Context: COVID-19 vaccination is associated with decreases in COVID infections, hospitalizations, and overall mortality. However, it is unknown if it confers specific inpatient benefits, such as inpatient mortality, length of stay, and treatment regimen needed in those admitted specifically for COVID-19. Objective: To study the inpatient courses of vaccinated vs unvaccinated COVID-19 inpatients. Study Design: Retrospective cohort study Setting: Data obtained from the EHR of a health system consisting of 5 acute-care hospitals. Population studied: All admissions for COVID-19 from March 1, 2021 to February 28, 2022 were included. Patients less than age 18 and those with unknown COVID vaccine status were excluded. Outcome Measures: The primary outcome measure was inpatient mortality. Inpatient length of stay and treatments used were secondary measures. Analysis: Continuous variables were summarized using means, categorical variables were summarized using proportions. Comparisons were made between vaccinated and unvaccinated groups. Means were analyzed using the 2-sample t-test, proportions were analyzed using chi square. To control for other factors, binary logistic regression was used to determine the odds of inpatient mortality and linear regression was used to determine the change in length of stay that can be attributed to COVID-19 vaccination. Analysis was conducted using STATA (Version 17, StataCorp). Results: 5,234 patients met inclusion and exclusion criteria, with 23.9% of these patients having completed a primary vaccination series against COVID-19. Vaccinated patients were older, more likely to be white, and more likely to have comorbid conditions (COPD, CHF, CKD, DM, CAD, and obesity). There was no difference between groups in treatment regimens (use of steroids, antivirals, immune modulators, high-flow oxygen, or intubation). Inpatient mortality was lower (5.8% vs 9.3%, p<0.001), and mean length of stay was shorter (7.0 vs 7.6 days, p=0.01) in the vaccinated group. When controlling for demographics, medical history, and treatments given, vaccinated patients had lower odds of inpatient mortality (OR=0.44, 95% CI 0.32-0.62, p<0.001) and vaccination accounted for a 0.74-day reduction in length of stay (95% 0.25-1.22 day reduction, p=0.003). Conclusions: In this study, COVID-19 vaccination was associated with decreased inpatient mortality and shorter hospital stays despite no difference in treatment regimens between those vaccinated and unvaccinated.

Unsafe firearm storage is associated with increased risk of accidental firearm-related deaths and firearm-related suicides. However, many firearm owners do not believe this data or advice regarding safe gun storage. Therefore, what other risky behaviors that they have been warned against do they not believe? The objective of this study was to evaluate the association of health-risk behaviors with high-risk firearm ownership. Cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System was performed. Data included adults age > 18 years who answered the question “Are any firearms kept in or around your home?”. The main outcome measure was the proportion of respondents who answered “Yes”, and these participants were identified in this study as “gun owners”. Secondary outcome measures included the proportion of respondents who were identified as “high-risk gun owners”, defined as those who reported owning firearms that were stored loaded and unlocked. Unadjusted proportions were compared using Pearson chi-square testing and adjusted comparisons controlling for confounders were compared using logistic regression. A final weighted sample of 13,118,021 adults was evaluated. 41.6% of participants were gun owners. Of those, 23.5% were considered high-risk. Health-risk behaviors associated with high-risk gun ownership included binge alcohol use (OR 1.92, 95% CI 1.21-3.06, p=0.006), and not always wearing a seatbelt in a vehicle (OR 2.11, 95% CI 1.36-3.28, p=0.001). This study demonstrates clearly defined health-risk behaviors associated with gun ownership. This can help to target preventive measures for specific behaviors in patients who own firearms to attempt to prevent future tragedies.

We read with great interest the paper by Bliss et al on the University of Utah Health Sciences Learning, Engagement, Achievement, and Progress (HS-LEAP) program's provision of longitudinal support and mentorship for underrepresented in medicine (URM) students. 1 The authors reported less than half of accepted students completed the program and suggested the attrition may be partially due to student specific deficits.In addition to student deficiency concerns, the leaky pipeline of diversity-focused programs also represents the need for academic institutions in general to take an inward look to determine how systems and processes should change to improve URM student retention and promote their advancement.The problem isn't always with the URM student.Students included as underrepresented in medicine were American Indian/Alaska Native, Black, Latinx, Pacific Islander, Southeast or Refugee Asians, and those from lower socioeconomic and rural backgrounds.The Association of American Medical Colleges does not provide recommendations for the implementation of pipeline programs, and as such, there are no requirements to address the societal bias and racism that contribute to low numbers of underrepresented minorities in medicine. 2 It is important for pipeline programs to address racism, isolation, low institutional expectations and privilege systems as they impact the success of URM learners. 3 Working from a skills-based only model, or a learner deficiency only model, is to deny the fact that race and racism make up part of a URM learner's identity and life experiences, and impact how the learner learns.Academic leaders must dismantle institutional systems and policies that advantage some learners and disadvantage others.For example, concerns about bias have been raised in medical school admissions and the Alpha Omega Alpha honors society. 4Academic leaders must promote equity for URM learners and ensure an academic environment that is inclusive and enriching.They must provide funding for URM-specific programing, and advocate for campus-wide policies that support this group. 5 We commend Dr Bliss and colleagues for their meaningful work in this longitudinal pipeline program and the successes they share despite challenges reported with attrition.The continued success of pipeline programs depends not only on learner ability, but also the academic environment in which the learner is placed.This letter is a call to action for all academic institutions with pipeline programs to look at their academic environments to dismantle systems of racism and privilege that impact the academic success of URM learners.The time is now.

BACKGROUND AND OBJECTIVESDespite the growing rate of deaths caused by firearms, it is not clear what role physicians should play in counseling patients about firearm safety. This study aims to delineate the perceptions and experiences of family physicians regarding firearm safety counseling.METHODSData were gathered as part of the 2020 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine practicing physicians. Participants were practicing physicians and members of one of four major academic family medicine organizations comprising CERA. The survey was delivered to a sample of 3,665 family physicians between January 15, 2020, and March 2, 2020. This was a mixed-methods epidemiological study that analyzed quantitative and qualitative survey data. We calculated a χ2 test of independence to examine interactions between demographic characteristics and beliefs and perceptions about firearm safety counseling.RESULTSThe overall response rate for the survey was 32.52%, with 92.7% answering questions in the firearm safety set; 93.7% of study participants viewed firearm safety as a public health issue and 95.3% felt family physicians should have the right to counsel patients on firearm safety. Family physicians who had received formal training on firearm safety counseling were significantly more likely to indicate a higher level of comfort with asking their patients about firearms (P<.0001).CONCLUSIONSFirearm safety is an important public health issue and family physicians would benefit from receiving formal training on firearm safety counseling early in their training. More education is needed around physician-initiated firearm safety counseling.

BACKGROUND AND OBJECTIVES: Burnout is considered a public health crisis among physicians and is related to poor quality of life, increased medical errors, and lower patient satisfaction. A recent literature review and conceptual model suggest that awareness of life meaning, or meaning salience, is related to improved stress and coping, and may also reduce experience of burnout. This study examined associations among meaning salience, burnout, fatigue, and quality of life among family medicine residency program directors. METHODS: Data were collected via an online survey administered by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA; n=268, response rate of 45.4%) in December 2018. Program directors completed measures of meaning salience, burnout, fatigue, and quality of life. Data were analyzed using Spearman correlations and path analysis. RESULTS: Program directors who reported greater experienced meaning salience also reported significantly less burnout (beta=-.40, P<.001) and less fatigue (beta=-.38, P<.001), which were then both significantly associated with greater quality of life (Ps<.001). Program directors who reported greater meaning salience also reported greater quality of life (beta=.21, P<.001). Additionally, there were significant indirect associations between meaning salience and quality of life through less burnout and fatigue (beta=.26, P<.001). CONCLUSIONS: The potential for increasing physicians' awareness of their sense of meaning as a means to prevent or decrease burnout is underresearched and warrants further study. Both preventive measures (eg, wellness curricula) and interventions with already-distressed physicians may encourage regular reflection on meaning in life, especially during busy workdays.

Background: The concept of body mass index (BMI) may not be well understood by patients. The purpose of this study was to evaluate patients' knowledge of BMI in the primary care setting. Methods: Adult patients seen in 18 practices in West Virginia and New Jersey were invited to complete a voluntary survey. The survey assessed the patient's baseline knowledge of BMI as well as demographic information and whether the patient had known chronic conditions associated with increased BMI, including hypertension, hyperlipidemia, diabetes mellitus, and sleep apnea. Results: While the majority (59.9%) of primary care patients knew the meaning of BMI and that it is related to obesity, there was little knowledge of BMI cutoff values; more than 80% of responses were incorrect when asked to define specific BMI levels and their meaning. Self-awareness of obesity was limited as well, with only 16.4% aware of their own personal BMI. Furthermore, nearly 70% of patients could not recall having discussed BMI with their physician. Conclusion: Findings indicate low comprehension of the term BMI. Increasing awareness of BMI may help patients address this key risk factor and significantly affect public health.

BACKGROUND AND OBJECTIVES: Precept-Assist (R) (PA) is a computer-based program developed by the Virtua Family Medicine Residency where residents receive a score on a Likert-type scale from an attending for each precept based on their knowledge base. The purpose of this study was to attempt to validate this program for precepting family medicine residents.METHODS: This was a validation study. PA and American Board of Family Medicine (ABFM) In-Training Exam (ITE) scores for all residents from a community-based family medicine residency between the years 2002 and 2011 were included (n=216). Pearson correlation coefficients were calculated between PA scores for the second quarter of the academic year (October 1 to December 31) and scores on the ITE. An ROC curve was also created to determine sensitivity and specificity for various PA scores in predicting residents scoring 500 or above on the ITE.RESULTS: The PA mean (SD) score was 5.18 (0.84) and the ITE mean (SD) score was 425.1 (87.6). The Pearson correlation coefficient between PA and ITE scores was 0.55, which is a moderately positive correlation. The AUC of the ROC curve was 0.783 (95% CI 0.704-0.859). A PA score of 5.5 (between the level of a PGY-2 and PGY-3) was 72% sensitive and 77% specific for scoring 500 or above on the ITE with a positive LR of 3.12.CONCLUSIONS: There is a significant correlation between PA scores and ABFM In-Training Exam scores. PA is a valid screening tool that can be used as a predictor for future performance in Family Medicine In-Training exams.

Objectives: To evaluate the real-world use of various weight loss techniques and to compare the effectiveness of nontraditional methods with diet and exercise in helping nongeriatric adults lose weight.Methods: A cross-sectional analysis of the 2005-2010 National Health and Nutrition Examination Survey was performed. Adult, nonpregnant participants aged 20 to 65 years with a body mass index of >= 18.5 who tried to lose weight in the previous year were analyzed (weighted n = 53,570,979). Outcome measures included the proportion of patients who used nontraditional weight loss methods and a comparison of weight loss between those who used diet and exercise and those who used nontraditional methods.Results: During the previous year, 56.9% (95% confidence interval 54.5-59.4) of participants used nontraditional methods (nonexclusive of diet and exercise) as their attempted weight loss methods. Overall, individuals gained a mean (standard error) of 4.9 (0.3) lb in the 12 months preceding the National Health and Nutrition Examination Survey questionnaire. Only 19.6% (95% confidence interval 18.0-21.2) of the sample lost weight within the previous 12 months. Those who used nontraditional methods gained more weight during the previous year than those who used diet and exercise only (for body mass index >= 18.5, 5.5 vs 3.5 lb; P < 0.01) in the overall sample, but there was no difference in the obese subgroup.Conclusions: Physicians need to reaffirm that diet and exercise are better methods for weight loss, and they need to advise their patients to avoid other methods when attempting to lose weight because they do not enhance weight loss attempts.

Methods: A cross-sectional analysis of the 2005Y2010 National Health and Nutrition Examination Survey was performed. Adult, nonpregnant participants aged 20 to 65 years with a body mass index of Q18.5 who tried to lose weight in the previous year were analyzed (weighted n = 53,570,979). Outcome measures included the proportion of patients who used nontraditional weight loss methods and a comparison of weight loss between those who used diet and exercise and those who used nontraditional methods.

PURPOSE Presentations of research are important in the dissemination of new knowledge, but they do not reach the same audience as research published in journals. The purpose of this study was to evaluate the proportion of presentations at recent major primary care research conferences that have become published. METHODS Oral and poster presentations for completed and work-in-progress projects from the 2007 and 2008 North American Primary Care Research Group (NAPCRG) and Society of Teachers of Family Medicine (STFM) annual conferences were included in the analysis. The first presenter for each presentation was searched on PubMed, and titles and abstracts for presentations were compared for content to titles and abstracts of potential matches found on PubMed. We analyzed the proportion of presentations that were published in peer-reviewed journals, mean time to publication, and the proportions of the type of journal in which the article appeared (family medicine vs other) were analyzed. RESULTS There were 1,329 presentations included in the study. Overall, 34.4% of projects presented were also published. More oral presentations (42.9%) were published than were poster presentations (25.3%) (P <.001). Mean time to publication was 15.4 months. Oral presentations were published more quickly (13.7 months) than poster presentations (18.6 months) (P <.001). Published reports appeared in 192 different journals. Family medicine journals accounted for 36.5% of published. CONCLUSIONS More than one-third of all presentations at STFM and NAPCRG conferences were published in journals indexed in PubMed. Time to publication was comparable to that of other specialties. Fewer than 2 of every 5 reports were published are in a family medicine journal, suggesting vast breadth in family medicine research. Family medicine academicians need to refocus efforts on transforming presentations into published articles in peer-reviewed journals for broader dissemination of research findings.

BACKGROUND AND OBJECTIVESMany adolescents seek care by family physicians for well visits and have the opportunity for HPV vaccination during these visits. Limited information is available regarding what affects physicians in offering the vaccine. The purpose of this study was to examine factors that affect family physician administration of the HPV vaccine.METHODSWe used a mail survey of recent graduates from family medicine residencies affiliated with the South Carolina Area Health Education Consortium.RESULTSThe response rate was 51.3%. Almost 79% offer the HPV vaccine at least most of the time to their adolescent female patients in their practice. Approximately 83% of respondents reported supporting the use of the HPV vaccine in males, but less than 8% reported having actually offered the vaccine to males. Those physicians who are female (OR=8.95, 95% CI=1.56--51.3), practice full time in an office setting (OR=9.08, 95% CI=1.71--48.3), are involved in teaching (OR=8.86, 95% CI=1.75--44.9), and practice in a family medicine setting (OR=8.20, 95% CI=1.69-39.8) had greater odds of offering the vaccine. Those who currently practiced in the southeastern United States were less likely to offer the vaccine (OR=0.04, 95% CI=0.002--0.59).CONCLUSIONSRecent graduates of family medicine training programs frequently offer the HPV vaccine to adolescent females. Multiple practice factors affected the odds of offering the vaccine. Though most respondents agree with using the vaccine in males, most do not offer it to males.

Attention-deficit/hyperactivity disorder in childhood can persist into adulthood in at least 30 percent of patients, with 3 to 4 percent of adults meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., diagnostic criteria. A number of conditions, such as thyroid disease, mood disorders, and substance use disorders, have symptoms similar to those of attention-deficit/hyperactivity disorder and should be considered in the differential diagnosis. Steroids, antihistamines, anticonvulsants, caffeine, and nicotine also can have adverse effects that mimic attention-deficit/hyperactivity disorder symptoms. Proper diagnosis and treatment can improve daily functioning. Diagnosis relies on a thorough clinical history, supported by a number of rating scales that take five to 20 minutes to complete, depending on the scale. Clinical guidelines recommend stimulants and the nonstimulant atomoxetine as first-line treatments, followed by antidepressants. Cognitive behavior therapy has also been shown to be helpful as adjunctive treatment with medication. For adults with coexisting depression, the combination of an antidepressant and stimulants has been shown to be safe and effective. To monitor for misuse or diversion of stimulants, family physicians should consider using a controlled substances agreement and random urine drug screening in addition to regular follow-up visits.

BACKGROUND AND OBJECTIVES Scholarly work is an important part of all medical specialties. A decline in publications by academic family medicine faculty during the 1990s was documented. The purpose of this study was to compare the publication productivity of family medicine academicians during the 2000s to that in the 1990s. METHODS A random sample of 1,500 individuals was drawn from the 2009 Society of Teachers of Family Medicine (STFM) membership. We then performed a PubMed search to identify publications by each of the subjects for the year 2009. Publications by STFM members in 1999 were identified from results of a previous study. We then compared differences between 1999 and 2009 in the percentage of STFM members publishing papers, the number of published papers per member, and the number of journals in which publications appeared. RESULTS The percentage of STFM members publishing at least one article increased from 8.5% (95% confidence interval [CI]=7.2%--10.0%) in 1999 to 20.9% (95% CI=18.9%--23.0%) in 2009. The mean number of publications by those who published increased from 1.73 (95% CI=1.68--1.78) to 2.22 (95% CI=2.13--2.31). STFM members were 2.85 (95% CI=2.29--3.55) times more likely to publish at least one paper in 2009 than in 1999. Publications appeared in 202 different journals in 2009 compared to 75 in 1999. CONCLUSIONS A higher percentage of family medicine academicians published papers in 2009 than in 1999. There were also more papers published per individual, and publications appeared in a wider range of journals.

Background: The evidence of the relationship between fiber intake and control of diabetes is mixed. The purpose of this study was to determine if an increase in dietary fiber affects glycosylated hemoglobin (HbA1c) and fasting blood glucose in patients with type 2 diabetes mellitus. Methods: Randomized studies published from January 1, 1980, to December 31, 2010, that involved an increase in dietary fiber intake as an intervention, evaluated HbA1c and/or fasting blood glucose as an outcome, and used human participants with known type 2 diabetes mellitus were selected for review. Results: Fifteen studies met inclusion and exclusion criteria. The overall mean difference of fiber versus placebo was a reduction of fasting blood glucose of 0.85 mmol/L (95% CI, 0.46–1.25). Dietary fiber as an intervention also had an effect on HbA1c over placebo, with an overall mean difference of a decrease in HbA1c of 0.26% (95% CI, 0.02–0.51). Conclusion: Overall, an intervention involving fiber supplementation for type 2 diabetes mellitus can reduce fasting blood glucose and HbA1c. This suggests that increasing dietary fiber in the diet of patients with type 2 diabetes is beneficial and should be encouraged as a disease management strategy.

BACKGROUND Physician counseling is effective in promoting healthy behavior. We evaluated whether patient reports of physician acknowledgment of overweight patients' weight status are associated with the patients' perceptions of their own weight and desire to lose weight. METHODS We analyzed the 2005-2008 National Health and Nutrition Examination Survey data on adults aged 20 to 64 years with a body mass index (BMI) of at least 25.0 (calculated as weight in kilograms divided by height in meters squared). Logistic regressions were computed to evaluate the impact of reports of physician acknowledgment of patients' weight status on patients' perceptions of their weight, desire to weigh less, and attempts to lose weight. RESULTS In logistic regressions controlling for relevant confounding variables, participants with a BMI of 25 or greater (odds ratio [OR], 6.11; 95% confidence interval [CI], 4.38-8.53) and those with a BMI of 30 or greater (OR, 7.58; 95% CI, 5.83-9.84) both had an increased likelihood to perceive themselves as overweight if they were told by their physician that they were overweight. Similarly, participants with a BMI of 25 or greater (OR, 2.51; 95% CI, 2.15-2.94) and those with a BMI of 30 or greater (OR, 2.24; 95% CI, 1.74-2.88) had an increased likelihood to have attempted to lose weight in the previous 12 months if they had reported being told they were overweight. However, only 45.2% of individuals with a BMI of 25 or greater and 66.4% of those with a BMI of 30 or greater reported being told by a physician that they were overweight. CONCLUSION Among patients who were overweight or obese, patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients' own weight, desire to lose weight, and recent attempts to lose weight.

Dietary modifications are common treatment strategies for patients with various chronic diseases, but it is unclear how often these individuals read food labels. The objective of this study was to determine whether patients with chronic disease who are advised to change their eating habits read nutrition labels more than patients who have not been so advised, and whether that impacts their energy and nutrient intake. Analysis of the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey of the United States population, was performed. Adults (20 years of age or older) who participated in the 2005-2006 National Health and Nutrition Examination Survey and who had type 2 diabetes, hypertension, and/or hyperlipidemia were included for analysis. There were 3,748 unweighted participants, which represents 170,958,166 in the US population. Proportions of patients with chronic disease who read nutrition labels were compared by χ2 analysis, mean values of various components of their diet were compared by the two-sample independent t test, and odds ratios and 95% confidence intervals were determined by logistic regression. Among patients with chronic disease, the odds of reading food labels when told by their doctor or another health professional to reduce calories or weight was 50% higher than in those without physician intervention (odds ratio=1.50, 95% confidence interval: 1.12 to 2.00). Those who read food labels consumed less energy, saturated fat, carbohydrates, and sugar, and more fiber than those who did not. These findings point to the value of dietary counseling in chronic disease management.

ley. Drafting of the manuscript: Tseng, Marrero, and Dudley. Critical revision of the manuscript for important intellectual content: Tseng, Waitzfelder, Tierney, Gerzoff, Marrero, Piette, Karter, Curb, Chung, Mangione, Crosson, and Dudley. Statistical analysis: Tseng, Tierney, Gerzoff, and Piette. Obtained funding: Waitzfelder, Karter, and Curb. Administrative, technical, and material support: Waitzfelder, Karter, Curb, Chung, and Crosson. Study supervision: Tseng, Curb, Mangione, and Dudley. Financial Disclosure: None reported. Funding/Support: This study was jointly funded by Program Announcement No. 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. Additional Contributions: We acknowledge the participation of our health plan partners. Significant contributions to this study were made by members of the Translating Research into Action for Diabetes (TRIAD) Study Group. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the opinions of the funding organizations.

Dizziness accounts for an estimated 5 percent of primary care clinic visits. The patient history can generally classify dizziness into one of four categories: vertigo, disequilibrium, presyncope, or lightheadedness. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis. Many medications can cause presyncope, and regimens should be assessed in patients with this type of dizziness. Parkinson disease and diabetic neuropathy should be considered with the diagnosis of disequilibrium. Psychiatric disorders, such as depression, anxiety, and hyperventilation syndrome, can cause vague lightheadedness. The differential diagnosis of dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis. A final diagnosis is not obtained in about 20 percent of cases. Treatment of vertigo includes the Epley maneuver (canalith repositioning) and vestibular rehabilitation for benign paroxysmal positional vertigo, intratympanic dexamethasone or gentamicin for Meniere disease, and steroids for vestibular neuritis. Orthostatic hypotension that causes presyncope can be treated with alpha agonists, mineralocorticoids, or lifestyle changes. Disequilibrium and lightheadedness can be alleviated by treating the underlying cause.

Gastrointestinal (GI) tract infections are caused by a wide variety of fungi, viruses, and bacteria, and all areas of the GI tract are affected. Infections range from mild, where disease is self-limited and supportive care is the treatment, to severe, where hospitalization and intravenous fluids and antibiotics are required for survival. In recent years, the increasing antibiotic resistance of various bacteria has become an important aspect of GI infection treatment and has resulted in augmentation of therapy.