical fields other than family medicine show that gender differences in publication rates are pronounced in many, but not all, fields of medicine. Our objective was to assess possible gender differences in publication rates in family medicine journals.

Using MEDLINE, we collected information on all journal articles published in 3 family medicine journals in the United States (
,
, and
) during the period 2008 to 2017. Gender of first and last author for each article was assigned using first names. The gender breakdown of the editorial boards during this time period was also examined.

For the 3 journals combined during the period 2008 to 2017, 46.1% (1,209/2,623) of first authors were female, and 38.6% (857/2,223) of last authors were female. For all journals combined, there was a statistically significant increase in first authorship (43.2% in 2008 vs 52.1% in 2017;
<.001) and last authorship (28.8% in 2008 vs 41.8% in 2017;
<.001) over time. The editorial boards of the journals combined were 37.2% (279/749) female, and this did not increase significantly over the time period studied (35.5% in 2008 vs 39.2% in 2017;
=.49).

Representation of female authors in family medicine journals is increasing, yet last authorship remains low, and there is variation between journals in terms of gender equity. Future studies can evaluate the reason for these differences and offer solutions to publications as they try to increase their female authorship.
Representation of female authors in family medicine journals is increasing, yet last authorship remains low, and there is variation between journals in terms of gender equity. link2 Future studies can evaluate the reason for these differences and offer solutions to publications as they try to increase their female authorship.
Describe primary care practices' implementation of CommunityRx-H3, a community resource referral intervention that utilized practice facilitators to support cardiovascular disease (CVD) prevention quality improvement.

Qualitative focus groups were conducted with practice facilitators to elicit perceptions of practices' experiences with CommunityRx-H3, practice-level factors affecting, and practice facilitator strategies to promote implementation. Qualitative data were analyzed using directed content analysis. The Consolidated Framework for Implementation Research was applied deductively to organize and interpret findings.

Fourteen of all 19 practice facilitators participated. Practice facilitators perceived that staff attitudes about connecting patients to community resources for CVD were largely positive. Practices were already using a range of non-systematic strategies to refer to community resources. Practice-level factors that facilitated CommunityRx-H3 implementation included clinician "champions,"primary care CVD prevention efforts.
Practice facilitators are increasingly being utilized by primary care practices to support quality improvement interventions and, as shown here, can also play an important role in implementation science. This study yields insights to improve implementation of community resource referral solutions to support primary care CVD prevention efforts.
To investigate whether the prospective association between electronic cigarette (e-cigarette) use and cigarette smoking is dependent on smoking intention status.

Waves 2 and 3 data of the Population Assessment of Tobacco and Health (PATH) Study, a US nationally representative prospective cohort study of tobacco use. Data were collected in 2014-2015 (wave 2) and 2015-2016 (wave 3) and analyzed in 2019.

At wave 2, 12.8% of adolescent never-smokers of conventional cigarettes had intention to smoke and 8.5% had ever used an e-cigarette. At wave 3, 3.2% had ever smoked a cigarette. Both smoking intention and ever using e-cigarettes at wave 2 were positively associated with cigarette smoking at wave 3 (adjusted odds ratio [aOR] = 3.03; 95% confidence interval [CI] = 1.97-4.68,
.001; aOR = 4.62, 95% CI = 2.87-7.42,
.001, respectively). The interaction between smoking intention and ever using e-cigarettes was significant (aOR = 0.34, 95% CI = 0.18-0.64,
.01). Among adolescents who had expressed intention to smoke conventional cigarettes at wave 2, the odds of cigarette smoking at wave 3 did not significantly differ for e-cigarette users and never e-cigarette users (aOR = 1.57; 95% CI 0.94-2.63;
= .08). Among adolescents who had no intention to smoke at wave 2, e-cigarette users, compared with never e-cigarette users, had >4 times the odds of cigarette smoking (aOR = 4.62; 95% CI 2.87-7.42;
.0001).

E-cigarette use is associated with increased odds of cigarette smoking among adolescents who had no previous smoking intention. E-cigarette use may create intention to smoke and/or nicotine use disorder that lead to onset of cigarette smoking.
E-cigarette use is associated with increased odds of cigarette smoking among adolescents who had no previous smoking intention. E-cigarette use may create intention to smoke and/or nicotine use disorder that lead to onset of cigarette smoking.
To quantify the prevalence of parental vaccine hesitancy (VH) in the United States and examine the association of VH with sociodemographics and childhood influenza vaccination coverage.

A 6-question VH module was included in the 2018 and 2019 National Immunization Survey-Flu, a telephone survey of households with children age 6 months to 17 years.

The percentage of children having a parent reporting they were "hesitant about childhood shots" was 25.8% in 2018 and 19.5% in 2019. The prevalence of concern about the number of vaccines a child gets at one time impacting the decision to get their child vaccinated was 22.8% in 2018 and 19.1% in 2019; the prevalence of concern about serious, long-term side effects impacting the parent's decision to get their child vaccinated was 27.3% in 2018 and 21.7% in 2019. link3 Only small differences in VH by sociodemographic variables were found, except for an 11.9 percentage point higher prevalence of "hesitant about childhood shots" and 9.9 percentage point higher prevalence of concerns about serious, long-term side effects among parents of Black compared with white children. In both seasons studied, children of parents reporting they were "hesitant about childhood shots" had 26 percentage points lower influenza vaccination coverage compared with children of parents not reporting hesitancy.

One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.
One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.
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