Factors Associated With Disordered Eating Behavior Among Adolescent Girls: Screening and Education

Introduction/Objectives: An unhealthy relationship with food can lead to disordered eating in adolescence, highlighting the importance of screening. This study describes the frequency of disordered eating behavior among female adolescents, as well as associated characteristics and health behaviors. Methods: Data are from a multidimensional risk factor screening survey administered at a university medical center’s adolescent clinic from 2016 to 2018. The instrument was adapted from existing screening tools such as the Rapid Assessment for Adolescent Preventive Services (RAAPS), the American Medical Association’s Guidelines for Adolescent Preventive Services (GAPS), and the Youth Risk Behavior Survey (YRBS). Analysis was limited to self-reported responses provided by females aged 10 to 21 years (N = 915). Statistical analyses included chi-square tests and independent sample T-tests. Results: Of the N = 915 females who reported on disordered eating behavior, n = 57 (6.2%) had engaged in some form of disordered eating behavior within the past 12 months. Disordered eating was significantly associated ( P < .001) with not consistently wearing a helmet while biking, having tried e-cigarettes, being bullied in the past 30 days, having an adverse childhood experience (ACE), and being African American ( P = .005). Subgroup analysis of the relationship between disordered eating and bullying, by race, yielded significant findings: disordered eating was more highly associated with being bullied in the past 30 days among African American females ( P = .038). The relationship between disordered eating and ACE was also significant ( P < .001) among Caucasian girls when stratified by race. Conclusions: Adolescent risk behaviors often co-occur, and disordered eating behavior may be differentially observed by race. Findings highlight the importance of education and screening to prevent the development of disordered eating, and identify those who may be struggling. These results can be useful to community health education and in healthcare to develop and implement health promotion and eating disorder prevention strategies. Further studies are needed to assess additional factors that promote or protect against disordered eating to improve prevention.

Hipertensão secundária: abordagem nos cuidados de saúde primários

Objetivos: Identificar situações sugestivas de hipertensão secundária (HS). Rever a fisiopatologia, manifestações clínicas e/ou laboratoriais, diagnóstico e tratamento das principais formas de HS, bem como estabelecer o papel do médico de família na sua abordagem à luz da evidência mais recente. Fontes de dados: MEDLINE/PubMed, The Cochrane Library, UpToDate, U.S. Preventive Services Task Force e normas de orientação clínica da Direção-Geral da Saúde. Métodos: Foi realizada a pesquisa de artigos científicos em plataformas online de medicina baseada em evidência utilizando as palavras-chave Secondary Hypertension e Primary Health Care. A pesquisa foi realizada em julho de 2019, sendo a seleção dos artigos feita com base no título, conteúdo do resumo e data de publicação. Foram também consultadas normas de orientação clínica e guidelines. Resultados: A HS deve ser suspeita em contexto de hipertensão resistente, início de hipertensão antes dos 30 anos num utente sem fatores de risco, elevação súbita ou instabilidade da pressão arterial basal, hipertensão maligna ou acelerada, início de hipertensão diastólica em idosos, hipertensão associada a distúrbios hidro-eletrolíticos ou hipertensão associada a clínica sugestiva de determinada etiologia específica. Em crianças e adolescentes, as principais causas de HS são as doenças do parênquima renal, ao passo que nos adultos as etiologias mais comuns incluem a síndroma da apneia obstrutiva do sono, doenças do parênquima renal, estenose da artéria renal, hiperaldosteronismo primário e feocromocitoma. O reconhecimento de manifestações clínicas e/ou laboratoriais sugestivas da etiologia da HS deve orientar a realização dos testes de rastreio para posterior tratamento ou referenciação. Conclusão: Avaliar em todos os utentes hipertensos a existência de causas secundárias não é custo-efetivo, pelo que apenas devem ser estudados os utentes com características sugestivas de HS. A realização e interpretação dos testes de rastreio de forma adequada é fundamental para a referenciação e tratamento dos utentes com HS.

More evidence for low-dose aspirin in preventing pre-eclampsia

Overview of: Henderson JT, Vesco KK, Senger CA, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2021;326:1192–1206.

Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care

OBJECTIVES: Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS: In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS: Between November 1, 2016, and December 31, 2019, 6 practices serving &gt;7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P &lt; .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P &lt; .001). CONCLUSIONS: Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

Resultados da aplicabilidade de um protocolo de rastreamento populacional de câncer de próstata em Chapecó-SC

Campanhas que estimulam o rastreamento do câncer de próstata no Brasil são realizadas anualmente e preconizam o uso do toque retal associado à dosagem sérica do antígeno prostático específico. Objetivo: Avaliar os resultados e a aplicabilidade de um protocolo de rastreamento do câncer de próstata em Chapecó-SC. Métodos: Foram analisados dados clínicos de questionários de perfil epidemiológico e testes de dosagem de PSA de 249 homens, acima de 45 anos, residentes de Chapecó-SC e conveniados à Unimed, por meio de consulta ao banco de dados e exames do laboratório do Hospital Unimed Chapecó. Resultados: A amostra foi composta por 249 homens cuja média de idade foi de 51,2 anos. A média de valor do PSA da amostra foi de 0,82 ng/dL e 3,2% dos pacientes tiveram seu resultado acima de 2,5 ng/dL. 14,05% possuem histórico de parente de primeiro grau com câncer de próstata. Discussão: Evidências sugerem que não é necessário realizar o rastreio para câncer de próstata. Todavia, nos Estados Unidos, a US Preventive Services Task Force recomendou a não realização do rastreio e houve um aumento de metástases à distância do câncer de próstata em indivíduos com idade superior a 75 anos. A recomendação mais atual indica que deve ser feito de forma individualizada em pacientes entre 55 e 69 anos, para diagnóstico em estágio inicial e redução do sobrediagnóstico e overtreatment. Conclusão: Diante dos dados apresentados, a individualização no rastreamento é mais importante que o rastreamento populacional indiscriminado.

How Sociodemographic Factors Impact the Utilization of Recommended Clinical Preventive Screening Services in Poland: A Nationwide Cross-Sectional Study

Cardiovascular disease (CVD) and cancer are the most frequent causes of mortality in Poland. To date, no study in Poland has attempted to analyze the impact of sociodemographic factors on the utilization of all recommended preventive services for these diseases. To address this challenge, a nationwide cross-sectional study was conducted. One thousand adults aged 18 years or older were interviewed using computer-assisted telephone surveys conducted via random selection. A representative population was obtained in accordance with existing demographics per voivodeship in Poland. We assessed whether factors such as age, gender, body mass index (BMI), net income, household size, place of residence, and education impacted the odds ratio of utilizing recommended preventive services for CVD and cancer. We determined that elderly patients receive influenza vaccination, measure blood pressure, PSA concentration, glucose and lipid profiles, and undergo colonoscopy and mammography more often than younger counterparts. Men were more often influenza vaccinated (OR = 1.56, 95% CI: 1.07–2.27) than women, while women measured blood glucose more often than men (OR = 0.62, 95% CI: 0.42–0.93). Furthermore, net income < 2000 PLN, BMI < 24 kg/m2 and at least secondary education level were found to be crucial predictors of undergoing mammography (OR = 2.16; 95% CI: 1.26–3.72), cervical smear tests (OR = 1.99, 95% CI: 1.24–3.17), and lipid measurements (OR = 1.76, 95% CI: 1.07–2.91), respectively. Educating people and financial support seem to play a crucial role in implementing novel campaigns and preventive programs in Poland. Addressing each significant factor may be of paramount importance in improving the receipt of preventive services and warranting greater preventive care coverage in the Polish population.