Integrating Primary Care Appointments Into Resident Orientation.

BACKGROUND: Trainee well-being is a major concern for institutions and programs, yet many residents report suboptimal access to or contact with primary care for themselves. OBJECTIVE: To address the health care needs of residents, we developed a mechanism whereby all incoming residents were offered an appointment with a primary care clinician (PCP) during institutional intern orientation. METHODS: In April 2019, all incoming residents (17 specialties) were invited to participate. A collaboration involving the GME office and family medicine and internal medicine departments enabled interested residents to attend PCP appointments that were held at predesignated times during orientation and did not conflict with other orientation or learning activities. Residents received appointment details, and insurance billing processes were followed. A survey was administered to all participating PCPs and incoming residents 2 weeks following their scheduled PCP appointment. RESULTS: Of the 144 incoming residents, 118 (82%) participated. Among the 71 of 144 (49%) residents who responded to the survey, 94% indicated that they desired an appointment, with 90% attending the appointment as scheduled; 52% purposed their visit as an introduction for future appointments, while 15% requested prescription refills. All but one recommended that the initiative be offered again in the future. Seventy-two percent stated that participating in the PCP initiative definitely/probably led to improvements in self-care, and 76% indicated that participating definitely/probably made them more conscious of their health and well-being. CONCLUSIONS: Integrating PCP appointments into orientation is feasible and was highly acceptable in a large academic medical center.

What is the role of nutrition counseling in the management of isolated mandible fractures?

OBJECTIVE: Providing perioperative nutrition counseling may improve operative outcomes. It is unclear, however, whether this benefit translates to oral and maxillofacial surgery patients. The purpose of this study was to measure the effect of nutrition counseling on operative outcomes and patient satisfaction in those undergoing surgery for mandible fractures. STUDY DESIGN: The investigators implemented a retrospective cohort study. The predictor variable was perioperative nutrition counseling by a registered dietitian (RD). The main outcome variables were weight change, postoperative complications, and results of a survey that evaluated the perioperative experience. RESULTS: Statistical analyses were conducted on a sample of 200 patients (mean age: 34 ± 14 years; 87% males). Overall, there was no difference in percent weight change between those who received nutrition counseling and those who did not (P = .46). Those who received nutrition counseling had fewer postoperative complications (3% vs 11%; adjusted P = .038). Patients who received nutrition counseling from an RD were more satisfied with the nutrition advice they received (P = .0375). CONCLUSIONS: The results suggest that perioperative nutrition counseling by an RD in the management of isolated mandible fractures has no effect on weight change but is associated with decreased postoperative complications and increased patient satisfaction with the nutrition advice they receive.

Characterisation of tissue transglutaminase-reactive T cells from patients with coeliac disease and healthy controls.

Previous studies have shown evidence for T lymphocytes specific for tissue transglutaminase (tTG) in the periphery of coeliac disease (CD) patients. These cells could play a role in disease pathogenesis and may be involved in providing help for the production of anti-tTG autoantibodies. The objective of this study was to further investigate the presence of tTG-specific T cells in patients with treated and untreated CD, and normal controls. Positive proliferative responses to three different commercial tTG antigens were detected in all groups tested, occurring more frequently and at higher levels in untreated CD patients. The addition of antibodies to HLA-DQ and HLA-DR caused a significant reduction in the proliferative response to tTG. T cell lines specific for tTG and composed predominantly of CD4-positive T cells were generated from responsive CD and control individuals, and were found to produce large amounts of interferon-γ, as well as interleukins 10, 17A, and 21.

The neighborhood alcohol environment and at-risk drinking among African-Americans.

BACKGROUND: Our objective was to examine whether components of the neighborhood alcohol environment-liquor store, on-premise outlet, convenience store, and supermarket densities-are positively associated with at-risk alcohol consumption among African-American drinkers. METHODS: A multilevel cross-sectional sample of 321 African-American women and men ages 21 to 65 years recruited from April 2002 to May 2003 from three community-based healthcare clinics in New Orleans, Louisiana, was studied. RESULTS: The alcohol environment had a significant impact on at-risk alcohol consumption among African-American drinkers, specifically liquor store density (adjusted OR = 3.11, 95% CI = 1.87, 11.07). Furthermore, the influence of the alcohol environment was much stronger for African-American female drinkers (adjusted OR = 6.96, 95% CI = 1.38, 35.08). CONCLUSIONS: Treatment and prevention programs should take into account the physical environment, and the concentration of outlets in minority neighborhoods must be addressed as it poses potential health risks to the residents of these neighborhoods.

The neighborhood alcohol environment and alcohol-related morbidity.

AIMS: The aims of this study were (1) to examine the association between neighborhood alcohol outlet density and individual self-reported alcohol-related health outcomes in the last year-sexually transmitted infections (STI), motor vehicle accidents, injury, liver problems, hypertension and experienced violence; (2) to determine whether the relationship between morbidity and alcohol outlet density is mediated by individual alcohol consumption; and (3) to explore the role of alcohol outlet density in explaining any observed racial and ethnic differences in morbidity. METHOD: Hierarchical models from a random sample of Los Angeles, CA, and Louisiana residents (N = 2881) from 217 census tracts were utilized. The clustering of health and social outcomes according to neighborhood varied by health problem examined. RESULTS: There was substantial clustering of STI (intraclass correlation coefficient, ICC = 12.8%) and experienced violence (ICC = 13.0%); moderate clustering of liver problems (ICC = 3.5%) and hypertension (ICC = 3.9%); and low clustering of motor vehicle accident (ICC = 1.2%) and injury (ICC = 1.4%). Alcohol outlet density was significantly and positively associated with STI (crude OR = 1.80, 95% CI = 1.10-3.00), liver problems (crude OR = 1.33, 95% CI = 1.02-1.75) and experienced violence (crude OR = 1.31, 95% CI = 1.13-1.51) although not with other morbidity outcomes. Mediation analyses of morbidity outcomes revealed partial mediation of individual alcohol consumption in the relationship between alcohol density and STI and violence, and full mediation for liver problems. CONCLUSIONS: Findings support the concept that off-premise alcohol outlets in the neighborhood environment may impact health and social outcomes, either directly or indirectly, through individual alcohol consumption and these associations may be heterogeneous with respect to race and ethnicity.