UTILITY OF PSYCHOLOGICAL SCREENING OF YOUNG ADULTS WITH TYPE 1 DIABETES TRANSITIONING TO ADULT PROVIDERS.

OBJECTIVE: Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. METHODS: Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. RESULTS: Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, P<.001, respectively), disordered eating accounted for the majority of observed variance (df = 1; F = 18.6; P<.001). Even though HbA1c was higher in patients with versus without disordered eating (P<.001), body mass index did not differ between the 2 groups (P = .51). CONCLUSION: In young adults with T1D, formal screening provides an opportunity to detect psychological problems, which, when treated, may help optimize metabolic control during the transition process. ABBREVIATIONS: T1D = type 1 diabetes HbA1C = hemoglobin A1c YCDP = Yale Children's Diabetes Program PHQ-8 = Patient Health Questionnaire-8 DDS = Diabetes Distress Scale DEPS-R = Diabetes Eating Problem Survey-Revised.

Screening guidelines for Chlamydia trachomatis infection. Evaluating physician awareness, agreement, and use.

OBJECTIVE: To assess whether physicians were aware of, agreed with, and followed the "1989 Canadian Guidelines for Screening for Chlamydia Trachomatis Infection "as they applied to screening asymptomatic women. DESIGN: A survey consisting of direct questions and case scenarios was scored according to the responses given in the guidelines. SETTING: Six hospital family practice teaching units in downtown Toronto. PARTICIPANTS: Of 153 staff physicians and residents surveyed (all staff and residents registered with the Department of Family and Community Medicine of the University of Toronto for the 1990-1991 academic year), a volunteer sample of 118 responded to a questionnaire through the mail. MAIN OUTCOME MEASURES: Reported awareness, agreement, and use of C trachomatis guidelines for screening asymptomatic women were analyzed using frequency distributions and cross-tabulations. RESULTS: Most (69%) respondents were unaware of the guidelines. Of those who were aware, 46% agreed with the guidelines and 39% claimed to follow the guidelines. Staff physicians appeared to be more aware of guidelines than family medicine residents (P = 0.0175, psi 2 = 11.98); P values less than 0.05 were considered statistically significant. There was no statistically significant association between total scores and physicians' reported awareness of guidelines (P = 0.2287, psi 2 = 4.321). CONCLUSIONS: Most physicians in the sample were unaware of the guidelines. Of physicians who reported awareness of the guidelines, less than half agreed with or routinely followed them. Better methods of influencing physician behaviour must be developed before more guidelines are designed and distributed.