A community-based study of abscess self-treatment and barriers to medical care among people who inject drugs in the United States.

Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess characteristics, treatment utilization, and barriers to medical treatment among N = 494 community-recruited PWID. We used descriptive statistics to determine the frequencies of self-treatment and medical treatment for their most recent past-3-month abscess as well as barriers to seeking medical treatment.

The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California.

Infectious disease remains a significant social and health concern in the United States. Preventing more people from contracting HIV/AIDS or Hepatitis C (HCV), requires a complex understanding of the interconnection between the biomedical and social dimensions of infectious disease. Opiate addiction in the US has skyrocketed in recent years.

Objective evidence of severe disease: opioid use in chronic pain.

Treating chronic pain presents numerous challenges. First, assessing patients with chronic pain is complicated by the lack of objective measures of pain itself. Chronic pain guidelines already developed by national organizations rely on careful history taking rather than objective measures.

Creating an effective and efficient publicly sponsored health care delivery system.

An effective and efficient publicly sponsored health care delivery system can increase access to care, improve health care outcomes, and reduce spending. A publicly sponsored health care delivery system can be created by integrating services that are already federally subsidized: community health centers (CHCs), public and safety-net hospitals, and residency training programs. The Patient Protection and Affordable Care Act includes measures that support primary care generally and CHCs in particular.

Controlling for race/ethnicity: a comparison of California commercial health plans CAHPS scores to NCBD benchmarks.

Background: Because California has higher managed care penetration and the race/ethnicity of Californians differs from the rest of the United States, we tested the hypothesis that California's lower health plan Consumer Assessment of Healthcare Providers and Systems (CAHPS(R)) survey results are attributable to the state's racial/ethnic composition.

Methods: California CAHPS survey responses for commercial health plans were compared to national responses for five selected measures: three global ratings of doctor, health plan and health care, and two composite scores regarding doctor communication and staff courtesy, respect, and helpfulness. We used the 2005 National CAHPS 3.

The relationship between a statewide preceptorship program and family medicine residency selection.

Objective: The purpose of this study was to investigate the extent to which participation in the California Academy of Family Physicians Foundation Family Medicine (FM) Preceptorship Program, as well as medical school, degree earned, gender, and match year predicted FM residency match.

Methods: Allopathic and osteopathic students who applied to the preceptorship program from 1996 to 2002 were followed until residency match. Chi-square (chi(2)) analysis was used to compare preceptorship participants, nonparticipants (students who applied but did not complete the preceptorship), and nonapplicants (students who did not apply to the preceptorship) for FM match rates and to compare participants to nonparticipants for primary care match rates.

Trends in rural and urban deliveries and vaginal births: California 1998-2002.

Context: Pregnant women in rural areas may give birth in either rural or urban hospitals. Differences in outcomes between rural and urban hospitals may influence patient decision making.

Purpose: Trends in rural and urban obstetric deliveries and neonatal and maternal mortality in California were compared to inform policy development and patient and provider decision making in rural health care settings.

Effects of echinacea on the frequency of upper respiratory tract symptoms: a randomized, double-blind, placebo-controlled trial.

Background: Upper respiratory tract infection symptoms are a common cause of morbidity. Herbal preparations of the plant Echinacea purpurea have immune-enhancing properties.

Objective: To compare the frequency of upper respiratory tract symptoms in individuals receiving E.

The missing link: improving quality with a chronic disease management intervention for the primary care office.

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community.

Physician perceptions of practice environment and professional satisfaction in California: from urban to rural.

Context: Few studies have systematically examined the experience of rural practice from the physician's perspective or included physicians from an array of specialties, particularly non-primary care.

Purpose: To better understand differences between rural and urban physicians in perceptions of their practice environment.

Methods: In 2001-2002, self-administered questionnaires were sent to a probability sample of primary care and specialist physicians identified from the American Medical Association's Physician masterfile in California.

Vaginal birth after cesarean in California: before and after a change in guidelines.

Purpose: In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision.

Methods: The 1996 through 2002 California Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and had a singleton birth planned in a California hospital.

High school census tract information predicts practice in rural and minority communities.

Purpose: Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings.

Methods: Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location.

Why we should reduce family practice training to two years.

Family practice (FP) should consider decreasing its residency training from three years to two years. These are troubling times for FP. The number of U.

Are sample medicines hurting the uninsured?

Background: Pharmaceutical representatives often give sample medications to physicians for distribution to patients. In chronic conditions such as hypertension, this practice can contribute to unnecessary medication changes, gaps in treatment, and inferior control of disease. The objective of the current study was to explore associations between use of free sample medicine, hypertension, and source of payment for health care.