This survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak panel, NORC's probability based panel designed to be representative of the U.S. household population. Panel members were randomly drawn from AmeriSpeak. The final stage completion rate is 33.9%. The overall margin of sampling error is +/-4.28 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups. Once the sample has been selected and fielded, and all the study data have been collected and made final, a post-stratification process is used to adjust for any survey nonresponse as well as any non-coverage or under and oversampling resulting from the study specific sample design. Post-stratification variables included age, gender, census division, race/ethnicity, and education. Weighting variables were obtained from the 2018 Current Population Survey. The weighted data reflects the U.S. population of adults age 70 and over. NOTE: All results show percentages among respondents, unless otherwise labeled.

Background: Previous work has established a surprisingly high prevalence of acanthosis nigricans (AN) and its association with increased risk of type 2 diabetes in a Southwestern practice-based research network (PBRN). Our objective was to establish whether this high prevalence of AN would be present in other areas.Methods: We examined the prevalence of type 2 diabetes and its risk factors and the prevalence of AN among patients aged 7 to 65 years who had been seen by one of 86 participating clinicians in a national PBRN consortium during a 1-week data collection period. In a subsample of nondiabetic matched pairs who had or did not have AN, we compared fasting glucose, insulin, and lipid levels.Results: AN was present in 19.4% of 1730 patients from among all age ranges studied. AN was most prevalent among persons with more risk factors for diabetes. Patients with AN were twice as likely as those without AN to have type 2 diabetes (35.4% vs 17.6%; P < .001). In multivariable analysis, the prevalence ratio for diabetes was 2.1 (95% CI, 1.3-3.5) among non-Hispanic whites with AN and 1.4 (95% CI, 1.1-1.7) among minority patients with AN. In a subsample of 11 matched pairs, those with AN had higher levels of insulin and insulin resistance.

Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated with dopamine agonists. An understanding of the disorders of sleep and the effects of medications is required for the appropriate use of medications affecting sleep.

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Background: Practical studies in real-world settings may be particularly vulnerable to unintended effects on intervention outcomes, including what is commonly known as the Hawthorne Effect. This phenomenon suggests that study subjects' behavior or study results are altered by the subjects' awareness that they are being studied or that they received additional attention. This is especially a concern when subjects are not blinded to randomization or when they participate in studies with observational components. As part of a larger practical intervention designed to improve the clinical management of skin and soft tissue infections (SSTIs), we specifically examined the potential for a Hawthorne Effect from the extra attention some clinicians received when completing follow-up case reviews.Methods: De-identified, electronic data from a larger practical intervention allowed for the comparison of the clinical management of SSTIs among 14 randomly selected clinicians who participated in follow-up case reviews versus 77 clinicians who did not.Results: There were no differences in the management of SSTIs between the 2 groups of clinicians. No evidence of a Hawthorne Effect was observed in this quality-improvement intervention.Conclusion :

PURPOSE Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their infl uence on clinical encounters in primary care. METHODSOur methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. RESULTSOne hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specifi c new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P <.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their fi rst choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%.CONCLUSIONS Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specifi c socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.

PURPOSE Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. METHODSWe undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas). RESULTSAdjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI -4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language. CONCLUSIONS Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain. 2014;204-214. doi: 10.1370/afm.1623. Ann Fam Med INTRODUCTIONC olorectal cancer screening is underutilized.1,2 Screening rates are particularly low among Hispanic persons, reflecting language and socioeconomic barriers. 1,3 Approaches to motivate more individuals to undergo colorectal cancer screening and lessen ethnic screening disparities are needed.Interventions tailored to sociopsychological factors that may influence behavior, such as self-efficacy, stage of readiness, barriers, and others, 4 show promise.5 Such interventions use responses elicited from individuals to match the content and amount of information to individual needs and sociopsychological factors, with the proximate goal of enhancing the factors. [6][7][8] Tailoring of information increases its perceived relevance, promotes deeper cognitive processing, and improves recall. 9 Further, in randomized controlled trials tailored interventions are more eff...

OBJECTIVE -Hypertension increases micro-and macrovascular complications of diabetes. The goal for blood pressure is Ͻ130/80 mmHg. In primary care, however, blood pressure in many patients exceeds this goal. In this study, we evaluated the clinical decision-making process when a patient with diabetes presents with elevated blood pressure.RESEARCH DESIGN AND METHODS -Twenty-six primary care practices in two practice-based research networks in Colorado participated. Questionnaires were completed after each encounter with an adult with type 2 diabetes. Data obtained from the survey included 1) demographic information, 2) blood pressure results, 3) action taken, 4) type of action if action was taken, and 5) reasons for inaction if action was not taken. Bivariate and multivariate analyses were performed to identify predictors of action.RESULTS -Completed surveys totaled 778. Blood pressure was 130/74 Ϯ 18.8/12.0 mmHg (mean Ϯ SD). Sixty-two percent of patients exceeded goals. Action was taken to lower blood pressure in 34.9% of those. Predictors of action were 1) blood pressure level, 2) total number of medicines the patient was taking, and 3) patient already taking medicines for blood pressure. As blood pressure rose, providers attributed inaction more often to "competing demands" and reasons other than "blood pressure being at or near goal." CONCLUSIONS -No evidence was found for patterns of poor care among primary care physicians. Providers balance the clinical circumstances, including how elevated the blood pressure is, and issues of polypharmacy, medication side effects, and costs when determining the best course of action. Knowledge deficit is not a common cause of inaction. Diabetes Care 29:2580 -2585, 2006T here is extensive clinical evidence linking hypertension with microand macrovascular complications of diabetes, including randomized controlled trials and a meta-analysis (1-6). Until 2000, the target blood pressure for individuals with diabetes was the same as that for individuals without diabetes (Ͻ140/90 mmHg). However, because of the demonstrated clinical benefit of lower blood pressure specifically for diabetes, national guidelines, established by the American Diabetes Association and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), call for more intensive management, with a target of Ͻ130/80 mmHg (7,8).Of the care provided to patients with type 2 diabetes, ϳ90% takes place in primary care practices (9). Unfortunately, blood pressure control in these settings is frequently suboptimal (10 -12) and may be even worse in those with diabetes and hypertension compared with those with hypertension alone (13).An essential component of lowering blood pressures to goal is the clinical decision made by the primary care provider at the visit in which blood pressure is elevated. Multiple factors may influence this decision. For example, it has been found that optimal blood pressure control often requires three or more medications (8), leading to increas...