Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may ...develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.
To examine the association between cooking frequency and Healthy Eating Index (HEI)-2015, overall and by income, among US adults.
Cross-sectional analysis using multivariable linear regression models ...to examine the association between cooking frequency and total HEI-2015 score adjusted for sociodemographic variables, overall and stratified by income.
Nationally representative survey data from the USA.
Adults aged ≥20 years (with 2 d of 24 h dietary recall data) obtained from the 2007 to 2010 National Health and Nutrition Examination Survey (n 8668).
Compared with cooking dinner 0-2 times/week, greater cooking frequency was associated with higher HEI-2015 score overall (≥7 times/week: +3·57 points, P < 0·001), among lower-income adults (≥7 times/week: +2·55 points, P = 0·001) and among higher-income adults (≥7 times/week: +5·07 points, P < 0·001). Overall, total HEI-2015 score was higher among adults living in households where dinner was cooked ≥7 times/week (54·54 points) compared with adults living in households where dinner was cooked 0-2 times/week (50·57 points). In households in which dinner was cooked ≥7 times/week, total HEI-2015 score differed significantly based on income status (lower-income: 52·51 points; higher-income: 57·35 points; P = 0·003). Cooking frequency was associated with significant differences in HEI-2015 component scores, but associations varied by income.
More frequent cooking at home is associated with better diet quality overall and among lower- and higher-income adults, although the association between cooking and better diet quality is stronger among high-income adults. Strategies are needed to help lower-income Americans consume a healthy diet regardless of how frequently they cook at home.
Purpose
Transgender and gender diverse (TGD) patients face significant hurdles in accessing affirming, knowledgeable care. Lack of provider knowledge presents a substantial barrier to both primary ...and transition‐related care and may deter patients from seeking health care. Little is known about factors that affect provider knowledge or whether exposure to TGD health content during training is associated with improved knowledge among providers. Using the TGD Healthcare Knowledge Scale, this study aimed to determine whether prior education on TGD health predicts clinicians’ current knowledge regarding health care for TGD patients.
Methods
An online survey examining exposure to TGD content and knowledge of TGD health care was distributed to all primary care providers in an integrated health care system in the Midwestern United States. Multivariable linear regression was used to predict provider knowledge, controlling for demographics, transphobia and other potential confounders.
Results
The response rate was 57.3% (n = 223). The mean knowledge score was 7.41 (SD = 1.31) on a 10‐point scale. Almost half (48.4%, n = 108) had no formal education on TGD health care, yet half (49.7%, n = 111) of providers reported previously caring for at least one transgender patient. In regression analysis, provider knowledge of TGD health care was associated with transphobia (β = −0.377, 95% CI = −0.559 to −0.194, p < 0.001), but not with hours of formal education (β = −0.027, 95% CI = −0.077 to 0.023, p = 0.292) or informal education (β = −0.012, 95% CI = −0.033 to 0.009, p = 0.259).
Conclusions
Increasing hours of education related to TGD health care may not be sufficient to improve providers’ competence in care for TGD individuals. Transphobia may be a barrier to learning that needs to be addressed. Broader efforts to address transphobia in society in general, and in medical education in particular, may be required to improve the quality of medical care for TGD patients.
By studying transgender healthcare, Stroumsa et al. discover that caregivers’ prejudices (transphobia) better predict competence than their knowledge.
Exercise Prescriptions in Older Adults Lee, Pearl Guozhu, MD, MS; Jackson, Elizabeth A., MD, MPH; Richardson, Caroline R., MD
American family physician,
04/2017, Letnik:
95, Številka:
7
Journal Article
Recenzirano
Regular physical activity and exercise are important for healthy aging and are beneficial for chronic disease management. Exercise prescriptions for older adults should account for the individual's ...health status and functional capacity. Any amount of exercise is better than being sedentary, even if health status prevents a person from achieving recommended goals. For most health outcomes, more benefits occur with physical activity performed at higher intensity, greater frequency, or longer duration. Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and at least two days of muscle-strengthening activities per week. Key components of the prescription include setting achievable activity goals, identifying barriers and providing potential solutions, and providing specific recommendations on the type, frequency, and intensity of activities. Older adults will derive distinct benefits from aerobic exercise, strength or resistance training, flexibility or stretching exercises, and balance training. Many community resources are available to help older adults begin a more active lifestyle.
Background
Physician-to-physician variation in electronic health record (EHR) documentation not driven by patients’ clinical status could be harmful.
Objective
Measure variation in completion of ...common clinical documentation domains. Identify perceived causes and effects of variation and strategies to mitigate negative effects.
Design
Sequential, explanatory, mixed methods using log data from a commercial EHR vendor and semi-structured interviews with outpatient primary care practices.
Participants
Quantitative: 170,332 encounters led by 809 physicians in 237 practices. Qualitative: 40 interviewees in 10 practices.
Main Measures
Interquartile range (IQR) of the proportion of encounters in which a physician completed documentation, for each documentation category. Multilevel linear regression measured the proportion of variation at the physician level.
Key Results
Five clinical documentation categories had substantial and statistically significant (
p
< 0.001) variation at the physician level after accounting for state, organization, and practice levels: (1) discussing results (IQR = 50.8%, proportion of variation explained by physician level = 78.1%); (2) assessment and diagnosis (IQR = 60.4%, physician-level variation = 76.0%); (3) problem list (IQR = 73.1%, physician-level variation = 70.1%); (4) review of systems (IQR = 62.3%, physician-level variation = 67.7%); and (5) social history (IQR = 53.3%, physician-level variation = 62.2%). Drivers of variation from interviews included user preferences and EHR designs with multiple places to record similar information. Variation was perceived to create documentation inefficiencies and risk patient harm due to missed or misinterpreted information. Mitigation strategies included targeted user training during EHR implementation and practice meetings focused on documentation standardization.
Conclusions
Physician-to-physician variation in EHR documentation impedes effective and safe use of EHRs, but there are potential strategies to mitigate negative consequences.
The United States is experiencing a surge in Chlamydia trachomatis (CT) infections representing a critical need to improve sexually transmitted infection (STI) screening and treatment programs. To ...understand where patients with STIs seek healthcare, we evaluated the relationship between CT infections and the place where individuals report usually receiving healthcare.
Our study used a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. The study population is adult patients, aged 18 to 39 years in whom a urine CT screen was obtained. Logistic regression models were used to determine if location of usual healthcare was predictive of a positive urine CT screen result. Models were adjusted for known confounders including age, gender, race/ethnicity, education, and insurance status.
In this nationally representative sample (n = 19,275; weighted n = 85.8 million), 1.9% of individuals had a positive urine CT result. Participants reported usually going to the doctor's office (70.3%), "no place" (24.8%), Emergency Department (ED) (3.3%), or "other" place (1.7%) for healthcare. In adjusted models, the predicted probability of having a positive urine CT result is higher (4.9% vs 3.2%, p = 0.022; OR = 1.58) among those that reported the ED as their usual place for healthcare compared to those that reported going to a doctor's office or clinic.
Individuals having a positive urine CT screen are associated with using the ED as a usual source for healthcare. Understanding this association has the potential to improve STI clinical and policy interventions as the ED may be a critical site in combatting the record high rates of STIs.
The initial ecology of medical care study was published in 1961, offering a framework by which to investigate individuals' contact with the medical system. We studied changes in the framework around ...the implementation of the Patient Protection and Affordable Care Act (ACA) within longer-term trends.
The 2002-2016 Medical Expenditure Panel Survey was used to determine rates of visit/contact per 1,000 individuals per month for physicians, primary care physicians, specialty physicians, emergency departments, inpatient hospitalizations, dental visits, and home health visits for the overall population and by age group, poverty category, health status, and race/ethnicity. Adjusted Wald tests were used to investigate differences between the pre-ACA (2012-2013) and post-ACA (2014-2015) periods. Multivariable linear regression was used to determine trends over the study period (2002-2016).
The survey included 525,804 person-years. The uninsured rate decreased from 12.8% (95% CI, 12.0%-13.7%) in 2013 to 7.6% (95% CI, 7.0%-8.3%) in 2016. From 2002 to 2016, the numbers of individuals in a month who had contact with primary care physicians, dental care, and inpatient hospitalizations decreased. Primary care physician contact decreased most among the elderly and those reporting fair/poor health. After ACA implementation, few significant changes were identified in the overall population or by age, poverty category, race/ethnicity, or health status.
The medical ecology framework was not notably altered 2 years after implementation of the ACA. The long-term decrease in primary care contact does not appear to have been interrupted after implementation of the ACA, was observed across income and age categories, and was most evident among the elderly and individuals reporting fair/poor health.
AbstractMuch of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional ...outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.
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