Mary Care Research Articles

Saint Louis Montfort’s Perfect Consecration “Totus Tuus”

The consecration to Mary, as taught by Saint Louis de Montfort, is a profound and transformative spiritual practice that has touched the lives of countless believers throughout the centuries. At the heart of Montfort's teaching is the understanding that Mary, as the Mother of Jesus and our spiritual mother, plays a vital role in our journey toward God. Through the act of consecration, we entrust ourselves entirely to Mary's care and guidance, acknowledging her as our advocate, intercessor, and protector. This act of consecration is not a mere formality but a profound commitment to live our lives in imitation of Mary's virtues, surrendering our will to hers and allowing her to lead us closer to her Son, Jesus Christ. By consecrating ourselves to Mary, we open ourselves to her powerful maternal love, inviting her to mold and shape us into instruments of God's grace, and to deepen our relationship with her Son. In essence, the consecration to Mary is an invitation to walk the path of holiness under her guidance, trusting in her maternal care as we strive to live authentic Christian lives. In St. Louis Montfort’s teaching, there exist two vital elements of the Totus Tuus consecration, namely: the nature of the consecration and the practices of the consecration. It has four fundamental characteristics that remarkably reflect the scriptural aspect of the consecration. There are also the so-called interior and exterior practices that provide people the knowledge of how to concretely bring the consecration to reality.

Simptomi i znakovi bubrežnih bolesti u djece tijekom pandemije COVID-19 u Sloveniji

Aim: The purpose of the study was to determine the prevalence of symptoms and signs of kidney diseases in children in Slovenia and to gain insight into the burden of kidney diseases in children at the primary care level at the time of the COVID-19 pandemic. Methods: The study methodology was cross-sectional. Data were obtained via an anonymous online questionnaire sent to all pri- mary care paediatricians in Slovenia via e-mail. An exact binomial test was used for each symptom case in order to determine whether the proportion of symptoms and/or signs in the sample deviates from the “theoretical” prevalence reported in the literature. Results: Data were obtained from 65 paediatricians and 9829 evaluated children were included in the study. The proportion of chil- dren with some symptoms and signs of kidney diseases, mostly found incidentally, such as haematuria, proteinuria and hyperten- sion were lower than previously described in the literature. There was no statistically significant difference in the prevalence of symp- toms and signs suggesting serious kidney diseases, such as oedema or persistent proteinuria. The most common cause of children’s visit to the outpatient clinics at the primary care level due to symptoms and signs of kidney diseases was urinary tract infection. Conclusions: Children with serious kidney diseases were identified as commonly as described in the literature, despite the COVID-19 pandemic. The latter influenced negatively the discovery rate of symptoms and signs of kidney diseases that are found incidentally, such as haematuria, proteinuria and hypertension.

Added value of bleach for tuberculosis microscopy diagnostic in limited resources setting.

Indonesia is one of the high burden tuberculosis (TB) countries. The utilization of molecular diagnostic has been setting over the country, however there are still a lot of remote areas that only depend on microscopic smear. Bleach might be used to increase the value of microscopy diagnostic. The study aimed to evaluate the added value of 1% bleach to increase the positivity rate of TB compared to conventional stain. This study was conducted on 70 subjects who were suspected as TB from various primary care centers in West Java and Banten, Indonesia. The sputum was 2-3 mL, and divided into two parts, both of them were stained using Ziehl-Neelsen (ZN), however the first was only stained and the second added 1% bleach. Bleach was added in same volume with sputum and incubated for 10 minutes. After 10 minutes, the sputum was stained with ZN. The positivity rate for ZN only was 39 (55.7%) compared to 1% bleach was 63 (90%), and significantly different (P=0.000) using Mann-Whitney U test. Bleach can be used as an alternative agent to improve the TB smear in setting that only depends on microscopy diagnostic.

Coordinated Treatment of Depression in Elderly People in Primary Care.

Depression in the elderly is mainly treated by primary care physicians; the treatment is often suboptimal because of the limited resources available in pri- mary care. New models of care in which treatment by a primary care physician is supplemented by the provision of brief, low-threshold interventions mediated by care managers are showing themselves to be a promising approach. In this open, cluster-randomized, controlled study, we sought to determine the superiority of a model of this type over the usual form of treatment by a primary care physician. Patients in primary care aged 60 and above with moderate depres- sive manifestations (PHQ-9: 10-14 points) were included in the study. The primary endpoint was the percentage of patients in remission (score <5 on the Patient Health Questionnaire, PHQ-9) after the end of the intervention (12 months after baseline). The study was registered in the German Clinical Studies Registry (Deutsches Register für Klinische Studien) with the number DRKS00003589. 71 primary care physicians entered 248 patients in the study, of whom 109 were in the control group and 139 in the intervention group. In an intention-to-treat analysis, the remission rate at 12 months was 25.6% (95% confidence interval [18.3; 32.8]) in the intervention group and 10.9% [5.4; 16.5]) in the control group (p = 0.004). This study demonstrates the superiority of the new care model in the primary care setting in Germany, as has been found in other countries.

A “Syndromic” Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children

ri P mary care physicians practicing in the United States are often less familiar with many of the common as well as more exotic diseases that children can acquire when traveling abroad. This review will focus mainly on infectious diseases specifically associated with travel-related exposures. While having access to reference material to help guide diagnostic resources and therapy is useful, it is most useful to have a consistent well-organized approach to help identify specific risk factors associated with both the most common and the most severe illnesses potentially occurring in a child who has recently traveled internationally. According to the National Travel and Tourism Office the number of Americans traveling abroad increased to more than 61.9 million in 2013. The main areas of travel included Europe at 34.6%, the Caribbean at 24.8%, Asia at 18.8%, South America at 7.3%, Central America at 6.9%, Africa at 3.1%, the Middle East at 5.9%, and Oceania at 1.9%. Nearly 27% of travel was to visit friends and families. This category accounts for a significant portion of the travel in the pediatric age groups. Although travel to Asia and Africa accounted for only 21.9% of US traveler the majority of travelrelated illnesses were acquired from Asia (32.6%) and sub-Saharan Africa (26.7%) according to a recent geosentinel-illness surveillance of returned international travelers presenting to the GeoSentinel Network. As

92. Measuring Up to the Common Core: What is Known About the Delivery of Primary Care Services in School-Based Health Centers (SBHCs)

92. Measuring Up to the Common Core: What is Known About the Delivery of Primary Care Services in School-Based Health Centers (SBHCs)

Calling All Doctors

Calling All Doctors

Primary Care Physicians' Use of an Informed Decision-Making Process for Prostate Cancer Screening

Leading professional organizations acknowledge the importance of an informed decision-making process for prostate cancer screening. We describe primary care physicians' reports of their prescreening discussions about the potential harms and benefits of prostate cancer screening. Members of the American Academy of Family Physicians National Research Network responded to a survey that included (1) an indicator of practice styles related to discussing harms and benefits of prostate-specific antigen testing and providing a screening recommendation or letting patients decide, and (2) indicators reflecting physicians' beliefs about prostate cancer screening. The survey was conducted between July 2007 and January 2008. Of 426 physicians 246 (57.7%) completed the survey questionnaire. Compared with physicians who ordered screening without discussion (24.3%), physicians who discussed harms and benefits with patients and then let them decide (47.7%) were more likely to endorse beliefs that scientific evidence does not support screening, that patients should be told about the lack of evidence, and that patients have a right to know the limitations of screening; they were also less likely to endorse the belief that there was no need to educate patients because they wanted to be screened. Concerns about medicolegal risk associated with not screening were more common among physicians who discussed the harms and benefits and recommended screening than among physicians who discussed screening and let their patients decide. Much of the variability in physicians' use of an informed decision-making process can be attributed to beliefs about screening. Concerns about medicolegal risk remain an important barrier for shared decision making.

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Imaging may produce unexpected or incidental findings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental findings are lacking. We set out to describe the type and prevalence of incidental chest radiography findings in primary care patients with acute cough. We report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specified signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional finding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these findings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. Incidental findings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental findings. Suspected nodules and shadows were reported in 1.8%. Incidental findings were more common is older participants and smokers (P <. 001). Clinically relevant incidental findings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting.

Proton Beam Therapy and Treatment for Localized Prostate Cancer: If You Build It, They Will Come

Proton Beam Therapy and Treatment for Localized Prostate Cancer: If You Build It, They Will Come

Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care

Depression symptoms are underreported by patients. We thus assessed individuals' reasons for not disclosing depression to their primary care physician. We conducted a follow-up telephone survey of 1,054 adults who had participated in the California Behavioral Risk Factor Survey System. Respondents were asked about reasons for nondisclosure of depressive symptoms to their primary care physician, depression-related beliefs, and demographic characteristics. Descriptive and inferential statistical procedures were used to characterize perceived obstacles to disclosure. Of the respondents, 43% reported 1 or more reasons for nondisclosure. The most frequent reason was the concern that the physician would recommend antidepressants (22.9%; 95% confidence interval, 18.8%-27.5%). Reported reasons for nondisclosure of depression varied based on whether the respondent had a history of depression. For example, respondents with no depression history were more likely to believe that depression falls outside the purview of primary care (P=.040) and more likely to fret about being referred to a psychiatrist (P=.036). Respondents with clinically significant depressive symptoms rated 10 of 11 barriers to disclosure as more personally applicable than did those without symptoms (all P values =.014). Number of reported disclosure barriers was predicted by demographic characteristics (being female, Hispanic, of low socioeconomic status), depression beliefs (depression is stigmatizing and should be under one's control), symptom severity, and absence of a family history of depression. Many adults subscribe to beliefs likely to inhibit explicit requests for help from their primary care physician during a depressive episode. Interventions should be developed to encourage patients to disclose their depression symptoms and physicians to ask about depression.

Commentary: The naive and the sentimental diagnostician - reflections on Rutter (2011)

Mothers may be among the best diagnosticians of developmental and behavioral problems in young children. If not for the positive predictive power of the mother's diagnostic ability, few kids would make it to the child and adolescent psychiatrist ('help-seeking') unless they really got into trouble. Mothers can sense that there is something wrong associated with a burden ('impairment') despite their being nao¨ve in the sense of medical diagnostic algorithms, while we, as doctors, with a more reflective and systematic- analytic approach, need to focus on what number, duration and composition of symptoms would lead to a diagnosis ('DSM, ICD'). This distinction of naivety and reflectiveness in diagnostic 'styles' is close to that which Friedrich Schiller made between nao¨ve poets who write spon- taneously and non-self-consciously, and sentimen- tal poets who are reflective and questioning about how and what they write (Pamuk, 2010). Orhan Pamuk, establishing the focus of his Harvard lec- tures on the application of this distinction to novel writing (and inspiring the title of this commentary), notes that the German sentimentalische has a closer meaning to 'reflective' or 'pensive'. Professor Rutter's article is so thought provoking, and so cogent, that it is both tempting and impos- sible to disagree with his points (Rutter, 2011). Each paragraph of Rutter's article deserving in-depth discussion, I will restrict this commentary to impairment, help-seeking and prognosis as parts of diagnosis, and a few points about trichotillomania and attention deficit/hyperactivity disorder (ADHD). A separate classification for primary care, as sug- gested in Professor Rutter's article (Rutter, 2011), is definitely an important need in the field of child and adolescent mental health, where there are several layers and levels of services, provided by medical and non-medical disciplines that are differentially sen- sitive to the diagnosable conditions. A prototype approach, somewhat naively utilized, can already be found in non-medical mental health professionals' approach and is useful for purposes of screening and referral. This is what parents may also be doing when they read a newspaper article about autism, find identical symptoms in their child, and seek help. A whole constellation of symptoms is reduced to 'one good reason' (of course, it can be two or three, but not many) at the 'screening' and 'referral'-based pri- mary care systems where the 'real' diagnosis and treatment is provided by the psychiatrist at a 'higher grade' of care. This fast and frugal approach may be necessary for the primary care level. The fast and frugal 'one good reason' approach, which may fit well with primary-care-level diagnostic needs, is based on 'looking up factors in order of importance, stopping the search if a factor allows it, and classifying the object according to this factor' (Gigenzerer, 2007).Thatprocesscan takeplace either in an emergency room setting (which patient with a chest pain should go to the intensive care unit?) or at a school (who should see the child and adolescent psychiatrist?), or at any place where more serious or complex cases should be triaged to receive 'higher' services. The primary care professional, the parents or the patient present the 'case' to the next level to learn whether there is a diagnosis associated with the condition so that it should receive clinical atten- tion.This is different from the comprehensive ('senti- mental') diagnostic process at a higher level of care. A prototype-screening diagnosis carries the hard- to-avoid risk of being rounded up to a 'real' diagno- sis, i.e., overdiagnosis of the condition as requiring clinical attention. For example, in school settings, diagnostic and treatment referrals take place via two main routes. If a prototype diagnosis of ADHD is established upon scoring above the cut-off on a symptom checklist, the possibility of a diagnosis of ADHD is present, and a consequent referral takes

Estudio del estado nutricional de los ancianos de Cantabria

Introduction: Population ageing is a main concern under the biosanitary point of view. Aim: To assess the nutritional status of people 65 year- old and older in Cantabria (Spain) Method: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by pri- mary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). Results: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. Conclusion: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.

Pain and its Management in Developing Countries

3 ISSN 1758-1869 10.2217/PMT.10.10 © 2011 Future Medicine Ltd Pain Manage. (2011) 1(1), 3–5 At the beginning of the 21st century it was very evident that despite significant advances in knowledge regarding the bio‐ logical, psychological and social aspects of the experience of pain, and the develop‐ ment across the Western world of multi‐ professional pain clinics, unimodal pain clinics, the introduction of acute pain management teams into hospitals, together with advances in pharmaco logical, inter‐ ventionalist and psycho logical manage‐ ment, few of these advances were evident in developing countries. The International Association for the Study of Pain (IASP) decided, in 2002, to step up its aid pro‐ grams for developing countries. Before that date it had provided grants for visit‐ ing lecturers and professors, IASP books for major libraries and financial sup‐ port for those in developing countries who wished to attend the triennial IASP world congresses. A developing countries task group was established (the DCWG) and links with the WHO, which had existed for many years, were strengthened through grants made to WHO projects in developing countries. The extent of unrelieved pain globally, but in developing countries in particular, is considerable, but reliable data regarding the prevalence and incidence of pain are lim‐ ited. For example, the incidence of cancers in developing countries is increasing and severe pain afflicts 70% of late HIV/AIDS victims. Other causes of pain in developing countries include sickle cell disease, lep‐ rosy, acute pain associated with war inju‐ ries and ordinance explosions long after wars have ceased, and chronic neuropathic pain after severe limb injuries. Childbirth is a widespread cause of untreated pain in Africa and other developing countries. A WHO collaborative study of pain in pri‐ mary care in developing countries revealed that chronic pain was present in approxi‐ mately 5–33% of those questioned [1]. In Western countries, the figure gained from a study of European countries by Breivik and others [2], by Blyth and others in Australia [3], and Eriksen and others in Denmark [4], give figures of approximately 18%. Chronic pain may be associated with depression; for example in the European Study it was present in 20% of those ques‐ tioned. Significantly, the WHO study sug‐ gested that lack of adequate healthcare and social support networks, cost implications of treatment and job security were signifi‐ cant factors amongst those in pain but not seeking help for it. The European Study

Learning Experiences and Assessment in the First 2 Years of the Medical Course at King's College London School of Medicine

The medical curriculum at King's College London School of Medicine is a 5 year course; an extended program (6 years) and a graduate entry program (4 years) are also available. The first 2 years of the curriculum comprise phases 1 and 2. The curriculum consists of core material that is common to all students and student-selected components (students undertake three such components in the first 2 years). Phase 1 lasts 12 weeks and students learn the principles of tissue and organ structure and function. They are also introduced to the practice of medicine (concepts of health, communication, ethics, inter-professional education and medicine in the community). Phase 2 consists of 36 weekly clinical scenarios that place basic medical science in a clinical context. Phase 2 covers cardiovascular, respiratory, gastrointestinal, renal and musculoskeletal systems; nutrition; endocrinology; head and neck anatomy; neuroscience; genetics; and infections. Teaching continues in pri! mary care and in the hospitals and includes basic and advanced life support. Learning experiences include lectures, tutorials, practical classes, dissection and prosection, communication skills, e-learning, student-led sessions and primary care and hospital visits. Assessment consists of in-course assessment (e.g., presentations, tests and essays) and end-of-year examinations which consist of written papers and an objective structured clinical examination at the end of year 2. The main strengths of the program include the scenario format of learning and the practice of medicine early on. The difficulties arise mainly from the large numbers of students (420 per year).

Barriers to Insulin Injection Therapy

To compare patients' perceptions of injection-related problems with clinicians' estimates of those problems. Data were obtained through 2 Internet surveys, one of US adults self-identified as taking insulin to treat diabetes and the second of health care professionals who treat people with diabetes who inject insulin, including primary care physicians, endocrinologists, and diabetes educators. A substantial majority of patients would like to reduce the number of injections they take each day; almost half said that they would be more likely to take their insulin injections regularly if a product were available to ease the pain. A much smaller proportion of patients reported that (1) injections were a serious burden, (2) they were dissatisfied with the way they took insulin, (3) injections had a substantial negative impact on quality of life, (4) they skipped injections they should take, or (5) injection-related problems affected the number of injections they were willing to take. Half of the patients said they mentioned injection-related problems to their provider; a similar number reported that their providers had not given them a solution to problems with injection-related pain and bruising. Although awareness of products to ease injection pain was high among providers (especially diabetes educators), this information was not effectively transmitted to patients. Patients should be encouraged to discuss their injection-related concerns, and providers should regularly ask about injection-related problems. Providers should offer patients information about tools to reduce injection-related worries, preferably by having them available to show and demonstrate.

Animal Behavior Case of the Month

Animal Behavior Case of the Month

PNP4: PHYSICIAN PERCEPTIONS ON THE USE OF MEDICATIONS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER

Children with ADHD require more than 1.5 times more pri- mary care visits, 9 times more outpatient mental health visits, and 3 times more prescriptions per year, compared to children without ADHD. 4 The total annual health care costs for children with ADHD are estimated to be more than twice that of children without the disorder, and these costs become significantly larg- er when a child with ADHD is diagnosed with a comorbid con- dition. 4-6 In a study conducted in the United States using data from the 1996 Medical Expenditure Panel Survey, the unad- justed mean health care expenditures for a child with ADHD were $1,151, much higher than the $661 in expenditures incurred by a healthy child in that same year. 6 ABSTRACT BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent mental health condition, occurring in 3% to 5% of school-aged children. Although stimulant medications are a recommended treatment for this disorder, physi- cians' views of these medications have not been systematically evaluated. OBJECTIVE: This study examined physician-prescriber perceptions of using medications to treat ADHD symptoms in children or adolescents. METHODS: A survey was developed with 4 physicians expert in treating ADHD in children. The survey was pilot-tested with a sample of 10 practicing physicians. A sample of 1,000 physicians, with a history of prescribing stimulant medications to children or adolescents, was randomly selected and mailed a 30-item survey. Items were rated on a 7-point response scale (strongly agree, agree, slightly agree, undecided, slightly disagree, disagree, strongly disagree). RESULTS: A total of 365 physicians responded to the survey, for a 37% response rate. More than 92% of respondents strongly agreed or agreed that ADHD symp- toms cause problems in pediatric patients and stimulants are effective in treating ADHD. The stimulant drug side effects of decreased appetite or weight loss, sleep disruption, and exacerbation of anxiety were a concern (strongly agree or agree response) for 32%, 50%, and 22% of physicians, respectively. Diversion of ADHD medication was a concern for 19% of respondents. Physicians reported that con- trolled medications for children or adolescents with ADHD are a burden for them- selves (32% strongly agreed or agreed), for their staff (37% strongly agreed or agreed), and for parents (40% strongly agreed or agreed). Approximately 38% of physicians responded that they would prefer prescribing a nonstimulant medica- tion with a U.S. Food and Drug Administration indication for treating children or adolescents instead of a stimulant medication, and 58% would prefer prescribing a noncontrolled medication that does not have evidence of abuse potential ver- sus one that is controlled and has evidence of abuse potential. CONCLUSION: Although physicians overwhelmingly perceive stimulant medica- tions as being effective for treating ADHD symptoms in children or adolescents, many would prefer a nonstimulant medication. While many physicians consider the side effects of the stimulants easily managed, others are concerned about prescribing stimulants because of their side effects, risk of diversion, and admin- istrative burden. The majority of physicians would prefer to prescribe a noncon- trolled medication without abuse potential instead of a controlled medication to treat children or adolescents with ADHD.

Perceptions and Usage of Glucosamine in Osteoarthritis Management

Glucosamine is a pop u lar al ter na tive treat merit for osteo -arthritis. Cur rent be liefs and prac tices among pri mary care med i cal prac-ti tio ners re gard ing the use of oral glucosamine for osteoarthritis (OA) man age ment were in ves ti gated by survey. A ques tion naire mailed to 600 ran domly se lected Ar i zona phy si cians and Phy si cian As sis tants yielded 195 re sponses. Sev enty-nine per cent rec om mended glucosamine to patients with osteoarthritis, and over half of the re spon dents be lieved that glucosamine has an al ge sic ben e fits and/or ac tiv ity against car ti lage deg ra-da tion. Only 16% of prac ti tio ners be lieved that glucosamine has ad verse effects, and 8% had re ceived ad verse re ports from pa tients. Fifty-six percent ofrespondentsfeltthatsufficientempiricalevidenceexiststosupport the use of glucosamine for 0 A. There fore, it ap pears that a con sid er able por tion of pri mary care pro vid ers in Ar i zona per ceive glucosamine as a safe and beneficial treat mer...

Promoting Help-Seeking Behavior for Urinary Incontinence

The authors evaluated the effectiveness of a combined primary care physician education and public awareness campaign about urinary incontinence. The campaign was designed to (a) trig ger help-seeking behavior in older adults with urine leakage problems and (b) encourage pri mary care providers to offer appropriate treatment for urinary incontinence (UI). Outcome measures included datafrom helpline callers and physician surveys before and after the two in terventions. Most callers who later sought care turned to their primary care physician. The me dian estimated number of patients presenting with UI in primary care doctor's offices changed from 9 per month to 11 per month, a change that was not statistically significant. Physicians'op timism for the potential gains from incontinence treatment increased.