Annals of family medicine
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Annals of family medicine · Jan 2023
Considerations for Creating a Restricted Data Environment with Complete Primary Care Electronic Medical Record Data.
Background: Historically, primary care databases have been limited to subsets of the full electronic medical record (EMR) data to maintain privacy. With the progression of artificial intelligence (AI) techniques (i.e., machine learning, natural language processing, and deep learning), practice-based research networks (PBRNs) have an opportunity to utilize previously difficult to access data to conduct essential primary care research and quality improvement. However, to ensure patient privacy and data security, novel infrastructure and processes are required. ⋯ Five major elements were recurrent throughout the QFAMR development process: data and technology, privacy, legal documentation, decision-making frameworks, and ethics and consent. Conclusion: Overall, the development of the QFAMR has provided a secure platform to successfully access data-rich primary care EMR records without data ever leaving Queen's University. Although accessing complete primary care EMR records has certain technological, privacy, legal, and ethical considerations and challenges, QFAMR is a significant opportunity to conduct novel and innovative primary care research.
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Annals of family medicine · Jan 2023
Assessing Electronic Cigarette Use and Depressive Symptoms among Adolescents in Kansas.
Purpose: The use of electronic cigarette has been increasing among adolescent in the United States population. With depression as a major risk factor for suicide in adolescent, this study examined depressive symptoms and electronic cigarette dependence in this age group. Methods: The authors conducted a retrospective patient chart review at a pediatric clinic in the Midwestern United States, from May 2021 to September 2021. ⋯ Findings of the mixed model analyses indicated that there was not a significant association between electronic cigarette dependence and depressive symptoms (OR=1.07; 95% confidence interval, 0.93-1.23; P=.0365). Conclusions: Our finding shows that while a third of adolescents screened positive for depression and majority (88%) depended on electronic cigarettes, there was no association between the outcomes. Future larger studies are needed to better understand the association between electronic cigarettes dependence and depressive symptoms as reported in the literature.
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Annals of family medicine · Jan 2023
Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic.
Context: The COVID-19 pandemic has impacted the volume and nature of pediatric primary care visits nationwide. Objective: This study aimed to identify trends in pediatric visits during COVID-19 at our institution to reveal challenges and opportunities to improve care. Study Design: Retrospective chart review of all pediatric visits from January 1, 2019 through September 30, 2021 using the electronic health record (EHR). ⋯ Video visit volume decreased from 2020-2021 in all age categories except for adolescents aged 12-<18, which remained stable at 43% of all visits. Conclusions: A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for children and adolescents now and in the post-pandemic era.
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Annals of family medicine · Jan 2023
The Association of Birth Weight and Early Childhood Weight Trajectories with the incidence of Type II Diabetes.
Background: Perinatal factors, including gestational age, birthweight, size-for-gestational age, delivery route, maternal parity, maternal age, and socioeconomic status, have been linked to the long-term incidence of chronic comorbidities. We evaluated the association of birth size characteristics and early childhood growth trajectories with Type II diabetes (DM2) in adolescence and adulthood. Methods: We conducted a population-based, nested case-control study in a birth cohort of infants born to residents of Olmsted County, MN between 1976-1982, using the resources of the Rochester Epidemiology Project. ⋯ The odds of being large-for-gestational-age versus average were significantly lower for DM2 cases compared to matched controls (OR 0.51; 95%CI 0.29-1.89) and the mean birthweight was significantly lower for DM2 cases compared to controls (mean [SD], 3379 [642]g vs. 3583 [540]g, p=0.002). Conclusion: Low birth weight, large for gestational age and a late term pregnancy were associated with DM2 after age 10 years compared with age- and sex-matched controls from the same birth cohort. Weight gain trajectories through 66 months of age were not associated with DM2.
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Annals of family medicine · Jan 2023
Primary Care Physicians' Perspectives on Identifying Familial Hypercholesterolaemia in Primary Care: A Qualitative Study.
Context Familial hypercholesterolaemia (FH) is a common autosomal dominant disorder, causing elevated cholesterol from birth, premature heart disease, and early death. Objective This study explored primary care physicians' experiences and perspectives on identifying FH in Malaysian primary care. Study Design and Analysis A qualitative study involving semi-structured interviews and focus group discussions with 22 primary care physicians (PCPs) in two primary care clinic settings. ⋯ The PCPs recommended a user-friendly case-finding tool for FH, and establishing FH registry and clinical practice guideline in Malaysia, alongside a national FH screening strategy and awareness campaigns for both clinicians and general public. Conclusions PCPs are positive about improving the identification of FH in primary care. However greater support in their practice and wider system developments and change are needed.