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The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

BackgroundAs a community of practice (CoP), medical education depends on its research literature to communicate new knowledge, examine alternative perspectives, and share methodological innovations. As a key route of communication, the medical education CoP must be concerned about the rigor and validity of its research literature, but prior studies have suggested the need to improve medical education research quality. Of concern in the present study is the question of how responsive the medical education research literature is to changes in the CoP. We examine the nature and extent of changes in the quality of medical education research over a decade, using a widely cited study of research quality in the medical education research literature as a benchmark to compare more recent quality indicators.MethodsA bibliometric analysis was conducted to examine the methodologic quality of quantitative medical education research studies published in 13 selected journals from September 2013 to December 2014. Quality scores were calculated for 482 medical education studies using a 10-item Medical Education Research Study Quality Instrument (MERSQI) that has demonstrated strong validity evidence. These data were compared with data from the original study for the same journals in the period September 2002 to December 2003. Eleven investigators representing 6 academic medical centers reviewed and scored the research studies that met inclusion and exclusion criteria. Primary outcome measures include MERSQI quality indicators for 6 domains: study design, sampling, type of data, validity, data analysis, and outcomes.ResultsThere were statistically significant improvements in four sub-domain measures: study design, type of data, validity and outcomes. There were no changes in sampling quality or the appropriateness of data analysis methods. There was a small but significant increase in the use of patient outcomes in these studies.ConclusionsOverall, we judge this as equivocal evidence for the responsiveness of the research literature to changes in the medical education CoP. This study identified areas of strength as well as opportunities for continued development of medical education research.

Despite many calls, there is little research addressing teachers' knowledge of reading assessments and how they utilize assessments for reading instruction. Therefore, the current research developed and validated a reliable measure of teachers' perceptions and knowledge of reading assessments, called the "Perceptions and Knowledge of Assessment in Literacy Survey" (PKALS). Through the analysis of two separate administrations, we provide evidence for validity of the PKALS and examine the associations between teachers' characteristics and their performance on the PKALS. This research also found that teacher experience was correlated with higher knowledge; however, teachers' certification and graduate degree status were not. The PKALS can support future researchers and teacher preparation programs to identify gaps in teacher knowledge, allowing for interventions to promote student reading success.

This paper shares findings drawn from data generated over a period of five years on self-reported reading skills, habits, and dispositions of pre-service and in-service K-12 teachers (primarily middle and high school) across content areas (N = 854). Using latent cluster analyses, we created a Teacher Reader Profile Type (TRPT) model that illuminates distinct differences between teachers in different content areas and across status (i.e. undergraduate v. graduate). Our results suggest five distinct TRPTs, each with relative strengths and areas for growth. We provide five recommendations for teacher education programs and policy makers to consider. In addition, the measurement tool in this study could be used for key assessment related to teachers as readers. Future research could focus on how to improve teacher progress toward reading maturity, and the extent to which TRPTs relate to their own students' literacy development.

Clinical workflows that prioritize repetitive patient intake screening to meet performance metrics may have unintended consequences. This retrospective analysis of electronic health record data from 24 Federally Qualified Health Centers assessed effectiveness and accuracy of the 2-item Patient Health Questionnaire (PHQ-2) for depression screening and Generalized Anxiety Disorder 2 (GAD-2) for anxiety screening from 2019 to 2021. Scores of over 91% of PHQ-2 and GAD-2 tests indicated low likelihood of depression or anxiety, which diverged markedly from published literature on screening outcomes. Visit-based screenings linked to performance metrics may not be delivering the intended value in a real-world setting and risk distracting clinical effort from other high value activities. Key words: performance measures; health care quality; administrative burden; practice-based research; PHQ-9; quality improvement; physician burnout, INTRODUCTION Primary care visits often start with a myriad of standardized intake screening questions that are tied to performance metrics and incorporated into electronic health records (EHRs). Prioritizing repetition of [...]

Although convergent research demonstrates that well-designed graphics can facilitate readers' understanding of text, there are select situations where graphics have been shown to have no effect on learners' overall text comprehension. Therefore, the current meta-analytic study examined 39 experimental studies published between 1985 and 2018 measuring graphics' effects on readers' comprehension. We first quantified the overall effect on reading comprehension. Then, we considered interactions with learners' characteristics, graphic types, and assessment formats. Our analysis revealed that the inclusion of graphics had a moderate overall positive effect (Hedges's g = 0.39) on students' reading comprehension, regardless of grade level. Regarding graphic type, we did not find a significant difference among pictures, pictorial diagrams, and flow diagrams. Only when compared to mixed graphics, pictures had a greater effect on comprehension. Additionally, compared with true and false assessments, graphics differentially benefited students' comprehension on open-ended comprehension assessments and mixed format assessments. Implications for future research are presented.

PURPOSE Integrating social care into clinical care requires substantial resources. Use of existing data through a geographic information system (GIS) has the potential to support efficient and effective integration of social care into clinical settings. We conducted a scoping literature review characterizing its use in primary care settings to identify and address social risk factors. METHODS In December 2018, we searched 2 databases and extracted structured data for eligible articles that (1) described the use of GIS in clinical settings to identify and/or intervene on social risks, (2) were published between December 2013 and December 2018, and (3) were based in the United States. Additional studies were identified by examining references. RESULTS Of the 5,574 articles included for review, 18 met study eligibility criteria: 14 (78%) were descriptive studies, 3 (17%) tested an intervention, and 1 (6%) was a theoretical report. All studies used GIS to identify social risks (increase awareness); 3 studies (17%) described interventions to address social risks, primarily by identifying relevant community resources and aligning clinical services to patients' needs. CONCLUSIONS Most studies describe associations between GIS and population health outcomes; however, there is a paucity of literature regarding GIS use to identify and address social risk factors in clinical settings. GIS technology may assist health systems seeking to address population health outcomes through alignment and advocacy; its current application in clinical care delivery is infrequent and largely limited to referring patients to local community resources. Key words: geographic information systems; geospatial data; geography, medical; social determinants of health; social risk factors; disparities; needs assessment; health information technology; population health; vulnerable populations https://doi.org/10.1370/afm.2932, INTRODUCTION There is increasing recognition of potential roles that health care delivery systems can play to identify and address social determinants of health--the social, economic, and environmental factors that influences [...]

A review of the current research literature demonstrates that teaching for social justice has been accepted by the research community as best practice for students, especially diverse students from traditionally marginalized populations and communities. However, best practices do no practical good if they are not implemented into real classroom teaching. Teachers must have access to theoretically-sound, research-based, instructional practices in order for classroom implementation to occur. This paper seeks to answer whether these theories and practices which support social justice education are being circulated in practitioner oriented journals, where they are highly accessible to classroom teachers. We conducted a systematic literature review of 12 top practitioner journals across content areas. We found 68 articles focused on social justice education. Our findings indicate that the social justice articles being published in practitioner journals include some strategies to incorporate into teaching practices; however, many recommendations only support superficial social justice education elements rather than truly addressing inequities in schools and society by fully delving into all tenets of teaching for social justice.

Background: Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. Methods and findings: This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. Conclusions: In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester. Catherine Arsenault and co-workers leverage international survey data collected at first antenatal care visits in Ethiopia, Kenya, India and South Africa to help understand where and why gaps may exist. Author summary: Why was this study done?: Past research has revealed gaps in the content and quality of antenatal care (ANC) in some settings. However, few studies have explored whether women at risk receive additional care during pregnancy. In general, evidence on the quality of risk detection during pregnancy in low-resource settings is limited. What did the researchers do and find?: We used the baseline survey of the eCohort, a study conducted in Ethiopia, Kenya, India, and South Africa, that enrolled 4,068 women during their first ANC visit and involved physical health assessments and patient interviews. We found large gaps in the provision of essential clinical actions during the first ANC visit where only 43% of essential clinical actions were provided in Ethiopia compared to 66% in Kenya, 73% in India, and 76% in South Africa. We found a high prevalence of anemia, chronic illnesses, undernutrition, obesity, and prior obstetric complications which are risk factors for poor pregnancy outcomes. We found little to no association between the presence of risk factors and the completeness of the first ANC visit. What do these findings mean?: Efforts to improve the detection and management of pregnancy risks as well as improvements in adherence to ANC standards are required. Policymakers should interrogate the structural factors, such as preservice training, supervision, facility infrastructure, or continuing education, responsible for poor performance. Some limitations may affect our results. For example, most of the data on care completeness was based on patient self-reports which may be influenced by the participants' education or by social desirability bias. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the quality of clinical brain imaging in healthy subjects and patients on an FDA‐approved commercial 0.55 T MRI scanner, and to provide information about the feasibility of using this scanner in a clinical workflow. In this IRB‐approved study, brain examinations on the scanner were prospectively performed in 10 healthy subjects (February–April 2022) and retrospectively derived from 44 patients (February–July 2022). Images collected using the following pulse sequences were available for assessment: axial DWI (diffusion‐weighted imaging), apparent diffusion coefficient maps, 2D axial fluid‐attenuated inversion recovery images, axial susceptibility‐weighted images (both magnitude and phase), sagittal T1‐weighted (T1w) Sampling Perfection with Application Optimized Contrast images, sagittal T1w MPRAGE (magnetization prepared rapid gradient echo) with contrast enhancement, axial T1w turbo spin echo (TSE) with and without contrast enhancement, and axial T2‐weighted TSE. Two readers retrospectively and independently evaluated image quality and specific anatomical features in a blinded fashion on a four‐point Likert scale, with a score of 1 being unacceptable and 4 being excellent, and determined the ability to answer the clinical question in patients. For each category of image sequences, the mean, standard deviation, and percentage of unacceptable quality images (<2) were calculated. Acceptable (rating ≥ 2) image quality was achieved at 0.55 T in all sequences for patients and 85% of the sequences for healthy subjects. Radiologists were able to answer the clinical question in all patients scanned. In total, 50% of the sequences used in patients and about 60% of the sequences used in healthy subjects exhibited good (rating ≥ 3) image quality. Based on these findings, we conclude that diagnostic quality clinical brain images can be successfully collected on this commercial 0.55 T scanner, indicating that the routine brain imaging protocol may be deployed on this system in the clinical workflow. [ABSTRACT FROM AUTHOR]

In many states, writing is tested only in selected grades causing writing instruction often to be over-emphasized some years and neglected in others. The present study examines how students' motivation for writing differs during the middle school years. We administered the "Self-Beliefs, Writing Beliefs, and Attitude Survey" (SWAS) to a cross-sectional sample of students at two middle schools shortly after the 7th graders completed a high-stakes writing exam. Results indicate that 6th and 8th graders had higher average scores of writing motivation compared to their 7th-grade peers, with 6th graders possessing higher average levels of attitude toward writing and beliefs about writing compared to 8th graders. The varying pressure and absence of writing may be influencing students' motivation to write and views of writing.

In this study, we examined students' access to text, defined as the number of texts freely available to children in their classrooms. From 60 elementary classrooms across five states, we catalogued the books in first, third and fifth grades in both high- and low-achieving schools (based on state-wide reading test scores) to create a database of more than 50,000 books. From this database, we concluded that the number of books per classroom varied significantly within and between states. However, the quantity of texts available to students did not appear to be related to variations in test scores; 54 of the 60 classrooms surpassed the recommended number of books per child based on previous research; two of the six classrooms that did not were in high-achieving schools. Our conclusion is that classroom libraries can provide children with necessary access to print, but access alone does little to explain differences between states in standardised test scores.

Context: The COVID-19 pandemic significantly affected both the 2021 and 2022 residency recruitment cycles. Many programs rapidly shifted their recruitment efforts to include a greater presence on social media (SoMe), assuming that applicants would use these avenues as supplemental sources of information. Objective: Our program sought to investigate the impact of SoMe from the perspective of applicants during the Family Medicine Virtual Match process. Study Design: Cross-sectional survey. Setting: Community Based University Affiliated Family Medicine Residency. Population Studied: Family medicine residency candidates selected to interview with our program. Intervention/Instrument: We gathered survey data through REDCap of interviewees to our residency program to assess social media use. We also acquired SoMe (Facebook, Instagram and Twitter) and google website analytics to obtain trends trafficking users to our official residency website. Outcome Measures: Survey items captured candidate preferences regarding recruitment. Facebook/Instagram 'reach' and Twitter 'impressions' were analyzed to evaluate SoMe engagement. Google analytics data were used to quantify sources of traffic. Results: n=55 completed the survey for a response rate of 28%. Participants indicated Instagram was most helpful in evaluating programs (45.5%, n=25), followed by Twitter (5.5%, n=3), and Facebook (3.6%, n=2). About half of participants stated they did not use SoMe to learn about programs at all (45.5%, n=25), whereas a fifth agreed or strongly agreed that SoMe played a vital role (21.7%, n=12). When residency website traffic was linked to SoMe analytics, we saw a small increase in activity with our program accounts after content generation, but this did not translate into increased website visits, our surrogate marker representing successful use of SoMe as a recruitment tool. Analysis of the traffic sources to our website revealed that Google was the greatest driver to our website, more than SoMe platforms. Outcomes: We expected candidates would utilize social media more than reported and increased SoMe content would increase website traffic. Though our findings are discordant with the previous studies, our data suggest SoMe is less significant in recruitment than we initially hypothesized. This was one of few studies aimed at the applicant experience, and further investigation is needed to better understand the different ways in which SoMe and other virtual platform., Presenters Annie Phung, DO, Katherine Wright, PhD, MPH, Natalie Choi, [...]

Context: To augment our research curriculum, our three family medicine residency programs participated in the American Board of Family Medicine (ABFM) Journal Club Pilot. We implemented the Medical Education Research Study Quality Instrument (MERSQI) to score journal articles and identify potential curriculum gaps. Objective: 1) summarize the body of literature included in the ABFM Journal Club Pilot by scoring each article for methodological quality; 2) identify research curriculum strengths and areas for growth Study Design: A bibliometric analysis was conducted to examine the methodologic quality of research studies included in the ABFM Journal Club Pilot. Additionally, we surveyed residents to document their confidence critically appraising journal articles. Dataset: MERSQI quality scores were calculated for 40 studies published in 25 journals selected by the ABFM. Intervention/Instrument: The 10-item MERSQI was used to assess methodological quality across six domains: study design, sampling (number of institutions and response rate), type of data, validity (internal structure, content, and relationships to other variables), data analysis (appropriateness and complexity), and outcomes. Previous studies document strong validity evidence for the MERSQI. The resident survey included 12 Likert scale items measuring confidence appraising different elements of journal club articles (e.g. interpreting confidence intervals, statistical power, etc.). Results: MERSQI scores ranged from 13 to 18, with the average being 16.31 (higher scores indicate higher quality). A majority of articles (80%) implemented a randomized control trial. Most articles (82%) with a survey had a response rate of 75% or above. Most studies were multi-institutional (90%) and presented objective measurements (87.2%) as opposed to self-assessment data alone (12.8%). At baseline before implementing the journal club pilot, a majority of residents indicated they had none or minimal experience evaluating journal articles (n=22, 52.4%). Conclusions: On average, ABFM journal club articles had relatively high MERSQI scores compared to other bibliometric analyses. The MERSQI was a useful tool to identify gaps in our journal club curriculum. This information may guide the selection of future journal articles and refine the curriculum moving forward., Presenters Katherine Wright, PhD, MPH, Santina Wheat, MD, MPH, Zahra Qasem, MD, [...]

Context: A strong publication record is essential to career advancement in academia, and peer reviewers often act as scientific gatekeepers within the academic publishing model. As the process of peer review is imperfect and relies heavily on subjective opinions of individuals, this is an area susceptible to bias. Objective: In this study, we present empirical explorations of the gender composition of peer reviewers for family medicine journals during the 2019-2020 calendar years. Study Design and Analysis: We conducted a secondary data analysis to determine the proportion of women serving as peer reviewers for four prominent family medicine journals, including: the Journal of the American Board of Family Medicine (JABFM), Family Medicine (Fam Med), American Family Physician (Am Fam Phy), the Journal of Family Practice (JFP), and the Annals of Family Medicine (Ann Fam Med). Setting or Dataset: Reviewer names were published in print or via social media websites by each journal to acknowledge reviewers for their service. Gender was derived algorithmically using the genderizeR package for the R programming language. Population Studied: Peer reviewers and editorial board members for 5 prominent family medicine journals Outcome Measures: The exact binomial test was used to compare proportions of female reviewers to the hypothesized value of .50. Results: Overall, women comprised 41% of the peer reviewers in our sample. Data were further disaggregated to determine if specific publications enlist more women reviewers. Women were underrepresented as peer reviewers in Ann Fam Med (observed proportion =.42), JFP (observed proportion = .39), Am Fam Phy (observed proportion =.32), and JABFM (observed proportion = .44) compared to the hypothesized proportion of .50. Family Medicine was the only journal in our sample with a greater proportion of women reviewers (observed proportion = .56) compared to our hypothesized benchmark. Conclusions: This study found gender disparities among peer reviewers in prominent family medicine journals. Limitations in the data do not allow us to explore article submission decisions among peer reviewers of different genders. Further research may be warranted to clarify the impact of gender in peer review processes, and to identify interventions to mitigate gender disparities in academic publishing and the broader field of academic medicine., Presenters Katherine Wright, PhD, MPH, Deborah Clements, MD, FAAFP, Santina Wheat, MD, MPH, Vanessa Rose, [...]