BackgroundThe number of students selecting careers in primary care has declined by 41% in the last decade, resulting in anticipated shortages.MethodsFirst-year medical students interested in primary care were paired with primary care mentors. Mentors were trained, and mentors and students participated in focus groups at the end of each academic year. Quantitative and qualitative results are presented.ResultsStudents who remained in the mentoring program matched to primary care programs at 87.5% in the first year and 78.9% in the second year, compared to overall discipline-specific match rates of 55.8% and 35.9% respectively. Students reported a better understanding of primary care and appreciated a relationship with a mentor.ConclusionsA longitudinal mentoring program can effectively support student interest in primary care if it focuses on the needs of the students and is supportive of the mentors.
Background The modulating effect of vitamin D on cytokine levels in severe coronavirus disease 2019 (COVID-19) remains unknown. Objectives To investigate the effect of a single high-dose of vitamin D3 on cytokines, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19. Methods This is a post-hoc, ancillary and exploratory analysis from a multicenter, double-blind, placebo-controlled, randomized clinical trial registered in ClinicalTrials.gov, NCT04449718. Patients with moderate to severe COVID-19 were recruited from two hospitals in Sao Paulo, Brazil. Of 240 randomized patients, 200 were assessed in this study and randomly assigned to receive a single oral dose of 200 000 IU of vitamin D3 (n = 101) or placebo (n = 99). The primary outcome was hospital length of stay, that has been published in our previous study. The prespecified secondary outcomes were serum levels of interleukin-1β, interleukin-6, interleukin-10, tumor necrosis factor alpha (TNF-α) and 25-hydroxyvitamin D. The post-hoc exploratory secondary outcomes were interleukin-4, interleukin-12p70, interleukin-17A, interferon gamma (IFN-γ), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-8, interferon-inducible protein-10 (IP-10), macrophage inflammatory protein-1 beta (MIP-1β), monocyte chemoattractant protein-1 (MCP-1), growth factor vascular endothelial (VEGF), and leukocytes count. Generalized estimating equations (GEE) for repeated measures, with Bonferroni's adjustment, were used for testing all outcomes. Results The study included 200 patients with a mean (SD) age 55.5 (14.3) years and body mass index (BMI) 32.2 (7.1) kg/m2, of which 109 (54.5%) were male. GM-CSF levels showed a significant group by time interaction effect (P = 0.04), although between-group difference at post-intervention after Bonferroni's adjustment was not significant. No significant effects were observed for the other outcomes. Conclusions The findings do not support the use of a single dose of 200 000 IU of vitamin D3, compared to placebo, for the improvement of cytokines, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19. Clinical Trial Registration: ClinicalTrials.gov, NCT04449718.
The PQAQ is a comprehensive instrument demonstrating face and content validity and strong interrater and test-retest reliability in the appraisal of pediatric economic evaluations. This tool will be valuable to health economists, methods researchers, and policy decision makers involved in allocation decisions for pediatric health care.
Background Vitamin D acts as a mediator in the immune system regulating antiviral mechanisms and inflammatory processes. Vitamin D insufficiency has been suggested as a potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although its impact on the prognosis of hospitalized patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective This multicenter prospective cohort study was designed to investigate whether serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with hospital length of stay and prognosis in hospitalized patients with COVID-19. Methods Patients with moderate to severe COVID-19 (n = 220) were recruited from 2 hospitals in Sao Paulo, Brazil. Serum 25(OH)D concentrations were categorized as follows: <10 ng/mL, 10 to <20 ng/mL, 20 to <30 ng/mL, and ≥30 ng/mL, and <10 ng/mL and ≥10 ng/mL. The primary outcome was hospital length of stay and the secondary outcomes were the rate of patients who required invasive mechanical ventilation and mortality. Results There were no significant differences in hospital length of stay when the 4 25(OH)D categories were compared (P = 0.120). Patients exhibiting 25(OH)D <10 ng/mL showed a trend (P = 0.057) for longer hospital length of stay compared with those with 25(OH)D ≥10 ng/mL [9.0 d (95% CI: 6.4, 11.6 d) vs. 7.0 d (95% CI: 6.6, 7.4 d)]. The multivariable Cox proportional hazard models showed no significant associations between 25(OH)D and primary or secondary outcomes. Conclusions Among hospitalized patients with moderate to severe COVID-19, those with severe 25(OH)D deficiency (<10 ng/mL) exhibited a trend for longer hospital length of stay compared with patients with higher 25(OH)D concentrations. This association was not significant in the multivariable Cox regression model. Prospective studies should test whether correcting severe 25(OH)D deficiency could improve the prognosis of patients with COVID-19.
Asthma management guidelines recommend the use of preventive medications in sufficient amounts to control asthma symptoms. The validity of a medication use index as a proxy for asthma severity has not been established. We recruited 1,279 Ontario adults with asthma or parents of children with asthma from a community-based surveillance program in 1995-96. Participants completed a telephone questionnaire at baseline, 3 and 6 mo. The questionnaire gathered information about asthma medication use, health care utilization, and symptoms. Asthma was classified as mild in 28%, moderate in 49%, or severe in 23% of patients based on the amount and types of medication used. There were significant differences among groups in health resource use such that adults with higher medication use visited primary care physicians and specialists more frequently, had pulmonary functions tests more frequently, and were admitted to hospital more frequently. The findings among children were similar. There were weak positive correlations between medication use and symptom frequency in adults and children. We conclude that a medication use index may be useful in population-based research where clinical asthma severity data are lacking. Such an index is distinct from but is related to disease control.
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