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BACKGROUND: Many different surveys have been used to evaluate the performance of medical groups, but there is a growing recognition that standardization could be helpful to consumers, purchasers, and others. OBJECTIVES: We sought to develop a version of the Consumer Assessment of Health Plans Study (CAHPS) survey for use with medical groups (G-CAHPS) and assess its reliability and validity. RESEARCH DESIGN: The research team reviewed existing instruments and conducted patient focus groups in 4 sites to identify aspects of care that were especially important to patients when evaluating medical groups. We tested a draft instrument in 75 cognitive interviews with adults 18 years of age or older in Knoxville, St. Louis, and California and pretests in 4 groups of adults in Boston and Denver. We then surveyed random samples of patients from medical groups and practice sites in California, Knoxville, St. Louis, and Denver. We analyzed the psychometric characteristics of the instrument. RESULTS: Data support the reliability and validity of 3 multi-item measures of access, office staff service, and patient clinician communication. Measures related to specialty care and preventive counseling did not differentiate among medical groups. CONCLUSIONS: The G-CAHPS instrument provides an assessment of selected aspects of care that are important to consumers and could be a useful complement to the plan-level CAHPS instrument. [ABSTRACT FROM AUTHOR]

Purpose: Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts., Method: The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy)., Results: A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently (123 [42.6%]), followed by curricula on helping patients get social care (assistance; 86 [29.8%]) and providing social risk-adjusted health care (adjustment; 81 [28.0%]). Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently (43 [14.9%] and 49 [17.0%], respectively). Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity., Conclusions: NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors., (Copyright © 2024 the Association of American Medical Colleges.)

Introduction: Adapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course., Methods: The authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment., Results: Practical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans., Discussion: Implementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios., Conclusion: The authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities., Competing Interests: Conflicts of Interest None declared

Introduction: Millions of deaths and co-morbidities have been brought on by the COVID-19 epidemic worldwide. Acute respiratory distress syndrome (ARDS), multiple organ failure, and death can result from the condition in some people. The disease's course can range from a moderate upper respiratory tract infection to severe pneumonia. Numerous reports have been made on the occurrence of pneumothorax in COVID-19 ICU patients, particularly in those who are receiving invasive ventilation. This study assesses factors associated with pneumothorax among mechanically ventilated COVID-19 ICU patients in Addis Ababa, Ethiopia., Methods: A case-control study design was employed from August 1, 2022, to August 31, 2022, GC, with a sample size of 281, where cases are 94 and controls are 187. A pre-tested structured quantitative tool was used to collect data on ODK and export it to SPSS version 26 for analysis. Descriptive statistics were presented using text and tables. The association between variables was analyzed with binary logistic regression. A statistical significance was declared at a p-value of 0.05 with a 95% confidence interval. Assumptions like model fitness and multicollinearity were checked to be satisfied., Results: A total of 281 (94 cases and 187 controls) patient charts were carefully reviewed. After adjustment for possible confounders in multivariate analysis, ARDS (AOR = 0.214, 95% CI (0.088, 0.519), P value =0.001) and invasive ventilation (AOR = 0.311, 95% CI (0.121, 0.796), P value =0.015) had a significant association with pneumothorax., Conclusion: Despite the introduction of preventive breathing methods, pneumothorax is still a frequent and deadly consequence in COVID-19 patients with ARDS. ARDS and invasive mechanical ventilation were found to be significantly associated with the development of pneumothorax. Health facilities should be well equipped with recent medical equipment in intensive care units and with well-trained and organized manpower., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Hundie et al.)

Introduction: Ninety-one percent of global Human Immunodeficiency Virus (HIV) infection in children occurs in sub-Saharan Africa. Provider Initiated Testing and Counselling (PITC) Strategy is a means of reducing missed opportunities for HIV exposed or infected children. The present study determined the prevalence of HIV infection using PITC Strategy among children seen at the Paediatric Emergency Unit of Federal Medical Centre (FMC), Ido-Ekiti, and the possible route of transmission., Methods: Cross-sectional study on prevalence of HIV infection using PITC model. 530 new patients whose HIV serostatus were unknown and aged 15 years or below were recruited consecutively and offered HIV testing. Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid test kits was adopted. Seropositive patients younger than eighteen months had HIV Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation., Results: Twenty-four (4.5%) of the 530 patients were confirmed to have HIV infection; of whom 19 (79.2%) were less than 18 months of old; with age range of 5 to 156 months. Fifteen (62.5%) of the infected children were females; likewise, the gender specific infection rate was higher (%) among the females compared with (%) among the males. Two of the HIV infected children's mothers were late, while the remaining 22 mothers (%) were HIV seropositive. Mother-to-child-transmission was the most likely route of transmission in the children., Conclusion: PITC strategy is vital to the early diagnosis and effective control of HIV infection in children. However, this cannot be totally effective if PMTCT is not optimized., Competing Interests: The authors declare no competing interests., (© Oluwaseyi Tosin Babatunde et al.)

Background Globally, efforts are being made to control tobacco use. However, adolescents who are susceptible to cigarette smoking constitute a major challenge to control efforts. Defining the magnitude of susceptible adolescents and associated factors in any setting is critical to the development of measures that will successfully address this issue. This study estimated the prevalence and factors associated with susceptibility to cigarette smoking among non smoking students in Ilorin, North Central Nigeria. Methods A cross sectional study involving 2000 secondary school students selected via multistage sampling technique. Data was collected using a self administered questionnaire, while analysis was done using SPSS 16.0. Results Prevalence of susceptibility to cigarette smoking among non smoking respondents was 13.6% (14.5% among males and 11.4% among females, respectively). Factors associated with susceptibility to cigarette smoking were parental smoking habit [odds ratio (OR) = 4.43], having close friends who smoke (OR = 6.54), engagement in vocational training (OR = 1.39), exposure to environmental tobacco smoke at home (OR = 1.61), knowledge of harmful effects of tobacco (OR = 2.35) and perceptions of the effect of cigarette smoking such as enhancing attractive among boys (OR = 2.03), and causing weight gain among boys (OR = 2.39) and among girls (OR = 6.05). Conclusion The high prevalence of susceptibility to cigarette smoking among the non smoking students highlights the potential for future increase in prevalence of cigarette smoking in the setting. Efforts at controlling cigarette smoking will not be totally successful if susceptibility to cigarette smoking among adolescents is not addressed.

Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here., (Project HOPE—The People-to-People Health Foundation, Inc.)

Increasing the amount of physical activity Americans get to recommended levels will require changes in community environments so that people can be more active as part of everyday life. Recent and pending federal legislation can provide the investments and other support necessary to make. These changes also positively address other major challenges we face as a nation, including climate change and the ailing economy.

Objective: To examine diurnal salivary cortisol rhythms and plasma IL-6 concentrations in persons with chronic fatigue syndrome (CFS), persons not fulfilling a diagnosis of CFS (we term them cases with insufficient symptoms or fatigue, ISF) and nonfatigued controls (NF). Previous studies of CFS patients have implicated the hypothalamic-pituitary-adrenal axis and the immune system in the pathophysiology of CFS, although results have been equivocal., Methods: Twenty-eight people with CFS, 35 persons with ISF, and 39 NF identified from the general population of Wichita, Kansas, were admitted to a research ward for 2 days. Saliva was collected immediately on awakening (6:30 AM), at 08:00 AM, 12 noon, 4:00 PM, 8:00 PM and at bedtime (10:00 PM) and plasma was obtained at 7:30 AM. Salivary cortisol concentrations were assessed using radioimmunoassay, and plasma IL-6 was measured using sandwich enzyme-linked immunosorbent assay., Results: People with CFS demonstrated lower salivary cortisol concentrations in the morning and higher salivary cortisol concentrations in the evening compared with both ISF and NF groups indicating a flattening of the diurnal cortisol profile. Mean plasma IL-6 concentrations were highest in CFS compared with the other groups, although these differences were no longer significant after controlling for BMI. Attenuated decline of salivary cortisol concentrations across the day and IL-6 concentration were associated with fatigue symptoms in CFS., Conclusions: These results suggest an altered diurnal cortisol rhythm and IL-6 concentrations in CFS cases identified from a population-based sample.

Background: Complaints of unrefreshing sleep are a prominent component of chronic fatigue syndrome (CFS); yet, polysomnographic studies have not consistently documented sleep abnormalities in CFS patients. We conducted this study to determine whether alterations in objective sleep characteristics are associated with subjective measures of poor sleep quality in persons with CFS., Methods: We examined the relationship between perceived sleep quality and polysomnographic measures of nighttime and daytime sleep in 35 people with CFS and 40 non-fatigued control subjects, identified from the general population of Wichita, Kansas and defined by empiric criteria. Perceived sleep quality and daytime sleepiness were assessed using clinical sleep questionnaires. Objective sleep characteristics were assessed by nocturnal polysomnography and daytime multiple sleep latency testing., Results: Participants with CFS reported unrefreshing sleep and problems sleeping during the preceding month significantly more often than did non-fatigued controls. Participants with CFS also rated their quality of sleep during the overnight sleep study as significantly worse than did control subjects. Control subjects reported significantly longer sleep onset latency than latency to fall asleep as measured by PSG and MSLT. There were no significant differences in sleep pathology or architecture between subjects with CFS and control subjects., Conclusion: People with CFS reported sleep problems significantly more often than control subjects. Yet, when measured these parameters and sleep architecture did not differ between the two subject groups. A unique finding requiring further study is that control, but not CFS subjects, significantly over reported sleep latency suggesting CFS subjects may have an increased appreciation of sleep behaviour that may contribute to their perception of sleep problems.

Background: The etiology and pathophysiology of chronic fatigue syndrome (CFS) remain inchoate. Attempts to elucidate the pathophysiology must consider sleep physiology, as unrefreshing sleep is the most commonly reported of the 8 case-defining symptoms of CFS. Although published studies have consistently reported inefficient sleep and documented a variable occurrence of previously undiagnosed primary sleep disorders, they have not identified characteristic disturbances in sleep architecture or a distinctive pattern of polysomnographic abnormalities associated with CFS., Methods: This study recruited CFS cases and non-fatigued controls from a population based study of CFS in Wichita, Kansas. Participants spent two nights in the research unit of a local hospital and underwent overnight polysomnographic and daytime multiple sleep latency testing in order to characterize sleep architecture., Results: Approximately 18% of persons with CFS and 7% of asymptomatic controls were diagnosed with severe primary sleep disorders and were excluded from further analysis. These rates were not significantly different. Persons with CFS had a significantly higher mean frequency of obstructive apnea per hour (p = .003); however, the difference was not clinically meaningful. Other characteristics of sleep architecture did not differ between persons with CFS and controls., Conclusion: Although disordered breathing during sleep may be associated with CFS, this study generally did not provide evidence that altered sleep architecture is a critical factor in CFS. Future studies should further scrutinize the relationship between subjective sleep quality relative to objective polysomnographic measures.

Peptide analogues of Tendamistat which include the most essential residues linked by novel omega-amino acids (X,Y,Z: H2N-(CH2)n-CO(2)H, where n=2-10) were designed, synthesized (Ac-Tyr(15)-X-Trp(18)-Arg(19)-Tyr(20)-Y-Thr(55)-Z-Asp(58)-Gly(59)-Tyr(60)-Ile(61)-Gly(62)-NH2), and analyzed for alpha-amylase inhibitory activity. Native dipeptide spacers sometimes were left intact at X and Z. Analogues demonstrated competitive inhibition with K(i) values ranging from 23 to 767 microM. 8-Aminooctanoic acid was the optimal linker at Y, while longer linkers were favored at the other positions.

Health care quality measurement initiatives often use health plans as the unit of analysis, but plans often contract with provider organizations that are managed independently. There is interest in understanding whether there is substantial variability in quality among such units. We evaluated the extent to which scores on the Consumer Assessment of Health Plans Study (CAHPS) survey vary across: health plans, regional service organizations (RSOs) (similar to independent practice associations [IPAs] and physician/hospital organizations [PHOs]), medical groups, and practice sites. There was significant variation among RSOs, groups and sites, with practice sites explaining the greatest share of variation for most measures.

This paper explores the impact of public policy on local health care systems in a representative sample of twelve U.S. communities. Site visits conducted in those communities suggest that public policy is an important force that shapes health system change, for instance, by establishing the underlying "rules of the game" for private and public actors and by influencing the decisions of national and regional entities to enter and exit local markets. These dynamics are explored through a discussion of several key policy areas, including Medicaid and Medicare managed care programs, state regulation of managed care, regulation of providers' rates, certificate-of-need rules, and oversight of conversions from nonprofit to for-profit status.