A vision for eye care

Ophthalmology is a low priority in many resource-poor countries, yet blindness has a huge impact on individuals and society. A link programme is helping to change this situation in Zambia.     

Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes

OBJECTIVE: The aim of this work was to study the frequency of examining for diabetic eye and foot complications in an Australian population and to study factors associated with regular screening. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. Participants identified as having previously diagnosed diabetes (n=475) were invited to participate in the complications study. Measures included foot examination, retinopathy photography, and self-report use of health care services. RESULTS: Seventy-seven percent of participants reported having an eye examination within the previous 2 years, and 50% reported having their feet examined by a health professional in the previous year. Type of diabetes treatment (odds ratio 1.46, 95% CI 0.85-2.50 for tablets versus diet alone and 4.17, 1.71-10.17 for insulin or insulin and tablets versus diet alone) and visiting a diabetes nurse educator in the previous 12 months (2.14, 1.18-3.87) were independent predictors of having had an eye examination. Duration of diabetes (1.33, 1.06-1.67 per year) and visiting a diabetes nurse educator in the previous 12 months (1.89, 1.20-2.95) were independent predictors of a foot examination. CONCLUSIONS: This study has shown that retinopathy screening is performed more frequently than foot screening in Australia. This may be due to the implementation of eye screening programs and awareness campaigns. Foot screening appears to be poor, with less than one-half of the population reporting a regular examination for foot complications. In Australia, diabetes nurse educators play a key role in promoting screening for diabetes complications.     

Improving eye care in the primary health care setting

One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO's providing eye care, decentralization of services and the establishment of an eye care committee in the region.     

Chlamydia screening in a metropolitan Atlanta primary care clinic

BACKGROUND: Chlamydia is the most commonly reported infectious disease in the United States, yet many women at risk for chlamydia infection are not being tested. METHODS: We conducted a chlamydia screening study (Phase I) and retrospective medical chart review (Phase II) of 199 women from 16 to 40 years of age attending a primary care clinic in metropolitan Atlanta. RESULTS: Two (1%) of the 199 study participants tested positive for chlamydia during Phase I. Phase II medical chart reviews indicated that only 35% of study participants had been tested for chlamydia at least once in the previous 15 months. Three of these individuals tested positive, yielding a prevalence of 5.6%. All infections occurred in women 30 years of age or younger. CONCLUSION: The results suggest that chlamydia screening is low and that recommended guidelines are not being followed. Strategies are needed to increase the rates of screening and adherence to these guidelines to ensure that chlamydia is detected before complications occur.     

Osteoporosis prevention, detection, and treatment. A mandate for primary care physicians

Prevention of bone loss through healthy lifestyle choices offers the greatest promise of minimizing fracture incidence. Safe, effective therapeutic options are available when drug therapy is prudent. Newer bisphosphonates, selective estrogen receptor modulators, and HRT delivery systems will soon be available to offer an even larger menu of choices for osteoporosis prevention and treatment. By implementing appropriate treatment, we can prevent bone loss, reduce fracture incidence, and improve function and quality of life, even in patients who have previously experienced fractures.     

Prostate cancer screening in primary care

BACKGROUND: Little is known about the actual frequency with which men have prostate screening in primary care settings, nor are the determinants of screening understood. METHODS: We examined the records of 50 consecutive primary care office visits by men aged 50 or older. Men were asked to complete a brief questionnaire outlining their previous use of prostate screening services and the factors that influenced screening. RESULTS: Screening in the previous year with digital rectal examination (DRE) and prostate specific antigen (PSA) was reported by 46% and 30% of respondents, respectively. Most respondents (86%) had heard of prostate screening and most (78%) believed it was effective. The only factor predictive of screening with DRE in multivariate analysis was a doctor's discussion of screening (odds ratio, 4.8). Two factors were predictive of PSA screening--knowing someone who had prostate cancer (odds ratio, 12.8) and advancing age (odds ratio [per year], 1.1). CONCLUSIONS: Many men are not having annual prostate screening. Men who were older, who reported knowing someone with prostate cancer, and whose doctors discussed screening, were more likely to have been screened in the past year.     

Case-finding and risk-group screening for depression in primary care

OBJECTIVE. Central health organizations suggest routine screening for depression in high-risk categories of primary care patients. This study compares the effectiveness of high-risk screening versus case-finding in identifying depression in primary care. DESIGN. Using an observational design, participating GPs included patients from 13 predefined risk groups and/or suspected of being depressed. Patients were assessed by the Major Depression Inventory (MDI) and ICD-10 criteria. Setting. Thirty-seven primary care practices in Mainland Denmark. Main outcome measures. Prevalence of depression, diagnostic agreement, effectiveness of screening methods, risk groups requiring special attention. RESULTS. A total of 37 (8.4%) of 440 invited GP practices participated. We found high-risk prevalence of depression in 672 patients for the following traits: (1) previous history of depression, (2) familial predisposition to depression, (3) chronic pain, (4) other mental disorders, and (5) refugee or immigrant. In the total sample, GPs demonstrated a depression diagnostic sensitivity of 87% and a specificity of 67% using a case-finding strategy. GP diagnoses of depression agreed well with the MDI (AUC values of 0.91-0.99). The potential added value of high-risk screening was 4.6% (31/672). Patients with other mental disorders were at increased risk of having an unrecognized depression (PR 3.15, 95% CI 1.91-5.20). If patients with other mental disorders were routinely tested, then 42% more depressed patients (14/31) would be recognized. CONCLUSIONS. A broad case-finding approach including a short validation test can help GPs identify depressed patients, particularly by including patients with other mental disorders in this strategy. This exploratory study cannot support the screening strategy proposed by central health organizations.     

The role of nurse practitioners in a primary care eye clinic

This paper reports on a study conducted to audit the practice of nurse practitioners in a primary care eye clinic at St Paul's Eye Unit at the Royal Liverpool University Hospital, UK. The clinic deals with ophthalmic accidents and emergencies and routine referral patients from general practitioners. This was a prospective study of the case notes of 250 consecutive patients who attended the clinic without prior appointment. The study was completed in 1 week.     

Improving substance abuse screening and intervention in a primary care clinic

Despite recent efforts to educate primary care providers in the identification and management of patients presenting with substance abuse problems, many opportunities to identify and intervene with these patients are overlooked. This project was designed to identify factors that interfere with rates of screening and brief intervention (SBI) of substance abuse problems in a primary care clinic in a major academic medical center in New York City. Six informants representing the disciplines of medicine, nursing, and social work in the primary care clinic provided information regarding SBI. Analysis was focused on substantiation of the need for enhanced diffusion of knowledge related to screening for substance abuse problems to improve rates of SBI in primary care. Recommendations for improvement included continued promotion of SBI by influential role models and opinion leaders, improvement in primary care providers' perceptions of the perceived characteristics of SBI to improve rates of adoption, implementation of interdisciplinary educational initiatives toward the goal of improving rates of SBI in the primary care clinic, and initiation of translational research at the clinic supporting SBI in primary care.     

儿童眼病筛查法在群体儿童眼保健中的应用效果

目的探究儿童眼病筛查法在群体儿童眼保健中的应用效果。方法回顾性分析我院2018年5月至2020年5月的167例儿童眼病筛查病例资料,全部儿童均接受了常规观察及眼病筛查,比较两种眼病筛查方法的异常检出率、漏诊率、误诊率、阴性预测值、阳性预测值、特异度、灵敏度。结果纳入儿童共167例,经过OCT检查后,正常儿童135例(80.84%),结果异常儿童32例(19.16%)。眼病筛查法的异常检出率显著高于常规观察法,差异具有统计学意义(P<0.05)。眼病筛查法的漏诊率显著低于常规观察法,差异具有统计学意义(P<0.05)。眼病筛查法的阴性预测值及灵敏度均高于常规观察法(P<0.05)。结论眼病筛查法应用于群体儿童眼保健中具有着较低的漏诊率,同时表现出了较高的灵敏度,对于提高儿童眼保健效果具有积极意义。     

Managing eye disease in primary care. Part 3. When to refer for ophthalmologic care

Most severe eye diseases and injuries ultimately require intervention by an ophthalmologist. The urgency of referral depends on various factors, including level of vision loss, duration of symptoms, and presence of comorbid diseases. Of special importance are five acute eye problems in which emergency management by primary care physicians can be critical to visual outcome: high-velocity injuries, chemical injuries, acute angle-closure glaucoma, arteritic ischemic optic neuropathy, and central retinal artery occlusion.     

Prospective nurses' appraisals of screening for child neglect in primary care settings

Screening for child neglect in primary care settings is a well-recognized, though largely untapped, resource in the campaign to prevent this pervasive childhood morbidity. Using a contemporary cognitive appraisal model as a conceptual guide, this study evaluated 71 upper-level undergraduate nursing students' thoughts about their future professional responsibility to screen children and families for child neglect. Seventy-one upper-level undergraduate nursing students voluntarily and independently completed a brief, 10-minute survey during a regularly scheduled class meeting. Data showed that participants perceived screening for neglect as important to and consistent with their future professional objectives. In addition, participants reported confidence in their ability to screen for neglect and to better the lives of children and families through universal screening procedures. In contrast, the majority of participants doubted their ability to emotionally tolerate the psychologic burden of routinely assessing caregivers' ability to nurture and protect their offspring. Although the majority of participants reported some degree of anxiety and a substantial minority reported some degree of hopelessness about screening for neglect, most were hopeful that this challenge would yield personal and professional benefits. Overall, data suggested that participants were highly motivated to invest cognitive and emotional resources in learning more about screening for child neglect in primary care settings.