Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study.

BACKGROUND: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2. METHODS: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences. RESULTS: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes. INTERPRETATION: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices.

Diagnostic Imaging and Mechanical Objectivity in Medicine.

BACKGROUND: Before the advent of automatism in image-making practices, scientists, anatomists, and physicians artistically depicted simplified images for scientific atlas making. This technique conferred subjectivity to a supposedly objective scientific process, sparking confrontations between anatomists regarding accuracy that heralded a new concept in the late 19th century - mechanical objectivity - that would revolutionize scientific knowledge and the field of medicine OBJECTIVES: The purpose of this health history research study is to trace the evolution of mechanical objectivity from empirical studies of early anatomists in the 19th century to the advent of x-ray technology, digitization of imaging, and disruptive technological innovations such as artificial intelligence, while simultaneously unveiling the challenges of mitigating human bias, despite advancements in medical imaging practices. METHODS: This narrative literature review was conducted using the Scopus® database under the guidance of both medical historians and practicing physicians to ensure its applicability and historical accuracy CONCLUSION: Despite a century-long quest for optimizing mechanical objectivity in diagnostic imaging to more accurately and efficiently interpret medical images, human bias remains an important factor. This historical review describes the development of medical imaging technologies over the last century with emphasis on the role played by human bias and subjectivity in a rapidly expanding field of medical imaging technology including artificial intelligence.

Climate Change and Child Health Inequality: A Review of Reviews.

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low-middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.