Assessing the Knowledge and Comfort Level of US Family Medicine Residents Regarding Consenting and Confidentiality in Adolescent Health Care.

OBJECTIVES: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. METHODS: Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. RESULTS: A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). CONCLUSIONS: Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.

Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

OBJECTIVES: Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. METHODS: We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. RESULTS: Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). CONCLUSIONS: The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

PURLs: Light therapy for nonseasonal major depressive disorder?

While bright light therapy already has a place in the treatment of seasonal affective disorder, a recent trial spotlights its utility beyond the winter months.

Linear alkylbenzene sulfonate tolerance in bacteria isolated from sediment of tropical water bodies polluted with detergents.

The discharge of untreated detergent-bearing waste introduces linear alklcylbenzene sulfonates (LAS) to the aquatic environment. The surfactant persists in some streams and rivers in Nigeria, some is adsorbed to suspended materials and end in the sediment of the receiving water bodies. In this study, bacteria isolated from sediments of some tropical detergent-effluent-polluted streams were tested for tolerance to LAS using the media dilution technique. LAS-tolerance was indicated by growth of the bacteria in the presence of the surfactant. The pH, concentrations of surfactant, population of heterotrophic bacteria and population of LAS-tolerant bacteria in the sediments were determined. A direct relationship (r = 0.9124) was found between the alkaline conditions (pH= 8.2-12.0) and high surfactant concentrations (45-132 mg/g) in the sediment. The sediments harboured a high population and a wide variety of bacteria; the populations of viable heterotrophic bacteria (VHB: 2.9 x 10(5) to 1.2 x 10(7) cfu/g) and LAS tolerant bacteria (LTB: 1.5 x 10(4) to 1.2 x 10(6) cfu/g) had a direct relationship (r = 0.9500). An inverse relationship resulted between each of them and the concentration of surfactant in the sediment, r(VHB/LAS) = -0.9303 and r(LTB/LAS) = -0.9143, respectively. Twelve bacteria species were isolated from the sediment: Alcaligenes odorans, Bacillus subtilis, Burkholderia cepacia, Citrobacter freundii, Citrobacter diversus, Escherichia coli, Micrococcus luteus, Micrococcus albus, Pseudomonas putida, Pseudomonas stutzeri, Staphylococcus aureus and Streptococcusfaecalis. Most of them were adapted to the surfactant with their maximum acceptable concentrations ranging between 0.03 and >1.0% (w/v). The sediments could serve as source of adapted organisms which can be used in bio-treatment of LAS-bearing waste.