Annals of family medicine
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Annals of family medicine · Jan 2023
Association of Family Financial Stress During the COVID-19 Pandemic and Child Social and Emotional Difficulties.
Context: The COVID-19 pandemic and associated public health measures have substantially increased stress on families, including financial stress. Objective: To explore the association between familial financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour as a potential mediator to this relationship. Study Design and Analysis: Cross-sectional cohort study using online survey data. ⋯ Conclusion: Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional health. Unproductive parenting behaviours, including overreactivity and laxness, significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child health.
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Annals of family medicine · Jan 2023
The Contribution of Pharmacogenetic Drug Interactions to 90-Day Hospital Readmissions in a Real-World Health System.
Context: Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there is limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. Objective: The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010-2020. Study Design and Analysis: Retrospective cohort study. ⋯ Univariate analyses indicated that the presence of at least one identified gene-x-drug interaction increased risk of 90-day readmission by more than 40% (OR=1.42, 95% confidence interval (CI) 1.09-1.84)(p=0.01). A multivariable model adjusting for age, race, sex, employment status, body mass index, and medical conditions, slightly attenuated the effect (OR=1.32, 95% CI 1.02-1.73)(p=0.04). Conclusions: Our results suggest that the presence of one or more CPIC gene-x-drug interactions increases the risk of 90-day hospital readmission, even after adjustment for demographic and clinical risk factors.
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Annals of family medicine · Jan 2023
Differences in Diabetes Control in Telemedicine vs. In-Person Only Visits in Ambulatory Care Setting.
Importance: The COVID-19 pandemic has led to increased utilization of telemedicine. Patients with diabetes are a vulnerable population that require regular treatment and monitoring. Little is known about the impact visit modality on diabetes outcomes in an ambulatory setting. ⋯ Patients with 2+ telemedicine visits had significantly lower odds of uncontrolled diabetes compared to all in-person visits after adjusting for age, gender, race, ethnicity, insurance status, and comorbidities (OR: 0.88; 95% CI: 0.79 - 0.99, p = 0.03). Conclusions and Relevance: Telemedicine visits were associated with a lower odds of uncontrolled diabetes. Further work is warranted to explore the relationship between telemedicine visits, equitable access to care, and diabetes outcomes.
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Context: Cancer is associated with many risk factors, including obesity. Specifically, abdominal obesity is linked to metabolic syndrome and is quantified by waist circumference (WC). Compared to WC, body mass index (BMI) is more accessible in the office to assess a patient's overall body fat composition. ⋯ We found that BMI and WC were significantly correlated in this cohort. Further follow-up is needed with a larger sample size and over a longer period. As body composition in this cohort has not been previously studied, further analyses may provide more biomarkers to aid in disease management.
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Annals of family medicine · Jan 2023
Clinical Outcomes of a Newly Instituted Hospital at Home Program During the COVID19 Pandemic.
Context: The COVID19 pandemic stressed U. S. health systems beyond their capacity and created worsening clinical outcomes. Hospital a Home (HaH) programs were utilized infrequently prior to pandemic. ⋯ HaH programs were associated with shorter inpatient length of stays, but longer total length of stays. In surge times, HaH programs could potentially reduce iLOS and increase bed capacity. Future studies should look to evaluate the economic impact of HaH programs and investigate the drivers of the increased tLOS.