School-based Screening Research Articles

Potential mental health-related harms associated with the universal screening of anxiety and depressive symptoms in Australian secondary schools

BackgroundAnxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools.MethodsA total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models.ResultsParticipants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition.ConclusionsThe intensive screening procedure did not appear to adversely impact adolescents’ mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students.Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821.

Priorities in school eye health in low and middle-income countries a scoping review.

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Abstract MP56: Screening for Familial Hypercholesterolemia: School Based Programs May Be Best Alternative

Introduction: Familial Hypercholesterolemia (FH) is an autosomal dominant condition characterized by elevated cholesterol and premature development of cardiovascular (CV) disease affecting 1/200 - 1/500 individuals. Only 10% of the affected population in the United States have been identified and treated compared to 50-70% in Scandinavian countries identified through school-based or universal screening programs. Hypothesis Statement: School based programs are the best mechanism for FH screening. Methods: The Healthy Hearts and Minds Program (HHM) through UCHealth performs biometric screenings on 5th, 7th, and 10th grade students in Northern Colorado. HHM tested 10,991 5th grade students (9/2017 - 5/2022) and identified 424 students with total cholesterol levels ≥200 mg/dL (range 200-302). A buccal smear test (APOB, LDLR, PCSK9) was performed on 99 individuals with the highest total cholesterol levels to identify genetic status. A binomial logistic regression model was used for analysis. Results: Of the 99 students, six tested positive (50% male, 10.3 years, 22.8 BMI) for FH with five (40% male, 11.3 years, 17.3 BMI.) reporting a variant of indeterminate significance. A sigmoidal association between total cholesterol and predicted chance of FH was identified with the inflection point at ~270 mg/dL. Conclusions: Comprehensive school based programs are the most effective and equitable means of identifying this genetic based disease and should be supported in a collaborative manner with health care systems, industry and the community. With availability to all students, diversity, equity, and inclusion concerns are addressed and provide at risk populations with personalized health information. The results from this study suggest a school-based screening program can be effective at identifying students most at risk for FH. These results further define the relation between total cholesterol and predicted chance of FH for a school-aged population where 245 mg/dL indicates a 10.3% of testing positive for FH whereas 275 mg/dL has a 54.8% chance. Additionally, the multiplier effect documented through cascade FH testing enhances the benefit of the information to other family members, as the autosomal dominant pattern insures that 50% of members will be at risk. The individual benefit of identifying FH early is the treatability of this condition. Early use of lipid lowering agents can make the CV disease risk equal to the general population. If left untreated, CV disease occurs approximately 10 years earlier which results in increased mortality and disability, along with increased health care costs. Therefore, if elevated cholesterol is present in school children, genetic testing is warranted and treatment considered by age 8-10 years, especially if signs of abnormal vascular plaquing is identified.

Midterm Follow-Up of Familial Hypercholesterolemia from a Cross-Sectional School-Based Cholesterol Screening Program

Midterm Follow-Up of Familial Hypercholesterolemia from a Cross-Sectional School-Based Cholesterol Screening Program

The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students.

This paper describes the development and psychometric evaluation of a brief self-report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4-11) as well as depression and eating difficulties (grades 6-11), with optional items for suicidality and self-harm (grades 7-11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4-5 and 31 items for grades 6-11 that fulfilled pre-set criteria. Study 2 extended testing with 10,479 students in grades 4-11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6-11) creating a total of 35 items for grades 6-11. All items, for both grade-level versions, met the pre-set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas .87 to .95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help-seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school-based screening for mental health problems.

The validity and reliability of school-based fundamental movement skills screening to identify children with motor difficulties.

Assess whether school-based teacher-led screening is effective at identifying children with motor difficulties. Teachers tested 217 children aged between 5 and 11 years old, after a one hour training session, using a freely available tool (FUNMOVES). Four classes (n = 91) were scored by both researchers and teachers to evaluate inter-rater reliability. Researchers assessed 22 children using the Movement Assessment Battery for Children (MABC-2; considered to be the 'gold standard' in Europe for use as part of the diagnostic process for Developmental Coordination Disorder) to assess concurrent and predictive validity. Inter-rater reliability for all individual activities within FUNMOVES ranged from 0.85-0.97 (unweighted Kappa; with 95%CI ranging from 0.77-1). For total score this was lower (κ = 0.76, 95%CI = 0.68-0.84), however when incorporating linear weighting, this improved (κ = 0.94, 95%CI = 0.89-0.99). When evaluating FUNMOVES total score against the MABC-2 total score, the specificity (1, 95%CI = 0.63-1) and positive predictive value (1; 95%CI = 0.68-1) of FUNMOVES were high, whereas sensitivity (0.57, 95%CI = 0.29-0.82) and negative predictive values (0.57, 95%CI = 0.42-0.71) were moderate. Evaluating only MABC-2 subscales which are directly related to fundamental movement skills (Aiming & Catching, and Balance) improved these values to 0.89 (95%CI = 0.52-1) and 0.93 (95%CI = 0.67-0.99) respectively. Teacher-led screening of fundamental movement skills (via FUNMOVES) is an effective method of identifying children with motor difficulties. Such universal screening in schools has the potential to identify movement difficulties and enable earlier intervention than the current norm.

Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020-2023).

COVID-19 self-testing strategy (COVIDST) can rapidly identify symptomatic and asymptomatic SARS-CoV-2-infected individuals and their contacts, potentially reducing transmission. In this living systematic review, we evaluated the evidence for real-world COVIDST performance. Two independent reviewers searched six databases (PubMed, Embase, Web of Science, World Health Organization database, Cochrane COVID-19 registry, Europe PMC) for the period April 1st, 2020, to January 18th, 2023. Data on studies evaluating COVIDST against laboratory-based conventional testing and reported on diagnostic accuracy, feasibility, acceptability, impact, and qualitative outcomes were abstracted. Bivariate random effects meta-analyses of COVIDST accuracy were performed (n = 14). Subgroup analyses (by sampling site, symptomatic/asymptomatic infection, supervised/unsupervised strategy, with/without digital supports) were conducted. Data from 70 included studies, conducted across 25 countries with a median sample size of 817 (range: 28-784,707) were pooled. Specificity and DOR was high overall, irrespective of subgroups (98.37-99.71%). Highest sensitivities were reported for: a) symptomatic individuals (73.91%, 95%CI: 68.41-78.75%; n = 9), b) mid-turbinate nasal samples (77.79%, 95%CI: 56.03-90.59%; n = 14), c) supervised strategy (86.67%, 95%CI: 59.64-96.62%; n = 13), and d) use of digital interventions (70.15%, 95%CI: 50.18-84.63%; n = 14). Lower sensitivity was attributed to absence of symptoms, errors in test conduct and absence of supervision or a digital support. We found no difference in COVIDST sensitivity between delta and omicron pre-dominant period. Digital supports increased confidence in COVIDST reporting and interpretation (n = 16). Overall acceptability was 91.0-98.7% (n = 2) with lower acceptability reported for daily self-testing (39.5-51.1%). Overall feasibility was 69.0-100.0% (n = 5) with lower feasibility (35.9-64.6%) for serial self-testing. COVIDST decreased closures in school, workplace, and social events (n = 4). COVIDST is an effective rapid screening strategy for home-, workplace- or school-based screening, for symptomatic persons, and for preventing transmission during outbreaks. These data will guide COVIDST policy. Our review demonstrates that COVIDST has paved the way for self-testing in pandemics worldwide.

School-Based Screening of Social Determinants of Health: A Scoping Review

School-based screening instruments have traditionally focused on assessing within-child factors, such as a student’s academic, social, emotional, behavioral, or physical development. This emphasis in school-based screening may be a missed opportunity to assess and ameliorate contextual factors (i.e., social determinants of health) influencing child development. In this scoping review, we aim to describe the current landscape of screening for social determinants of health (SDOH) in school settings. Following established practices for scoping reviews, we searched PsycInfo, ERIC, and CINAHL Plus in December 2022 for articles describing the development or use of an SDOH measure in a school setting. From each eligible article, two coders independently extracted (1) study characteristics, (2) measure characteristics, (3) available psychometric or usability information, and (4) reported outcomes of measure implementation. Descriptive and content analyses were used to examine data. We identified six articles describing the development or use of SDOH measures in elementary, high school, or university settings. These articles yielded six unique SDOH measures, intended for either adolescent or young adult self-report, caregiver proxy-report, or both. Measures included 6–25 SDOH items, with additional items assessing demographics, health behaviors, or mental health (e.g., depression). Reported outcomes included increased referrals to services and implementation of school-based supports to reduce social risk (e.g., school food pantry). We discuss next steps for research evaluating the feasibility and social consequences of school-based SDOH screening.

Measurement Invariance of the Social, Academic, and Emotional Behavior Risk Screener - Teacher Rating Scale

School-based universal screening in the social, emotional, and behavioral (SEB) domains allows for the early identification of students in need of SEB support. Importantly, equitable assessment in universal screening for the SEB domains is critical to engage in accurate and ethical data-based decision-making. Measurement invariance is one method for examining potential inequities in assessment tools, permitting the ability to evaluate which assessments or assessment items perform differently across groups. As such, this study utilized multi-group confirmatory factor analysis to evaluate the extent of measurement invariance for a commonly used universal screening tool for the SEB domains: the Social, Academic, and Emotional Behavior Risk Screener - Teacher Rating Scale (SAEBRS-TRS). The sample consisted of 1949 students in kindergarten through fourth grade in a Midwest, suburban school district. Examination of factor structures indicated the bifactor model yielded adequate fit and was utilized for measurement invariance testing. Multi-group confirmatory factor analysis results provided preliminary evidence that the SAEBRS-TRS displays invariance across a variety of student characteristics. Specifically, results supported configural and metric/scalar invariance of the bifactor model across the student characteristics of racial or ethnic identity, sex assigned at birth, and eligibility for free or reduced-price lunch. Yet, future research is needed to corroborate these findings. Limitations, implications for practice, and directions for future research are discussed.

Parent opinion on peer support programs to promote adolescent mental health

RationaleEvidence-based adolescent peer support programs for suicide prevention have shown promise in schools through increased knowledge and acceptability of help-seeking. While multiple social contacts may influence adolescent help-seeking, parents are a major factor. Thus, parent backing for peer support programs is likely to influence their impact, but little is known regarding parent perspectives on such programs. ObjectiveIn the context of a randomized clinical trial evaluating school-based depression screening, qualitative work indicated Pennsylvania parents held positive views of peer support programs. The objective of this study was to gain an understanding of parent perception of adolescent peer support programs at the national level. MethodCross-sectional US-based survey with the C.S. Mott Children’s Hospital National Poll on Children’s Health; 985 parents had a child 13–18 years-old and were eligible. Post-stratification weights were generated by survey vendor, Ipsos. Descriptive and bivariate results were calculated; logistic regression models controlled for parent demographics. ResultsParents were 55 % female, 56 % White, 81 % employed, and 52 % with an income <$100 K. Backing for peer support programs was rated as 33 % definitely, 46 % probably, 14 % unsure, and 7 % would not support; 29 % reported existing peer support programming at their teen’s school. Odds of “definitely/probably” versus “unsure/do not” support were greater among mothers versus fathers (OR 1.53 [95 % CI 1.08, 2.16]), Latinx versus White parents (OR 1.96 [95 % CI 1.15, 3.34]), and employed parents (OR 1.92 [95 % CI 1.25, 2.94]). Adding parent report of an existing program at their teen’s school to the model retained the aforementioned variables with greater support among parents exposed to this programming OR 3.20 ([95 % CI 2.01, 5.08]). Conclusions. One-third of parents favored peer support programs, especially those previously exposed to this programming. Data suggest programs may appeal to Latinx families, presenting an innovative approach to mitigate mental health disparities.

A Population-Based Study of the Utility of Screening for Tics and the Relative Contribution of Tics and Psychiatric Comorbidity to Academic and Social Impairment in Adolescents

ABSTRACT This study examined the performance of a brief screening tool for tics in adolescents. Academic and social impairment in students by tic screen status and emotional/behavioral problem status were examined. Data were collected as part of an epidemiologic study, the Project to Learn about Youth – Mental Health. Participants were 2,312 secondary school students at the Ohio site (47.4% female; 94.4% non-Hispanic white) and their teachers. Students completed 6 items from the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES-6) and the Strengths and Difficulties Questionnaire (SDQ). Teachers completed the Proxy Report Questionnaire for tics and SDQ. Based on responses to the MOVES-6, 11.1% of students screened positive for tics. Internal consistency was adequate (α = 0.76); inter-rater consistency between teachers and students was low (0.03). Based on student self-report, those who screened positive for tics self-reported more academic and social impairment than students who screened negative for tics; teacher-report of impairment was similar between those with a positive or negative tic screen. Students who screened positive for tics and reported internalizing difficulties reported more academic and social impairment than students with only a positive tic screen. Teachers perceived those screening positive for tics and externalizing difficulties as the most socially impaired. In conclusion, a positive self-reported tic screen was associated with self-reported academic and social impairment. Findings reveal the independent contribution of tics to impairment, even when internalizing and externalizing problems are present, and the potential utility of a school-based screening for tics in adolescents.

Evaluating the Practices of Inclusive Education in the Secondary Schools: A Social Realist Perspective

The purpose of the study was to evaluate inclusive education practices at secondary schools in rural settings in the Lebopo Circuit of South Africa. The qualitative research approach was used to evaluate inclusive education practices using the social realist perspective. The study used the case study research design together with an interpretive paradigm to evaluate the daily practices of inclusive education. The study consists of a population of 10 teachers, 5 School-Based Support Team (SBST) members and 5 principals from the selected schools. The participants were selected following purposive sampling and some participants have experience in implementing inclusive education. Data was collected through individual semi-structured interviews, observation and document review. The data was analysed thematically. Archer’s social realist perspective and Bernstein’s pedagogic discourse were used as theoretical lenses to evaluate the practices of inclusive education in the circuit under study. The study results revealed that teachers misinterpret the policy of inclusive education because they view it as a policy supporting only learners with disabilities. The study further showed that the majority of schools do not have functional school-based support teams, and they are not aware of and do not perform their duties as expected. The study concluded that there is a knowledge gap in School-Based Support Teams in fulfilling their roles in inclusive education practices, no sufficient support from the parents and monitoring by the Department of Basic Education in the implementation of inclusive education practices. The study recommended that the School-Based Support Teams be provided with continuous sufficient training with the engagement of the district-based support teams and that a parent-teacher collaborative approach be used to accomplish positive outcomes. Keywords: Inclusive education practices, School-Based Support Teams, Screening, Identification, Assessment and Support.

Informant Discrepancies in Universal Screening as a Function of Student and Teacher Characteristics

Despite the widespread use of school-based universal screening systems for social, emotional, and behavioral risk, limited research has examined discrepancies in ratings provided by teachers and their secondary students. Using the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS; teacher report) and mySAEBRS (student report) scores from a middle school sample, we examined the magnitudes and prevalence of informant discrepancies as well as associated student and teacher factors. Analyses revealed discrepancies consistently in the direction of teachers reporting lower levels of risk than students and were starkest for the Emotional Behavior Risk subscale. Across subscales, multiple student and teacher factors significantly predicted variance in discrepancies. We discuss these findings in the context of implications for selecting screening informants at the secondary level and opportunities to advance practical guidance in this area. Impact Statement Middle school students and their teachers provide discrepant ratings within universal screenings of students’ social, emotional, and behavioral risk. In this sample, students self-reported higher levels of risk than their teachers reported for them. This was especially true for risk in the Emotional Behavior domain and for students and teachers with certain demographic characteristics.

Understanding COVID-19 Vaccine Hesitancy Among K-12 Staff, Parents, and Students: District of Columbia, February to April, 2022.

Despite widespread availability of COVID-19 vaccines, millions of Americans have not received the recommended vaccine doses. In the District of Columbia (DC), COVID-19 vaccination rates are lowest among residents who are Non-Hispanic (NH) Black and among school-aged children. We assessed COVID-19 vaccine hesitancy among staff and parents of students in DC K-12 public and public charter schools. We conducted a telephone-based survey from February 6 to April 16, 2022 to staff, students, and parents of students who participated in school-based COVID-19 screening testing. COVID-19-related survey items included: vaccination status, reasons for not getting vaccinated, perceived vaccine access, and trusted COVID-19 information sources. Utilizing time-to-event analyses, we evaluated differences across demographic groups. The interview response rate was 25.8% (308/1193). Most unvaccinated participants were NH Black and ages 5 to 11 years. Median time from vaccine eligibility to uptake was 236 days for NH Black participants vs. 10 days for NH White participants. Vaccine safety was the top concern among unvaccinated participants. Government and healthcare providers were the most trusted COVID-19 information sources. Differences in timing of vaccine uptake among respondents and greater vaccine hesitancy among NH Black participants compared to other racial/ethnic groups highlight a need for continued tailored outreach and communication using trusted sources to convey the importance, benefits, and safety of COVID-19 vaccination.

Cost-effectiveness of school-based caries screening using transillumination

ObjectivesSchool-based screening for caries lesions usually only employs visual-tactile detection means (standard of care). Near-infrared-light-transillumination (NILT) could be used to support school-based screening and to identify early proximal caries, facilitating referral and appropriate non- or micro-invasive management in dental practice. MethodWe assessed the cost-effectiveness of NILT for school-based caries screening. A German mixed-payers’ perspective was adopted. A Markov model was used to simulate the consequences of true and false positive and negative detections and the subsequent decisions over the lifetime of initially 12 years old patients. Our health outcome was tooth retention in years. Costs were measured in Euro 2020. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness-acceptability at different willingness-to-pay-thresholds were quantified. ResultsNILT was minimally more effective (tooth retention for a mean (2.5–97.5%) 56 (53–59) years) and minimally less costly (515 (416–616) Euro) than standard of care (56 (50–59) years; 526 (427–628 Euro)). The ICER was -503 Euro/year, i.e. school-based caries screening using NILT saved money at higher effectiveness in the modelled population. The cost-effectiveness of NILT increased for payers with a willingness-to-pay for additional tooth retention time. The biggest driver of costs were (avoided) tooth replacements later in life. ConclusionsNILT-based screening is likely to yield limited effectiveness gains and cost savings in the modelled populations. In countries where regular practice-based screening of children is less common than in Germany, the cost-effectiveness of NILT for school-based caries screening is likely higher. Clinical significanceNILT-based caries screening in German schools is unlikely to be cost-effective. In countries with different utilization patterns or generally higher caries prevalence and risk, this may differ.

Cardiac screening in school children: Combining auscultation and electrocardiography with a crowdsourcing model

School-based cardiac screening is useful for identifying children and adolescents with a high risk of sudden cardiac death. However, because of challenges associated with cost, distance, and human resources, cardiac screening is not widely implemented, especially in rural areas with limited medical resources. This study aims to establish a cloud-based system suitable for mass cardiac screening of schoolchildren in rural areas with limited medical resources. Students from three schools were included. They or their guardians completed a simple questionnaire, administered in paper or electronic form. Heart sounds were recorded using an electronic stethoscope. Twelve-lead electrocardiograms (ECGs) were recorded and digitalized. The signals were transmitted through Bluetooth to a tablet computer and then uploaded to a cloud server over Wi-Fi. Crowdsourced pediatric cardiologists reviewed those data from a web-based platform and provided remote consultation. In cases in which abnormal heart sounds or ECGs were noted, the students were referred to the hospital for further evaluation. A total of 1004 students were enrolled in this study. Of the 138 students referred, 62 were diagnosed as having an abnormal heart condition and most had previously been undiagnosed. The interrater agreeability was high. An innovative strategy combining a cloud-based cardiac screening system with remote consultation by crowdsourced experts was established. This system allows pediatric cardiologists to provide consultation and make reliable diagnoses. Combined with crowdsourcing, the system constitutes a viable approach for mass cardiac screening in children and adolescents living in rural areas with insufficient medical resources.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools.

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. https://doi.org/10.23641/asha.23661876.

Predicting Long-Term Ventricular Arrhythmia Risk in Children with Acute Lymphoblastic Leukemia Using Normal Values of Ventricular Repolarization Markers Established from Japanese Cohort Study.

Cardiac complications due to anthracycline treatment may become evident several years after chemotherapy and are recognized as a serious cause of morbidity and mortality in cancer patients or childhood cancer survivors. We analyzed ventricular repolarization parameters in electrocardiography for pediatric acute lymphoblastic leukemia patients during chemotherapy and in long-term follow-up. To establish the reference values of ventricular repolarization parameters in children, we retrospectively summarized the Tpe interval, QT interval, QTc interval, and Tpe/QT ratio in healthy Japanese children. Electrocardiography data recorded from students in 1st and 7th grades were randomly selected from a database maintained by the school-based screening system in the Oita city cohort, Japan. Subsequently, chronological data of the Tpe/QT ratio in 17 pediatric patients with acute lymphoblastic leukemia were analyzed over time. The mean ± standard deviation of the Tpe interval in 1st and 7th graders was 70 ± 7 and 78 ± 17 ms, respectively, while the mean ± standard deviation of the Tpe/QT ratio was 0.21 ± 0.02 and 0.22 ± 0.02 ms, respectively. During the intensive phase of treatment, the Tpe/QT ratios of 3 high-risk patients among the 17 patients with acute lymphoblastic leukemia exceeded the upper limit. The Tpe/QT ratio has a potential clinical application in predicting the risk of long-term ventricular arrhythmia of cancer patients or childhood cancer survivors from childhood to adulthood.

Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis

Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China. A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis. Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings). Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries. National Natural Science Foundation of China,NSFC(82171051),Beijing Natural Science Foundation(JQ20029),Capital Health Research and Development of Special(2020-2-1081),National Natural Science Foundation of China, NSFC(82071000),National Natural Science Foundation of China, NSFC (8197030562).

Adolescents' experiences and views of the national school-based thalassaemia screening programme in Malaysia: a qualitative study.

In 2016, a national school-based thalassemia screening programme was implemented in Malaysia. This study aimed to explore the experiences and views of adolescents from an urban school who had undergone the screening programme. We carried out in-depth interviews with 18 participants aged between 18 and 19 years old, with 12 of them identified as carriers during the school screening. Interviews were transcribed verbatim and analysed using thematic analysis. Three main themes emerged from this study: (1) issues encountered at various levels of the school screening programme: appropriate age for screening, thalassaemia education in school, parental consent and follow-up visit and post-test counselling; (2) experiencing emotional rollercoaster: worry, anxiety, shame, stigma; (3) choosing future partners after carrier status was known-prepared or unprepared? Various issues and screening-related challenges were encountered before, during and after the screening test. Recommendations include improving thalassaemia screening education for both school-going adolescents and parents, and better follow-up care and support for those identified as carriers. These will help stakeholders to be well informed and supportive of thalassaemia screening in schools.