Based on a collaborative symposium in 2014 hosted by the Society of Behavioral Medicine (SBM) and the American College of Sports Medicine (ACSM), this article presents a model for physical activity counseling for primary care physicians (PCPs). Most US adults do not meet national recommendations for physical activity levels. Socioecological factors drive differences in physical activity levels by geography, sex, age, and racial/ethnic group. The recent Patient Protection and Affordable Care Act incentivizes PCPs to offer patients physical activity counseling. However, PCPs have reported socioecological barriers to physical activity counseling and also patient barriers to physical activity, spanning from the individual to the environmental (e.g., lack of safe spaces for physical activity), policy (e.g., reimbursement policies), and organizational (e.g., electronic medical record protocols, worksite norms/policies) levels. This article discusses barriers to PCP counseling for physical activity; provides evidence-based strategies and techniques to help PCPs address these counseling barriers; and suggests practical steps for PCPs to counsel patients on physical activity using strategies and supports from policy, the primary care team, and other support networks.

Children in the US who live in or visit homes with firearms are clearly at an increased risk of firearm-related injuries, suicide, and homicide. Authors surveyed parents to determine whether they would be receptive to discussing firearm safety with their pediatrician. Although most parents said they would welcome firearm safety counseling, few reported that these discussions had occurred. Many gun owners preferred not to be asked about household firearms and indicated that counseling to have a firearm-free home was unlikely to change their behavior and would be offensive. Therefore, treating a loaded firearm as an avoidable hazard that parents must secure, similar to medications or household poisons, may be a more effective approach than counseling to eliminate guns from the home.

Although pregnancy outcomes have improved for women with chronic kidney disease (CKD), questions remain about the longer term effects of a pregnancy on these women and their children. In this month's AJKD, Dr. Matthew Hall discusses health considerations for women with CKD before, during, and after pregnancy. Such topics include fetal survival, the effect of pregnancy on kidney function, and common complications in these women, like preeclampsia and premature birth.

In 2016, the US Department of Health and Human Services and the Interagency Pain Research Coordinating Committee of the National Institutes of Health released the National Pain Strategy, which sought to "provide a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, time frames and resources." Objectives included estimating chronic pain prevalence; studying pain treatment with electronic health care data; and developing metrics to assess progress in reducing chronic pain impact. In this article, the research work group reviews concepts relevant to achieving these aims. In addition, the authors report pilot test data developed to inform initial steps taken to achieve these population research objectives.

African-American and Latino children experience higher rates of traumatic injury and mortality. This study evaluated the association between caregiver race/ethnicity and adherence to injury prevention recommendations based on five domains: car seat safety, sleeping safety, fire safety, hot water safety, and fall prevention. Compared with whites, Hispanic caregivers and black, non-Hispanic caregivers had higher odds of nonadherence to car seat safety and lower odds of nonadherence to fall prevention. Black, non-Hispanic caregivers also had higher odds of nonadherence to sleeping safety compared with whites.

Most uterine cancer patients are in hybrid referral patterns that incorporate high and low volume center care, which may affect treatment outcomes.

Can measuring the functional level of an inpatient rehabilitation population better predict 30-day acute care readmission than the current testing that uses demographics and/or comorbidities? In a retrospective database analysis, US researchers found that functional models of measurement better correlated with risk of readmission to a hospital. They point out that recognizing the importance of functional level can be of value.

A study in JAMA Internal Medicine suggests a web-based, seven-question prediabetes test promoted by the CDC and other groups may lead to unnecessary blood glucose testing in millions of healthy people. The test "falsely identifies a big majority of the population as having prediabetes while they are in fact normal," said researcher Saeid Shahraz of Tufts Medical Center.

About one-fifth of health care workers go without their annual flu vaccine, with 79% vaccinated during the 2015-2016 flu season and 77% protected for the previous season, according to a study in the CDC's Morbidity and Mortality Weekly Report. The report found that 91% of health care workers in hospitals were vaccinated, as were 80% of clinic staff and 69% of nursing home and long-term-care facility health care staff.

Researchers analyzed data for 5,261 black participants in a Jackson, Miss.-based study and found that every five-beats-per-minute increase in resting heart rate was tied to a 14% increased mortality risk and a 10% higher risk of heart failure hospitalization. The findings, published in JAMA Cardiology, also showed patients with the highest baseline heart rates had increased rates of diabetes, hypertension, heart failure and chronic lung disease.

A survey found 40% of primary care physicians and 63% of primary care practitioners at the Department of Veterans Affairs did not know about the Choosing Wisely campaign, researchers reported in the Journal of General Internal Medicine. Primary care physicians said while some of the 12 Choosing Wisely recommendations included in the study would be easy to follow, others may be difficult for patients to accept.

Deloitte Center for Health Solutions researchers found that 70% of physicians associate EHR use with reduced productivity, while 75% believe the technology increases practice costs. The findings, based on a survey of 600 primary care and specialty physicians in the US, showed that 78% believe EHRs are most useful for reporting and analytics capabilities.

Sixty-six percent of consumers responding to a survey said they have trouble planning for out-of-pocket health care costs, 69% said health care terminology significantly impedes their decision-making, 44% struggle to make health care savings and investment decisions, and 41% struggle to understand and manage benefits. The survey "clearly signals the need for significant education, tools, and support that engages and empowers consumers to take ownership and make savvier healthcare decisions," according to a report from Algeus.