Sexual health affects many aspects of patient health; however, it is often not addressed with patients, and research shows that sexual health is not emphasized in medical education. Primary care providers ought to be on the front lines of the integration of sexual health into patient centered care. In rural areas, this responsibility often falls to family medicine physicians as patients do not have access to Ob/Gyns (obstetrician and gynecologist). The objective of this study was to assess the types and prevalence of sexual health concerns among patients in rural Appalachia and also to assess the comfort level of family medicine physicians in addressing and managing sexual health concerns. Sexual health was defined to include sexual wellness, infections, contraception, and sexual dysfunction. Participants included East Tennessee State University (ETSU) family medicine attending physicians (faculty physicians) and resident physicians at three designated ETSU residency clinic sites. We designed and distributed an eighteen-question survey to residents and faculty physicians in order to evaluate how the recently emerging sexual health emphasis has translated to the practice of family medicine in East Tennessee. Of note in the data analysis, the majority of providers reported they feel at least moderately comfortable discussing sexual health with patients. However, when asked how frequency they address sexual health with patients, most providers reported that they do not frequently ask patients about sexual health concerns. Even though the American College of Obstetrics and Gynecology (ACOG) recommends long-acting reversible contraceptives (LARCs) as first-line contraceptives, less than half of providers recommend LARCs to patients. Additional exploration is needed to address why most family medicine physicians do not ask patients about sexual health as well as to determine if any regional barriers exist. This data also suggests that family medicine providers often do not have the means to recommend first-line contraception, likely due to lack of access and/or lack of knowledge regarding current recommendations. This study suggests that more emphasis should be placed on addressing sexual health and there is a need for additional training perhaps through educational workshops, or the distribution of educational brochures, or training in LARC placement.

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Thesis presented in partial fulfilment of the requirements for a degree of Masters of Arts in the Department of Counselling Psychology at the University of Zululand, South Africa, 2005. / The present study aimed to identify those resiliency factors that enabled Indian families to transform and adapt after the loss of a family member. Using a convenience sampling method, thirty families were identified. Open-ended questions and the following measurement scales were completed by the parent and an adolescent of each selected family: a biographical questionnaire, Social Support Index, Relative and Friend Support Index, Family Problem Solving Communication Index, Family Hardiness Index, The family Attachment and Changeability Index 8, and Family Time and Routine Index. Results show that open communication between family members, religion, support of relatives and friends, problem solving communication, family hardiness, mobilization of the family to get help, redefinition of the problem, family time and routine were the resiliency factors identified in this study.

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Adult immunizations effectively reduce diseases. Despite this, it is difficult to convince patients to be vaccinated. We developed and implemented two different strategies, each deployed separately to improve our flu vaccination rates in two flu seasons. Data assayed from two seasons (2015-16 and 2016-17) show changes by approach used. Results suggest the strategy involving the most effort was no more effective than the lower effort strategy. These data are discussed in terms of appropriate metrics and future research.

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