Elastic Scattering Spectroscopy on Patient-Selected Lesions Concerning for Skin Cancer.

BACKGROUND: Access to dermatologists is limited in parts of the US, making primary care clinicians (PCCs) integral for early detection of skin cancers. A handheld device using elastic scattering spectroscopy (ESS) was developed to aid PCCs in their clinical assessment of skin lesions. METHODS: In this prospective study, 3 PCCs evaluated skin lesions reported by patients as concerning and scanned each lesion with the handheld ESS device. The comparison was pathology results or a 3-dermatologist panel examining high resolution dermatoscopic and clinical images. PCCs reported their diagnosis, management decision, and confidence level for each lesion. Evaluation of results included sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and Area Under the Curve (AUC). RESULTS: A total of 155 patients and 178 lesions were included in the final analysis. The most commonly patient-reported concerning feature was "new or changing lesion" (91.6%). Device diagnostic sensitivity and specificity were 90.0% and 60.7%, respectively, based on biopsy result or dermatologist panel reference standard; comparatively, PCC sensitivity was 40.0% and 84.8% specificity without the use of the device. Device NPV was 98.9%, and device PPV was 13.6%. The device recommended patient referral to dermatology with 88.2% concordance with the dermatologist panel. AUC for the device and PCCs were 0.815 and 0.643, respectively. CONCLUSIONS: The use of the ESS device by PCCs can improve diagnostic and management sensitivity for select malignant skin lesions by correctly classifying most benign lesions of patient concern. This may increase skin cancer detection while improving access to specialist care.

Relationship Between Primary Care Physician Capacity and Usual Source of Care.

BACKGROUND: The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC. METHODS: Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity. RESULTS: The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas. CONCLUSIONS: Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.

Recent Innovations in Primary Care Cancer Survivorship Roles.

BACKGROUND: Despite 2 decades of cancer survivorship research, policy, and advocacy, primary care in the United States has not fully integrated survivorship care into its generalist role. This manuscript describes innovative roles primary care physicians have adopted in survivorship care and how these roles emerged. METHODS: We conducted qualitative in-depth interviews with a snowball sample of 10 US primary care physician innovators in survivorship care. Interviews were recorded and professionally transcribed. Our team met weekly as interviews were completed to review transcripts and write summaries. We analyzed data using an immersion-crystallization process. RESULTS: Innovators did not receive formal survivorship training but gained knowledge experientially and through self-guided education. All worked in academic primary care and/or cancer centers; context strongly influenced role operationalization. We delineated 4 major role-types along a spectrum, with primary care generalist orientations at one end and cancer generalist orientations at the other. Primary care generalists applied survivorship guidelines during regular visits ("GENERALISTS+") or focused on cancer treatment effects amid other comorbidities during blocked clinic time ("oncoGENERALISTS"). Cancer generalists focused on cancer-related sequalae during and after treatment; some provided continuity care to survivors ("ONCOGENERALISTS"), while others incorporated unmet primary care needs into survivorship consults ("ONCOgeneralists"). CONCLUSIONS: Primary care survivorship innovations are occurring in academic primary care and cancer centers settings in the US. To move beyond the work of individual innovators, systematic investments are needed to support adoption of such innovations. For wider diffusion of survivorship care into community primary care, additional strategies that include primary care survivorship education and workforce development are needed to facilitate risk-stratified and shared-care models.

Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review.

BACKGROUND: Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice. AIM: This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS). METHODS: We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians. RESULTS: Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice. CONCLUSION: The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.

Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for its diagnosis, follow up and prognosis, especially for assessing left ventricular ejection fraction (LVEF), one of the essential hemodynamic cardiac markers. At a time when access to specialists is difficult, what if primary health care physicians had a tool that enabled them to sort and prioritize patients with suspected or diagnosed HF? Point-of-care ultrasound (POCUS) is already used in daily medical practice to provide optimum bedside diagnostics and tailored medical cares. Thus, we conduct a systematic review up to January 2024, including 42 studies, gathering 6598 patients with suspected or diagnosed HF, with 60% of outpatients. After a brief theoretical and practical training (a median of 4.5 hours and 25 cardiac POCUS), 351 physicians without expertise in cardiac ultrasound (defined as "non-experts") evaluated LVEF in unselected patients with cardiac POCUS, then compared with the experts' assessment. A strong to excellent agreement was found between the two groups, depending on the type of ultrasound device used. The LVEF assessment using cardiac POCUS after a short training course appears to be an accurate complementary tool for non-expert physicians. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.

Prescription patterns of statins in cirrhotic patients: a survey among primary care physicians and cardiologists.

Background: Statin therapy is widely utilized for preventing atherosclerotic cardiovascular disease, both as a primary and secondary measure. Despite the American Association for the Study of Liver Diseases' endorsement of statin use in cirrhotic patients, practitioners exhibit hesitancy, primarily due to concerns regarding hepatotoxicity. This study aimed to evaluate statin prescription patterns in cirrhotic patients by primary care physicians (PCPs) and cardiologists through a survey. Methods: A voluntary survey via Survey Monkey with nine objective-type questions was sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected, and a chi square test was used to compare the two groups. A P value ≤ 0.05 was considered statistically significant. Results: A total of 64 PCPs (29.1%) and 15 cardiologists (20%) completed the survey. Overall, 12.6% did not prescribe statins for primary prevention of atherosclerotic cardiovascular disease in compensated cirrhotic patients. While all cardiologists prescribed statins for secondary prevention, over 50% preferred lower-intensity options. Conversely, 14.1% of PCPs avoided statin prescriptions for secondary prevention. Cardiologists were significantly more inclined to prescribe statins, especially for cirrhosis due to metabolic dysfunction-associated steatotic liver disease compared to PCPs (73.3% vs 45.3%, P = 0.05). Conclusions: Despite increasing evidence favoring use of statins in cirrhosis for improving portal hemodynamics and decreasing ascites, hepatic encephalopathy, the incidence of hepatocellular carcinoma, and mortality, there is still hesitation on the part of prescribers for the fear of worsening liver disease. Wider dissemination of current guidelines and education practices may help to bridge this gap.

Japanese primary care physicians' postpartum mental health care: A cross-sectional study.

Background: Postpartum mental health care is a public health priority requiring interprofessional and interorganizational collaboration. Primary care physicians (PCPs) have the potential to play an essential role in facilitating access to health care and providing comprehensive and coordinated care for postpartum mental health problems. In Japan, however, there are no previous studies on the extent to which PCPs are involved in postpartum mental health care. Therefore, this study aimed to investigate the practices and experiences of Japanese PCPs in providing such care. Methods: This study presents a subset of the findings from a cross-sectional study using an online questionnaire on postpartum care among Japanese PCPs. We employed descriptive analysis to examine their practices and experiences in providing general and postpartum mental health care. Results: We received 339 valid responses from 5811 PCPs. The median proportion of the outpatients with mental health problems that PCPs regularly saw was 15%. Approximately two out of three PCPs (68.7%) reported routinely performing screening for depression and anxiety. Seventy-six percent of PCPs had the opportunity to provide care for postpartum women. Approximately one in two PCPs (47.8%) had managed cases of postpartum mental health problems and collaborated with various professionals and resources to provide care. Conclusions: The majority of Japanese PCP participants in the study provide mental health care and have managed cases of postpartum mental health problems, collaborating with various health professionals.

Leprosy knowledge among primary care physicians in Southern Brazil: are we underdiagnosing?

BACKGROUND: Leprosy is a chronic infection with high morbidity in Brazil. Primary care physicians' lack of knowledge about the disease may play a significant role in underdiagnosis. This study aimed to assess primary care physicians' ability to identify typical leprosy skin lesions and their knowledge of the subject. METHODS: This cross-sectional study relied on a questionnaire in which participating doctors chose one main diagnostic hypothesis and two differential diagnoses for each skin lesion presented. Five leprosy lesions were included. Questions regarding management, follow-up, and diagnostic workup for the disease were also included. The questionnaire was sent to primary care physicians working in Curitiba, in the Southern Brazilian state of Paraná, and dermatologists, who constituted the control group. RESULTS: Thirty-two primary care physicians and 26 dermatologists agreed to participate in the study. Primary care physicians accurately identified a mean of 1.8 ± 1.2 of the five leprosy skin lesions, while dermatologists accurately identified 2.5 ± 0.9 (P = 0.009). The main misdiagnosed leprosy forms were the lepromatous and histoid variants. Among primary care physicians, 56.2% claimed to have little knowledge of the subject and a large share of participants was unaware of recent updates in treating paucibacillary forms, even within the dermatologist subgroup. CONCLUSIONS: Primary care physicians in Curitiba have little information regarding the diagnosis, treatment, and follow-up of leprosy. Even dermatologists had difficulties with treatment and patient management, emphasizing the constant need for education on this subject.

Primary care physicians' perceptions of artificial intelligence systems in the care of adolescents' mental health.

BACKGROUND: Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks. METHODS: We used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis. RESULTS: We reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients' data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm. CONCLUSION: This study provides the groundwork for assessing PCPs' perceptions of AI systems' features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents' perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.

Screening for primary aldosteronism in primary care: a scoping review.

BACKGROUND: Primary aldosteronism (PA) is the most common treatable and potentially curable cause of secondary hypertension. Prompt diagnosis and management by primary care physicians (PCPs) is important given the increased risk of cardiovascular complications however screening rates are low in primary care. Our aim was to identify factors that influence screening behaviour for PA among PCPs. METHOD: A rigorous scoping review of seven databases between 16/08/22 and 09/08/23 was used to investigate PA screening practices. Articles written in English from peer-reviewed literature within the last 20 years were eligible for inclusion if an aspect of their study was conducted in primary care. RESULTS: A total of 1380 titles and abstracts, and 61 full texts were screened, with 20 studies selected for data extraction. We identified three broad categories of factors influencing screening by PCPs-the patient, the clinician, and the healthcare system. Some studies targeted these factors to improve screening rates although there is little data on implementation and outcomes. CONCLUSION: Low awareness, inadequate guidelines, and poor access to testing were identified as key barriers to PA screening. Targeted education sessions for PCPs, clear guidelines, and closer proximity to diagnostic centres may be required to improve PA detection in primary care.

Dermatological guide for primary care physicians: full body skin checks, skin cancer detection, and patient education on self-skin checks and sun protection.

Dermatological conditions and skin cancers are common health concerns that require early detection and intervention. Primary care physicians play a crucial role in recognizing these conditions and serving as the first line of defense against skin cancers. This guide provides a systematic approach to conducting thorough skin examinations and enhancing understanding of common presentations of precancerous and cancerous lesions. We emphasize the importance of performing annual full-body skin exams to facilitate early detection and management of skin conditions, including a step-by-step, systematic protocol for conducting these exams, comprising preparing the patient, documenting findings, educating the patient, and considering biopsy or referral for suspicious lesions. Furthermore, we explore the atypical features of skin lesions that raise clinical suspicion and warrant further investigation. We describe the characteristics of common skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. We stress the importance of patient education on self-skin checks and sun protection measures. By incorporating the knowledge and skills presented in this guide, primary care physicians can confidently perform thorough full-body skin checks, identify common dermatological findings and early signs of skin cancers, and provide comprehensive care to patients. This will help ensure optimal outcomes in dermatological health.

Physical Activity Knowledge and Personal Habits with Recommendations for Patients: Self-Assessment by Primary Care Physicians.

Primary care physicians (PCPs) should be active and reliable promoters of physical activity (PA), but there is no strong evidence that their knowledge and personal habits contribute to this. The aim of this study was to evaluate the frequency of PA recommendations provided by PCPs to patients in terms of their self-assessed PA knowledge and personal habits. This study used a cross-sectional design and data were collected through a self-reported online questionnaire. The study sample consisted of 202 PCPs from a large Lithuanian city, Kaunas, of which 122 were females (60.4%) and 80 were males (39.6%). The data were analyzed using SPSS version 29 (Statistical Package for the Social Sciences) for Windows. The findings show that the frequency of recommendations related to providing PA to patients is statistically significantly dependent on PCP health-friendly or partially favorable PA habits, their self-assessed level of knowledge about physical activity, and their self-assessed competence related to providing PA recommendations to patients, but this is not statistically dependent on objectively assessed level of knowledge related to PA.

Impact of educational intervention on hypertension management by primary care physician: A randomized control trial.

Objective: The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods: This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results: A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion: After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation: The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

What Complexity Science Predicts About the Potential of Artificial Intelligence/Machine Learning to Improve Primary Care.

Primary care physicians are likely both excited and apprehensive at the prospects for artificial intelligence (AI) and machine learning (ML). Complexity science may provide insight into which AI/ML applications will most likely affect primary care in the future. AI/ML has successfully diagnosed some diseases from digital images, helped with administrative tasks such as writing notes in the electronic record by converting voice to text, and organized information from multiple sources within a health care system. AI/ML has less successfully recommended treatments for patients with complicated single diseases such as cancer; or improved diagnosing, patient shared decision making, and treating patients with multiple comorbidities and social determinant challenges. AI/ML has magnified disparities in health equity, and almost nothing is known of the effect of AI/ML on primary care physician-patient relationships. An intervention in Victoria, Australia showed promise where an AI/ML tool was used only as an adjunct to complex medical decision making. Putting these findings in a complex adaptive system framework, AI/ML tools will likely work when its tasks are limited in scope, have clean data that are mostly linear and deterministic, and fit well into existing workflows. AI/ML has rarely improved comprehensive care, especially in primary care settings, where data have a significant number of errors and inconsistencies. Primary care should be intimately involved in AI/ML development, and its tools carefully tested before implementation; and unlike electronic health records, not just assumed that AI/ML tools will improve primary care work life, quality, safety, and person-centered clinical decision making.

Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius.

Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

[Nutrition counseling in medical practices-a cross-sectional study]. / Ernährungsberatung in ärztlichen Praxen verschiedener Fachrichtungen ­ eine Querschnittsstudie.

INTRODUCTION: The purpose of this study was to assess the status of nutrition care and counseling in German medical practices, including physicians' nutrition interest and knowledge, existing obstacles, and possible ways of improving nutrition care. METHODS: After development and a two-stage pretest, questionnaires with 32 items were distributed to all resident doctors of general medicine, internal medicine, gynecology and obstetrics, orthopedics, and occupational medicine in Aachen (n = 360) in early spring 2022. RESULTS: The response rate was 29.2% and n = 105 participants were included in the analysis. During their consultation hours, 85.7% of the doctors conducted nutrition counseling (NC). While doctors estimated that 39.5% of their patients need NC, they counseled only 28.1%. General practitioners spent an average of 13 min on NC; all other specialties spent 9.5 min. Most participants felt well informed about healthy nutrition (95.2%). Nutrition was of high personal interest to 57.7% of the participants, and 47.6% considered it important for their work as a doctor. Barriers preventing better NC included the lack of nutrition education during medical studies (89.5%) and specialist training (79.6%), and the lack of time (75.2%). Most participants were willing to conduct more NC if they were paid better and had more time for NC during their working hours. DISCUSSION: Doctors consider NC a relevant part of their work, despite many barriers. To make better use of NC as a measure for treating and preventing common diseases, improvements like better nutrition education for doctors, better funding, and more time for NC are required.

Trends in decision-making by primary care physicians regarding common infectious complaints.

BACKGROUND: Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. OBJECTIVES: This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. METHODS: We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018-2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. RESULTS: In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. CONCLUSIONS: Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance.

The use of medical health applications by primary care physicians in Israel: a cross-sectional study.

BACKGROUND: The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated. METHODS: From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them. RESULTS: From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps. CONCLUSIONS: mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.

Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic.

INTRODUCTION: Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic caused changes in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers. OBJECTIVE: We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit. MATERIAL AND METHODS: We conducted an analytical and cross-sectional study during November and December 2022. We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19. RESULTS: A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality. CONCLUSIONS: During the pandemic, the stress of health workers increased due to work alterations that were necessary to treat the greatest number of patients, so their quality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Attitudes and knowledge about weight management among primary care physicians in Israel: a cross-sectional study.

BACKGROUND: The prevalence of obesity has been increasing worldwide and is associated with increased risk of morbidity and mortality. Weight management can reduce the risk of complications and improve the quality of life of patients with obesity. This study explored primary care physicians' (PCPs') attitudes and knowledge about weight management. METHODS: An anonymous questionnaire was distributed to 400 PCPs between 2020 and 2021. The survey included questions on treatment approaches (pharmaceutical and surgical) and items regarding the respondents' demographic characteristics. We compared PCPs with low or high proactivity toward weight management. We explored attitudes and knowledge with the chi-square test for categorical variables or the Mann-Whitney test for continuous variables. RESULTS: A total of 145 PCPs answered our survey (a response rate of 36.25%). More than half (53.8%) of the respondents showed low proactivity toward weight management in their practice. Proactive respondents were more likely to believe that pharmaceutical treatment effectively reduces weight and offered medical and surgical treatment options more frequently to their patients. Lack of knowledge was the most predominant reason for PCPs avoiding offering treatment to their patients, especially in less proactive PCPs (33.3% vs. 5.3%, p-value < 0.001). When comparing different pharmaceutical options, 46.6% of PCPs report they tend to prescribe liraglutide to their patients compared with only 11% who prescribe orlistat and 10.3% who prescribe phentermine (p-value < 0.001). CONCLUSIONS: Many PCPs still do not actively provide obesity treatment despite improved awareness and therapeutic options. PCPs' proactivity and attitudes are vital to this effort.

Feasibility and acceptability of a primary care mentoring programme for undergraduate students.

Mentoring plays a crucial role in increasing the attractiveness of primary care careers for medical students. Based on a literature review and structured group discussions, the authors developed a primary care mentoring platform centred on undergraduate medical students' needs. All second- to sixth-year students were invited to enrol into the programme by choosing a mentor from an online platform, which was pilot tested during one academic year (2021-2022) with 16 mentors. Fifteen mentees enrolled into the pilot programme. The evaluation assessed the procedures' feasibility as well as the student-centeredness and acceptability of the programme. Mentees completed a quantitative survey evaluating satisfaction and the mentoring relationship's personal and content aspects. Mentors' feedback was collected during focus groups discussing the programme's acceptability and practical aspects. Both mentees and mentors expressed high levels of satisfaction with the programme. Mentees rated their mentoring relationships highly across most aspects. Mentees' content-related needs included postgraduate training, meeting an inspiring person, work-life balance, and questions about running a private practice. Mentors described the programme as a rewarding experience. They enjoyed the flexible structure that allowed them to adapt to the mentees' individual needs. Maintaining the relationship was mostly the mentors' responsibility. Further structured guidance from the programme coordinators was identified as potentially beneficial for future implementation. The findings highlight the feasibility and the advantages of a flexible, student-centred mentoring programme. The programme attracted students interested in primary care from all levels of undergraduate education. Such programmes may contribute to fostering students' interest in primary care careers.