Notes

[A evaluate about the application of UK Biobank inside neuroimaging].
Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes.

A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits.

The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n=1,484) had HHI scores suggestive of 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). 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. Plerixafor antagonist 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. Future studies can evaluate the reason for these differences and offer solutions to publications as they try to increase their female authorship.
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