Screen-positive Rate Research Articles

Adverse childhood experiences screening in pediatric primary care and changes in the rate of visits to social work and behavioral health

BackgroundThere is increasing interest in screening for adverse childhood experiences in pediatric primary care, but no evidence of the actual consequences on behavioral/mental health services. This study tested the association between initiation of ACEs screening in pediatric primary care and changes in the rate of referrals to social work and visits to social work and behavioral health.MethodsData came from the electronic health records of children and adolescents between 2 and 18 years old who were members of a large integrated healthcare system serving Southern California (N = 513,812). Poisson regression was used to compare the rate of referrals and visits to social work and behavioral health visits for clinics doing standardized ACEs screening (i.e., intervention clinics; n = 28) versus clinics not screening (i.e., control clinics; n = 64) during June 1-December 31 2022 as well as for these same months in 2020 and 2021.ResultsIntervention clinics had an average screening rate of 57% (range 26.8 to 91.9%) and an average positive screen rate of 11% (range 1.6–25.1%). The difference in the adjusted rate from 2021 to 2022 was significantly different between intervention and control clinics for referrals to social work (RR 1.48, 95% CI 1.25, 1.74), but was not statistically different for visits to social work or behavioral health.ConclusionsThe findings suggest that ACEs screening does not significantly increase the rates of social work and behavioral health visits, although it did increase referrals to social work. We acknowledge that this may vary based on geographic areas and populations served by different healthcare systems.

P-363. Containing an Outbreak of Carbapenemase-producing Organisms in a Singapore Hospital

Abstract Background Tan Tock Seng Hospital is a 1700-bed academic teaching hospital in Singapore. Active surveillance using rapid PCR for the detection of asymptomatic carriage of carbapenemase-producing organisms (CPO) is routinely performed (Fig. 1). Where available, identified carriers are cohorted or isolated under contact precautions. We describe a hospital-wide multispecies OXA-48-like and NDM outbreak, findings from epidemiological investigations and the subsequent infection prevention and control (IPC) measures. Existing and intensified CPO screening strategies Methods Initial response included additional intensified contact tracing (Fig. 1), expansion of isolation bed capacity and audits of IPC practices. Case-control analysis involved 280 cases and 995 controls. Universal admission screening was conducted to validate the accuracy of existing high risk screening (HRS) criteria. Wards with high transmission underwent environmental sampling. Results The CPO screening positivity rate was observed to be on a steady increase during 2022/23, from a baseline of 1.3-1.7% in 2020/21, peaking at 6.5% in June 2023 (Fig. 2). Spot audits demonstrated a decrease in hand hygiene compliance, improper cleaning of shared equipment, and poor IPC practices especially during diaper changes. Isolates were predominantly Klebsiella pneumoniae and sequence type 307. OXA was the commonest carbapenemase, followed by NDM. Risk factors for acquisition were presence of an indwelling urinary catheter for OXA (adjusted odds ratio [AOR] 1.62, 95% CI 1.02-2.48, p = 0.028), exposure to third-generation cephalosporins for NDM (AOR 3.83, 95% CI, 1.86-7.92, p < 0.001) and length of stay of 15-21 days for both (AOR 3.19, 95% CI, 2.05-4.96, p < 0.001). 4.8% of OXA carriers developed clinical infection within a median of 17 days (Fig. 3). Sensitivity of HRS criteria was 70%, though compliance to screening was only 60-80%. Periods of higher transmission were associated with lower rates of CPO cohorting (Fig. 4). CPO was found in 6.9% (9/130) of environmental samples. Rate and time to onset of clinical infection for asymptomatic carriers according to CPO genotype Conclusion Drivers of the outbreak were lower rates of CPO cohorting/isolation, a decrease in IPC standards, the inadequate compliance to HRS and the introduction of a highly transmissible bacterial clone. Early detection coupled with isolation remains a key strategy to control the spread of CPO. Epidemiologic curve of the CPO outbreak in relation to cohorting efforts (%) Disclosures Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship

Evaluation of a Depression Screening Program in Pediatric Orthopaedic Sports Clinics: Identifying At-Risk Adolescents.

Mental health is a contributing factor to the overall well-being of patients, and the 2-question Patient Health Questionnaire (PHQ-2) and 9-question Patient Health Questionnaire (PHQ-9) are reliable in-clinic tools to assess depression and self-harm. The prevalence of adolescents with depression symptoms within a pediatric orthopaedic sports clinic has not been assessed. That rates of depression and risk of self-harm would vary based on presenting pathology among adolescents sustaining a sports-related injury. Cross-sectional study; Level of evidence, 3. A query of the institutional electronic medical record was performed to identify all patients aged 12 to 21 years who were administered the PHQ-2 or PHQ-9 over a 2.3-year period within pediatric orthopaedic sports clinics. The rate of a positive screen prompting administration of PHQ-9 (PHQ-2 score ≥3), rate of depression risk (PHQ-9 score ≥10), and rate of patients indicating self-harm (affirmative score on question 9) were evaluated. Patients were placed into 4 broad diagnostic categories: knee instability, knee other, shoulder pathology, or other sports-related injuries. Multivariate binary logistic regression was performed to identify available patient and diagnosis predictors of self-harm risk. A total of 3298 patients were screened in pediatric orthopaedic sports clinics from 2018 to 2021. The overall positive screen rate (PHQ-2) was 4.2% (n = 138), the depression risk rate (PHQ-9) was 1.9% (n = 63), and the self-harm rate was 0.9% (n = 29). Self-harm showed a significant difference, with shoulder and knee instability having the highest rate. Black/African American race (OR, 3.8; 95% CI, 1.3-11; P = .02), female sex (OR, 3.0; 95% CI, 1.3-6.9; P = .01), public/government insurance (OR, 2.2; 95% CI, 1.03-4.8; P = .041), shoulder pathology (OR, 3.4; 95% CI, 1.3-9.4; P = .016), and knee instability diagnosis (OR, 2.8; 95% CI, 1.2-6.5; P = .02) were associated with an increased risk of self-harm. This study demonstrated a 2% rate of depression risk and a 1% rate of self-harm risk in adolescents treated within pediatric orthopaedic sports clinics. Race, sex, and public/government insurance were found to be predictive factors. Knowledge of risk factors can help increase awareness and recognition of potential mental health conditions that may need to be addressed during treatment for adolescents with sports-related injuries. The authors recommend that adolescents >12 years of age complete this quick assessment at the start of their orthopaedic sports clinic encounter.

In Reply to Beyond the Screen Positive Rate: Racial Equity Considerations for Serum Screening for Open Neural Tube Defects.

In Reply to Beyond the Screen Positive Rate: Racial Equity Considerations for Serum Screening for Open Neural Tube Defects.

Universal Suicide Risk Screening in Pediatric Neurologic, Developmental, and Behavioral Clinics.

Suicidal thoughts and behaviors in youth have been increasing over the last 30 years, resulting in recommendations to screen for suicide risk. Our aim was to evaluate suicide risk screenings in children during outpatient care at a specialty care facility for those with neurologic, developmental, and behavioral disorders (NDBDs). This cross-sectional, retrospective study utilized suicide screening data from the Ask Suicide-Screening Questions tool administered to children attending initial outpatient visits at medical, behavioral health, or autism specialty clinics serving individuals with NDBDs. Primary outcomes included whether screening occurred or was declined, and if it yielded elevated risk for suicide. Predictive factors were examined. In total, 15,462 children aged 8 to 17 (38.4% female; 47.7% White, 26.0% Black; 21.0% Medicaid) were offered screening as part of routine care. Overall, 10,970 children underwent screening; 4492 (29.1%) declined. The probability of declined screenings was greater if children were younger, male, attended a medical clinic appointment and were offered the screening prior to the COVID-19 pandemic. The overall rate of positive screening was 10.3%. Children as young as age 8 screened positive in all settings. Positive screening rates in medical, behavioral health, and autism specialty clinics were 7.9%, 12.2%, and 12.7%, respectively. Screenings were more likely to be positive for children who were older, female, self-reported rather than caregiver-reported, and occurring within a behavioral health or autism specialty clinic. Suicide risk was identified in children across all pediatric programs, indicating strong support for universal suicide screening of children and youth in pediatric settings.

Routine 36-week scan: prediction of small-for-gestational-age neonate.

First, to compare the predictive performance of routine ultrasonographic estimated fetal weight (EFW) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation for delivery of a small-for-gestational-age (SGA) neonate. Second, to compare the predictive performance of EFW at 36 weeks' gestation for SGA vs fetal growth restriction (FGR) at birth. Third, to compare the predictive performance for delivery of a SGA neonate of EFW < 10th percentile vs a model combining maternal demographic characteristics and elements of medical history with EFW. This was a retrospective analysis of prospectively collected data in 21 676 women with a singleton pregnancy who had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 107 875 women with a singleton pregnancy who had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks. Measurements of fetal head circumference, abdominal circumference and femur length were used to calculate EFW according to the Hadlock formula and this was expressed as a percentile according to the Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used to diagnose SGA neonates with birth weight < 10th or < 3rd percentile. FGR was defined as birth weight < 10th percentile in addition to Doppler anomalies. For each gestational-age window at screening, the screen-positive rate and detection rate were calculated at different EFW cut-offs between the 10th and 50th percentiles for predicting the delivery of a SGA neonate with birth weight < 10th or < 3rd percentile, either within 2 weeks or at any time after assessment. The areas under the receiver-operating-characteristics curves (AUC) of screening for a SGA neonate by EFW at 31 + 0 to 33 + 6 weeks and at 35 + 0 to 36 + 6 weeks were compared. The predictive performance of routine ultrasonographic examination during the third trimester for delivery of a SGA neonate is higher if: first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation rather than at 31 + 0 to 33 + 6 weeks; second, the outcome measure is birth weight < 3rd rather than < 10th percentile; third, the outcome measure is FGR rather than SGA; fourth, if delivery occurs within 2 weeks after assessment rather than at any time after assessment; and fifth, prediction is performed using a model that combines maternal demographic characteristics and elements of medical history with EFW rather than EFW < 10th percentile alone. At 35 + 0 to 36 + 6 weeks' gestation, detection of ≥ 85% of SGA neonates with birth weight < 10th percentile born at any time after assessment necessitates the use of EFW < 40th percentile. Screening at this percentile cut-off predicted 95% and 98% of neonates with birth weight < 10th and < 3rd percentile, respectively, born within 2 weeks after assessment, and the respective values for neonates born at any time after assessment were 85% and 93%. Routine third-trimester ultrasonographic screening for a SGA neonate performs best when the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation, rather than at 31 + 0 to 33 + 6 weeks, and when EFW is combined with maternal risk factors to estimate the patient-specific risk. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prospective multicenter cohort study on breast cancer screening using an automated breast ultrasound with remote reading

Objective: To construct a remote screening network for breast cancer based on automated breast ultrasound (ABUS) and explore the value of ABUS with remote reading for breast cancer screening. Methods: We constructed a remote breast cancer screening network including one remote reading center and 48 image-acquisition centers. We recruited women to participate in breast cancer screening at one of these image-acquisition centers from January 2021 to January 2023. The technicians collected the whole breast images using the ABUS. The images were then sent to the reading center through the PVBUS System and interpreted independently by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1 and 2 indicate negative screening results, and women diagnosed with these categories were recommended for annual breast ultrasound screening. BI-RADS categories 3, 4, and 5 indicate positive results. Women with BI-RADS category 3 lesions were recommended for follow-up examinations every 6 months using ABUS or handheld ultrasound, while those with BI-RADS 4 and 5 lesions were suggested to undergo pathological examinations. Results: In our study, we enrolled 10 344 women who completed the ABUS screening and were followed up for more than 12 months. After remote reading, 6 164 women were diagnosed with BI-RADS category 1 and 2 626 woman were within BI-RADS category 2. In contrast, 1 404 women were within BI-RADS category 3, a total of 135 women were within BI-RADS category 4, and 15 women were within BI-RADS category 5. The positive screening rate of ABUS was 15.0% (1 554/10 344). The ABUS with remote reading had a detection rate of 3.7/1 000 (38/10 344) for breast cancer screening, with a sensitivity of 97.4% (38/39) and a specificity of 85.3% (8 789/10 305). Among the 38 breast cancer cases detected, 92.1% (35/38) were invasive carcinomas, and 63.2% (24/38) were stage 0 or Ⅰ breast cancers. Conclusions: Breast cancer screening based on ABUS with remote reading provided an efficient and feasible solution to the problem of unevenly distributed medical resources and medical staff levels in various regions of China, enabling the decentralization of high-quality medical resources and improving the accessibility of high-quality screening services. It has provided an alternative for breast cancer screening in China.

Social Determinants of Health in Cerebral Palsy.

Background/Objectives: To describe social and psychological needs, such as poverty, early trauma, or adverse childhood events, of caregivers with a child newly diagnosed with cerebral palsy (CP) or receiving a designation of high-risk for cerebral palsy (HRCP). Methods: Caregiver self-report questionnaires screening for unmet social needs, adverse childhood experiences (ACEs), depression symptoms, and trauma were collected from 97 caregivers of children with CP/HRCP seen in a high-risk infant follow-up clinic (adjusted age range 1-24 months). We compared their responses to those of 97 caregivers of age-matched controls seen in the same clinic with similar risk factors over the equivalent time period. Results: Income insecurity and positive screening rate for depressive and trauma symptoms were high for both groups (CP/HRCP, matched control group); no differences were found between CP/HRCP and control groups. Rates of food and housing insecurity and caregiver ACEs were not different between groups. All families received referrals to appropriate community support at the visit. Conclusions: Caregivers of children with CP/HRCP in high-risk infant follow-up clinics may face difficult conversations and decision-making in the context of high psychological and social adversity. Comprehensive support should be considered as early as possible.

Cystic Fibrosis Screening Efficacy and Seasonal Variation in California: 15-Year Comparison of IRT Cutoffs Versus Daily Percentile for First-Tier Testing.

The California Genetic Disease Screening Program (GDSP) employs a fixed immunoreactive trypsinogen (IRT) cutoff followed by molecular testing to screen newborns for cystic fibrosis (CF). The cutoffs approximate a 1.6% yearly IRT screen-positive rate; however, seasonal variation in IRT population means has led us to develop a model to establish fixed IRT cutoffs that anticipate seasonal variation and minimize missed cases below cutoff. We utilized an ARIMA model to fit monthly IRT screen-positive percentiles and estimated regular seasonal expectations. We established a retrospective cohort followed for at least 1.5 years to capture missed false-negative CF cases. We compared missed CF cases identified by seasonal cutoffs vs. floating cutoffs. GDSP screened 7,410,003 newborns, from July 2007 to December 2022, and missed 36 CF cases below the fixed cutoff; five of the 36 were within 3 ng/mL below the cutoff. There was a regular, seasonal cycle that varied from 1.4% in summer to 1.8% in winter. We would have missed 59 CF cases using a 1.6% daily floating cutoff. California would need to use a 4% daily floating cutoff to improve our current detection rate, which would double the number of specimens sent for costly molecular analysis.

Continuous Risk Assessment of Late and Term Preeclampsia Throughout Pregnancy: A Retrospective Cohort Study.

Background and Objectives: To evaluate the diagnostic accuracy of widely available biomarkers longitudinally measured throughout pregnancy to predict all and term (delivery at ≥37 weeks) preeclampsia (PE). Materials and Methods: This is a longitudinal retrospective study performed at Hospital Universitario de Torrejón (Madrid, Spain) and Shterev Hospital (Sofia, Bulgaria) between August 2017 and December 2022. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination and first-trimester screening for preterm PE at 11 + 0 to 13 + 6 weeks' gestation at the participating centers were invited to participate in a larger study for the prediction of pregnancy complications. The dataset was divided into two subsets to develop and validate a joint model of time-to-event outcome and longitudinal data, and to evaluate how the area under the receiving operating characteristic curve (AUROC) evolved with time. Results: 4056 pregnancies were included in the training set (59 all PE, 40 term PE) and 944 in the validation set (23 all PE, 20 term PE). For the joint model and all PE, the AUROC was 0.84 (95% CI 0.73 to 0.94) and the detection rate (DR) for a 10% screening positive rate (SPR) was 56.5 (95% CI 34.5 to 76.8). For term PE, AUROC was 0.80 (95% CI 0.69 to 0.91), and DR for a 10% SPR was 55.0 (95% CI 31.5 to 76.9). The AUROC using only information from the first trimester was 0.50 (95% CI 0.37 to 0.64) and it increased to 0.84 (0.73 to 0.94) when using all information available. Conclusions: Routinely measuring MAP and UtA-PI throughout pregnancy may improve the predictive prediction power for all and term-PE.

Abstract 4115235: Disparities in Youth Cardiac Screening by Childhood Opportunity Index: Insights from the Heartbytes Database

Intro: The AHA endorses screening youth athletes to identify risk for sudden cardiac arrest (SCA). Rates of SCA can be predicted by social determinants of health (SDOH) such as education level and proportion of Black residents in ZIP Code. The Child Opportunity Index (COI) quantifies neighborhood factors that influence health and development. The link between COI and youth cardiac screening findings and outcomes remains unclear. Hypothesis: Cardiac screening data will differ significantly by COI. Aims: To identify differences in cardiac screening data in children of varying COI. Methods: The HeartBytes Database, including sports exams, self-reported physical activity (PA), and zip codes from Simon's Heart screenings was augmented with COI index zip code data. Chi-squared and logistic regression were used to analyze demographics, cardiac risk factors, and screening results. Data: Screening data of 11,431 youth athletes (median age 14.3 (IQR = 3), BMI 20.6 (4.8), 53.7% male, 70.6% White) was analyzed. The majority of children had very high overall COI (Figure 1). Hypertension, hyperlipidemia, Kawasaki disease, and heart infection were similar across COI levels (p &gt; 0.05). Levels of physical activity varied significantly across levels of overall COI, with the highest levels reported in the lowest COI group (50.4% with &gt; 10 hours PA/week) (Chi-Squared; p = 0.007). Positive screening rates varied significantly by level of COI (p = 0.013) (Figure 2). The overall level of education, health environment, and socioeconomic COI did not predict positive screening outcomes in logistic regression analysis (all p&gt;0.05). Conclusion: Prevalence of cardiac risk factors did not vary significantly across COI levels, however, positive screening rates were highest in moderate and very low COI levels. Simon’s Heart engaged communities across the COI spectrum; however, a majority of children had high or very high COI. Further efforts are needed to expand access to underserved populations of lower COI.

Low Dose Computed Tomography for Lung Cancer Screening in Tuberculosis Endemic Countries: A Systematic Review and Meta-Analysis

Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces mortality. Nevertheless, in high tuberculosis-burden countries (HTBC), there are concerns about high false-positive rates due to persistent lung lesions from prior tuberculosis (TB) infections. This study aims to evaluate the screen-positive rate (SPR) of LDCT screening in HTBC. We conducted a systematic review and meta-analysis to identify studies utilizing LDCT for LCS in HTBC and reported SPR from inception to December 6, 2023. The primary outcome was the SPR, and the secondary outcome was the lung cancer detection rate (LCDR). The summary data was pooled using a random-effects model, and factors influencing the SPR were analyzed using multivariable meta-regression analysis. A total of 44 studies with 477,424 individuals (59.3% men) were included in the systematic review. Lung Imaging Reporting and Data System (Lung-RADS) (31%, 14 studies) and National Lung Screening Trial (NLST) criteria (non-calcified nodule ≥ 4 mm; 10 studies) were the most common criteria used for assessing SPR. The pooled SPR and LCDR were 18.36% (95% confidence interval [CI]: 14.6-22.1) and 0.94% (95% confidence interval: 0.75-1.15), respectively. Although SPR was significantly higher with NLST criteria than Lung-RADS criteria (25.6% versus 10.4%, p < 0.0001), the LCDR remained similar (0.91% versus 0.95%, p= 0.92). Studies using NLST criteria had a higher SPR in multivariable meta-regression analysis. Nevertheless, the analysis is limited by significant statistical heterogeneity and publication bias. Lung cancer screening by LDCT in HTBC demonstrates comparable SPR and LCDR to regions with lower TB incidence rates. Lung-RADS criteria are preferable to NLST criteria for LCS in HTBC to mitigate false-positive rates.

Application of NRS2002 and PG-SGA in nutritional assessment for perioperative patients with head and neck squamous cell carcinoma: An observational study.

This study aimed to compare the effectiveness of 2 nutritional assessment tools, the Nutritional Risk Screening Scale 2002 (NRS2002) and the Patient-Generated Subjective Global Assessment (PG-SGA), for evaluating the nutritional status of perioperative head and neck squamous cell carcinoma (HNSCC) patients, to facilitate early nutritional interventions and improve clinical outcomes. An observational, comparative study was conducted at the Zhejiang Cancer Hospital, recruiting patients diagnosed with HNSCC scheduled for surgical treatment. The NRS2002 and PG-SGA were applied to assess patients' nutritional risk at multiple time points: upon admission, the day before surgery, 2 days after surgery, a week after surgery, and at discharge. Statistical analyses were performed using McNemar and Kappa tests to assess differences and consistency between NRS2002 and PG-SGA. A total of 209 patients were included in this study, predominantly male, with an average age of 60 years. Nutritional risk assessments identified an inverted "V" trend in nutritional risk, with the peak occurring 2 days post-surgery. PG-SGA consistently showed a higher screening positivity rate compared to NRS2002. The receiver operating characteristic curve analysis highlighted the discriminative power of both tools, with PG-SGA and NRS2002 showing high area under the curve values. Both NRS2002 and PG-SGA are effective for nutritional screening in HNSCC patients, with PG-SGA demonstrating a slightly higher sensitivity before surgery. PG-SGA may be more suitable for preoperative application, whereas NRS2002 is more appropriate for postoperative use.

Expanded Newborn Screening Using Genome Sequencing for Early Actionable Conditions

The feasibility of implementing genome sequencing as an adjunct to traditional newborn screening (NBS) in newborns of different racial and ethnic groups is not well understood. To report interim results of acceptability, feasibility, and outcomes of an ongoing genomic NBS study in a diverse population in New York City within the context of the New York State Department of Health Newborn Screening Program. The Genomic Uniform-screening Against Rare Disease in All Newborns (GUARDIAN) study was a multisite, single-group, prospective, observational investigation of supplemental newborn genome screening with a planned enrollment of 100 000 participants. Parent-reported race and ethnicity were recorded at the time of recruitment. Results of the first 4000 newborns enrolled in 6 New York City hospitals between September 2022 and July 2023 are reported here as part of a prespecified interim analysis. Sequencing of 156 early-onset genetic conditions with established interventions selected by the investigators were screened in all participants and 99 neurodevelopmental disorders associated with seizures were optional. The primary outcome was screen-positive rate. Additional outcomes included enrollment rate and successful completion of sequencing. Over 11 months, 5555 families were approached and 4000 (72.0%) consented to participate. Enrolled participants reflected a diverse group by parent-reported race (American Indian or Alaska Native, 0.5%; Asian, 16.5%; Black, 25.1%; Native Hawaiian or Other Pacific Islander, 0.1%; White, 44.7%; 2 or more races, 13.0%) and ethnicity (Hispanic, 44.0%; not Hispanic, 56.0%). The majority of families consented to screening of both groups of conditions (both groups, 90.6%; disorders with established interventions only, 9.4%). Testing was successfully completed for 99.6% of cases. The screen-positive rate was 3.7%, including treatable conditions that are not currently included in NBS. These interim findings demonstrate the feasibility of targeted interpretation of a predefined set of genes from genome sequencing in a population of different racial and ethnic groups. DNA sequencing offers an additional method to improve screening for conditions already included in NBS and to add those that cannot be readily screened because there is no biomarker currently detectable in dried blood spots. Additional studies are required to understand if these findings are generalizable to populations of different racial and ethnic groups and whether introduction of sequencing leads to changes in management and improved health outcomes. ClinicalTrials.gov Identifier: NCT05990179.

Predictive diagnostic value of mean platelet volume to platelet count and neutrophil to lymphocyte ratios in the gray zone of prostate cancer with tPSA between 4 to 10 ng/mL.

Exploration of the Predictive Diagnostic Value of Mean Platelet Volume to Platelet Count Ratio (MPV/PLT,PVI) and Neutrophil-to-Lymphocyte Ratio (NLR) in the tPSA Gray Zone of Prostate Cancer. A retrospective study was conducted on 65 prostate cancer (Pca) patients and 52 benign prostatic hyperplasia (BPH) patients who underwent transperineal prostate biopsy at Xiangtan Central Hospital from December 2021 to December 2023. Descriptive statistics and logistic regression models were used to investigate the predictive diagnostic value of PVI and NLR in the tPSA gray zone of prostate cancer. Receiver operating characteristic (ROC) curves were constructed based on PVI and NLR values to determine the classification thresholds. A total of 117 patients were enrolled, including 65 cases of prostate cancer (PCa) and 52 cases of benign prostatic hyperplasia (BPH). There were no statistically significant differences in age, BMI, history of hypertension, history of diabetes, history of coronary heart disease, pre-biopsy white blood cell count, history of drinking, history of smoking, and tPSA between the PCa and BPH patients. The results of logistic regression analysis showed that PVI (OR=2.03, 95%CI: 1.34~3.07, P<0.00) and NLR (OR=0.32, 95%CI: 0.18~0.58, P<0.00) were independent predictors for diagnosing prostate cancer in the tPSA gray zone (VIF=1.04).The maximum area under the curve (AUC) for PVI was 0.70, with an optimal cut-off value of 0.05 (P ≤ 0.01). The maximum AUC for NLR was 0.76, with an optimal cut-off value of 2.86 (P ≤ 0.01).The calibration curve showed good consistency between the predicted and actual outcomes in both the PCa and BPH groups, indicating that the nomogram model had good predictive performance.When using PVI and NLR to plot the receiver operating characteristic (ROC) curves to predict the assessment of PCa in the tpsa gray zone, the area under the curve (AUC) for PVI was the largest at 0.70, with an optimal cutoff value of 0.05 (P ≤ 0.01). The AUC for NLR was the largest at 0.76, with an optimal cutoff value of 2.86 (P ≤ 0.01). PVI and NLR have certain predictive diagnostic value for Pca in the tPSA gray zone, and appropriate use of PVI and NLR can improve the positive rate of early screening for Pca in the gray zone.

Prenatal maternal diabetes, comorbidities, and risk for neurodevelopmental impairment in the first two years.

Maternal diabetes is a known risk for neurodevelopmental delay in offspring, and often presents with comorbid metabolic conditions, such as obesity and hypertension. However, their combined effects on neurodevelopmental outcomes remain unclear. We investigated the independent and combined associations of maternal diabetes and comorbidities with the risk of neurodevelopmental delay in children aged 12 and 24 months. A prospective longitudinal cohort of children from Pregnancy during the COVID-19 Pandemic study. Neurodevelopmental screening at 12 and 24 months was conducted using the Ages and Stages Questionnaire, which assesses domain-specific development. Maternal diabetes was not associated with neurodevelopmental risks either at 12 or 24 months. However, in combined analyses, maternal diabetes and pre-pregnancy overweight were associated with an increased risk of neurodevelopmental delay in personal-social skills (odds ratio [OR], 1.75 [95%CI,1.01-3.01]) at 24 months, though not at 12 months. Maternal diabetes and pre-pregnancy obesity were also associated with an increased risk for neurodevelopmental delay in communication (OR, 1.71 [95%CI,1.01-2.82]) and personal-social skills (OR, 2.01 [95%CI,1.03-3.73]) at 24 months. Furthermore, maternal diabetes and hypertensive disorders of pregnancy (HDP) had higher rates of positive screening for delay in fine-motor skills (OR, 3.54 [95%CI, 1.28-8.41]) at 12 months but not at 24 months. Post-hoc analysis revealed an independent association of maternal pre-pregnancy obesity, but not overweight, with an increased risk of neurodevelopmental delay in communication, fine-motor, and personal-social skills (ORs ranging from 1.44 to 1.71) at 24 months but not 12 months. Similarly, there was an independent association of maternal HDP with an increased risk of neurodevelopmental delay in fine-motor and and personal-social skills (ORs ranging from 2.01 to 2.19) at 24 months. Maternal diabetes with comorbid conditions is likely to increase the risk of neurodevelopmental delay during infancy than individual exposure, suggesting the persistent influence of prenatal exposure on offspring neurodevelopment. 1. Identifying modifiable prenatal risk factors for neurodevelopmental impairment in offspring is crucial for targeted interventions and providing support to mothers during pregnancy, which can lead to improved child health outcomes. 2. Maternal diabetes was not associated with neurodevelopmental delays in children at 12 or 24 months. 3. Maternal diabetes in combination with pre-pregnancy overweight or obesity increased the risk of cognitive delay at 24 months. 4. Maternal pre-pregnancy obesity but not overweight, and hypertensive disorders of pregnancy independently increased risks of cognitive and motor delays at 24 months.

A comparative analysis of supportive care service needs in patients with pancreas versus other gastrointestinal cancers.

272 Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer death and presents with advanced incurable disease approximately 75% of the time, contributing to the lowest survival rate and worst multidimensional quality of life (QOL) compared to other adult solid tumors. Standardized screening for early integration of interdisciplinary care (IDC) services, advance care planning, and utilization of electronic patient-reported outcomes (ePROs) for improved QOL and symptom management are recommended, yet the literature is lacking in rigorously-conducted PDAC needs assessments, an important prerequisite to care model design. Methods: Between September 12, 2023 and May 7, 2024, 525 patients with gastrointestinal (GI) malignancies were sent a Supportive Care Questionnaire (SCQ), an ePRO survey assessing multi-dimensional IDC needs prior to first visit at an NCI-designated comprehensive cancer center in the Pacific Northwest. The SCQ includes validated surveys and a total of 12 domains chosen by the IDC service responsible for management of the given need(s), who also set trigger thresholds for referral to the IDC service. Rates of positive screens for each service were compared by cancer type (PDAC, Colorectal [CRC], gastroesophageal [GE]). Results: 340 (65%) SCQs were completed (57% via MyChart, 43% in person) similarly across disease groups; with an average of 10 mins to complete. Respondents were 49% female/59% male (Race: White (76.5%), Asian (10%), Black/African-American (4.5%), Other/Unknown (9%)/Ethnicity Non-Hispanic (90%, Hispanic 7.6%), Other/Declined/Unknown 2.4%), with primary language spoken being English (92%), Spanish (3.5%), simplified Chinese (1.5%) and Other (2.5%). Table 1 shows – by GI cancer type –the total number of responses and the proportion of patients who screened positive for one or more IDC services. Conclusions: Patients with PDAC had the greatest need for IDC services with most frequent positive screens indicating need for nutrition, social work, palliative care and patient navigation services when surveyed in our institution-wide program of SC screening for all new GI cancer patients. Results will inform further development of IDC services in PDAC and other GI cancers, including via staff prediction modeling. The SCQ is also being considered for SC screening and management across the Canopy Cancer Collective, a nationwide learning health network of pancreas cancer programs. PDAC CRC GE Surveyed 187 237 101 Completed 122 (65%) 153 (65%) 65 (64%) Positive Screen 68 (56%) 70 (46%) 26 (40%)

Positive Autism Screening Rates in Toddlers Born During the COVID-19 Pandemic

Stress and viral illness during pregnancy are associated with neurodevelopmental conditions in offspring. Autism screening positivity for children born during the pandemic remains unknown. To examine associations between prenatal exposure to the pandemic milieu and maternal SARS-CoV-2 infection with rates of positive Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) screenings. Data for this cohort study were drawn from the COVID-19 Mother Baby Outcomes (COMBO) Initiative. M-CHAT-R scores obtained from children aged 16 to 30 months during routine clinical care at Columbia University Irving Medical Center in New York City were abstracted from electronic health records (EHRs) for children born between January 2018 and September 2021 (COMBO-EHR cohort). Separately, the M-CHAT-R was administered at 18 months for children born between February 2020 and September 2021 through a prospective longitudinal study (COMBO-RSCH cohort). Prenatal pandemic exposure (birth after March 1, 2020) and maternal SARS-CoV-2 status during pregnancy was determined through EHRs. Data were analyzed from March 2022 to June 2024. Prenatal exposures to the pandemic milieu and maternal SARS-CoV-2 infection. The primary outcome was rate of positive M-CHAT-R screenings. For all primary analyses, unadjusted χ2 tests and adjusted logistic regression models were performed. The COMBO-EHR cohort included 1664 children (442 born before the pandemic and 1222 born during the pandemic; 997 SARS-CoV-2 unexposed, 130 SARS-CoV-2 exposed, and 95 with unknown SARS-CoV-2 exposure status), of whom 266 (16.0%) were Black, 991 (59.6%) were Hispanic, 400 (24.0%) were White, 1245 (74.8%) were insured through Medicaid, 880 (52.9%) were male, and 204 (12.3%) were born prematurely. The COMBO-RSCH cohort included 385 children (74 born before the pandemic and 311 born during the pandemic; 201 SARS-CoV-2 unexposed, 101 SARS-CoV-2 exposed, and 9 with unknown SARS-CoV-2 exposure status), of whom 39 (10.1%) were Black, 168 (43.6%) were Hispanic, 157 (40.8%) were White, 161 (41.8%) were insured through Medicaid, 222 (57.7%) were male, and 38 (9.9%) were born prematurely. Prenatal pandemic exposure was not associated with a higher positive M-CHAT-R screening rate in either the COMBO-EHR or COMBO-RSCH cohort. Prenatal exposure to maternal SARS-CoV-2 infection was associated with a lower rate of M-CHAT-R positivity in the COMBO-EHR cohort (12.3% [16 children] vs 24.0% [239 children]; adjusted odds ratio, 0.40; 95% CI, 0.22-0.68; P = .001), but no association was found in the COMBO-RSCH cohort (12.9% [13 children] vs 19.9% [40 children]; adjusted odds ratio, 0.51; 95% CI, 0.24-1.04; P = .07). In this cohort study of 2 groups of children with prenatal pandemic exposure and/or exposure to maternal SARS-CoV-2 infection, neither exposure was associated with greater M-CHAT-R positivity.

Application of artificial intelligence in lung cancer screening: A real-world study in a Chinese physical examination population.

With the rapid increase of chest computed tomography (CT) images, the workload faced by radiologists has increased dramatically. It is undeniable that the use of artificial intelligence (AI) image-assisted diagnosis system in clinical treatment is a major trend in medical development. Therefore, in order to explore the value and diagnostic accuracy of the current AI system in clinical application, we aim to compare the detection and differentiation of benign and malignant pulmonary nodules between AI system and physicians, so as to provide a theoretical basis for clinical application. Our study encompassed a cohort of 23 336 patients who underwent chest low-dose spiral CT screening for lung cancer at the Health Management Center of West China Hospital. We conducted a comparative analysis between AI-assisted reading and manual interpretation, focusing on the detection and differentiation of benign and malignant pulmonary nodules. The AI-assisted reading exhibited a significantly higher screening positive rate and probability of diagnosing malignant pulmonary nodules compared with manual interpretation (p < 0.001). Moreover, AI scanning demonstrated a markedly superior detection rate of malignant pulmonary nodules compared with manual scanning (97.2% vs. 86.4%, p < 0.001). Additionally, the lung cancer detection rate was substantially higher in the AI reading group compared with the manual reading group (98.9% vs. 90.3%, p < 0.001). Our findings underscore the superior screening positive rate and lung cancer detection rate achieved through AI-assisted reading compared with manual interpretation. Thus, AI exhibits considerable potential as an adjunctive tool in lung cancer screening within clinical practice settings.

Autism screening and diagnostic outcomes among toddlers bornpreterm.

To examine the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), with follow-up screening and diagnostic outcomes for children born preterm. A secondary aim was to examine diagnostic evaluation attendance after screening to inform clinical practice. Using a cross-sectional design, 9725 toddlers (4951 males; 4774 females) whose gestational age was reported were screened at 15-month, 18-month, or 24-month well-child visits; screen-positive children were invited for an autism evaluation. Screening measure performance and diagnostic outcomes were evaluated according to preterm classification (Screening: nExtPreterm = 111; nVeryPreterm = 186; nModPreterm = 1122; nFullTerm = 8306; Evaluation: nExtPreterm = 27; nVeryPreterm = 21; nModPreterm = 86; nFullTerm = 301). Screen-positive rates were highest for children born extremely preterm (51.35%) and lowest for children born at term (6.95%). Evaluation attendance for screen-positive cases did not differ according to preterm classification. Rates of autism diagnoses differed depending on preterm birth status: for children born extremely preterm, it was 16.05%; for children born very preterm, it was 2.00%; for children born moderately preterm, it was 2.89%; and for children born at term, it was 1.49%. M-CHAT-R/F sensitivity decreased with increasing gestational age, whereas specificity improved with increasing gestational age. Positive predictive value was highest for children born extremely preterm and children born at term. Negative predictive value was consistently strong across all groups. The likelihood ratio for positive screening increased with gestational age. The sensitivity and specificity of the M-CHAT-R/F are acceptable in toddlers born preterm. Autism screening-positive rates and prevalence increased with earlier preterm birth. Those born extremely preterm showed the greatest likelihood of an autism diagnosis; screening should not be delayed based on adjusted age.