Abuse Screening Research Articles

Cannabis addiction in Tunisia: sociodemographic profile and neuropsychological complications

IntroductionCannabis consumption constitutes a public health problem both because of its serious repercussions and complications and the psychological and social problems it causes.ObjectivesOur objective was to assess the level of cannabis dependence in consumers receiving care at the Sfax detoxification center in Tunisia, to describe the sociodemographic profile of these consumers and the neuropsychological complications that may be caused.MethodsWe conducted a cross-sectional study, over a period of 13 months (September 2020 to October 2021), among cannabis users consulting the Sfax detoxification center in Tunisia. We used the Cannabis Abuse Screening Test (CAST) in order to detect a “problematic” cannabis use, along with a clinical information sheet to collect epidemiological and clinical data. All patients gave their free and informed oral consent to participate in the survey while ensuring anonymity.ResultsWe included 38 patients. The average age was 26 years old with a median age of starting cannabis use at 17 years old. The sex ratio was 8.5 with an over-representation of men. Most of the subjects were single, lived with their family and had a secondary school education. Consumption was daily for the majority of patients (68.5%) with an average quantity of 4 joints/day. According to the CAST scale, 36 users (94.7%) had problematic cannabis use. The factors favouring cannabis consumption were stress and anxiety in 34 patients (89.5%) followed by depression and the festive atmosphere in 14 subjects (36.8%) each. Among the participants, 26.3% had a psychiatric history including depression (5.3%), a psychopathic personality disorder (10.5%) and cannabis-induced psychotic disorder (10.5%). History of psychiatric hospitalization and history of suicide attempt were found in 21.1% and 26.3% of the patients respectively. Concerning the complications caused by cannabis, 68.4% of the patients described a phenomenon of tolerance, while 63.2% reported the sensation of craving. Psychotic symptoms such as delirium and/or hallucinations were found in 6 patients (15.8%) and 8 subjects (21.1%) reported a history of overdose in the form of cannabis psychosis. Chronic complications were an amotivational syndrome (63.2%) and social disintegration (52.6%). Treatment of cannabis dependence was considered effective with total withdrawal in 31.6% of subjects. Weaning was partial in 42.1% of the patients.ConclusionsCannabis use is emerging as one among many interacting factors that can affect psychological and physical health, with an impact on various levels including mood, neurocognition and general health. Although studies have shown functional brain mechanisms underlying the effects of cannabis, the exact mechanisms remain unclear. Overall, treatment for substance use disorders generally prevents these complications and improves prognosis.Disclosure of InterestNone Declared

Protocolized abuse screening to decrease provider bias and increase capture of potential events

BackgroundEarly identification of child abuse is critical to prevent death and disability. Studies suggest implicit bias of providers may lead to overrepresentation of minority and impoverished children in child abuse reporting. At our institution, universal screening for sexual and physical abuse for all children under 18 years of age was implemented in 2016. A rigorous, objective evaluation protocol focusing on the mechanism of injury and exam findings to improve recognition and eliminate bias was implemented in 2019.FindingsDemographics and clinical characteristics of patients less than 18 years of age were abstracted by chart review (2014–2015) and from a forensic database (2016–2022). International Classification of Diseases codes 995.5 (version 9) and T76.12XA (version 10) were used to identify patients before the establishment of forensic database. Relative frequency and patient characteristics of the three time periods (pre universal screening: 2014–2015, post universal screening: 2016–2019, post protocol implementation: 2020–2022) were compared using Chi-square tests and modified Poisson regression. Universal screening significantly increased the number of cases identified. The demographic profile of potential victims by race significantly changed over the reporting periods with an increased number of white children identified, consistent with state demographics. The proportion of publicly insured patients trended down with universal screening and protocol implementation, despite a significant increase in the number of children publicly insured in the state during this time.ConclusionThese single institutional results lend support to objective, evidence-based protocols to help eliminate bias surrounding race and poverty.

DRUG AND ALCOHOL USE IN ORTHOPAEDIC TRAUMA PATIENTS: A PROSPECTIVE STUDY

The objective of this study is to prospectively investigate the prevalence, patterns, and correlates of drug and alcohol use among orthopaedic trauma patients. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Jinnah Postgraduate Medical Center from 01/09/23 to 29/02/24. Baseline data was collected upon admission and included demographic information (such as age and gender) and a comprehensive assessment of substance use history. Substance use was assessed using validated screening tools, including the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST), to capture patterns of alcohol and drug use, frequency, duration, and any previous treatment history for substance use disorders. In the present study, the prevalence of drug and alcohol use among the orthopedic traumatic participants was (40%). Among them, the majority (51%) were using alcohol, followed by marijuana use (25%), and then cocaine (11%). The means of hospital stay of participants in substance non-users and users (2.4±0.8 vs. 6.83±1.1; P<0.0001). Pre-injury alcohol and drug use appear to correlate with extended hospital stays among patients with traumatic orthopaedic injuries.

Prevalence and associated factors of substance use disorders among people who use drugs: a population-based cross-sectional study in the Western Province of Sri Lanka

Introduction: This study aimed to assess the prevalence of substance use disorders and associated factors among people who use drugs in the Western Province of Sri Lanka. Methods: A cross-sectional study was conducted in the Western Province of Sri Lanka, using a respondent-driven sampling technique. Sampling was initiated with 20 seeds and peers were recruited by peers through handing out coupons. The number of recruited participants was proportional to the estimated number of people who use drugs in each district of Western Province. A total of 870 people who use drugs participated in the study. A validated Sinhala version of the Drug Abuse Screening Test was used to assess the drug use severity among the participants and a pre-tested validated questionnaire was used to collect data to assess the associated factors. RDS Analyst software version 0.64 was used to assess frequency estimates. To assess factors associated with substance use disorders multiple logistic regression analysis was performed using SPSS software version 22. Results: The median age of the study sample was 39 years. The incidence of substance use disorder among the sample was 88.4%. Being employed, using heroin as a psychoactive drug, using drugs daily, using more than one drug, being a heavy alcohol user, buying drugs, stealing money or exchanging goods to get drugs, spending a substantial amount per month on drugs (Rs > 40,001), past or present medical history of tuberculosis and those who had disclosed their drug use behavior to their immediate family were found to be significantly associated with an increased risk of having a substance use disorder. Conclusion: A high prevalence of substance use disorder was found in the sample with multiple economic, behavioral, and health-related risk factors.

Self-Harming Behaviors and Psychopathy Traits in Abused Children

This study aimed to explore child abuse and neglect in relation to psychopathy and self-harming behaviors. A cross-sectional correlational research design was used to carry out the research. A sample of 100 children (50 boys & 50 girls) was selected at age ranging from 12-18 years through purposive sampling. The data was collected from two NGOs in Lahore through purposive sampling. An adapted and translated Child Abuse Screening Tool was used to identify children with different levels and types of abuse and neglect. Urdu version of the Youth Psychopathy Inventory was used to find out psychopathy traits. The deliberate Self-Harm Inventory was translated into Urdu for the purpose of assessing self-harm behavior in participants along with a demographic questionnaire. Pearson product-moment correlation showed there was no significant relationship between psychopathy and child abuse. It was identified that there were no significant gender differences between psychopathy traits and self-harming behaviors in abused children. The current study is significant because it addresses the pressing public issue prevailing in the country day by day, and it has a negative impact on the victim’s survival. The findings revealed that child abuse leads victims towards self-harm and can develop psychopathic traits. On the basis of results, further study is needed to be conducted on these variables, as self-harm was more reported in abused children as compared to psychopathic traits. The variables used in this study needed to be addressed broadly to evaluate the clear impact of abuse in this study, the limitation was the availability of limited data due to the sensitivity of the topic or legal issues that could be addressed in future studies.

Revealing the Unseen: Detecting Negative Symptoms in Students.

Background: The transnosographic nature of negative symptoms (NS) makes them fruitful for detecting psychiatric symptoms. The main objective of this study was to determine whether NS can be useful in screening for ultra-high risk of psychosis (UHR) or depressive symptoms in the no-help-seeking student population. The most prevalent NS and their relationship with cannabis use were also researched. Methods: From an online survey sent to students, 2128 filled out the Self-evaluation of Negative Symptoms (SNS), Prodromal Questionnaire 16 (PQ-16), Beck Depression Inventory (BDI), and Cannabis Abuse Screening Test (CAST). Results: 367 students (17.2%, 95% CI [15.6-18.9]) were considered to have UHR (PQ-16 distress score ≥ 9) and/or depression (BDI ≥ 16). The receiver operation characteristic curve showed that a threshold of 13 for the SNS score discriminated this subgroup of students with a sensitivity and specificity of 79.8% and 70.6%, respectively. The motivational dimension was overrepresented and linked to cannabis use. Conclusions: The early detection of NS in the no-help-seeking student population is relevant for detecting depressive and prodromal symptoms. This will enable early intervention to limit the progression to chronic mental disorders. The predominance of NS linked to the amotivational dimension was observed and related to cannabis use.

Integration of Substance Use Screening Into the Electronic Health Record for Adolescent Trauma Patients: A Quality Improvement Project.

Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers. This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma. This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12-21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12months of preintervention data (January 2021 through January 2022) to 15months of postintervention data (February 2022 through May 2023). A total of N =241 patients met inclusion criteria, of which most were male, n =168 (69.7%), White n =185 (76.8%), and Hispanic n =179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%. Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.

Prevalence of Loneliness in Older Adults in Rural Population and Its Association with Depression and Caregiver Abuse.

Loneliness in the elderly is of public health importance as it is a risk factor for adverse consequences. There is lack of data on loneliness among the elderly population of India, especially those residing in a rural community. To estimate loneliness and its association with depression and caregiver abuse. A cross-sectional study was conducted in a rural health clinic in North India. 125 elderly persons were evaluated on the UCLA Loneliness Scale, Patient Health Questionnaire-15, Geriatric Depression Rating Scale‑30 (GDS), and Caregiver Abuse Screening (CASE) scale. 67.6 years was the mean age of the study's subjects, with a mean number of years of education of 2.9. Most were female, married, and from lower socioeconomic status and belonged to a non-nuclear family. The prevalence of loneliness was 66.4%. Regarding specific features, subjects reported a lack of companionship (64.8%), being left out in life (45.2%), and being isolated from others (52.8%). The severity of depression, somatization, psychological and physical abuse, neglect abuse, and caregiver abuse had a significant positive association with loneliness. Those with a presence of loneliness scored higher on GDS and CASE than those without. Those who were single at the time of the study reported significantly more loneliness than married ones. Those from nuclear families and middle socioeconomic status reported a significantly higher level of loneliness. Loneliness among the elderly rural population is significantly high. The severity of loneliness is associated with higher severity of depression, somatization, and caregiver abuse.

The Implementation of a Clinical Pathway to Improve Child Abuse Screening in Young Children With Fractures: A Quality Improvement Analysis

The American Academy of Pediatrics recommends screening children under 2 years of age with a concerning fracture for physical abuse with a skeletal survey (SS). Nationally, 30% to 77% of children are not screened appropriately in emergency department settings. After implementation of an electronic clinical pathway for pediatric emergency department providers, guideline adherence improved from 61% to 81%. Among infants, SS performance increased from 79% to 81%. More non-White children received an SS, indicating potential implicit bias in screening practices. The results support clinical pathways to improve guideline adherence while promoting further examination of providers’ determination of screening needs.

Incomplete Fractures of Distal Long Bones Among Children in Early Stages of Mobility: Few Concerns for Physical Child Abuse at a Single Pediatric Level I Trauma Center.

This study aimed to describe the characteristics, reported mechanism of injury, fracture morphology, and level of physical abuse concern among children in the early stages of mobility diagnosed with an incomplete distal extremity long bone fracture. A retrospective chart review was performed for all children aged 10 to 12 months with an incomplete fracture of a distal forearm or distal lower limb who were reportedly pulling up, cruising, or ambulating, and who were evaluated by the child abuse pediatrics team at a single pediatric level I trauma center. Of the 29 patients who met inclusion criteria, the child abuse pediatrics team had concerns about physical child abuse for 3 children. Not every case with an unknown or discrepant history of injury was deemed concerning for abuse, but all 3 for whom the team determined that concern was warranted had an unknown or discrepant history. All 3 of these children had distal forearm fractures; 1 child had multiple concomitant fractures (including a scapular fracture), and 2 had evidence of bone healing at initial presentation. Each of these observations raises concern for abusive injury based on current evidence. Both-bone buckle fractures of the radius/ulna and tibia/fibula were the most common type of incomplete distal fracture. This age group presents a unique challenge when designing evidence-based algorithms for the detection of occult injuries in emergency departments. Incomplete fractures of a distal limb are commonly related to a fall and may be considered "low specificity" for physical abuse. However, some publications conclude they should prompt universal physical abuse screening. Our small study indicated that the presence or absence of certain risk factors may provide additional information which could help guide the need for a more thorough evaluation for occult injury in early-mobile children with incomplete distal extremity long bone fractures. Ongoing research is warranted.

Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults.

Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia. Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes. AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes. Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.

Methods and tools to screen and assess risks for intimate partner violence among women from culturally and linguistically diverse backgrounds in six high-income countries: A scoping review

Abstract Purpose The purpose of this review is to collate literature on approaches to screening women from culturally and linguistically diverse (CaLD) backgrounds for experiences of intimate partner violence (IPV) and assessing risks, with a view to identifying examples of best practice and research gaps. Methods A scoping review methodology was adopted. Medline (Ovid), Embase, CINALH and CENTRAL databases were searched, with supplementary searches for grey literature. Results were independently screened by two reviewers. Studies were included if they focused on women from CaLD backgrounds living in Australia, Canada, Ireland, New Zealand, United Kingdom or United States of America being screened/assessed in a health setting in relation to IPV. Data on study characteristics and key findings were extracted and critical appraisal of study quality was performed. Results A total of n = 1,320 results were yielded. After deduplication, the titles and abstracts of n = 846 studies were screened. A total of n = 5 studies were included in the final analysis, and four screening or risk assessment tools/methods were assessed (Danger Assessment for Immigrant Women, Safe Start, Index of Spouse Abuse and Southern Asian Violence Screen). Conclusions Given the documented barriers to migrant help-seeking, screening and risk assessment has an important role to play in ensuring that women from CaLD backgrounds are linked into appropriate IPV support services in a timely manner. However, there is very limited evidence to demonstrate that existing screening/risk assessment tools and strategies meet the specific needs of CaLD populations, and more attention needs to be given to intersectional experiences of violence.

Psychological Distress and Substance Abuse as Predictors of Psychological Well-Being of Smallholder Farmers’ in Makurdi Local Government Area of Benue State.

Farmers work hard throughout the seasons to produce food and meet Sustainable Development Goal 2, which aims to eliminate all forms of hunger by 2030 and achieve food security. Understanding the psychological distress that smallholder farmers’ experience is critical to advancing food and nutrition security. According to research, farmers are particularly vulnerable to psychological distress. Depression, anxiety, stress, and substance abuse were investigated as predictors of farmers’ psychological well-being in Makurdi Local Government Area, Benue State. The study included 355 farmers from four communities in Kighir and Adem, Apir, and Adeke, chosen at random. Five hypotheses were proposed and tested.Data were gathered using the Depression, Anxiety, and Stress Scale (DASS-21), the Drug Abuse Screen Test (DAST-10), and the Psychological Well-Being Scale (PWB-18). Using Multiple Linear Regression for data analysis, results from the four-hypothesis showed that depression, anxiety, stress, and substance abuse all had a significant negative impact on farmers’ psychological well-being. The fifth hypothesis (β= -0.262, t= -2.637, P< 0.05 and β= -0.211, t= -2.135, P< 0.05) found that depression and stress jointly have a significant negative impact on farmers’ psychological well-being. The study recommends that the federal, state, and local governments, non-governmental organizations, philanthropists, and private sector actors take immediate action to address the causes of distress in farming communities and provide farmers with access to psychological services in farming communities. In conclusion, the study emphasizes the critical need for psychological research, citing the study’s population and psychological well-being as important topics in mental health discussions.

Violência doméstica, obesidade e desnutrição em pessoas idosas de uma capital do Sul do Brasil - Estudo EpiFloripa Idoso

Abstract The objective of this article was to verify the association between domestic violence and obesity and malnutrition in elderly people in Florianópolis, Santa Catarina, Brazil. Cross-sectional study evaluated in the EpiFloripa Elderly cohort in 2013/2014. The outcomes were body mass index (BMI) and abdominal obesity (increased WC). Violence against elderly people was measured using the HawlekSengstock Elder Abuse Screening Test (H-S/EAST) instrument, and IPV using the Conflict Tatics Scales Form R (CTS-1) instrument. Logistic regression and multinomial logistic regression models were used. It was observed that men had a greater chance of abdominal obesity when in situations of violence and in the potential abuse dimension. Women were more likely to have abdominal obesity in the dimension of violation of personal rights or abuse, when they suffered IPV and when they were perpetrators of IPV. In relation to BMI, elderly women in situations of violence were associated with a greater chance of being overweight and those who suffered IPV. On the other hand, men in vulnerable situations were more likely to be underweight. It is concluded that violence against elderly people and IPV generate an asymmetric impact on nutritional status in relation to sex.

Evaluation of elder abuse in elderly patients presenting to an emergency department

With the increase in the elderly population worldwide, elder abuse and neglect cases are not increasing gradually. Elder abuse is not only physical abuse but also sexual, psychological, and economic. This study aimed to evaluate the findings of elderly individuals admitted to an emergency department for abuse and neglect. This study was performed on patients aged 65 years and older who were admitted to the emergency department of a tertiary care hospital. Between January 1, 2019 and January 4, 2019, a presurvey and the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) were administered. Among the elderly included in this study, 48.8% (n=240) were female and 51.2% (n=252) were male. The total scores of the general test were found to be statistically significantly higher (p<0.05) in the elderly who were living alone, widowed, illiterate, unemployed, did not have children, came to the emergency department with trauma findings, had a history of more than one previous trauma, or who felt that they had recently been subjected to violence or physically, psychologically, or economically abused. It should be kept in mind that elderly patients admitted to an emergency department may suffer from elder abuse and neglect. Providing the right communication and appropriate environment to detect elder abuse is important for diagnosis, treatment, and rehabilitation.

Evaluation of the Urine Drug Abuse Screening Tests.

Substance use is an important public health problem and increasing all over the world. Different methods have been defined for drug abuse testing in medical laboratories. We aimed to compare two urine drug screening methods with liquid chromatography-tandem mass spectrometry (LC-MS/MS). A total of 102 patients' urine samples were analyzed by test dip card and EMIT (enzyme multiplied im-munoassay technique). Randomly selected samples (n = 51; 50%) were also analyzed by LC-MS/MS as the reference method. The drug results of all patients analyzed with the test card and EMIT were compatible. Nine of 51 samples (18%) were negative according to all methods. The sensitivity and specificity percentages of AMP, COC, MDMA, OPI/MOP, and THC using test card were 70/96, 100/100, 47/100, 50/100, and 80/85, respectively. Similarly, the sensitivity and specificity percentages of AMP, COC, MDMA, OPI/MOP, and THC using EMIT were 76/97, 100/100, 57/100, 56/100, and 76/91, respectively. The performances of two immunochemical methods were similar for AMP, BZO, COC, MDMA, OPI/MOP, and THC whereas lower than LCMS/MS for AMP, MDMA, OPI/MOP, and THC. A sample that is positive according to any immunochemical method should be confirmed by definitive techniques such as LC-MS/MS.

Performance Evaluation of Multi-Drug Rapid Test for Rapid Detection of Multiple Drugs and Drug Metabolites in Human Blood Samples

Objective: The Multi-Drug Rapid Test Cassette, developed by Hangzhou AllTest Biotech Co., Ltd, is a rapid chromatographic immunoassay designed for the qualitative detection of multiple drugs and drug metabolites in human whole blood, serum, or plasma. It aims to simultaneously detect various abused substances, including Amphetamine (AMP), Barbiturates (BAR), Benzodiazepines (BZO), Buprenorphine (BUP), Cocaine (COC), Cannabis (THC), Methadone (MTD), Methamphetamine (MET), 3,4-Methylenedioxymethamphetamine (MDMA), Morphine (MOP/OPI), Propoxyphene (PPX), Tricyclic antidepressants (TCA), Oxycodone (OXY), 2-Ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), Cotinine (COT), Tramadol (TML), Fentanyl (FYL), 3,4-Methylenedioxy pyrovalerone (MDPV), Synthetic cannabinoids(K2), Phencyclidine(PCP), Ketamine(KET), Lysergic acid diethylamide(LSD), 3,4-Methylenedioxyamphetamine(MDA), Acetaminophen(ACE), Ketamine(CAT), 6-Monoacetylmorphine (6-MAM), Zolpidem (ZOL), AB-PINACA (ABP/K3). Therefore, the present research was done to evaluate the diagnostic performance of this test. Material and Method: In this study, the accuracy, precision, and sensitivity of the drug testing methods were assessed. Approximately 100 specimens of each drug, obtained from previous drug screening tests, were tested. The results were compared to confirmatory analysis using GC/MS, and the accuracy of the testing was determined based on the comparative classification results. The evaluation of precision included measuring the consistency of measurements within a single run, between different runs, and among different operators, using the AllTest multi-drug detection tool across three different hospitals and three different batches. To evaluate the sensitivity of the detection method, various concentrations of drugs were added to a pool of whole blood, serum, or plasma without any drugs. The positive and negative results obtained from the testing were analyzed to assess the method’s ability to detect drugs at different concentrations. Results: In this study, we evaluated the performance of the Multi-Drug Rapid Test Cassette developed by Hangzhou AllTest Biotech Co., Ltd. The results demonstrated excellent performance of the test in terms of accuracy, sensitivity, and precision. Conclusion: The Multi-Drug Rapid Test Cassette developed by Hangzhou AllTest Biotech Co., Ltd exhibited reliable detection of multiple drugs and drug metabolites, providing trustworthy results for drug abuse screening. These findings have significant implications for drug control and monitoring, as well as supporting the broad application of this test in clinical and legal settings.

Why Substance Use Screening Frequency Matters in Adult Primary Care.

Evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time. Quantitative data were obtained from seven primary care sites implementing SBIRT, with patients who were screened twice using the Drug Abuse Screening Test, US Alcohol Use Disorders Identification Test, or the Alcohol, Smoking, and Substance Involvement Screening Test and experienced any risk category change (n = 1,364). Patients were 49% male, 51% female, 81% White, and 14% Black. An intercept-only generalized estimating equation model tested whether category changes between screen one and screen two were statistically significant. The average number of months between screenings for those experiencing a risk category change was 9.01 with a range of 0 to 46 months. There was a statistically significant change between screening one and screening two (P > 0.001), with 44% undergoing a decrease in risk category and 56% undergoing an increase in risk category. Of those undergoing an increase in risk category, 91% moved from a negative/low risk category to a positive/higher risk category. Results suggest that frequent screening policies may improve identification of substance use risk category changes. The results act as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection.

Defining trimester-specific reference intervals for carbohydrate deficient transferrin in pregnant women

ObjectivesExtensive consumption of alcohol during pregnancy can lead to severe complications for the unborn child. Carbohydrate-deficient transferrin (CDT) levels in serum have become a common biomarker for excessive alcohol intake. However, during pregnancy CDT levels can rise to levels above commonly used cut-off values, for reasons unrelated to alcohol intake. The aim of this study is to investigate the changes in CDT values during pregnancy and to determine accurate, trimester dependent reference intervals. Methods439 serum samples of 147 healthy pregnant women were obtained for trimester 1, 2, 3, and post-partum and were analysed by high-performance liquid chromatography (HPLC) and an N-Latex immunonephelometric assay. New trimester-specific reference intervals were established. ResultsThis study demonstrates there is a trimester-dependent increase of %CDT, as up to 39.4% of the population exceeded the previously established upper reference limit of 1.7%. In our study the estimated upper reference limit for %DST/%CDT were 1.55%, 1.96%, 2.05% and 1.35% for trimester 1, 2, 3 and post-partum for the HPLC-method and 2.02%, 2.19%, 2.19% and 1.96% for the N-Latex immunoassay. ConclusionsWe demonstrate that CDT levels rise during pregnancy. The magnitude of the increase is method-dependent and needs to be taken into account. We have established method- and trimester-specific reference intervals to prevent false-positive results in alcohol abuse screening tests during pregnancy.

Breaking the Silence: Investigating the Prevalence and Key Risk Factors of Child Maltreatment among Male Working Children in a Rural Community in Bangladesh

Introduction. Child labor is widely regarded as one of the most severe forms of child maltreatment (CM), but little is known about how working children, especially in low-income countries like Bangladesh, experience different forms of CM. This paper explores the extent of physical, psychological, and sexual abuse and neglect experienced by working children and determines the important risk factors for these forms of CM among them. Methods. This cross-sectional study included 398 working children from four local Bazars (rural marketplace) of Raiganj Upazila, Sirajganj district, who were enrolled in this study in March and April of 2017, through a snowball approach, due to a lack of a list of working children. The International Child Abuse Screening Tools for Children (ICAST-C) was used to estimate the different forms of CM in this study. Results. Lifetime prevalence of psychological abuse (PsyA), physical abuse (PA), neglect, and sexual abuse (SA) were 100%, 100%, 82.7%, and 13.5%, while the past year prevalence rates were 100%, 84.2%, 67.1%, and 9.9%, respectively. Common forms of PsyA experienced by children include shouting, yelling, or screaming, as well as restrictions on outings and time-outs. PA typically involves slapping on the face or head, hitting with objects (excluding the buttocks), and ear twisting. Watching pornography is the primary form of SA, while the leading form of neglect is unmet medical needs. The prevalence of PsyA, PA, SA, and neglect was higher among children who lived with individuals other than their parents. Both PsyA and PA were found to be associated with family violence, such as the presence of weapons in the household and adults engaging in frightening screaming behavior. Additionally, children who were bullied by their siblings, had a parent with a primary level of education or less, and always felt safe at home were at an increased risk of experiencing PA. Children who did not feel safe at home all the time were more likely to experience SA. Furthermore, for every one-year increase in schooling, the likelihood of experiencing neglect decreased by 8.3% (B: -.157, P value < .003). Conclusion. Nearly all male working children in rural areas of Bangladesh experienced PsyA and PA, and adult negligence was also prevalent. Although male SA is not a widely discussed issue in Bangladesh, the results of this study are alarming.