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Studied how teaching and learning in a community-based ambulatory setting varied by gender of students and preceptors using data contributed by 93 medical students on 5,017 patient encounters. Results show differences of potential importance in teaching and learning by gender of the student-preceptor dyad. (SLD)

The SunSafe program promoted sun protection among rural New Hampshire children in elementary schools and day-care centers using education and outreach. The program was part of a randomized, controlled trial. Evaluation involved parent and teacher feedback, caregiver interviews, student testing, and observation. Results indicated that the program was acceptable and effective in influencing policies, attitudes, and behaviors. (SM)

Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC. Keywords: depression, psychotherapy, counseling, primary care, coping

DEPRESSION IS ONE of most prevalent and disabling mental illnesses in the United States and is twice as likely to affect women as men. (1,2) Because rates of major depression [...], OBJECTIVES. The goals were (1) to determine the feasibility and yield of maternal depression screening during all well-child visits, (2) to understand how pediatricians and mothers respond to depression screening information, and (3) to assess the time required for discussion of screening results. METHODS. Implementation of brief depression screening of mothers at well-child visits for children of all ages was studied in 3 rural pediatric practices. Two screening trials introduced screening (1 month) and then determined whether screening could be sustained (6 months). Screening used the 2-question Patient Health Questionnaire. Practices tracked the proportions of visits screened and provided data about the screening process. RESULTS. Practices were able to screen in the majority of well-child visits (74% in trial 1 and 67% in trial 2). Of 1398 mothers screened, 17% had I of the depressive symptoms and 6% (n = 88) scored as being at risk for a major depressive disorder. During discussion, 5.7% of all mothers thought they might be depressed and 4.7% thought they were stressed but not depressed. Pediatric clinicians intervened with 62.4% of mothers who screened positive and 38.2% of mothers with lesser symptoms. Pediatrician actions included discussion of the impact on the child, a follow-up visit or call, and referral to an adult primary care provider, a mental health clinician, or community supports. Pediatrician time needed to discuss screening results decreased in the second trial. Prolonged discussion time was uncommon (5-10 minutes in 3% of all well-child visits and >10 minutes in 2%). CONCLUSIONS. Routine, brief, maternal depression screening conducted during well-child visits was feasible and detected mothers who were willing to discuss depression and stress issues with their pediatrician. The discussion after screening revealed additional mothers who felt depressed among those with lesser symptoms. The additional discussion time was usually brief and resulted in specific pediatrician actions. www.pediatrics.org/cgi/doi/10.1542/ peds.2005-2346 doi:10.1542/peds.2005-2346 Key Words depression, maternal, primary care, screening Abbreviations EPDS--Edinburgh Postnatal Depression Scale USPSTF--US Preventive Services Task Force PHQ--Patient Health Questionnaire

ABBREVIATION. AAP, American Academy of Pediatrics Both maternal depressive symptoms and depressive disorders may have a substantial impact on a child's health and experience within the family. Postpartum and other [...], Objective. To describe the attitudes and approaches of primary care pediatricians in the identification and management of postpartum and other maternal depression. Methods. A national survey of randomly selected primary care pediatricians reported their management of the last recalled case of postpartum or other maternal depression, barriers to care, their attitudes about recognition and management, confidence in skills, and their willingness to implement new strategies to improve care. Results. Of 888 eligible primary care pediatricians, 508 (57%) completed surveys. Of these pediatricians, 57% felt responsible for recognizing maternal depression. In their last recalled case, respondents used an unstructured approach for identification based primarily on maternal appearance or complaints. When maternal depression was suspected, additional assessment of any kind was done by 48% of pediatricians. Although 7% perceived themselves to be responsible for treating maternal depression, pediatricians indicated they had an active role in 66% of cases in which they provided 1 or more brief interventions. The major barriers that were believed to limit their diagnosis or management were insufficient time for adequate history (70%) or education/counseling (73%) and insufficient training/knowledge to diagnose/ counsel (64%) or treat (48%). Responses with cases involving maternal depression and the specific situation of postpartum depression were very similar. Forty-five percent were confident in their ability to diagnose maternal depression, whereas 32% were confident in their ability to diagnose postpartum depression. Nearly one fourth of pediatricians were willing to change their approach to identification. Pediatricians who felt responsible for recognizing maternal depression were more likely to assess more completely and intervene in cases as well as consider implementing change in their practice. Conclusion. Pediatricians' current attitudes and skills that are relevant to maternal depression limit their ability to play an effective role in recognition and management. Future interventions need to address each of these issues. Educational efforts and new clinical approaches may be more effective with those who feel responsible and willing to change their approach to maternal depression. Pediatrics 2002;110:1169-1176; continuing medical education, primary care, depressive symptoms, depression, family, mental health services, pediatric providers, postpartum, maternal.

A longitudinal study of students (n=70) entering Dartmouth Medical School (New Hampshire) in 1984 found attitudes toward family practice initially positive and improving. However, of 25 indicating early interest in family medicine, only 6 chose a related residency. Student concerns about the specialty's demands are seen as a possible factor. (Author/MSE)

A group of 30 community physicians who practiced in northeastern United States and who participated in the Cancer Prevention in Community Practice project in 1988 were interviewed five years later. The aim of the interviews was to assess the long-term impact of the preventive services office system which had been introduced by the project. The qualitative analysis of interviews revealed three distinct physician philosophies about the provision of preventive services: * a Request Only focus, responding to specific patient inquiries about prevention but taking no initiative to recommend indicated services; * a Health Maintenance Visit focus, providing indicated services only during visits specifically scheduled for preventive care; and * an Opportunistic Prevention focus, providing indicated preventive services at every chance. Physicians demonstrated these philosophies in their overall view of disease prevention, perceived obstacles to delivery of preventive care, as well as in their continued use of flow sheets and their impression of the value of the Cancer Prevention in Community Practice project. The long-term impact of the office system was most apparent in the Opportunistic Prevention group. We conclude that the durability of a preventive services office system is influenced by a physician's preventive care philosophy. Key words - preventive health services, interviews semi-structured, qualitative research, durability, physicians' practice patterns, cancer prevention and early detection.