Annals of family medicine
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Annals of family medicine · Apr 2022
Lower dementia risk in patients vaccinated against herpes zoster.
Context: Herpes zoster (HZ) infection increases dementia risk but it is not known if HZ vaccination is associated with lower risk for dementia. Objective: Determine if patients with HZ vaccination vs. those who remain unvaccinated, have a lower risk for dementia in a cohort of Veterans Health Administration (VHA) patients. Replicate results in a private sector, medical claims patient cohort. ⋯ Confirmation in other study designs is warranted. Results may be explained by nonspecific neuroprotection and vaccination training the immune system to limit damaging inflammation. Results highlight the importance of HZ vaccination.
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Annals of family medicine · Apr 2022
Supporting goal-oriented care using mobile technology: Findings from the mixed-methods trial of the ePRO tool.
Context: Goal-oriented models of care are becoming more widely used as part of primary care delivery for older adults with multimorbidity and complex care needs. While these models hold promise, implementation remains challenging. Digital health solutions may improve adoption however, they require evaluation to determine feasibility and impact. ⋯ Conclusions: Implementation challenges were broad and largely unexpected. The difficultly in aligning meaningfulness of a complex intervention across diverse user groups over time, suggests the intervention may not be sufficiently adaptable, or that more dynamic trial methods may be required. Including ethnographic data collection reveals critical underlying mechanisms driving digital health innovations.
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Annals of family medicine · Apr 2022
Relationship between COVID-19 cases and vaccination rates in New York State counties.
Context: The presence of new viral variants, in combination with the relaxation of social distancing and other preventative measures, has led to a spike in COVID-19 cases in the United States. The development of COVID-19 vaccinations may reduce the impact of these viral variants on case rates in the population. Objective: To determine the impact of COVID-19 vaccination rates on cases/100k population in each New York State (NYS) county. ⋯ Conclusion: While COVID-19 variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.
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Annals of family medicine · Apr 2022
Doctor-patient communication about blood tests: Qualitative interview study in general practice.
Context: Shared decision making is widely advocated, however most research focuses on treatment decisions. Evidence for shared decision-making in relation to diagnostic testing is limited to specific tests such as prostate specific antigen, screening and genetic tests. There is a lack of evidence regarding the relevance of shared decision-making to routine blood tests, despite increasing rates of laboratory testing in primary care. ⋯ Conclusions: The results have implications, not just for models of shared decision making, but more fundamentally, informed consent. Shared decision-making for diagnostic testing differs from treatment decisions. Promoting a shared understanding and shared decision-making could help rationalize testing, potentially reducing unnecessary investigations and improving patient-centered care.
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Firearm violence is a rising cause of death in the US. More than 38,000 individuals die annually from firearm violence. The estimated annual cost of firearm injuries were $174.1 billion. ⋯ Forms of firearm violence may be associated with various health related risk factors and consequences. Findings from NJ can inform NJ and other states of prevention and intervention initiatives that are locally relevant. By better understanding forms of firearm violence and their factors among various populations, we can develop tailored prevention and intervention strategies in clinical settings and communities. Clinical safety protocols are needed for individuals with risk factors, such as suicidal ideations, youth violence, and IPV.