Background Checks Research Articles

PD-1 and PD-L1 Expression in Endometrial Cancer: A Systematic Review of the Literature.

Background/Objectives: Cancer immunotherapy through the use of PD-1/PD-L1 inhibitors have shown significant promise in endometrial carcinoma (EC), particularly in tumors with microsatellite instability (MSI) or mismatch repair deficiency (dMMR), present in approximately 30% of cases. This review evaluated PD-L1 and PD-1 expression as potential biomarkers for immunotherapy response in EC, focusing on their relationship with MSI status. Methods: A systematic review, adhering to PRISMA guidelines, analyzed studies from MEDLINE and Embase until February 2023 on PD-1/PD-L1 expression in EC stratified by MSI status, including diverse study designs but excluding conference abstracts, with independent screening, data extraction, and additional reference checks to ensure comprehensive coverage. Results: A systematic analysis of 10 studies found that PD-L1 expression was more frequently expressed in MSI tumors (49%) compared to microsatellite-stable tumors (MSS) (33.5%), while PD-1 was expressed in 58% of MSI cases and 48% of MSS cases. Despite these findings, the prognostic value of PD-L1/PD-1 remains uncertain, with conflicting results regarding their association with survival outcomes. PD-L1 expression varied across molecular subtypes, being highest in POLE-mutated tumors (76.56%) and serous carcinomas (73%). Differences in PD-L1 expression between primary and metastatic sites were also noted, complicating its use as a biomarker. Conclusions: The assessment of PD-L1 expression in EC could represent a valuable option for selecting patients who may benefit from immune checkpoint inhibitors (ICI), including those in the MSS cohort, thereby ensuring a more tailored and personalized treatment strategy.

The Role of Gli1+ Mesenchymal Stem Cells in Craniofacial Development and Disease Treatment.

This review summarises the role of Gli1+ (Glioma-associated oncogene homologue 1) mesenchymal stem cells in craniofacial growth and development or tissue repair, and their application in the treatment of some diseases. The search for this narrative review was conducted in PubMed and Web of Science using relevant keywords, including checking reference lists of journal articles by hand searching. Gli1+ mesenchymal stem cells play an important role in the growth and development of the skull, tooth, periodontium and mandibular condyle. They can be applied to the treatment of pulp and periodontal diseases, temporomandibular joint osteoarthritis and other diseases. Gli1+ mesenchymal stem cells are crucial for the development and repair of craniofacial tissue.

Pre-employment background check: A review and research agenda

Research background: This review paper is about the pre-employment background check by the human resources of the desired job candidates for the offered job. Pre-employment background check is a crucial part for the final selection of the right candidate. Purpose of the article: The aim of the article is to evaluate one of the important functions of human resource management, pre-employment background checks (PBC) based on the existing available literature. This will be achieved by conducting a critical literature review in the context of its definition, needs, processes, and limitations, presented in a simple and narrative manner. Methods: Methods such as synthesis, comparison, deduction, and systematic-analytical examination of scientific articles were used in the preparation of the article. Primary literary sources on the given topic were searched in the Web of Science and Scopus databases. The data collection period focused on the years 2000 to 2024. Findings & Value added: Although the process of background check for the job candidates can be conducted at any stage of their employment history, PBC is an important step as the final part of selection process. According to the literature, PBC is an imperative step for the employers in the selection process to get a clean employee reducing the chances of future accusation of negligent hiring. Although being an important step of the selection process, this area of HRM is comparatively under-researched. Therefore, this paper with enriched information about PBC can benefit multiple stakeholders such as employers, employees, researchers and independent hiring agencies.

Using latent variables to improve the management of depression among hemodialysis patients

Background Screening for depression can be challenging among hemodialysis patients due to the overlap of depressive symptoms with dialysis or kidney disease related symptoms. The aim of this study was to understand these overlapping symptoms and develop a depression screening tool for better clinical assessment of depressive symptoms in dialysis patients. Methods We surveyed 1,085 dialysis patients between March 1, 2018 and February 28, 2023 at 15 dialysis facilities in Northeast Ohio with the 9-item patient health questionnaire (PHQ-9) and kidney disease quality of life (KDQOL) instrument. To evaluate overlap across questionnaire items, we used structural equation modeling (SEM). We predicted and transformed factor scores to create a hemodialysis-adjusted PHQ-9 (hdPHQ-9). In exploratory analysis (N = 173), we evaluated the performance of the hdPHQ-9 relative to the PHQ-9 that also received a Mini-International Neuropsychiatric Interview. Results Our study sample included a high percentage of Black patients (74.6%) and 157 (14.5%) survey participants screened positive for depression (PHQ-9 ≥ 10). The magnitude of overlap was small for (respectively, PHQ-9 item with KDQOLTM item) fatigue with washed out, guilt with burden on family, appetite with nausea and movement with lightheaded. The hdPHQ-9 showed reasonably high sensitivity (0.81 with 95% confidence interval [CI] 0.58, 0.95) and specificity (0.84 with 95% CI 0.77, 0.89); however, this was not a significant improvement from the PHQ-9. Conclusion There is little overlap between depressive symptoms and dialysis or kidney disease symptoms. The PHQ-9 was found to be an appropriate depression screening instrument for dialysis patients.

Hyperbaric Oxygen Therapy in Aesthetic Medicine and Anti-Aging: A Systematic Review.

Continued interest in the optimization of recovery in aesthetics has led to the exploration of adjunctive therapies. Hyperbaric oxygen therapy (HBOT) serves as one such therapy that may have an impact in this field. HBOT is hypothesized to improve ischemia, reduce swelling, and minimize secondary hypoxic tissue damage. Its application in aesthetic procedures aims to improve healing, reduce downtime, and enhance the overall quality of outcomes. A systematic review was performed, searching the PubMed database. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA) guidelines. Included studies evaluated the use of HBOT in aesthetic surgery, medicine, and longevity and anti-aging. Selected studies matched predetermined criteria according to the employed intervention and outcomes. The systematic review was performed in April2024, with the primary search yielding 591 articles. Abstract review resulted in 53 articles of potential relevance. Comprehensive review of the articles and manual reference checks was performed, independently, by two authors. This yielded a total of 15 articles meeting inclusion criteria. HBOT may serve a valuable adjunct in aesthetic surgery, medicine, and anti-aging. However, the evidence to support its use, and justify its cost, is limited. This review serves as an update, capturing the currently available literature on HBOTs use in aesthetics, and provides the first discussion of HBOTs role in anti-aging. It underscores the need for future large-scale, randomized trials with standardization of HBOT protocols being employed to allow for full assessment of HBOTs utility in this clinical space. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Awareness and Readiness of Fire Officers on The Possession of Firearms: Basis for Policy Development

Republic Act No. 11589, known as the Bureau of Fire Protection Modernization Act of 2021, aims to enhance the Bureau of Fire Protection (BFP) in the Philippines by improving firefighters' ca-pabilities in fire prevention, suppression, investigation, and emer-gency medical services. The law also authorizes the issuance of firearms to certain firefighters to ensure their safety and that of their colleagues while performing their duties. This study used a descriptive-correlational research design and quantitative meth-ods to assess BFP fire officers' awareness and readiness regarding firearm possession, bearing, and carrying. Data were collected from 120 respondents at the Caloocan City Fire Station between November 15 and 28, 2023. The findings indicate that fire officers generally understand firearm laws and procedures well, including licensing requirements such as age limits and background checks, though they encounter challenges with paperwork and license re-newals. They are also familiar with the rules for carrying firearms, including permit requirements and concealment during duty. The results highlight the need for enhanced training and clearer regula-tions to ensure safe firearm use and minimize incidents, in line with broader research on firearm policies and education. The study concludes that, despite a solid understanding of firearm reg-ulations, there is a need for improved licensing processes and training. Recommendations include developing comprehensive and practical training programs, conducting regular refresher courses, creating accessible reference materials, and improving licensing procedures through flexible scheduling and simplified paperwork, as well as addressing training challenges through bet-ter recruitment, funding, and facilities.

General Educational Institutions of Tyumen in 1945–1953

Introduction. The aim of the work is to determine the significance of the transformation of the educational process in general educational institutions of Tyumen in the post-war period. In the context of the study, the authors study the expansion of the network and the technical condition of general educational institutions, note changes in the staffing of schools, reveal various aspects of the methodological training of teachers, as well as the process of transforming the educational programs of educational institutions. Methods and materials. The basis of the research work was made up of previously unpublished archival records and statistical materials, regulations that were published as part of collections of documents during the period under study, as well as information from periodicals of the post-war years. In addition, over the past decade, a significant number of regional studies have appeared in historiography concerning the problem of school education in the period under study. Analysis. Soviet education in 1945–1953 was experiencing a serious crisis. School buildings in need of repair, lack of a sufficient number of classrooms and teaching staff, difficult financial and living conditions of general education institutions, difficulties in implementing the law on universal education, increasing requirements for the general education training of students and the teaching activities of teachers – these are not all the problems that Soviet education faced in the post-war period. Results. The researchers come to the conclusion that the post-war years became an important time for the transformation of the educational process in the schools of Tyumen, causing its transition to peacetime. During the study period, the network of educational institutions in the city was expanding, and the number of students was also growing. At the same time, a number of problems remained unresolved, which concerned the low technical condition of educational institutions and multi-shift classes. In the mid-1940s and early 1950s, in the schools of the city, there was an increase in the number, experience, and level of education of teaching staff. Author’s contribution. The search, systematization, and analysis of archival documents, regulations, periodicals, as well as research literature on the topic of research work, followed by composing the main part of the article, was carried out by Candidate of Sciences (History), Associate Professor of the Department of History of Tyumen State University, E.V. Borodulina. Posing general conclusions and checking references was carried out by A.V. Skochin. Funding. The study was carried out with the financial support of the Russian Foundation for Basic Research within the framework of the scientific project No. 20-49-720018.

Effectiveness of Acceptance and Commitment Therapy on Mental Health Issues: A Systematic Review

Background Mental health disorders rank among the most common psychiatric conditions, with lifetime prevalence rates that have a significant effect on the global population. Although CBT is still the most generally recommended psychosocial intervention for mental health problems, a significant number of patients do not fully react to therapy, which results in persistent symptoms. Acceptance and Commitment Therapy (ACT) has gained worldwide attention as a promising intervention with a growing body of empirical support across a variety of mental health conditions. Summary A systematic review was conducted to evaluate ACT’s impact on mental health. Comprehensive searches of Scopus, PubMed, Google Scholar, and Shodganga, along with reference and citation checks, yielded 15 studies meeting the inclusion criteria. Four independent reviewers assessed the studies for eligibility, methodological rigor, and data extraction. The findings revealed that ACT consistently reduces symptom severity, improves emotional regulation, enhances life satisfaction, and increases psychological flexibility. However, common methodological limitations include small sample sizes, lack of long-term follow-ups, and limited control group comparisons. Key Message ACT demonstrates significant promise as a trans-diagnostic intervention adaptable to various mental health issues. Despite its evident benefits in symptom reduction and psychological well-being, further research addressing methodological constraints is crucial to optimize its clinical applications and establish its long-term efficacy.

A STUDY ON RECRUITMENT AND SELECTION PRACTICES OF ANDHRA PRADESH PAPER MILLS LIMITED, UNIT: KADIYAM

Recruitment and selection are critical processes in human resource management that aim to identify, attract, and hire the best candidates for organizational roles. Effective recruitment ensures a diverse and qualified candidate pool, while a well-structured selection process helps organizations choose the most suitable individuals. The recruitment process involves job advertising, sourcing candidates, and engaging with potential employees through various channels, including digital platforms, job fairs, and networking. Selection, on the other hand, focuses on assessing candidates through interviews, tests, background checks, and reference verification to determine their skills, experience, and cultural fit. This process is essential for enhancing organizational performance, reducing turnover, and maintaining a positive work environment. The growing use of technology, such as applicant tracking systems (ATS) and artificial intelligence (AI) in recruitment, has streamlined the process, making it more efficient and data- driven. This study explores the significance of recruitment and selection, factors influencing these processes, and modern trends that shape talent acquisition strategies in today's competitive job market. *** Keywords: effective recruitment strategies, candidate satisfaction.

Maternal Nutrition and Human Milk Nutrients: A Scoping Review.

To explore the influence of maternal nutrition factors, including body mass index, nutritional supplementation, and dietary intake during the breastfeeding period, on macro and micronutrient composition in human milk. We conducted a scoping review using the PRISMA-ScR checklist, initially identifying 5,984 original studies published in the English language from PubMed, Scopus, and Web of Science that presented findings on the association of maternal nutritional factors on human milk nutrient composition. After screening the title and abstract, we selected 69 studies for full review, including 3 studies found through checking reference lists. After full review, we included 23 studies in this scoping review. Most studies found maternal body mass index and supplement consumption affected human milk macro and micronutrient composition, whereas inconsistent results were found on the relationship between maternal diet and human milk nutrients. Methodologies varied substantially across studies, especially for milk sample collection methods and maternal nutrition assessments. Maternal nutrition factors may affect levels of human milk nutrients, requiring maternal nutrition monitoring during breastfeeding. However, given the considerable variability in the results between studies and methodological approaches, further studies should use standardized and validated procedures to strengthen the findings on this topic.

A Systematic Review on Clinical Evidence for Topical Metformin: Old Medication With New Application.

Metformin is a widely used oral agent for controlling diabetes mellitus, but it also has other therapeutic benefits for various conditions. In addition, conventional oral metformin, and topical metformin have been used in, in-vitro studies in the treatment of acne, psoriasis, wound healing, and and so forth. While topical metformin has shown promising results in animal studies, there is limited data on its effectiveness in humans. Our study aims to summarize the clinical findings of human studies on the efficacy of topical metformin. This review followed the PRISMA standards and systematically searched multiple databases using specific keywords. The relevant articles were selected according to the inclusions and exclusions criteria. Our search strategy yielded 1831 articles, after screening, 27 articles met our inclusion criteria which were: human studies, articles published before the start of the search, and topical forms of metformin. We also identified three additional relevant articles through reference checking. Therefore, our systematic review included a total of 30 articles. Most commonly, topical metformin has been studied in dentistry and dermatology. In dentistry, it has been found effective in treating periodontitis when used with scaling and root planning. Combining metformin with platelet-rich fibrin can provide better benefits for furcation-involved teeth, and coating dental implants with metformin improves osseointegration. In dermatology, studies on melasma have had inconsistent results. Topical metformin has also shown promising results in promoting hair regrowth, wound healing, and acne vulgaris, suggesting it could be a potential treatment option for these conditions.

Evaluation of the Vitros® Anti-T. cruzi Assay for its incorporation into the Trypanosoma cruzi Infection Diagnostic Algorithm

Background and objectiveSerological screening for Chagas disease (CD) in Latin American adults living in Europe is a cost-effective strategy for transmission prevention. The World Health Organization recommends two different serological tests including native and recombinant antigens for IgG detection. In Spain, most commercialized native tests require manual processing. We aimed to evaluate the sensitivity and specificity of the automated Vitros® Anti-T. cruzi native antigen-based test. MethodsA total of 556 serum samples were tested using two different tests: 1) our reference assay, a chemiluminescence immunoassay employing a recombinant multi-antigen protein (Liaison® XL Murex Chagas); 2) a chemiluminescence immunoassay with native antigen (Vitros® Anti-T. cruzi assay). Additionally, 180 samples were also processed by a manual indirect immunofluorescent assay (Chagas IFA). Sensibility, specificity and kappa index were calculated. ResultsVitros® showed a kappa index of 0.94 (IC 95%: 0.86-1.03) compared to Liaison® XL with a sensitivity of 93.6% and specificity of 99.5%. Compared to IFA, Vitros® showed a kappa index of 0.61 (IC 95%: 0.47-0.76), sensitivity of 97.5% and specificity of 70.37%. Discrepant results were obtained mainly in treated patients. ConclusionsThe Vitros® Anti-T. cruzi assay showed potential for implementation as an automated serological screening test, enhancing the diagnostic process in high-throughput microbiology laboratories.

Beta-Blockers and Mortality Reduction in Heart Failure: A Systematic Review of Randomized Controlled Trials

Background: Heart failure is a leading cause of morbidity and mortality. This systematic review evaluates beta blockers' effects on all-cause mortality, cardiovascular mortality, and hospital admissions in heart failure, synthesizing data from over 50 randomized controlled trials. Methods: Using PRISMA principles, the data regarding the effect of beta blockers on heart failure mortality and hospitalizations were synthesized. Extensive database searches (PubMed, Embase, Cochrane Library, and Web of Science) and manual reference checks were used to identify randomized controlled studies that compared beta blockers with placebo or conventional treatment in adults. The quality of data extraction process was evaluated according to the Cochrane Risk of Bias tool following the guidelines. Heterogeneity was assessed (I2), sensitivity analyses guaranteed robustness, and random-effects meta-analyses quantified results. Transparency was guaranteed via PROSPERO registration. Results: Beta-blockers were linked to a 29% decrease in cardiovascular mortality (OR 0.71, 95% CI 0.64–0.79, p< 0.05) and a 33% decrease in all cause mortality (OR 0.67, 95% CI 0.59–0.76, p < 0.05) when compared to alternative therapies. Additionally, beta-blocker-treated patients saw a 37% decrease in hospital admissions (OR 0.63, 95% CI: 0.56–0.71, p < 0.05). The class impact of beta blockers in heart failure treatment is supported by these advantages which were constant across subgroups and beta blocker types. Conclusion: This systematic review corroborates the well-established benefit of beta blockers in lowering mortality and hospitalizations in heart failure patients, particularly with HFrEF. The findings support the use of beta blockers as a cornerstone of heart failure therapy and there is a need for further research to optimize the use of beta blockers in combination with other emerging therapies.

Methodological literature on the reporting of systematic reviews of health economic evaluations: a scoping review protocol

Systematic reviews of health economic evaluations play a crucial role in informing evidence-based healthcare decisions, yet they lack standardized reporting guidelines. A project has been initiated that aims to extend the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for systematic reviews of health economic evaluations (PRISMA-EconEval). This scoping review forms a foundation for the PRISMA-EconEval project, aiming to identify, map, and extract candidate reporting items from the methodological literature. The scoping review will follow the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist and involve comprehensive searches in databases such as PubMed MEDLINE, Embase, and Web of Science, covering the period from 2015 to 2024. Supplementary searching, reference checking and citation searching will target grey literature, overlooked studies and evidence prior to 2015. Inclusion criteria will focus on methodological papers that provide frameworks or recommendations for reporting systematic reviews of health economic evaluations and enhanced case studies that critically discuss methods and reporting structures. The extracted data will be coded and analyzed to produce an initial list of candidate reporting items, structured according to conventional sections of a systematic review (e.g., title, abstract, methods, results). This initial list will be used in the subsequent stages of the project and disseminated through a peer-reviewed publication and presentations at international conferences. The outcome of this scoping review will significantly contribute to the development of a comprehensive PRISMA-EconEval reporting guideline, aimed at enhancing the transparency, consistency, and quality of systematic reviews of health economic evaluations, and provide an essential tool for authors, editors, peer-reviewers, and stakeholders.

The optimal approach for retrieving systematic reviews was achieved when searching MEDLINE and Epistemonikos in addition to reference checking: a methodological validation study

BackgroundSystematic reviews (SRs) are used to inform clinical practice guidelines and healthcare decision making by synthesising the results of primary studies. Efficiently retrieving as many relevant SRs as possible is challenging with a minimum number of databases, as there is currently no guidance on how to do this optimally. In a previous study, we determined which individual databases contain the most SRs, and which combination of databases retrieved the most SRs. In this study, we aimed to validate those previous results by using a different, larger, and more recent set of SRs.MethodsWe obtained a set of 100 Overviews of Reviews that included a total of 2276 SRs. SR inclusion was assessed in MEDLINE, Embase, and Epistemonikos. The mean inclusion rates (% of included SRs) and corresponding 95% confidence intervals were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking. Features of SRs not identified by the best database combination were reviewed qualitatively.ResultsInclusion rates of SRs were similar in all three databases (mean inclusion rates in % with 95% confidence intervals: 94.3 [93.9–94.8] for MEDLINE, 94.4 [94.0-94.9] for Embase, and 94.4 [93.9–94.9] for Epistemonikos). Adding reference checking to MEDLINE increased the inclusion rate to 95.5 [95.1–96.0]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (98.1 [97.7–98.5]). Among the 44/2276 SRs not identified by this combination, 34 were published in journals from China, four were other journal publications, three were health agency reports, two were dissertations, and one was a preprint. When discounting the journal publications from China, the SR inclusion rate in the recommended combination (MEDLINE, Epistemonikos and reference checking) was even higher than in the previous study (99.6 vs. 99.2%).ConclusionsA combination of databases and reference checking was the best approach to searching for biomedical SRs. MEDLINE and Epistemonikos, complemented by checking the references of the included studies, was the most efficient and produced the highest recall. However, our results point to the presence of geographical bias, because some publications in journals from China were not identified.Study registrationhttps://doi.org/10.17605/OSF.IO/R5EAS (Open Science Framework).

Electronic screening and brief interventions promoting healthy diet and physical activity among adult patients in medical settings: A systematic review

Background & AimsElectronic screening and brief interventions (eSBIs) are promising health promoting approaches but their utilization towards nutrition outcomes has been little documented so far. The aim of this systematic review is to examine the nature and findings of eSBIs targeting diet and/or physical activity (PA) among adult patients in healthcare settings since smartphone technologies emerged. MethodsThree systematic searches in PubMed, ScienceDirect and PsycINFO were conducted from January 2010 to May 2023. We include all studies assessing eSBI towards lifestyle habits (dietary habits and/or PA at least), implemented in healthcare settings and targeting adult participants. ResultsOf 1981 articles identified, 15 studies met inclusion criteria. Most of them documented eSBIs implemented in primary care (n=11), targeting PA (n=11) and diet (n=9) alone or combined (n=5). Some eSBIs targeted additional behaviors (e.g. smoking, drinking). Delivery modes included computer (n=8), printed documents (n=8) or phone (n=2) but only four eSBIs were interactive (or partially automated). In addition to personalized feedback, most common behavior change techniques were “information about social and environmental consequences” (n=9), “goal setting” (n=7), and “information about health consequences” (n=7). Most studies assessing behavior change had a control group (8 in 10), and eight studies found positive changes in behavior. ConclusionsAlthough implementing eSBIs towards PA/diet among adult patients in medical settings seems promising for primary, secondary and tertiary prevention, common conceptual framework, intervention and outcomes are severely lacking, and the extent to which they follow existing SBI guidelines remains unclear. Demonstrating their effectiveness requires fixing these issues before conducting prospective assessment studies in medical settings.

Contextual Factors Influencing Firearm Deaths Occurring Among Children.

Contextual factors that contribute to firearm injuries among children aged 0 to 10 are not well understood. A retrospective review of the National Fatality Review-Case Reporting System was conducted for firearm deaths of children aged 0 to 10 from 2004 to 2020. Descriptive analyses characterized child and parent demographics, incident details, firearm characteristics, and firearm use. Cluster analysis identified key clustering of contextual variables to inform prevention efforts. Within the study timeframe, 1167 child firearm deaths were reported (Mage = 4.9; 63.2% male; 39.4% urban). At the time of the incident, 52.4% of firearms were reported unlocked and 38.5% loaded. Firearm deaths occurred primarily at the child's home (69.0%) or a friend or relative's home (15.9%), with most involving a handgun (80.6%). Children were supervised in 74.6% of incidents, and 38.4% of child supervisors were impaired during the incident. Cluster analysis identified incident contextual factors clustering in distinct groups, including unsupervised firearm play, long gun discharge while cleaning, hunting, or target shooting, supervised discharge within the child's home, murder-suicide events, deaths occurring in the context of intimate partner violence, and community violence firearm deaths. Data highlight the importance of primary prevention through secure firearm storage to prevent child firearm deaths. Efforts focused on identifying and reducing intimate partner violence, addressing community violence (eg, community greening), and implementing policy that limit firearm access (eg, domestic violence restraining orders, background checks), may reduce child firearm deaths.

Employer Credit Checks: Poverty Traps Versus Matching Efficiency

Abstract We develop a framework to understand pre-employment credit screening as a signal from credit markets that alleviates adverse selection in labour markets. In our theory, people differ in both their propensity to default on debt and the profits they create for firms that employ them; in our calibrated economy, highly productive workers have a low default probability. This leads firms to create more jobs for those with good credit, which creates a poverty trap: an unemployed worker with poor credit has a low job finding rate, but cannot improve her credit without a job. This manifests as an endogenous loss in present-discounted wages that is typically taken as exogenous in quantitative models of consumer default. Banning employer credit checks eliminates the poverty trap, but pools job seekers and reduces matching efficiency: average unemployment duration rises by 2 days for high productivity workers and falls by 13 days for low-productivity workers.

Quality of life after screening for atrial fibrillation: a substudy from a randomised screening trial

Abstract Background Screening for atrial fibrillation (AF) is rising, yet trials have failed to show efficacy for stroke prevention from screening and subsequent anticoagulation. Quality of life is an important outcome for patients and physicians, however, it is largely unknown how this outcome is affected by screening for AF. The adverse effects of screening should be considered before implementing systematic screening. Purpose To explore changes in quality of life associated with screening for AF and subsequent anticoagulant treatment upon AF detection. Methods We used quality of life data from 6,004 persons with stroke risk factors randomised to usual care (n=4,503) or screening for AF using implantable loop recorder and anticoagulation for AF episodes lasting ≥6 minutes (n=1,501). The validated EQ-5D-5L tool evaluates health-related quality of life in five domains (mobility, selfcare, usual activities, pain/discomfort and anxiety/depression), rendering a final score in EQ-index (worst=-0.76 best=1.00) combined with an EQ-VAS score (worst=0, best=100). EQ-index and EQ-VAS were analysed with linear mixed models from baseline through year three. The domains were also analysed with logistic regression to report the risk of major problems (defined as a rating of 3, 4, or 5 in the range [1-5], where 1 corresponds to no problem and 5 corresponds to an extreme problem within a given domain) overall and separately. Sensitivity analyses with imputation for missing data were performed. Results Data were available for 5,162 (86.0%) participants at baseline and in year three, and 227 (5.0%) in usual care and 65 (4.3%) in the screened group had died before the last assessment. At baseline, 1,202 of 5,162 (23.3%) participants reported major pain/discomfort problems, and 666 of 5,162 (12.9%) reported major mobility problems (Figure 1). Major selfcare problems were the least frequent problem reported by 83 of 5,162 participants (1.6%). The occurrence of major problems was increased after 3 years in all domains and in both randomisation groups, with a 2% higher occurrence of major pain/discomfort in the control group compared to the screened group. At baseline, the average EQ-index was 0.88 (±0.16) and EQ-VAS 78.4 (±16.2). After three years, the EQ-index decreased by -0.05 (-0.05; -0.04), p<0.0001 in the control group vs. -0.04 (-0.05; -0.02) in the screened group and EQ-VAS with -6.06 (-6.54; -5.57) in the control group vs. -5.18 (-6.52; -3.78) in the screened group, resulting in no statistically significant difference between the groups (p=0.063 and p=0.056) (Figure 2). The screened group was equally likely to report at least one major problem in quality of life after three years (odds ratio 0.93 (0.77;1.13)), but was less likely to report major pain/discomfort (odds ratio 0.84 (0.72;0.98)), compared with the control group. Conclusion Systematic and intensive screening for atrial fibrillation did not improve quality of life compared to usual practice.

Atrial fibrillation screening to prevent stroke in persons with low-normal thyrotropin

Abstract Background Screening for atrial fibrillation (AF) has been proposed as a method to prevent strokes in high-risk individuals. Recent trials were unable to prove efficacy for stroke prevention but suggested that a more refined approach may be beneficial. Low-normal thyroid-stimulating hormone (TSH) is a marker for AF and stroke risk and may be used to select individuals for AF screening. Purpose To explore TSH as a tool to select individuals for AF screening to prevent stroke. Methods Post hoc analysis of a clinical trial enrolling 6004 participants with stroke risk factors but no known AF randomized 1:3 to implantable loop recorder (ILR) screening for AF and initiation of oral anticoagulation (OAC) upon AF detection versus usual care (control group). The primary outcome was stroke or systemic embolism (SE). Secondary outcomes included the combination of stroke, SE, or cardiovascular (CV) death, all-cause death, AF diagnosis, and OAC initiation. All outcomes were adjudicated. Results Baseline TSH was measured in 6003 participants (99.98%); 1500 randomized to ILR vs 4503 to control. The mean age was 75±4 years, 2836 (47%) were women. The tertiles of TSH were at ≤1.2, 1.2-1.9, and >1.9 mIU/L. Participants in the first tertile had slightly higher levels of the thyroid hormones (T3, T4, and free T4), were slightly younger, had more smoking pack-years, and higher pulse rate compared to other tertiles. The median follow-up duration was 5.4 (4.9-5.8) years, and no participants were lost to follow-up. AF was diagnosed in 476 (31.7%) participants in the ILR group vs 550 (12.2%) in the control group and this difference was similar across tertiles (p-interaction=0.44). Similar patters were observed for OAC initiation. In the first TSH tertile, participants in the ILR group were significantly less likely to experience the primary outcome (hazard ratio 0.52 [0.30–0.90]; p=0.019) or the combination of stroke, SE, or CV death (hazard ratio 0.54 [0.35–0.84]; p=0.006, respectively) compared to control, while there was no effect in participants with higher TSH (p-interaction 0.029 and 0.014, respectively) and there was no effect on all-cause death in any tertile. When TSH was modelled as a continuous variable, the effect of ILR screening gradually increased with decreasing TSH, with the upper bound of the confidence interval reaching HR<1 at TSH<1.2-1.5 mIU/L. Sensitivity analyses excluding participants with baseline TSH outside reference range (0.3-4.0 mIU/L) and/or treated with thyroid hormone replacement or antithyroid agents yielded similar results. Conclusion In persons with stroke risk factors and TSH <1.2-1.5 mIU/L, ILR screening for AF and anticoagulation upon detection led to significantly decreased stroke risk. There was no effect in persons with higher TSH, though the yield of screening was similar across levels. This suggests that low-normal TSH may indicate benefit from AF screening while higher levels may lead to overdiagnosis.TableFigure