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INTRODUCTION Primary care is widely viewed as the cornerstone of a high-functioning health care system. (1-4) Considerable variability in health care system design and in how primary care is provided [...], PURPOSE To examine the psychometric properties and scores of the Person-Centered Primary Care Measure (PCPCM) in 28 languages and 35 Organisation for Economic Co-operation and Development (OECD) countries. METHODS Using a paid online sampling service, we requested age- and sex-representative samples of 360 adults in each country. We administered the Person-Centered Primary Care Measure--a previously validated 11-item, patient-reported measure that was developed using what patients and clinicians said is most important about primary care. We also assessed construct validity through associations with demographics, the Patient-Enablement Instrument, number of years the person had been with their primary care physician and practice, whether the patient thought the doctor knowing the results would improve their care, and whether it was hard to complete the survey. We assessed the psychometric properties of the PCPCM in each country and report the summative and item-specific PCPCM scores for each country. RESULTS The PCPCM exhibited solid psychometric properties across all languages and countries, with Cronbach's alphas ranging from 0.88 to 0.95, and corrected item-total correlations ranging from 0.47 to 0.81, with the vast majority of countries ranging from the low 0.50s to the high 0.70s. Multiple analyses showed strong evidence of concurrent validity. With a potential range from a low of 1 to a high of 4, the overall mean score was 2.74, with a standard deviation of 0.19. Mean PCPCM scores ranged from the lowest in Sweden (2.28) to the highest in Turkey (3.08), with Germany ranking second (3.01), and the United States third (2.99). CONCLUSIONS The internal consistency and concurrent validity of the PCPCM across multiple countries provides strong evidence of the coherence of the breadth of primary care functions that patients and clinicians say are important. The diversity of total and item-specific scores across countries provokes interesting hypotheses about the influence of each different country's policies, practices, demographics, and culture on primary care, and provides a strong impetus for further ecological and individual data analyses using the Person-Centered Primary Care Measure. Key words: primary care; quantitative methods: health status/QOL measurement; measure development; international comparison

Background: The prevalence of Post Traumatic Stress Disorder (PTSD) has been rising since the start of the COVID-19 pandemic, and affects females, sexual and gender minorities, and individuals with social risks at higher rates. Objective: This study examines if the prevalence of PTSD increased from 2019 to 2022 among patients who received care in a national network of safety-net, community-based health centers with integrated behavioral health programs that serve patients at high risk for PTSD. Methods: We analyzed electronic health record data from patients with 1 or more behavioral health visits during 2019 to 2022 using repeated cross-sectional data to visualize trends. Change in PTSD prevalence based on the diagnoses associated with each visit from 2019 to 2022 was assessed using a general linear mixed model adjusted for patient-level factors. Results: Over 4 years, 182 419 distinct patients received care for PTSD, with prevalence increasing from 2019 to 2022 (OR = 1.09, 95% CI = 1.08, 1.10). Females (OR = 1.81, 95% CI = 1.78, 1.84), LGBTQIA individuals (OR = 1.29, 95% CI = 1.26, 1.33), gender diverse individuals (OR = 1.36, 95% CI = 1.29, 1.42), and patients who reported 1 or more social determinants of health needs (OR = 1.52, 95% CI = 1.46, 1.57) were more likely to have a diagnosis of PTSD. Conclusions: In a worrying trend, PTSD prevalence has increased among people receiving integrated behavioral health care at community-based health centers, with disparities observed in subpopulations. Continued effort and investment are needed to meet this increasing need in safety-net settings, particularly for those subpopulations observed to have higher prevalence. [ABSTRACT FROM AUTHOR]

Presenters Maya Takagi, BA, Samantha Hess, Karissa Gawronski, Nicholas Haddad, Bernard Noveloso, MD, Stephen Zyzanski, PhD, Nelly Ragina, PhD, Director [...], Context: Mass vaccination serves as a potential solution to combat the Coronavirus disease 2019 (COVID-19) pandemic, with vaccine hesitancy being a recognized impediment. Collection of data defining the characteristics of healthcare worker (HCW) attitudes towards the vaccine can provide insight into vaccine hesitancy. Objective: To determine HCWs' attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy. Study Design and Analysis: This cross-sectional study surveyed the attitudes of HCWs in Michigan using three-point agree/disagree scale questions. t-test and analysis of variance were used to measure HCWs' attitudes towards the COVID-19 virus and vaccines. Population studied: 120 HCWs from Isabella, Saginaw, Sanilac, and Wayne counties in Michigan. Results: Most HCWs received (95.9%) and recommended (98.3%) the COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine to a patient are: 1) Efficacy of the vaccine, 2) Current exposure to patients with active COVID-19 infection and risk of virus spread, and 3) Safety of vaccine and long-term follow-up. Being a female HCW (P=0.01) or being a HCW outside of the 55-64 years age range (P=0.036) was associated with increased concern of contracting COVID-19. Regarding the COVID-19 vaccines, our data demonstrated that: 1) HCWs who specialized in family medicine (P=0.028) were more likely to agree that there was adequate testing compared to those who did not specialize in family medicine; 2) White HCWs (P=0.024) were less concerned with the speed of development compared to non-white HCWs; 3) Of all age groups, HCWs aged 55-64 years (P=0.02) were the least concerned about side effects 4) Of all provider types, physicians (P=0.017) were the least concerned about long-term effects. Conclusion: Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among attitudes towards the COVID-19 virus and vaccines. Vaccine hesitancy among HCWs can have negative effects on their patients. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

Background: The COVID-19 pandemic has exacerbated existing healthcare disparities among American Indian/Alaska Native (AI/AN) populations rooted in historical traumas and systemic marginalization. Methods: This study conducted at a single Indian Health Service (IHS) clinic in central Michigan evaluates two educational interventions for enhancing COVID-19 knowledge and attitudes in a sample AI/AN population. Utilizing a pre/post-intervention prospective study design, participants received either a video or infographic educational intervention, followed by a survey assessing their COVID-19 knowledge and attitudes. Results: The results indicate significant improvements in knowledge and attitudes post-intervention, with both modalities proving effective. However, specific factors such as gender, political affiliation, and place of residence influenced COVID-19 attitudes and knowledge, emphasizing the importance of tailored interventions. Conclusions: Despite limitations, this study highlights the critical role of educational interventions in addressing vaccine hesitancy and promoting health equity within AI/AN communities. Moving forward, comprehensive strategies involving increased Indian Health Service funding, culturally relevant interventions, and policy advocacy are crucial in mitigating healthcare disparities and promoting health equity within AI/AN communities. [ABSTRACT FROM AUTHOR]

INTRODUCTION Measures matter because they focus the precious commodity of attention. (1) Increasingly, measures also are used to concentrate material resources and infrastructure, and even to influence the right to [...], PURPOSE To develop and evaluate a concise measure of primary care that is grounded in the experience of patients, clinicians, and health care payers. METHODS We asked crowd-sourced samples of 412 patients, 525 primary care clinicians, and 85 health care payers to describe what provides value in primary care, then asked 70 primary care and health services experts in a 21/2 day international conference to provide additional insights. A multidisciplinary team conducted a qualitative analysis of the combined data to develop a parsimonious set of patient-reported items. We evaluated items using factor analysis, Rasch modeling, and association analyses among 2 online samples and 4 clinical samples from diverse patient populations. RESULTS The resulting person-centered primary care measure parsimoniously represents the broad scope of primary care, with 11 domains each represented by a single item: accessibility, advocacy, community context, comprehensiveness, continuity, coordination, family context, goal-oriented care, health promotion, integration, and relationship. Principal axes factor analysis identified a single factor. Factor loadings and corrected item-total correlations were >0.6 in online samples (n = 2,229) and >0.5 in clinical samples (n = 323). Factor scores were fairly normally distributed in online patient samples, and skewed toward higher ratings in point-of-care patient samples. Rasch models showed a broad spread of person and item scores, acceptable item-fit statistics, and little item redundancy. Preliminary concurrent validity analyses supported hypothesized associations. CONCLUSIONS The person-centered primary care measure reliably, comprehensively, and parsimoniously assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. The measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.

Incentives have shown a variable effect in improving survey response rates, but the effect of a pen from an organization to which the respondent has loyalty has not been studied. Recent college graduates were randomized to receive or not receive a college logo pen accompanying an initial survey mailing. Among 119 total respondents, there were no differences in response rate to the initial mailing, to a second mailing to nonrespondents who did not receive a pen in the initial mailing, or in total response rate. Investigators may save money by not including a pen incentive or may consider stronger incentives. (Contains 2 tables.)

Health care disparities have been documented in cancer screenings of adults with intellectual and other developmental disabilities. Developmental disabilities nurses were surveyed to better understand and improve this deficiency. Two thirds of respondents believed that adults with intellectual and developmental disabilities received fewer cancer screenings compared with the general population. The most frequently cited barriers to cancer screenings were as follows: patient need for sedation, unsuccessful attempts at screening, and failure of the primary care clinician to order cancer screening tests. Nurses observed that health care providers frequently did not tailor cancer screening recommendations to individuals' family histories, life expectancies, or their disability-specific cancer risks. The authors suggest interventions to improve cancer screening centered around education and training, accessibility, financing-insurance, modification of procedures, and patient tracking.

Author(s): Nora Wells[sup.1] , Suzanne Bronheim[sup.2] , Stephen Zyzanski[sup.3] , Clarissa Hoover[sup.1] Author Affiliations: (1) Family Voices, Inc., Albuquerque, NM, USA (2) Georgetown University, Washington, DC, USA (3) Case Western [...], The objective of this study was to create a psychometrically sound measure of family-centered care, the Family-Centered Care Assessment (FCCA), developed through a process led by families in collaboration with maternal and child health leaders. The items for the FCCA scale were initially developed by families of children and youth with special needs in partnership with pediatric providers and researchers. Using an Institutional Review Board-approved research protocol, the questions were revised based on input from focus groups of diverse parents in three states. Parental responses (N = 790) to the revised 59-item survey were collected online from families in 49 states. Item distributions uniformly showed excellent spread. A principal axes factor analysis confirmed the existence of a single factor. Rasch modeling item analyses identified a reduced subset of 24 items that demonstrated excellent psychometric properties. All items met the criteria for a linear Rasch scale. Empirical evidence in support of the construct validity of the 24-item measure was derived: all items had a positive and substantial item-total correlation; person alpha scale reliability was >0.80 and the item reliability was >0.90; both separation indices were >2.0; infit and outfit statistics were within 0.5-1.5; and item difficulties ranged between -2 and +2 logits. Strong rank-ordered associations and large effect sizes were observed for six indicators of quality of care. This study's family-led process produced a tool, the FCCA, to measure families' experience of care with excellent psychometric properties.

Osteoporosis screening of 107 adults, ages 40 to 60, with mental retardation who attended community-based training centers found 21 percent had osteoporosis and 34 percent had osteopenia. The most significant predictor of lower bone mineral densities were Down syndrome, mobility status, and race. (Contains references.) (Author/DB)

Introduction Length of the inter-pregnancy intervals, often defined as the interval between the end of one pregnancy and the start of the next pregnancy, is important to consider in the [...], To investigate the relationship among parity, length of the inter-pregnancy intervals and excessive pregnancy weight gain in the first pregnancy and the risk of obesity. Using a prospective cohort study of 3,422 non-obese, non-pregnant US women aged 14-22 years at baseline, adjusted Cox models were used to estimate the association among parity, inter-pregnancy intervals, and excessive pregnancy weight gain in the first pregnancy and the relative hazard rate (HR) of obesity. Compared to nulliparous women, primiparous women with excessive pregnancy weight gain in the first pregnancy had a HR of obesity of 1.79 (95% CI 1.40, 2.29); no significant difference was seen between primiparous without excessive pregnancy weight gain in the first pregnancy and nulliparous women. Among women with the same pregnancy weight gain in the first pregnancy and the same number of inter-pregnancy intervals (12 and 18 months or ≥ 18 months), the HR of obesity increased 2.43-fold (95% CI 1.21, 4.89; p = 0.01) for every additional inter-pregnancy interval of < 12 months; no significant association was seen for longer inter-pregnancy intervals. Among women with the same parity and inter-pregnancy interval pattern, women with excessive pregnancy weight gain in the first pregnancy had an HR of obesity 2.41 times higher (95% CI 1.81, 3.21; p < 0.001) than women without. Primiparous and nulliparous women had similar obesity risk unless the primiparous women had excessive pregnancy weight gain in the first pregnancy, then their risk of obesity was greater. Multiparous women with the same excessive pregnancy weight gain in the first pregnancy and at least one additional short inter-pregnancy interval had a significant risk of obesity after childbirth. Perinatal interventions that prevent excessive pregnancy weight gain in the first pregnancy or lengthen the inter-pregnancy interval are necessary for reducing maternal obesity. Keywords Pregnancy * Inter-pregnancy interval * Maternal obesity * Parity * Excessive pregnancy weight gain

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.12.023 Byline: Amy Y. Zhang (a), Stephen J. Zyzanski (a), Laura A. Siminoff (b) Abstract: This study examined the differences of opinion between cancer patients and caregivers with regard to treatment and care decisions. 184 advanced lung cancer patients and 171 primary caregivers were recruited as a convenience sample from hospitals in Cleveland, Ohio. A telephone interview was conducted to collect data using a semi-structured questionnaire. Nonparametric tests and regression analysis were performed. The findings showed that patients and caregivers reported significant disagreement on three main issues: trade-off between treatment side effects and benefits; reporting treatment side effects to physicians, and hospice care. Caregivers were more concerned about patient's quality of life and more willing to discuss hospice issues than were patients (p [less than or equal to] 01). Perceived family disagreement is associated with depression in both patients and caregivers (p [less than or equal to] 01; R.sup.2=8%). The study provided empirical evidence for patient-caregiver disagreement about treatment and care decisions and its significant adverse impact on both patients and caregivers. Author Affiliation: (a) Case Western Reserve University, Cleveland, OH, United States (b) Virginia Commonwealth University, Richmond, VA, United States

Objectives. We investigated the relationship between childbirth and 5-year incidence of obesity. Methods. We performed a prospective analysis of data on 2923 nonobese, non-pregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compared with women who did not have children. Results. The 5-year incidence of obesity was 11.3 per 100 parous women, compared with 4.5 per 100 nulliparous women (relative risk [RR]=3.5; 95% confidence interval [Cl]=2.4, 4.9; P Conclusions. Parous women have a higher incidence of obesity than do nulliparous women, and minority women have a higher incidence of parity-related obesity than do White women. Thus, efforts to reduce obesity should target postpartum women and minority women who give birth. (Am J Public Health. 2009;99:294-299. doi:10.2105/AJPH.2007.132373)

Many parents of children with leukemia do not understand basic aspects of medical research such as randomization, according to a study of 137 parents. Half of the parents did not understand randomization even after it was explained to them. Randomization in a clinical trial means the people participating in the trial are randomly assigned to one of two groups: the group that receives the experimental treatment and the group that does not.

Assent is a pivotal concept in pediatric ethics. Only through a careful combination of soliciting the assent of the child and the permission of parent(s) can informed consent in pediatric [...], Objective. Assent is a critical issue in pediatric ethics that has not been well-studied. We examined the role of older children in discussing a recent diagnosis of acute leukemia and treatment options, including participation in a randomized, clinical trial (RCT). Design. Our sample was drawn from data collected as part of a larger, National Cancer Institute-funded study in which we observed, tape-recorded, and transcribed the informed consent conference (ICC) for children with leukemia at 6 institutions. We analyzed the data for the child's presence and role, examined 5 discussion categories relevant to assent in the context of pediatric cancer treatment/research, conducted parent interviews, and administered clinician questionnaires to examine these issues. We report a qualitative analysis of 14 cases in which the child was present for the ICC. Results. Clinicians varied with regard to whom they directed specific discussions when patients were present. Questions asked by the children predominantly related to details of the disease and treatment, with few questions about the RCT. Clinicians and parents attribute responsibility for decision-making about participation in RCTs in a variety of ways. In conferences that included the child-patient, parents asked significantly fewer questions than in other ICCs. Conclusion. There is significant variation among ICCs that include the older child. Additional empirical study of assent is warranted, and our data suggest several hypotheses that should be tested in future research. Pediatrics 2002;109:806-814; assent, research ethics, leukemia, pediatric ethics, randomized trials.