Availability Of Screening Tools Research Articles

Preventive healthcare practice by allied health professionals: Results from a cross-sectional survey in rural and regional Victoria

ObjectivesTo describe the frequency of preventive healthcare practice (assess, advice, refer for support) provided by allied health professionals (AHPs) practicing in regional and rural healthcare settings to address smoking, diet and physical inactivity. To identify factors that influence the delivery of preventive healthcare practice. MethodsAHPs working in public healthcare services in the Loddon Mallee region of Victoria were surveyed. Clinicians reported on the proportion of clients where they had provided preventive care. Likert scale questions measured factors influencing preventive healthcare practice. ResultsIn total, 115 clinicians completed the survey. AHPs reported that they assess for smoking and physical activity behaviours but not diet. Preventive health practice that included providing advice or referrals for follow-on support was rarely undertaken. Availability of screening tools and automated referral letters increased the likelihood of preventive healthcare practice. ConclusionsGreater attention to addressing modifiable lifestyle behaviours by AHPs might be warranted to match the rates of risk factors in rural and regional Victoria. Integrating support systems, for example, embedding screening questions within clinical assessments can assist preventive healthcare practice. Implication for public healthMany AHPs are not promoting healthy behaviours to prevent poor health. We present some strategies that could potentially improve this.

Predicting intention of intimate partner violence screening among Thai nursing students: A cross-sectional study.

Using the theory of planned behaviour, the aim of this study was to examine predictors of intention to screen patients for intimate partner violence among Thai nursing students. We employed a cross-sectional, anonymous online survey study with convenience sampling of senior nursing students from across Thailand in April 2019. We administered the Intimate Partner Violence Screening Intention, Nursing Students, a 36-item tool, and analysed relationships between students' intentions and attitudes, subjective norms and perceived behavioural control towards intimate partner violence screening. PROCESS was used to test mediation analyses. Of N=639 respondents. Most (90%) reported intention to screen patients for intimate partner violence. Approximately 41% reported having no intimate partner violence training in their nursing school. Results of the multiple logistic analysis showed that attitudes (OR: 8.5; 95% CI 1.2-4.6) and subjective norms (OR: 4.4; 95% CI 1.4-4.6) significantly predicted intention, whereas perceived behavioural control (OR: 1.7; 95% CI 0.5-4.9) did not. Moreover, attitudes and subjective norm significantly mediated the association between providing a screening tool at clinical sites, and intention. Attitudes and subjective norms were significant predictors of intention of intimate partner violence screening. However, participants lacked adequate role models and training. Future research should improve the predictive power of the framework by integrating additional constructs such as the availability of screening tools, the presence of role models, to design and evaluate effective training and support for future nurses to address intimate partner violence in practice. It is time to seriously consider integrating intimate partner violence content and training into the Thai nursing curriculum, and address the policies, guidelines, and practice culture. The study was designed to examine predictors of intention to screen patients for intimate partner violence. Thai senior nursing students were contributed in the design and conduct of the study. However, the study did not include input from the public or the intended participants.

Nurses' and midwives' awareness of intimate partner violence-related mental healthcare and associated factors in Tanzania.

Although intimate partner violence (IPV) is a significant public health problem in Tanzania, the country's system to provide IPV-related mental healthcare is not sufficiently prepared to respond to IPV care needs. This study aimed to assess nurses' and midwives' awareness of IPV-related mental healthcare and associated factors to encourage care provision. A cross-sectional, anonymous, self-administered survey was conducted among nurses and midwives in health facilities in the Mbeya region, from December 2018 to January 2019. The questions gauged awareness of IPV-related mental disorders, availability of screening tools, confidence in providing IPV-related mental healthcare and the presence of a mental health focal/resource person, in addition to socio-demographic and institutional characteristics. Of 1,321 nurses and midwives in the region, 662 (50.1%) participated in the study, and the analysis included 568 (85.8%) responses without missing values. The median awareness score was 5 (range: 0-6), and 34.0% of the participants were aware of all six examined IPV-related mental health disorders. Separate logistic regression analyses were conducted for those working in hospitals and those working in health centres (HCs), assessing potential factors associated with nurses' and midwives' awareness of IPV-related mental disorders. Among nurses and midwives in hospitals, high professional education (adjusted odds ratio [AOR]: 1.207; 95% confidence interval [CI]: 0.787, 1.852; p=.045) and long work experience (AOR: 1.479; 95% CI: 1.009, 2.169; p=.007) were associated with high awareness of IPV-related mental disorders. For those in HCs, government ownership (AOR: 3.526; 95% CI: 1.082, 11.489; p=.037) and having a mental health focal/resource person (AOR: 3.251; 95% CI: 1.184, 8.932; p=.036) were associated with high awareness of IPV-related mental disorders. Appropriate distribution of mental health focal/resource persons is required for improving awareness of IPV-related mental healthcare provision among nurses and midwives in remote areas of Tanzania.

Abstract 4238: Impact of diabetes mellitus on adenoma detection rates in three disparate institutions

Abstract Background: Racial disparities persist in the incidence and mortality of colorectal cancer despite the availability of screening tools. Adenoma detection rates have been associated with diabetes in some studies. This study seeks to evaluate the effect of diabetes mellitus on adenoma detection rates (ADR) in initial screening colonoscopies performed at three distinct institutions. Methods: A retrospective chart review was performed on all initial average risk screening colonoscopies performed on patients between 45-75 years at an Urban Safety Net Hospital (USNH), an Urban University Hospital (UUH) and a Suburban University Hospital (SUH) from January 1st to December 30th 2012 to coordinate existing databases at the three institutions. Patients were excluded if they had a history of colon cancer, polyps, alarm symptoms, or if the current colonoscopy was incomplete or had poor bowel prep. Data points collected included sex, age, race, insurance, BMI, smoking status, diabetic status and attending provider. Univariate analysis was performed comparing ADRs between the three institutions using Graph Pad Prism. Further comparisons were made between current smoking and diabetes status with ADR. Results: There were a total of 2225 initial screening colonoscopies (SUH, n =647; UUH, n = 444; USNH, n = 1134) excluding 135 incomplete and/or poor prep colonoscopies (SUH, n = 34; UUH, n = 50; USNH, n = 51). USNH and UUH patients were more likely to be African-American (93% and 88% vs 7%, p<0.0001) and diabetic (29.7 and 29.8% vs 12%, p <0.0001) than the SUH patients. UUH and SUH patients were more likely to be male (39% and 40% vs. 32%, p<0.0001), more likely to be current smokers than the USNH patients (11.9% and 12.8% vs 5.8%, p<0.0001), and were less likely to be uninsured (7% and 3% vs 43%, p<0.0001). In 2012 the ADR was significantly lower in patients at the USNH compared to both the UUH and SUH( 17% vs 30% and 26%, p<0.0001), but with the institution of ADR monitoring at the USNH, the ADR has since increased to 29% in 2017. Across all three institutions diabetics were noted to have higher ADRs (26% vs 18%, OR 1.6 95% CI 1.3-2.0, p<0.0001) and current smokers were noted to have higher ADRs (30% vs. 20%, OR 1.8 95% CI 1.3-2.4, p = 0.001) Discussion: Diabetes and current smoking are associated with increased ADR across all three institutions despite differences in race and baseline ADR. Patients should be counseled on the increased risk associated with diabetes and smoking. Initiatives should be implemented to insure improved screening rates for adenomas among diabetics and also to screen for diabetes so that interventions can be made early to reduce the impact of diabetes on colon cancer risk. Further prospective studies are needed to validate these findings. Citation Format: Yakira David, Lorenzo Ottaviano, Sadat Iqbal, Brandon Lung, Michelle Likhtshtegyn, Samir Kumar, Ellen Li, Laura Martello-Rooney, Shivakumar Vignesh, Joshua Miller, Evan Grossman. Impact of diabetes mellitus on adenoma detection rates in three disparate institutions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4238.

Screening Children for Caries: An Ethical Dilemma in Nigeria

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening tools, poor access to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health implementation. Failure to address challenges associated with dental service utilization by children in Nigeria increases the risk of screening programmes promoting inequitable access to oral health care services.

Do we need an SBIRT program?

Drug use has an impact on physical and mental health. Quite often, patients attend accident and emergency (A&E) departments due to drug-use-related disorders, and this is why screening and brief intervention for substance use disorders are relevant in emergency room settings. Studies have shown that screening, brief intervention, and referral to treatment (SBIRT) programmes are effective in several medical settings, including A&E departments. Since most of the evidence has been gathered in the US, this study tries to identify the relevance of substance use disorders in a large Spanish A&E Department and the possible need to implement a SBIRT programme. All medical doctors on duty in a given day were asked prospectively about ward consultations attended during their 16 hours-shift. The questionnaire included information on patients’ substance use and if this was related to the medical visit, whether or not they thought the patient needed referral to an addiction specialist and their opinion on what may help them to improve the management of those patients. 194 patients were attended. 22 patients (11.3%) were reported as substance users. Only 2 were visited by the psychiatrist (1%). Alcohol (n=10), cannabis (n=3) and benzodiazepines (n=4) were the most reported drugs (n=10). Practitioners considered that support from an addiction specialist (8, 7/10) and specific training in the management of substance users (8, 2/10) as the most valuable aids. Availability of screening tools was somewhat less valued (7, 2/10). The number of patients who present to the A&E department with a drug related-problem is large, yet these patients are scarcely seen by the psychiatrist. Practitioners see training opportunities in the management of substance users and the availability of addiction specialists as the most valued aids. Regardless, the rate of patients presenting with substance use related disorders warrants further research and suggests the convenience to implement SBIRT programmes in A&E department settings.

Little Children with Big Worries: Addressing the Needs of Young, Anxious Children and the Problem of Parent Engagement

Anxiety disorders in preschool-age children represent an important clinical problem due to high prevalence, substantial impairment, persistence, and associated risk for later emotional problems. Early intervention may mitigate these problems by capitalizing on a strategic developmental period. Elevated neuroplasticity, availability of screening tools, and the potential to modify parenting practices position anxiety as a good candidate for early intervention and preventive efforts. While some novel interventions show promise, the broad success of such programs will largely depend on parent engagement. Since parents are less likely to identify and seek help for anxiety problems compared to other childhood behavior problems, especially in a preventive manner, methods for understanding parents' decisions to participate and enhancing levels of engagement are central to the success of early childhood anxiety prevention and intervention. Understanding these processes is particularly important for families characterized by sociodemographic adversity, which have been underrepresented in anxiety treatment research. This review summarizes the developmental phenomenology of early emerging anxiety symptoms, the rationale for early intervention, and the current state of research on interventions for young, anxious children. The roles of parent engagement and help-seeking processes are emphasized, especially among economically disadvantaged and ethnic minority communities who are acutely at risk. Evidence-based strategies to enhance parent engagement to facilitate the development and dissemination of efficacious programs are offered.

Why are we Afraid to Screen Adolescents for Depression?

Depression is the fourth leading cause of global burden of disease [1]. Depression is present in all regions of the world, significantly affecting the younger and older age groups (World Health Organization [WHO], 2000; Institute for Health Metrics and Evaluation [IHME], 2013) [2]. It is estimated that upwards of 8% of adolescents meet criteria for depression [3]. Depression during adolescence is a disabling condition that is associated with serious long-term morbidities and an increased risk of suicide [3-6]. It has been reported that among adolescents with major depression, as many as 7% commit suicide in their early adult years [7]. Yet despite these alarming statistics, adolescent depression often goes undiagnosed despite the availability of screening tools that have been demonstrated to be effective (National Institute for Health Care Management [NIHCM], 2010).

Is Seasonal Variation Another Risk Factor for Postpartum Depression?

Postpartum depression (PPD) occurs in the first 6 months after delivery in 10% to 20% of mothers. Despite the availability of screening tools, there is a general consensus that PPD is under-diagnosed. A number of risk factors contributing to PPD have been investigated, but role of seasonal variability in PPD is unclear. Our purpose was to assess whether seasonal variation is another risk factor for PPD. This cross-sectional pilot study was conducted at 2 family medicine clinics and an obstetrics/gynecology clinic over 24 months. During their postpartum visit, mothers who gave consent were asked to fill out a survey requesting demographic data, followed by the Edinburgh Postpartum Depression Scale (EPDS). The EPDS is a well-validated tool shown to be highly effective in detecting postnatal depression. A score >12 on the EPDS indicated a likely risk of PPD. Of the 556 patients approached, 530 completed the EPDS. Mean (+/-SE) patient age was 24.9 +/- 0.2 years; 71% were African Americans; 74% were single mothers; and 39% had at least some college education. On the EPDS, 17.8% scored > or =13. Of the depressed patients, 18.1% had babies born during the winter, 19.2% had babies born during the spring, 13.4% during the summer, and 21.5% during autumn (chi(2); P = .342). Mothers with very good or excellent support at home had lower EPDS scores (12.6%) than mothers with just adequate support (44.0%) or very little or no support (30.8%; P < .0005). A greater proportion of women with a history of depression (42.9% vs 12.9%) or who were currently taking antidepressives (58.3% vs 15.9%) were in the depressed group (P < .0005). Logistic regression analysis with the above variables, excluding education and income (excess missing data), on the 452 women with complete datasets found 4 significant predictors of an EPDS score >12. Predictors were history of depression (odds ratio [OR], 4.003; 95% CI, 2.016-7.949); parity (OR, 1.431; 95% CI, 0.204-1.701); social support (OR, 3.904; 95% CI, 2.08-7.325); and currently taking medication for depression (OR, 3.613; 95% CI, 1.207-10.817). The slight seasonal variation in PPD in our pilot study was not statistically significant. Our study was underpowered to detect the projected differences in seasons. Additional patients are needed to diversify the participants and provide an adequate sample to test the projected seasonal differences. The high ORs found for greater parity, weak social support, history of depression, and currently taking antidepressants suggest that new mothers with these characteristics should be questioned about symptoms of PPD.