Family Medicine Center Research Articles

Do interferon-gamma release assays have better sensitivity and specificity than the TST for the diagnosis of active tuberculosis in high-risk populations?

Medstar Health/Georgetown-Washington Hospital Center Family Medicine Residency Program Colmar Manor, MD The authors declare no conflicts of interest.

Morbidity, mortality and case fatality rate from chronic hepatitis B with and without a delta agent in Kyrgyzstan for the period 2010–2017

The purpose of the study is to research the morbidity, mortality and case fatality rate y of chronic viral hepatitis B without and with a delta agent from 2010–2017. in Kyrgyzstan.Materials and methods: analyzed state reporting forms No. 12 “Report on morbidity and preventive work (family medicine center, dispensary)” and “C51 — Distribution of deaths by sex, age groups and causes of death” from 2010–2017. Data processed by Microsoft Office Excel.Results: In the country from 2010–2017 3292 cases of chronic viral hepatitis B were detected, 1738 patients of them verified an independent course (СhHBV), and 1,554 patients combined with a delta agent (СhHDV), while the incidence did not have a statistically significant difference (3.80/0000, 95% CI 2.4–4.0 and 3.40/0000, 95% CI 2.2–3.4, СhHBV and СhHDV, respectively) were 20 times lower compared to the HBV Carrier (60 40/0000). There was no statistically significant difference between the cumulative morbidity, mortality, case fatality rate and the proportion of deaths in СhHBV and СhHDV. The death rate СhHBV increased by 4.7 times (0.090/0000 and 0.410/0000), case fatality rate — by 11.8 times (1355.00/0000 and 16025.60/0000) amid a decrease the incidence is 2.5 times (6.40/0000 and 2.50/0000) from 2014 to 2017, respectively. At СhHDV, the mortality rate was also increased by 4.7 times (0.030/0000 and 0.160/0000), case fatality rate — by 32.3 times (793.70/0000 and 25641.80/0000) against the background of a decrease in incidence by 6.9 times (4.40/0000 and 0.60/0000) from 2014 to 2017, respectively.Conclusion: In Kyrgyzstan from 2010–2017, relatively low detectability of chronic forms of HBV infection with and without delta agent was found, compared with the “HBV carrier”. There has been an increase in mortality and case fatality rate over the past 4 years, with a sharp rise in 2017 against the background of a downward trend in the incidence of СhHBV and СhHDV.

Vitamin D level in a sample of egyptian females in child bearing period attending a family medicine center

Abstract Background Vitamin D deficiency is now recognized as a pandemic. It plays an important role in the development of bone health and possibly non-communicable diseases. The normal range of Vitamin D in the Arab countries is much lower than the international standards. Some Arab countries had made their own national studies to assess serum vitamin D level among women, yet in Egypt there is no national survey done, therefore we tried to assess serum vitamin D level among women during the child bearing period in Egypt and to investigate the factors affecting it. Objective To measure vitamin D level among a sample of females during the child-bearing period attending a family medicine center. To identify the factors affecting vitamin D level among studied females. Patients and Methods In the present study, we included 100 healthy adult females in their childbearing period who were attending a Family Medicine Center. The age of the included women ranged from minimum 19 years to maximum 49 years old with a mean age of 34 ± 8.47 years. We found that the majority of participants have deficiency and insufficiency of vitamin D level; 43% of the included women had vitamin D deficiency and 13% of the women had vitamin D insufficiency. In the present study, we sought to identify the factors affecting vitamin D level among studied females. Results The analysis showed that there was a statistically significance association between the employment status of the included women and vitamin D3 level groups; unemployed women were more likely to have vitamin D deficiency than employed women. In the present study, a statistically significance association was observed between the duration of sun exposure and vitamin D3 level groups. Participants who exposed to sun > 30 min/day were more likely to have sufficient vitamin D level. The results of the present study demonstrated that all participants who consume fish ≥3 times/week have sufficient vitamin D level. Therefore, there was a statistically significance association between a number of consuming fish/week and vitamin D3 level groups. The results of the present study also showed that there was statistically significant association between number of consumed milk cups/day and vitamin D3 level groups. All participants who drink 2 cups of milk have sufficient vitamin D level. In addition, we found no statistically significance association between using multivitamins and vitamin D3 level groups. Half of the participants who were using multivitamins had vitamin D insufficiency. Conclusion Vitamin D deficiency and insufficiency are prevalent among Egyptian women in childbearing period. In addition, the unemployment, low milk and fish consumption, and infrequent sun exposure are significant risk factors for vitamin D deficiency. Therefore, for improving the health and productivity of women in childbearing period, a routine monitoring system for vitamin D and the other factors should be put in place. Nevertheless, future research on the role of multivitamins supplements and fish consumption in improving vitamin D nutrition is warranted.

Self-Care of Women during Postpartum period in Rural Area

Background: The postpartum period is the period when women adjust physically and psychologically after the delivery of the baby. It is the period after the end of labor during which special attention of a community health nurse is required on the women's and the baby's health. Research Design: a quasi-experimental design was used. The aim of this study was to Assess postpartum women's knowledge and practice related to self-care in rural area. Setting: This study was conducted at family medicine centers affiliated to shesht El- Enaam health unit at El-Behara Governorate and postpartum women's homes. Sampling: purposive sample of 67postpartum women were included, Primipara and multipara postnatal mothers, during first two weeks from postpartum period, women who delivered normally or by cesarean section and women free from any medical or gynecological disease or disability and their babies free from anomalies. Tools: for data collection three tools were used,1 st tool: an interviewing questionnaire for the postpartum women includes five parts; Part one: socio-demographic characteristics, Part two: obstetric history, Part three: Postpartum woman's cultures and beliefs about postpartum period, Part four: Postpartum woman's knowledge regarding postpartum self-care, Part five: Postpartum woman's self-care during postpartum period, 2 nd tool: review of infant's growth and development measurements sheet, 3 rd tool: home environmental assessment observational checklist. Results:the current study revealed thatless than three quarter of postpartum women had negative total cultures and beliefs regarding postpartum self-care, more than two fifth of postpartum women had satisfactory knowledge toward total postpartum self-care, also majority had inadequate self-care. With a highly statistically significant difference between knowledge and self-care practice Conclusion: the total score level for self-care practice revealed that the majority of study sample unaware of adequate self-care practice in rural areas. Recommendations: applying health education programs about maternal health issues through ministry of health.

Do needle exchange programs decrease the incidence of HIV?

University of Minnesota Medical Center Family Medicine Residency Program, Minneapolis, MN The authors declare no conflicts of interest.

Determinants and Impact of Childhood Asthma in Outpatient Clinics of Family Medicine Centers of New Minia City

Determinants and Impact of Childhood Asthma in Outpatient Clinics of Family Medicine Centers of New Minia City

Measuring the level of patient's satisfaction for those attending primary health centers versus family medicine centers in Basrah governorate

Background: Patient satisfaction is defined as the total judgments made by the recipient of a healthcare as to whether -or not- their expectations have been met. It is an important measure of healthcare quality as it offers information on the provider’s success to meet the clients’ expectations.The Study Objectives: The study aimed at measuring patient's satisfaction in primary health centers of Basrah governorate with a comparison between primary health centers that follow family medicine strategy versus general primary health centers.Methodology: It's a cross sectional study involved patients attended primary health care centers in Basrah governorate during June 2016.Standard check lists and questionnaires from Iraqi Ministry of Health were used to measure five main indicators of patient satisfaction including: appearance, credibility, responsiveness, security and empathy with a four likert scale to measure the satisfaction of patient. A total sample included 456 patients. Results: The lowest Cronbach's coefficient alpha value was found by the study to be in the "general appearance" dimension which included the general infrastructural appearance of the health facility with appropriate waiting areas for the attendees, cleanliness and lighting of the facility in addition to the general look and appearance of the health workers and service providers. While “assurance” dimensions shows the highest percentage of satisfaction. In addition, no significant difference was revealed for the chosen satisfactory dimensions between the health care centers providing family-medicine services compared to those with no family-medicine ones.Conclusions: The study remarks important weaknesses in some of the patient satisfactory dimensions including general appearance, responsiveness, apathy and assurance. However, it provides an evidence of having no significant difference for the chosen satisfactory dimensions between the health care centers providing family-medicine services compared to those with no family-medicine ones.

Is there an association between hormonal contraception methods and suicide attempts?

MedStar Health/Georgetown-Washington Hospital, Center Family Medicine Residency Program, Washington, DC Cassopolis Family Clinic Network, Cassopolis, MI The authors declare no conflicts of interest.

Тенденции распространенности злокачественных новообразований молочной железы в Киргизской Республике

Currently, malignant neoplasms are one of the leading causes of mortality not only in the world, but also in the Kyrgyz Republic. By 2030, the number of new cancer cases is projected to increase to 26.4 million per year and the number of deaths to 17 million. In assessing cancer incidence and mortality from 25 major cancers in 40 countries in Europe, breast cancer was one of the most common causes of cancer death. Statistical data from the Electronic Health Centre and the National Oncology and Hematology Centre of the Ministry of Health of the Kyrgyz Republic were analyzed. In the Kyrgyz Republic, there is a positive trend among women in the increase in the incidence of malignant neoplasms in 0.03% in 2016 to 1.7% in 2015 and 2018. By the regions of the Republic, a high level of morbidity was revealed with an increase in the indicator in Batken, Issyk–Kul, Osh region and Osh city. The prevalence of malignant new growths of a mammary gland among women of the Kyrgyz Republic tended growth in the studied years for 1.5, 2.1, 1.7 and 1.9% respectively. Across the regions of the republic in all years the growth of the indicator was observed in Jalal–Abad, Issyk–Kul, Osh regions and Osh. There was also an increase in the Batken and Naryn regions, except in 2015. In 2018, compared to 2014, there was a decrease in female mortality from malignant neoplasms by 61.8% in terms of visibility. In terms of mortality from malignant breast neoplasms, there is a reverse trend among women of the Republic. Thus, the indicator increased by 107.6%. The main reasons for the high one-year fatality are the late appeal of patients to specialists, the lack of qualified personnel at the primary level of medical services, the absence of observation rooms in family medicine centers, the reduction of oncological caution of doctors and the population of the Republic. Screening of the female population and treatment of pre-tumor breast diseases should be carried out.

Improved Breastfeeding Outcomes Following an On-site Support Intervention in an Academic Family Medicine Center.

Despite the importance of breastfeeding, most US women do not meet recommendations for length of any or exclusive breastfeeding. Support in primary care settings is recommended (US Preventive Services Task Force, 2016), but optimal implementation strategies are not established. We evaluated the effect on breastfeeding rates of on-site breastfeeding support within an academic family medicine center with a diverse patient population. We conducted a retrospective chart review 10 months before and 10 months following the implementation of integrated breastfeeding support provided by an International Board Certified Lactation Consultant (IBCLC) or MD-IBCLC. Two hundred eighty-one infants were identified, 140 before implementation and 141 after. A research assistant extracted data from the electronic medical record. We performed bivariate and multiple logistic regression analyses using STATA. There were no significant demographic differences before and after the intervention. The proportion of infants with any breastfeeding at 2, 4, and 6 months was greater in the postimplementation group (71.7% vs 86.7% at 2 months, P=.05; 61.5% vs 77.1% at 4 months, P=.08; and 50.7% vs 64.4%, P=.09 at 6 months). The proportion of infants exclusively breastfed was also greater in the postimplementation group (58.7% vs 77.8% at 2 months, P=.04; 50.5% vs. 54.2% at 4 months, P=.06; and 44.0% vs 49.3% at 6 months, P=.12). Providing on-site IBCLC breastfeeding support services within an academic family medicine clinic is associated with significant increases in breastfeeding, supporting the provision of lactation services on-site where mothers and children receive primary care.

Clinical features of low back pain in an outpatient clinic

To determine the clinical features of low back pain and the conditions associated with this symptom in family medicine center in Bishkek, Kyrgyzstan. The study was included medical reports of patients with LBP at the age of 18-75 years attending in family medicine center №7 in Bishkek from 2017 to 2018.The examination included a consultation of a neurologist, magnetic resonance imaging (MRI) of the spine, and blood tests. During the study period 184 (85 men and 99 women) had LBP. Among these patients 11 (5,98%) of them had a specific cause of back pain: 3 - a traumatic spinal injury, 3 - a tumor lesion of the spine, 3 - rheumatoid polyarthritis and tuberculosis were present in 2 patients. The remaining 173 (94,02%) patients had a nonspecific cause of back pain associated with degenerative spinal disease and included low back pain -94 (54,33%), low back pain with nerve root pain suggestive of disk herniation 73 (42,2%), and low back pain with nerve root pain and lumbar spinal stenosis -6 (3,47%). When clarifying the anamnesis, it was revealed that the main initiating factor was inadequate physical activity and emotional stress. The obtained data once again emphasize the importance of careful collection of anamnesis and a physical examination to identify “red flags” to excluding specific back pain. In connection with the growing role of outpatient care in our country, there is a need to develop common approaches to correct evaluation of pain syndrome, determination the scope of the examination and choice the effective treatment tactics.

Night Eating Syndrome and Food Addiction in Turkish Population

Objectives: The aim of this study was to determine the prevalence of food addiction (FA) and night eating syndrome (NES) and to investigate any correlation between them in Turkish population. Materials and Methods: Subjects registered with family medicine centers were randomly invited to participate in the study (415 volunteers). Participants were evaluated with a socio-demographic data form, the Yale Food Addiction Scale (YFAS) and the Night Eating Questionnaire (NEQ). Results: A total of 295 subjects, including 160 females and 135 males, were evaluated in our study. The mean age of the participants was 33.78±10.72 and the mean BMI was 25.11±4.63. 7.8% of the subjects had FA according to the YFAS, and 13.2% had NES according to the NEQ. The prevalence of a coexistence of NES and FA was 2%. Using Pearson correlation analysis, a positive correlation was established between BMI and NEQ (r=0.14, p<0.01) and a positive correlation was found between total scores from the NEQ and the YFAS (r=0.14, p<0.01). With multiple linear regression analysis, it was demonstrated that 18.4% of total NEQ scores could be explained by eight YFAS symptom scores (p<0.001). Conclusion: It should be kept in mind that normal-weight, overweight or obese individuals may have NES or FA or both. Therefore, it could be useful to assess these problematic eating behaviors in individuals presented to family medicine outpatient clinics and to refer those with these problematic eating behaviors to relevant treatment centers.

Student Pharmacist Quality Improvement Project to Improve Medicare Annual Wellness Visits in a Federally Qualified Health Center Family Medicine Clinic

Student Pharmacist Quality Improvement Project to Improve Medicare Annual Wellness Visits in a Federally Qualified Health Center Family Medicine Clinic

Are empiric antibiotics to prevent Lyme disease warranted in patients with tick bites?

Texas Tech Health Sciences Center Family Medicine Residency, Lubbock, TX The authors declare no conflicts of interest.

Opioid Prescribing Habits in a Family Medicine Residency Program for the Management of Non-Cancer Pain.

1. List components of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, 2. Describe the prescribing habits of medical residents and attending physicians within a family medicine residency program, 3. Discuss the direction of future research. A report was generated for all patients with opioids listed as a medication at Christ Health Center family medicine clinic from July 2016 to June 2017. A total of 153 patients were identified with prescriptions written for chronic non-cancer pain indications. Clinical management via a retrospective chart review was completed utilizing a standardized data collection form centered around four of twelve recommendations within the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: (1) Avoid concurrent opioid and benzodiazepine prescribing; (2) evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy; (3) perform urine drug testing before starting opioids and consider at least annually; and (4) offer/prescribe medication for opioid use disorder for all patients taking chronic opioids. A total of 153 prescriptions were written for chronic indications. The most common indications were chronic back pain (32.0%), unspecified chronic pain (31.4%), and osteoarthritis (9.8%). Average duration of therapy was 26.6 months. Forty-two (27.5%) patients were concurrently receiving benzodiazepine therapy. Eighteen (11.8%) patients performed a drug test before or during therapy. Twenty-two (14.4%) patients had documented discussion with their prescriber evaluating the benefits and harms of their opioid regimens. No patients were prescribed medication for opioid overdose. Prescribing habits did not align with the four-guideline recommendations evaluated. The need for provider-focused education on current pain management practice guidelines was identified.

Smoking cessation clinic and its working practice in a family medicine center

Bu yazıda bir sigara bırakma kliniğinin çalışma pratiği ve başvuran özellikleri ele alınmıştır.

POSTPARTUM EVALUATION OF THE MOTHERS’ KNOWLEDGE ABOUT BREASTFEEDING AND THE IMPORTANCE OF BREAST MILK -

Aim: The aim of this study is to evaluate the sociodemographic factors about breast milk and breastfeeding descriptively. We want the emphasize the importance of breastmilk by evaluating the reasons behind short duration of nursing and the knowledge levels of the mothers about breast milk and breastfeeding. Material and Methods: The sampling consisted of 201 voluntary postpartum mothers aged 17-43 whom are followed by 2 separate family physician specialist MDs at two different Family Medicine centers in Istanbul during March 2017- July 2017. The data were obtained face to face by one researcher using a questionnaire of 20 questions. Postpartum mothers who have not yet started nursing and are not in between 17-43 years of age were excluded from the study. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) programe was used to analyse the statistics. Value of p0,05) Also there was again no statistically significant difference about the mothers education status and their knowledge level about breastfeeding and breast milk. There was a statistically significant difference between mothers’ occupational status and breastfeeding knowledge levels; working mothers had higher levels of knowlegde than the housewives (p=0,001; p

Approach of Family Physicians to Pediatric Eye Screening in Diyarbakır

Objectives:In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children.Materials and Methods:Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakır.Results:The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial.Conclusion:Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.

Evaluation of Relationship between Glycemic Control and Quality of Life in Type 2 Diabetics Attending Abu-Khalifa Family Practice Center, Ismailia Governorate, Egypt

Introduction: Diabetes is one of the most common chronic diseases that impact quality of life and its management must go beyond glycemic control to include quality of life. Objectives: The aim of this study is to evaluate the relationship between quality of life and glycemic control in type 2 diabetic patients attending Abu Khalifa family medicine center in Ismailia. Methods: A cross sectional study was conducted to assess quality of life in 151 adult patients with type 2 diabetes attending Abu-Khalifa family medicine center. SES (socioeconomic status) scale and SF-36 questionnaire were interviewed to all patients who were also tested for HbA1c. Data analysis was applied to identify the relationship between quality of life and glycemic control ,presented by HbA1c, and other significant predictors of quality of life with significant limit of P<0.05. Results: Total sample include 151 patients of whom mean age was 50.01 ± 8.6, 80.1% females, 19.9% males. The mean HbA1c level was 8 ± 1.5, mean duration of diabetes was 7.92 ± 5.6, and mean quality of life 48.7 ± 24.2%. HbA1c was significantly associated with quality of life. Males had significantly higher scores than females. Older age, prolonged duration of diabetes and complications were significantly associated with less quality of life scores. Conclusion: Poor glycemic control, older age and women appear to be the most incremental correlate for poor quality of life so special consideration to future research on gender specific attributes to improve quality of care to this vulnerable group.

Matching Our Mission: A Strategic Plan to Create a Diverse Family Medicine Residency.

Increasing the number of underrepresented minority (URM) physicians improves access and quality of care. URMs are more likely to practice primary care and work in underserved communities. The racial and ethnic diversity of family physicians lags behind the general population. To create a more diverse residency, the Boston Medical Center Family Medicine Residency Program (BMCFMRP) developed, implemented, and evaluated a strategic plan for diversity recruitment. In academic year (AY) 2014-2015, we set goals to increase the number of URM applicants and the percentage of matched URMs. From 2014-2017, we implemented an intervention focused on: (1) increasing outreach to URM candidates, (2) revising interviews to minimize bias, and (3) analyzing recruitment data. From 2014-2017, the total number of URM applicants increased by 80% (61 to 110). Evaluating recruitment trends from 2010-2017, there was a statistically significant increase (P&lt;0.001) in the percentage of URM applicants from 13.3% (29 of 218 total applicants) to 19.9% (110 of 402). There was also a significant increase (P=0.029) in the percentage of matched URMs. Before the intervention, the percentage ranged from 0% to 20% (2011: 0% [n=0/6], 2014: 0% [n=0/10], 2013: 20% [n=2/10]). During the intervention, the percentage ranged from 25% to 50% (2017: 25% [n=3/12], 2016: 50% [n=6/12]). The implementation of a strategic plan for diversity recruitment increased the number of URM applicants and the percentage of URMs matching into the BMCFMRP. Additional research is needed to determine if these strategies produce similar results in residency programs at other institutions and in other medical specialties.