20-year-old man • sudden-onset chest pain • worsening pain with cough and exertion • Dx?

► Sudden-onset chest pain ► Worsening pain with cough and exertion ► No improvement with naproxen.

Early identification and intervention for behavior problems in primary care: a comparison of two abbreviated versions of parent-child interaction therapy.

Behavioral screening and preventive intervention were implemented for 3- to 6-year-olds in pediatric primary care with subclinical behavior problems. One hundred eleven children were screened with the Eyberg Child Behavior Inventory. Thirty children who scored within one standard deviation of the normative mean whose mothers indicated wanting help for their child's behavior were randomized to one of two abbreviated versions of Parent-Child Interaction Therapy (PCIT) for use in pediatric primary care: (a) a 4-session group preventive intervention called Primary Care PCIT (PC-PCIT); or (b) written materials describing basic steps of PCIT and guidelines for practice, called PCIT Anticipatory Guidance (PCIT-AG). Decreases in child problem behaviors and ineffective parenting strategies, and increases in parental feelings of control were not significantly different between versions at post-intervention or 6-month follow-up. Changes during intervention were significantly larger for both groups than changes during pretreatment baseline, with moderate to large effect sizes. These brief versions of PCIT are both promising primary care preventive interventions that deserve further study.

Mental health services for preschool children in primary care: a survey of maternal attitudes and beliefs.

OBJECTIVE: This study examined maternal attitudes and practices that may prevent preschoolers from receiving needed mental health services. METHODS: Mothers of 110 children ages 3-6 completed a survey of maternal attitudes and practices and the Eyberg Child Behavior Inventory (ECBI). RESULTS: Mothers wanted pediatrician assistance with child behavior concerns. Mothers of children with elevated ECBI scores reported most often discussing disruptive behaviors with their pediatrician, and preferred clinician-provided services, whereas mothers of children with normal range ECBI scores most often discussed developmental issues with the pediatrician and preferred parenting help from handouts and books. Mothers reported receiving clinician-provided services almost never. CONCLUSIONS: Mothers were open to psychosocial services for child behavior problems, particularly via primary care, and ratings of barriers were relatively low despite reporting infrequent service use. Mothers' responses highlight the need for mental health providers in primary care to ensure accessibility of desired services.