Parasitology Screening of Latin American Children in a Primary Care Clinic

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 279-283
Author(s):  
Joel L. Bass ◽  
Kishor A. Mehta ◽  
Bonnie Eppes

A screening program based in a Massachusetts community hospital primary care clinic, which included 124 children from 12 different Latin American countries, demonstrated that nearly 35% were carriers of pathogenic parasites. The large majority (83.7%) of these children were asymptomatic at the time of the examination. Although there may be considerable variation based on country of origin, the present results, as well as a review of the literature, suggest this is likely to be a common finding among children born in most regions of Latin America. Compliance with the screening process was significantly higher in groups with higher infection rates and the successive yield in those patients who submitted two or more stool samples revealed that most pathogens were identified in the first sample. Schoolage children were found to have the highest risk for both roundworm infections and multiple parasitic infections. For those children with identified pathogens, nearly 90% received treatment. Current trends in immigration, international adoptions, and special circumstances including day care, family shelters, and increasing numbers of human immunodeficiency virus-infected children have made an appreciation of the extent of parasitosis, and awareness of possible management approaches, an important consideration for primary care physicians in the United States.

2020 ◽  
pp. 088626052095964
Author(s):  
Paula Tavrow ◽  
Danny Azucar ◽  
Dan Huynh ◽  
Caroline Yoo ◽  
Di Liang ◽  
...  

Risks of intimate partner violence (IPV) often are higher among immigrant women, due to dependency, language barriers, deportation fears, cultural beliefs, and limited access to services. In the United States, Asian immigrant women experiencing IPV often are reluctant to disclose abuse. Viewing videos that depict IPV survivors who have successfully obtained help might encourage disclosure. After conducting formative research, we created brief videos in four Asian languages (Korean, Mandarin Chinese, Thai, and Vietnamese) for use in primary care clinic consultation rooms. We then conducted in-depth interviews with 60 Asian immigrant women in California to get their perspectives on how helpful the videos might be in achieving disclosure. Most participants believed the videos would promote disclosure in clinics, although those who had been abused seemed more skeptical. Many had stereotyped views of victims, who they felt needed to be emotive to be credible. Videos should be upbeat, highlighting the positive outcomes of escaping violence and showing clearly each step of the process. Various types of IPV should be described, so that women understand the violence is not exclusively physical. Victims would need reassurance that they will not be arrested, deported, or forced to leave their abusers. Discussing the benefits of escaping violence to children could be influential. Victims also must be convinced that providers are trustworthy, confidential, and want to help. To assist immigrant populations to disclose IPV to a health provider, videos need to be culturally relevant, explain various types of violence, allay fears, and show clear processes and benefits.


2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 180-180
Author(s):  
Lidia Schapira ◽  
Marcy Winget ◽  
Siqi WU ◽  
Jennifer Kim ◽  
Cati Brown-Johnson

180 Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age < 46, 11 age 46-59, and 7 age > = 60. 23 (56%) patients had stage < 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients < 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free > 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.


2020 ◽  
Author(s):  
James Benjamin ◽  
Justin Sun ◽  
Devon Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  

Abstract Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions: Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.


2005 ◽  
Vol 35 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Albert Yeung ◽  
Winnie W. Kung ◽  
Jessica L. Murakami ◽  
David Mischoulon ◽  
Jonathan E. Alpert ◽  
...  

Purpose: This study aims to examine the effect of identifying Chinese American patients as having major depressive disorder (MDD) to their primary care physicians (PCPs) on the latter's attention given to the treatment of depression. Methodology: Forty Chinese American patients from a primary care clinic were identified as having major depressive disorder (MDD), and their primary care physicians (PCPs) were notified of the diagnosis by letter. Three months later, medical records of subjects in the study were reviewed to see if their PCPs had intervened through referral and/or initiated treatment of depression. Results: PCPs documented intervention in 19 patients (47%) regarding their depression. Two of these patients (11%) were started on an antidepressant. Four (21%) accepted and 13 (68%) declined referral to mental health services. No intervention was recorded for 21 (53%) patients. Conclusion: We conclude that recognition alone of MDD among Chinese Americans in the community primary care setting does not lead to adequate initiation of treatment for depression by PCPs.


1998 ◽  
Vol 28 (3) ◽  
pp. 293-302 ◽  
Author(s):  
Cheryl N. Carmin ◽  
John W. Klocek

Objective: It is estimated that 5 percent to 10 percent of primary care patients meet criteria for Major Depressive Disorder with an additional 10 percent to 30 percent experiencing significant subclinical depression. However, only 18 percent to 50 percent of depressed primary care patients are so diagnosed by their primary care physicians and even fewer receive professional mental health care. The current study proposes a quick and efficient means to assist physicians in determining for which patients the resource intensive process of thoroughly screening for depression should be engaged. Method: The present study examined responses of 358 consecutively reporting patients to a midwest university-based primary care clinic on the Beck Depression Inventory. Results: Among individuals reporting high levels of depressive symptomatology, five questions from the Beck Depression Inventory were endorsed by 90 percent or greater of the participants. Analyses by gender indicated that while the same five items were endorsed by males and females, three additional items were frequently endorsed by males. Conclusions: These findings suggest that a means for efficiently identifying individuals who warrant screening for depression may be readily available to primary care physicians. Surprisingly, this screening was found to emphasize psychological rather than vegetative symptoms. Thus, attending to these symptoms and/or complaints during the course of an office visit may serve as an indicator that a thorough screening for depression, or possibly referral, is warranted.


2010 ◽  
Vol 59 (Supplement) ◽  
pp. S58-S65 ◽  
Author(s):  
Edward E. Yackel ◽  
Madelyn S. McKennan ◽  
Adrianna Fox-Deise

2018 ◽  
Vol 58 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Nikita Habermehl ◽  
Elizabeth Diekroger ◽  
Rina Lazebnik ◽  
Grace Kim

Unintentional injuries are the leading cause of childhood mortality in the United States. Study aims included educating families about injury prevention and improving satisfaction with the waiting room experience. Two hundred caregivers with young children in the waiting room of an underserved pediatric primary care clinic participated in brief individual education sessions and received a toolkit containing small safety items and content highlighting age-appropriate safety topics. Participants completed 2 follow-up surveys, and most caregivers (94%) reported learning new information about injury prevention and thought that the intervention resulted in a better waiting room experience (91%). Of those who completed the 2-week follow-up survey (84%), 93.5% made changes at home and 42.7% bought new safety equipment. Injury prevention education can be effectively provided in the waiting room of a pediatric primary care clinic by improving reported caregiver safety knowledge and behaviors as well as satisfaction with the waiting room experience.


2021 ◽  
Vol 6 (2) ◽  
pp. 281-290
Author(s):  
Oğuz YILMAZ ◽  
Handan TURAN DİZDAR ◽  
Büşra Nur ESER ◽  
Büşranur TAŞÇI ◽  
Öyküm Esra AŞKIN ◽  
...  

2020 ◽  
pp. bjgp20X714053
Author(s):  
Regina Wing-shan Sit ◽  
Shirley Yue Kwan Choi ◽  
Bo Wang ◽  
Dicken Chan ◽  
Daisy, Dexing Zhang ◽  
...  

Abstract Background: Exercise therapy is commonly prescribed by primary care physicians (PCPs) in the management of chronic musculoskeletal (MSK) pain. Aims: We evaluated the clinical effectiveness of a supervised neuromuscular (NM) exercise program in older people with chronic MSK pain. Design: A 12-week, two-arm randomized controlled trial comparing 6 weeks supervised NM exercise versus waiting list control. Setting: We enrolled 72 participants with chronic MSK pain in a primary care clinic. Methods: Participants were randomly allocated (block size of 12) in 1:1 ratio to the NM (N=36) and control group (N=36). Data were collected at baseline, 6 and 12 weeks. The primary outcome was the Brief Pain Inventory (BPI) score at 6 weeks (post-intervention). Secondary outcomes included the Pain Self-Efficacy Questionnaire (PSEQ), Short form of Health Survey (SF-12), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scores, and functional measurement using the Timed-Up-and-Go test and handgrip strength. Results: Compared with the control group at 6 weeks, the NM group demonstrated a significantly greater improvement in the BPI-severity pain (between-group difference -1.27, 95% CI = -2.08 to -0.45, P = 0.002) and PSEQ (between-group difference 6.50, 95% CI = 2.022 to 10.77, P = 0.003). Participants who complied to the protocol also demonstrated statistical significant improvement in the SF-12-physical score and PHQ-9 score. Conclusion and implications: NM exercise has the potential of reducing pain, improving self-efficacy, physical function and mood in older people with chronic MSK pain. It can be an option to PCPs in exercise prescriptions.


1997 ◽  
Vol 27 (2) ◽  
pp. 107-128 ◽  
Author(s):  
Tassy Parker ◽  
Philip A. May ◽  
Marcello A. Maviglia ◽  
Steven Petrakis ◽  
Scott Sunde ◽  
...  

Objective: To examine the utility of using PRIME-MD (Primary Care Evaluation of Mental Disorders) for diagnosing mental disorders in American Indians. Method: One hundred randomly selected, adult, American-Indian patients who receive health care services at an urban Indian Health Service primary care clinic were evaluated for mental disorder by three primary care physicians using the PRIME-MD diagnostic assessment procedure. The main outcome measures were PRIME-MD diagnoses, diagnoses by an independent mental health professional, and treatment/referral decisions. Results: Eighteen percent of the patients had a threshold (met full DSM-IV criteria) PRIME-MD diagnosis, and an additional 17 percent had a subthreshold PRIME-MD diagnosis. The most frequently occurring PRIME-MD diagnoses were: probable alcohol abuse/dependence, major depressive disorder, and generalized anxiety disorder. Over 60 percent of the patients with a PRIME-MD diagnosis who were known “somewhat” or “fairly well” to their physician had not been recognized as having that psychiatric disorder prior to the PRIME-MD assessment. Therapy and/or referral was initiated for nineteen of the twenty-seven patients with a PRIME-MD diagnosis who were not previously receiving treatment. The primary care physicians were able to complete the PRIME-MD evaluations within an average of 7.8 minutes. There was a fair agreement between the PRIME-MD diagnoses and the diagnoses of the mental health professional (kappa = 0.56; overall accuracy rate = 79%). Conclusions: The present study represents the first formal examination of the use of PRIME-MD with American Indians. The results are encouraging. Further studies using PRIME-MD with other urban groups and reservation populations are recommended.


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