Screening In Primary Care Settings Research Articles

Conversion of a Validated Melanoma Risk Stratification Tool Into a Tablet-Based Patient Questionnaire for Targeted Melanoma Screening in Primary Care Settings: A Pilot Study.

Risk stratification can identify individuals in primary care settings who are at increased risk of developing melanoma. Converting and implementing a validated risk stratification tool as a patient self-administered tablet-based survey. Mackie risk stratification tool was transformed into a patient questionnaire. The questionnaire was completed in academic dermatologist practices by patients and dermatologists and revised to optimize sensitivity and specificity using physician assessment as gold standard. The optimized survey was administered before routine primary care visits during 2019 to 2021. High-risk patients were referred to dermatology. The number needed to screen (NNS), sensitivity, specificity, positive predictive value, and negative predictive value to identify a melanoma were calculated. Of the 7,893 respondents, 5,842 (74%) and 2,051 (26%) patients were categorized as low-risk and high-risk population, respectively. The NNS to identify 1 melanoma was 64 in the high-risk population. Incorporating self-administered patient-risk stratification tools in primary care settings can identify high-risk individuals for targeted melanoma screening. Further studies are needed to optimize specificity and sensitivity in more targeted populations.

Mental Health Screening in Primary Care: A Literature Review

This literature review explores the role of mental health screening in primary care settings. It provides an overview of the prevalence and impact of mental health disorders, the importance of early detection and intervention, and the challenges faced by primary care providers in identifying and managing mental health conditions. The review also examines various screening tools and strategies employed in primary care settings, highlighting their effectiveness and limitations. Finally, recommendations for future research and practice are discussed to enhance mental health screening and improve outcomes in primary care. Keywords: mental health screening, primary care

Gaps in Primary Care Suicide Screening for Asian American Adults in Honolulu Hawaii

Introduction/background: Asian Americans have experienced worsened mental health outcomes and increased rates of suicidality since the COVID-19 pandemic. Suicide screening in primary care settings need to be re-evaluated to properly screen mental health needs while accounting for barriers related to cultural norms and stigma.
 Who is it for? Asians are a fast growing racial group in the United States, and a majority racial group in the state of Hawaii. Increased cultural awareness and understanding of how suicidality presents in this group would benefit primary care providers (PCPs) to improve screening and treatment. Cultural norms, stigma, attitudes towards mental health and suicidality contribute to barriers to reporting needs to providers, and increased understanding of these barriers will support providers in regions around the world where there is an increasing Asian population assimilating with the majority cultural group.
 Who did you involve? A focus group was created to ensure the study reflects the perspectives of the Asian American community. Three individuals were recruited on the criteria of identifying as Asian, report of past or present suicidality, and having ever experienced barriers to discussing suicidality with their PCPs. The group’s responses support the design of the study in gathering personal experiences with navigating care, personal and cultural stigma of mental health and suicide, and ideas on how suicide screening could be improved to meet their needs considering their culture and values.
 What did you do? This study aims to identify the barriers that Asian Americans in Hawaii face in discussing or reporting suicidality with their PCPs through qualitative interviews with Asian individuals to assess for past or present suicidality. Those who report past or present suicidality will be interviewed further to determine whether they were able to discuss the topic with their PCP and what they feel could have improved their experience of the screening process or encouraged them to share more. Taking a person-centered approach, individual experiences are collected through a qualitative format with results to be presented as testimonials to help the audience better understand the thoughts, expectations, and needs of this community when presenting with suicidality in primary care. 
 What results did you get? It is expected that a percentage of the people interviewed will report some suicidality consistent with the national average for Asian Americans in the United States. Based on the literature review, it is expected that there will be barriers to the comfort level of reporting or discussing suicidality with PCPs and identified barriers related to limitations in language access, stereotypes or cultural stigma, settings of care delivery, and concerns with discrimination. Interviews are in process and results are expected in summer 2023.
 What is the learning for the international audience? Providers in communities where the Asian population is not the majority cultural group need to consider the unique barriers that Asian patients experience in reporting suicidality to provide effective and culturally-sensitive treatment. Identifying these gaps will provide insight for primary care practices to adapt the suicide screening process in a supportive way for Asian patients. 
  

Abstract C116: Provider input following implementation trial to address overdue colorectal cancer screening

Abstract Implementing Fit Kit Colorectal Cancer (CRC) Screening in At-Risk Populations Study was a trial of 4 evidence-based strategies to increase colorectal cancer (CRC) screening in the primary care setting. The focus of this report is the factors that impacted implementation of these interventions in a safety net setting. Using the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework, we evaluated providers’ assessments of the impact of the intervention on the 2 main outcomes: 1) CRC screening ordered; 2) CRC screening completed in a diverse population with more than 3,000 individuals overdue for screening. Methods:  We conducted a Qualtrics evaluation survey among 51 staff members identified as individuals involved in cancer screening in a safety net primary care setting that serves over 38,000 individuals in New Haven, CT.  The staff surveys are part of the evaluation of the program at one-year post-intervention. Invited staff were provided links through group emails from the provider partners requesting participation in a 2–5-minute Qualtrics survey. Questions on job title, role in CRC screening, and whether and how the interventions (referred to as “the study”) impacted CRC screening in this facility, understanding of the procedures in place to facilitate scheduling and completion of CRC screening, and the barriers and facilitators that impact CRC screening completion were queried.  Descriptive results will be mapped to relevant aspects of the RE-AIM framework. Results: Twenty (39%) staff members completed the survey including  9 (45.0%) registered nurses/advanced practice registered nurses, 6 (30.0%) physicians, 2 (10.0%) physician assistants, and 3 (15.0%) individuals in other roles, e.g., schedulers. 87.5% (n=14) were authorized to order colorectal cancer (CRC) screening tests, either colonoscopy or stool-based testing, for their patients. By self-report, effectiveness of the intervention on provider behavior was limited with only 22.2% reporting that the study impacted decisions to order CRC screening. Yet 41% of providers in the study placed a “blanket order” for all individuals who were due for CRC screening even if they were not seen for an appointment during the study period. Barriers to completion of CRC screening were “patient factors” (37%) and insufficient consultation time during appointments (27.3%). Most health care providers cited COVID-19 as a significant factor in delivering an effective CRC screening program. Provider suggestions to improve CRC screening uptake included posted information in exam rooms, use of clinical decision-making tools in the electronic medical record to determine if colonoscopy or FIT (stool-based) testing is the best option, nurse visits to teach use of stool-based testing and making in-home test kits available over the counter in pharmacies.  Discussion: Although the results from this small sample of providers has limited generalizability, the findings will be useful in designing scalable interventions in similar high volume primary care settings. Citation Format: Beth A. Jones, Denise L. Stevens, Sakinah Suttiratana, Sarah A. DeGiovanni, Laney Zhang, Margarita Vargas-Torres, Michael Couturie, Levita Robinson. Provider input following implementation trial to address overdue colorectal cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C116.

Older adults’ attitudes and motivations towards learning about personal dementia risk and their willingness to make changes to improve their health in primary care settings

ABSTRACT Objective This study assessed older adults’ preferences, attitudes, and motivations to understand and change their individual risk for developing dementia via screening in primary care settings. Method Eighty-six community-dwelling older adults (aged 60–91 years, M = 74.03, SD = 6.83) completed measures of behavioural intent to undergo dementia risk screening, response efficacy (i.e., belief that screening is useful), negative affective responses (e.g., risk screening results making individuals more scared about the future), motivation to change risk-related behaviours, level of social support, depression, and anxiety symptomatology. Results Overall, participants reported positive attitudes towards dementia risk screening and risk reduction. Two ordinal logistic regressions indicated that response efficacy was a significant predictor of behavioural intent to undergo dementia risk screening, whereas self-efficacy and family history of dementia were significant predictors of motivation to change risk-related behaviours. Barriers included lack of information, motivation, and self-control. Facilitators included access to formal and informal supports, and engagement with social and non-social activities. Conclusions Dementia risk screening and risk reduction in primary care may be more desirable for those with a family history of dementia, high response efficacy, and high self-efficacy. Addressing barriers such as lack of information, motivation, and self-control may improve older adults’ engagement with dementia risk reduction.

Perinatal depression screening in community pharmacy: Exploring pharmacists' roles, training and resource needs using content analysis.

Perinatal depression (PND) screening is often recommended in primary care settings, which includes the community pharmacy setting. However, there is limited research exploring pharmacists' perspectives on their roles in screening for perinatal mental illness. This study aimed to explore pharmacists' views of pharmacists' roles in PND screening, as well as training and resource needs for PND screening in community pharmacy settings. A questionnaire including three open-ended questions focusing on pharmacists' perspectives of their role in PND screening, their training, and resource needs in this area, was disseminated to pharmacists across Australia via professional organisations and social media. Each open-ended question was separately analysed by inductive content analysis. Subcategories were deductively mapped to the Theoretical Framework of Acceptability. Responses (N = 149) from the first open-ended question about pharmacists' roles in PND screening resulted in three categories (PND screening in primary care settings will support the community, community pharmacy environment, and system and policy changes) and ten subcategories. Responses to question two on training needs (n = 148) were categorised as: training content, training length, and training delivery while responses about resource needs (n = 147) fell into three categories: adapting community pharmacy operating structures, pharmacist-specific resources, and consumer-specific resources. While some pharmacists were accepting of a role in PND screening due to pharmacists' accessibility and positive relationships with consumers, others had concerns regarding whether PND screening was within pharmacists' scope of practice. Further training and resources are needed to facilitate pharmacists' roles in PND screening, referral and care.

Nutrition Risk Is Associated with 3-Year Strength and Performance Indicators among Older Adults in the Canadian Longitudinal Study on Aging.

Determine if nutrition risk, as measured by SCREEN-8 is predictive of 3-year strength and performance indicators among community-living older adults after adjusting for key demographic and health variables. Sex-stratified analyses were also determined. Cohort study with baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging (CLSA). Participants 55 years and older at baseline were included (n = 22,502); those who reported nasogastric or abdominal tube feeding at either timepoint were excluded (n = 26). The final sample of participants available for analyses slightly varied depending on completion of the three outcome variables. List-wise deletion was used for nutrition risk and covariates to arrive at the sample available for analysis (n = 17,250). The valid and reliable SCREEN-8 tool was used to measure nutrition risk. The minimum and maximum score of SCREEN-8 is 0 and 48, respectively, with lower scores indicating greater nutrition risk. Baseline SCREEN-8 score was used in analyses. Grip strength, chair rise test time and gait speed assessed at the 3-year follow-up were the strength and performance outcomes. Criteria outlined by the European Working Group on Sarcopenia in Older People 2 were used to determine low performance for grip strength (<27 kg for males and <16 kg for females), chair rise test time (>15 seconds) and gait speed (≤0.8 m/s). Half of participants were female (49.4%) and mean age was 66.7 years (SD 7.9). Mean SCREEN-8 score was 39.2 (SD 6.0). Low grip strength, chair rise test performance and gait speed were found in 18.5%, 19.6% and 29.3% of participants, respectively. After adjusting for covariates (e.g., sex, age, education), SCREEN-8 score was significantly associated with grip strength (F = 11.21, p = .001; OR = 0.98, CI [0.97, 0.99]), chair rise time (F = 5.97, p = .015; OR = 0.99, CI [0.97, 0.997]), and gait speed (F = 9.99, p = .002; OR = 0.98, CI [0.97, 0.99]). Similar interpretation was seen in sex-stratified analyses, although chair rise time was not significant. Age, body mass index, Life Space Index Score and self-rated health were consistently associated with all outcome measures. Nutrition risk, as measured by SCREEN-8, significantly predicted 3-year strength and performance measures. Greater nutrition risk is associated with an increased odds of low performance on grip strength, chair rise test, and gait speed. Future research should implement nutrition risk screening in primary care settings with subsequent assessment and treatment for at risk clients to determine if nutrition interventions implemented post screening can delay age-related losses in strength and performance.

Parental Preferences for Mental Health Screening of Youths From a Multinational Survey

Screening youths for mental disorders may assist in prevention, promote early identification, and be associated with reduced related lifetime impairment and distress. To assess parents' and caregivers' comfort with and preferences for pediatric mental health screening and factors associated with these preferences. This survey study used an online survey available from July 11 to 14, 2021, through Prolific Academic. Analyses were conducted from November 2021 to November 2022. The survey was administered to English-speaking parents and caregivers in the US, UK, Canada, and 16 other countries who were aged 21 years or older and had at least 1 child aged 5 to 21 years living at home. The main outcomes were parental preferences regarding content, implementation, and review of the findings of pediatric mental health screening. Parental comfort with screening topics was reported on a 6-point Likert scale with 6 indicating highest comfort. Mixed-effects logistic regression models were used to evaluate factors associated with parental comfort levels. Of 1200 survey responses requested, data were collected from 1136 participants (94.7%). The final sample meeting the inclusion criteria comprised 972 parents and caregivers aged 21 to 65 years (mean [SD] age, 39.4 [6.9] years; 606 [62.3%] female). A total of 631 participants (64.9%) supported annual mental health screening for their child, and 872 (89.7%) preferred reviewing the screening results with professional staff (eg, physicians). Participants reported significantly decreased comfort with child self-report compared with parent-report screening assessments (b = -0.278; SE = 0.009; P < .001), although they were generally comfortable with both options. Despite slight variations based on country of residence, screening topic, and child's age, participants were generally comfortable discussing all 21 screening topics on the survey. The greatest comfort was with sleep problems (mean [SE] score, 5.30 [0.03]); the least comfort was with firearms (mean [SE] score, 4.71 [0.05]), gender identity (mean [SE] score, 4.68 [0.05]), suicidality (mean [SE] score, 4.62 [0.05]), and substance use or abuse (mean [SE] score, 4.78 [0.05]). In this survey study of parents and caregivers, parent-reported and child self-reported mental health screening in primary care settings was supported by the majority of the sample, although comfort levels differed according to various factors (eg, screening topic). Participants preferred to discuss screening results with professional health care staff. In addition to parental need for expert guidance, the study findings highlight the growing awareness of child mental health needs and the importance of addressing mental health concerns early via regular mental health screenings.

Barriers and facilitators of vision screening in the US pediatric primary care setting: a mixed methods systematic review protocol.

The objective of this review is to understand the barriers and facilitators of vision screening in the US primary care setting for children aged 3 to 17 years. Childhood vision screening is crucial because it detects children at risk of undiagnosed vision problems. Previous studies report low rates of appropriate vision screening in the primary care setting. We aim to identify barriers and facilitators of pediatric primary care vision screening to inform future interventions to improve childhood vision screening. Studies of all types that identify barriers and facilitators of vision screening in children aged 3 to 17 years in the pediatric primary care setting in the US will be considered for inclusion. We will search PubMed, CINAHL Complete (EBSCO), Scopus, Web of Science (SCI-EXPANDED, ESCI, CPCI-S, SSCI), Cochrane Library, and Embase. We will also search gray literature, including conference proceedings, professional organization reports, and clinical trials. We will use supplemental search strategies, including citation tracking and contacting authors for unpublished data. Titles and abstracts will be screened independently by 2 reviewers and selected for full-text screening based on prespecified inclusion criteria. Only studies in English will be considered. Each included study will be appraised using the mixed methods appraisal tool. Data will be extracted using a modified JBI mixed methods data extraction form. Qualitative and quantitative data will be integrated using a convergent integrated approach. Open Science Framework https://osf.io/nhf5d/.

Knowledge Attitude and Practices of Health Care Workers towards Colorectal Cancer Screening in Primary Care Settings in Durban, South Africa: A Cross-Sectional Survey

BACKGROUND: South Africa has the highest number of colorectal cancer (CRC) patients in sub-Saharan Africa, with the CRC projected new cases at 8 000 per 100&amp;nbsp;000 population by 2030. Screening assists with the early detection and control of cancer. This study determined knowledge, attitude, and practices (KAP) related to CRC among Health Care Workers (HCWs).&#x0D; &#x0D; METHODS: A cross-sectional descriptive study was conducted between April and November 2021 using a self-administered close-ended questionnaire. Data was collected from 109 HCWs in public primary health care facilities in Durban, South Africa. Summary descriptive and association analysis were conducted using IBM SPSS vs. 28.&#x0D; &#x0D; RESULTS: Overall CRC screening knowledge score was 12% (mean 13) with 39% that were familiar with the National Department of Health Cancer Control framework. Only 15% of participants perceived the Perceived the National Cancer Control Guidelines to be influential for the implementation of colorectal cancer screening. 70% of participants would recommend CRC screening to patients. Over one-fifth, (22%) of participants felt that fecal occult blood, flexible sigmoidoscopy, and colonoscopy were effective for CRC screening. Over a third (44%) preferred a structured CRC screening programme. Most participants (81%) were willing to recommend CRC screening to their patients. Only 10% of participants had ever conducted colorectal screening before. The vast majority were unfamiliar with the types of CRC screening tests. Lack of CRC screening guidelines, training, equipment and CRC low burden were identified as barriers to screening.&#x0D; &#x0D; CONCLUSION: The vast majority of HCWs lacked knowledge of the CRC screening programme and its procedures. However, the vast majority of HCWs were willing to conduct screening once trained. This study also highlighted perceived health systems barriers affecting CRC screening. Currently, South Africa does not have national guidelines for CRC screening in South Africa, hence, a national risk differentiation CRC screening guideline is needed to guide implementation at the PHC level. Health systems strengthening interventions, including training of HCWs, availability of screening tests and materials to facilitate the integration of CRC screening noting that PH already implements screening programmes for other cancer types.&amp;nbsp;

How Clinicians Conceptualize "Actionability" in Genomic Screening.

Over the last decade, the concept of actionability has become a primary framework for assessing whether genetic data is useful and appropriate to return to patients. Despite the popularity of this concept, there is little consensus about what should count as "actionable" information. This is particularly true in population genomic screening, where there is considerable disagreement about what counts as good evidence and which clinical actions are appropriate for which patients. The pathway from scientific evidence to clinical action is not straightforward-it is as much social and political as it is scientific. This research explores the social dynamics shaping the integration of "actionable" genomic data into primary care settings. Based on semi-structured interviews with 35 genetics experts and primary care providers, we find that clinicians vary in how they define and operationalize "actionable" information. There are two main sources of disagreement. First, clinicians differ on the levels and types of evidence required for a result to be actionable, such as when we can be confident that genomic data provides accurate information. Second, there are disagreements about the clinical actions that must be available so that patients can benefit from that information. By highlighting the underlying values and assumptions embedded in discussions of actionability for genomic screening, we provide an empirical basis for building more nuanced policies regarding the actionability of genomic data in terms of population screening in primary care settings.

A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening.

Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, "Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?" We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.

Watch me grow integrated (WMG-I): protocol for a cluster randomised controlled trial of a web-based surveillance approach for developmental screening in primary care settings

IntroductionThe increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and...

A Qualitative Exploration of the Acceptability of an Online Web Application to Promote Breast and Cervical Cancer Screening in Primary Care Settings in Malaysia

PURPOSE In Malaysia, breast and cervical are the most common and third most common cancers respectively. They are associated with high morbidity and mortality in women. With the rapid development of information communication technology and widespread adoption of mobile devices in low to middle-income countries, online web applications (app) could be one of the strategies to engage patients to go for screening programs. METHODS Fifteen (15) health care professionals (HCPs) and 25 patients visiting the primary care were interviewed through focus groups and in-depth interviews to determine the acceptability of an online web application to promote screening for these cancers. RESULTS Both HCPs and patients expressed that an online web app would be beneficial to the technology-savvy group such as the younger generation. However, the older-aged group could benefit from it with some assistance. The primary consideration identified is the user's information technology (IT) competency. Participants suggested that the use of easy-to-use features (eg, download method), visually easy-to-understand formats (eg, less text and more pictures, videos), and provision of support to navigate the web app may be critical to ensure good uptake of a web app on screening. Contents of the app suggested to be included were: individual risk assessment for the users of the app, benefits of screening, information addressing patients' barriers such as fear, embarrassment, logistic, and cost issues. CONCLUSION The findings of our study may be useful as a guide to developing an online web app to promote breast and cervical cancer screening.

Collaborative Care for Low-Income Patients From Racial-Ethnic Minority Groups in Primary Care: Engagement and Clinical Outcomes.

To assess model impact and opportunities for improvement, this study examined collaborative care model (CoCM) engagement and clinical outcomes among low-income patients from racial-ethnic minority groups with depression and anxiety. Starting in 2015, the CoCM was implemented in seven primary care practices of an urban academic medical center serving patients from racial-ethnic minority backgrounds, predominantly Medicaid beneficiaries. Eligible individuals scored positive for depressive or anxiety symptoms (or both) on the Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 and the Generalized Anxiety Disorder Scale-2 (GAD-2) and GAD-7 during systematic screening in primary care settings. Screening rates and yield, patient characteristics, and CoCM engagement and outcomes were examined. Clinical improvement was measured by the difference in PHQ-9 and GAD-7 scores at baseline and at 10-to-14-week follow-up. High rates of screening (87%, N=88,236 of 101,091) and identification of individuals with depression or anxiety (13%, N=11,886) were observed, and 58% of 3,957 patients who engaged in minimally adequate CoCM treatment had significant clinical improvement. Nevertheless, only 56% of eligible patients engaged in the model, and 25% of those individuals did not return for at least one follow-up appointment. Being female with clinically significant comorbid anxiety and depressive symptoms and having Medicaid or commercial insurance increased the likelihood of CoCM engagement. CoCM can help engage vulnerable patients in behavioral health care and improve clinical symptoms. However, significant opportunity exists to advance the model's impact in treating depressive and anxiety disorders and decreasing health disparities by addressing engagement barriers.

Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey.

IntroductionPsychiatric disorders are among the leading causes of disability in children and adolescents globally. In Lebanon, a country that has endured a prolonged history of conflict and economic and political uncertainty, mental health surveys in children and adolescents have been limited to specific disorders or specific settings or cities. PALS (Psychopathology in Children and Adolescents in Lebanon Study) is the first study to screen a nationally representative sample of children and adolescents for psychiatric disorders and estimate the national prevalence of children and adolescents at risk of having a psychiatric disorder.MethodsA nationally representative household sample of 1517 children and adolescents (aged 5 years 0 months to 17 years 11 months) was recruited through a multi-stage stratified proportionate sampling technique between February 2018 and November 2018. Parents and adolescents completed a battery of self-reported scales including the Strengths and Feelings Questionnaire (SDQ), Mood and Feelings Questionnaire (MFQ), Screen for Child Anxiety and Emotional Related Disorders (SCARED), the Peer Relations Questionnaire (PRQ), General Health Questionnaire (GHQ), and Conflict Behavior Questionnaire (CBQ), Child Revised Impact of Events Scale (CRIES), and a demographic/clinical information questionnaire. Logistic regression models were used to examine the correlates of screening positive for psychiatric disorders.ResultsAbout a third of children and adolescents (32.7%, n = 497) screened positive for at least one psychiatric disorder, of whom only 5% (n = 25) reported ever seeking professional mental health help. Academic performance, having a chronic physical illness, higher parental GHQ scores, and involvement in bullying were associated with a higher odds of screening positive for a psychiatric disorder. Higher family income was negatively associated with screening positive for a psychiatric disorder.ConclusionThis first national study shows a high prevalence of psychiatric symptoms in Lebanese children and adolescents and an alarming treatment gap. School-based primary prevention programs or screening in primary care settings are key for early detection and management of psychiatric symptoms, and prevention of psychiatric disorders.

The yield of fecal occult blood testing as a screening tool for colon cancer in a primary care setting.

The most common cancer among men and the third most common among women in Saudi Arabia is colon cancer. This study aimed to evaluate the yield of the fecal occult blood test (FOBT) used as a screening tool for colon cancer. Medical records of all patients above the age of 50 years who had visited the Family Medicine clinic at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia and who had undergone the FOBT screening between January 2002 and March 2017 were retrospectively reviewed. We collected patients' demographic data, FOBT results, and colonoscopy pathology reports results. Data were analyzed using the Statistical Package for Social Science Version 25 (IBM Corp., Armonk, NY, USA). We included 2179 patients in this study. The mean age was 59.8 ± 8 years. As a result of the FOBT screening, 19.7% of the patients had a positive FOBT. Colon cancer accounted for 3.5% of all abnormal colonoscopy pathology reports. The Saudi age-standardized incidence rate (ASIR) in our study was 26.56 per 100,000 persons. FOBT is a feasible tool that can be used for colon cancer screening in primary care settings. The Saudi ASIR in our study was higher than the Saudi Cancer Registry, but it was still lower in comparison to other countries. We recommend the establishment of a national community-based colon cancer screening program.

The effect of education seminars on pediatric vision screening in the primary care settings.

The primary aim of this study was to assess the practice behaviors of physicians on pediatric vision screening (VS) in primary care settings in Turkey and compare the groups in respect of previous education on VS. All physicians working in the primary care settings of Kayseri province of Turkey were directly administered a 24-item questionnaire at planned education seminars. The groups were compared according to a history of VS education (Group 1) and no history of VS education (Group 2). The self-reported questionnaire results were analyzed statistically. A total of 124 of 453 physicians completed the survey with a response rate of 27.3%. VS was reported to be performed as recommended by 70.2% of the participants. The physicians in Group 1 were significantly older (P < 0.05) and more experienced (P < 0.05) than those in Group 2. Group 1 performed the red reflex (RR) test significantly more frequently (P < 0.05) and referred the patients to an ophthalmologist less frequently than Group 2 (P < 0.05). Regression analysis revealed that age (P < 0.05) and previous education (P < 0.05) were the independent factors for visual acuity and RR testing, respectively. Practice-related factors were the most commonly reported barriers to VS in primary care settings. Although there is a high rate of reported full adherence to the recommendations for pediatric VS, it seems to be more likely to be performed insufficiently. Practice-related barriers should be handled by publicly available education materials (e.g., YouTube videos). VS education should be added at an earlier stage of medical training programs.

Exploring the structure of the GAD-7 scale in primary care patients with emotional disorders: A network analysis approach.

Anxiety symptoms are one of the most frequent manifestations in people attending primary care, although how the symptoms are associated is unclear. This study aimed to establish the symptom structure of the Generalized Anxiety Disorder scale (GAD-7) using a novel network approach in combination with traditional analytical tools. A sample of 1704 primary care patients with emotional disorders (i.e., anxiety, depression, and/or somatization) completed the GAD-7 to report their anxiety symptoms. We examined the GAD-7 structure using exploratory graph analysis (EGA) compared to exploratoryfactor analysis (EFA) and confirmatory factor analysis. The EFA results showed a one-factor solution, but EGA revealed a two-factor solution (cognitive-emotional and somatic). "Worrying too much" and "difficulty relaxing" were the most relevant symptoms. The results support the possible distinction between the somatic and cognitive-emotional components of the GAD-7, thus permitting more specific screening in primary care settings.

Validity of the Handheld Expiratory Flowmeter for COPD Screening in the Primary Care Setting of China.

PurposeThe use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flowmeter (Vitalograph Ltd., COPD-6®, Ireland) for COPD screening in Chinese primary care settings.MethodsIn our cross-sectional study, subjects were randomly selected in eight primary care settings. Tests with the handheld expiratory flowmeter and the conventional spirometry were sequentially performed on all participants. The correlation between the handheld expiratory flowmeter and the conventional spirometry was determined. Validity was determined by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1)/forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points.ResultsA total of 229 subjects (15.4%) were diagnosed with airflow limitation by conventional spirometry. FEV1, FEV6, and FEV1/FEV6 measured by the handheld expiratory flowmeter were correlated with FEV1, FVC, and FEV1/FVC measured by the conventional spirometry (r=0.889, 0.835 and 0.647, p<0.001), respectively. AUC of the FEV1/FEV6 to determine airflow obstruction was 0.857 (95% CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic group (AUC=0.869 vs 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs 0.840; P=0.515). The cut-off point for FEV1/FEV6 was 0.77 and the corresponding sensitivity and specificity were 71.2% and 89.8%, respectively.ConclusionThe handheld expiratory flowmeter might be used as a screening device for COPD in Chinese primary care settings.