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Behavioral parenting interventions can enhance positive parenting practice, which is crucial in preventing maltreatment and promoting child well-being. Primary care has been increasingly recognized as an underutilized platform to widely disseminate evidence-based parenting interventions, given parents' ongoing access to primary care without stigma and the perceptions toward health-care providers as a trustworthy source of information about positive parenting. This study sought to explore the effects of primary care-based parenting interventions on parenting practice and child behavioral outcomes while examining the types of and the theories of change underlying these interventions. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Randomized controlled trials or quasi-experimental studies of interventions targeting caregivers of children aged between 1 and 17 were included in the review. Information sources included electronic databases, relevant government and private organizational websites, and expert consultations. The final sample included 17 studies focusing on 10 interventions. Positive results were found in knowledge gain, locus of control, monitoring, parent-child interactions, and negative discipline. Child behavior outcomes were inconsistent as most studies reported nonsignificant changes while one study reported significant intervention effects on various externalizing behaviors. A limited number of studies described the process of adapting, installing, and implementing the interventions in primary care. Future studies should examine the types, dosages, and delivery formats that are most suitable and sustainable in the context of primary care to maximize its utility in promoting child well-being while preventing maltreatment through integrated behavioral parenting interventions.

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Ms Morrison had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

BACKGROUND Management of basal cell carcinoma (BCC) varies by histopathologic subtype; however, biopsies may inadequately characterize them as nonaggressive, risking potential suboptimal treatment. OBJECTIVE To characterize the rate of undetected aggressive BCC subtypes by size, location, and histopathology type. MATERIALS AND METHODS Retrospective cohort study of 928 BCCs treated with Mohs Micrographic Surgery (MMS) at a tertiary academic institution from 2015 to 2017, comparing patient and tumor characteristics and histopathologic subtype on biopsy versus Mohs. RESULTS Among the 825 BCCs with known subtypes on biopsy, 68% (561/825) were classified as nonaggressive, 28% (159/561) of which were subsequently found to have aggressive subtypes on MMS. Aggressive features were more often underrepresented in biopsy samples taken from Area H compared with Area M/L (odd ratio [OR] 2.65, 95% confidence interval [CI] 1.73-4.08, p , .001) or those with nodular subtypes (OR 2.19, CI 1.08-4.45, p 5 .03). Of concern, these unsuspected aggressive BCCs required more Mohs stages for clearance (mean 2.37, SD 0.72, p , .001) compared with BCCs that remained nonaggressive on both biopsy and Mohs (mean 1.50, SD 0.75). CONCLUSION Given the high percentage of BCCs with unsuspected aggressive subtypes, higher clinical suspicion for undiagnosed high-risk BCCs should be given to nodular BCCs and to BCCs on Area H.