School Screening Research Articles

Advancing Mental Health Screening in Schools: Innovative, Field-Tested Practices and Observed Trends During a 15-Month Learning Collaborative.

Schools are well positioned to facilitate early identification and intervention for youth with emerging mental health needs through universal mental health screening. Early identification of mental health concerns via screening can improve long-term student development and success, but schools face logistical challenges and lack of pragmatic guidance to develop local screening policies and practices. This study summarizes mental health screening practices tested by six school districts participating in a 15-month learning collaborative. Qualitative analysis of 42 Plan-Do-Study-Act cycles revealed that districts tested quality improvement changes across seven screening practice areas, with all teams conducting at least one test to: 1) build a foundation; and 2) identify resources, logistics and administration processes. Quantitative data indicated that the average percentage of total students screened increased from 0% to 22% (range = 270 - 4,850 students screened at follow-up). Together, these results demonstrate how school districts not currently engaged in mental health screening can apply small, specific tests of change to develop a locally-tailored, practical and scalable process to screen for student mental health concerns. Lessons learned are provided to inform future directions for school-based teams.

Different Types of Screen Behavior and Depression in Children and Adolescents.

The purpose of this study was to examine the associations between different types of screen behavior and depression, taking into account exercise and sleep among children and adolescents. A total of 23,573 Japanese children and adolescents (aged 8–15 years) participated in this cross-sectional study. Different types of screen behavior, weekly exercise time, sleep duration, and prevalence of depression were assessed using a questionnaire. Independent associations between various types of screen behavior and prevalence of depression were examined using logistic regression analyses after adjusting for age, school, sleep duration, exercise time, and other screen behavior types. A two-way analysis of covariance was conducted to examine whether exercise and sleep can attenuate the negative effects of screen behavior. The associations between screen behavior and depression varied by screen behavior types and participant characteristics. More time spent engaging in newer types of screen behavior, including social media, online games, and online videos, was associated with a higher prevalence of depression. In contrast, more time spent on TV was associated with a lower prevalence of depression. Sufficient exercise can lower the prevalence of depression, regardless of the length of time and content of the screen, and its associations were particularly significant for junior high school girls. Sleep was not associated with the prevalence of depression among any participant group except elementary school boys. Our findings suggest that age- and sex-specific intervention strategies that also consider screen-based behavior can effectively lower the risk of depression in children and adolescents.

The Effectiveness of Two Implementation Strategies for Improving Teachers’ Delivery of an Evidenced-based HIV Prevention Program

BackgroundEffective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers’ implementation of an evidenced-based HIV intervention.MethodsUsing our 7-item pre-implementation school screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets grade six through grade 8 students. After completing a two-day curriculum workshop, 81 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the two-month intervention curriculum. This optimization trial examines the impact of two implementation strategies: biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. Linear mixed-effects model was used to examine the association of the implementation strategies with implementation fidelity.ResultsBMF and SAM were significantly associated with teachers’ implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities (15 core activities on average), followed by teachers who received either BMF (6.9 activities) or SAM (7.9 activities). Teachers who did not receive BMF or SAM taught the lowest numbers (4.1 activities). Teachers’ sustained implementation of FOYC in the prior school year was related to increased implementation fidelity during the optimization trial. Teachers’ confidence in implementing five core activities, attitudes toward sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ fidelity of implementation before the optimization trial.ConclusionBMF and SAM are effective in promoting teachers’ implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers’ attitudes toward sex education, perceived principal support, and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.

Prevalence and Burden of Refractive Errors at National and Sub-national Levels in Iran.

PurposeTo estimate the prevalence, burden of refractive errors and their associated trend from 1990 to 2018 and geographic inequalities in Iran.MethodsData regarding the epidemiology of refractive errors was extracted from three different sources: systematic review of published literature, data from visual school screening programs, and data from Iran's national health survey (NHS). The pool of all available data on refractive errors as well as demographic, location, and socioeconomic status covariates were fitted in spatio-temporal and Gaussian process regression models to predict the prevalence of refractive errors from the years 1990 to 2018 in 31 provinces grouped by age and sex in order to calculate years lived with disability (YLDs).Results In 2018, the age-adjusted prevalence of refractive errors was 16.32% (95% uncertainty interval [UI]: 12.44–21.48%) in both sexes, 17.98% (95% UI: 13.74–23.61%) in women, and 14.66% (95% UI: 11.14–19.36%) in men. The prevalence of refractive errors reveals that it increases with age. Refractive errors contributed to 441.41 and 348.38 YLDs in men and women, respectively. The age-standardized prevalence growth was 31.30% in females and 24.32% in males from the years 1990 to 2018. Significant geographical heterogeneity was observed. The age-standardized YLDs rates of refractive errors represent an increasing trend of 28.9% increase from 1990 to 2018.ConclusionOver 28 years, the prevalence of refractive errors increased significantly. Women tend to have higher rates of prevalence. The prevalence increased in older ages. Border provinces had the lowest prevalence. Age-standardized YLDs rates of refractive errors increased by about 30%.

SARS-CoV-2 Saliva Mass Screening in Primary Schools: A 10-Week Sentinel Surveillance Study in Munich, Germany.

Representative, actively collected surveillance data on asymptomatic SARS-CoV-2 infections in primary schoolchildren remain scarce. We evaluated the feasibility of a saliva mass screening concept and assessed infectious activity in primary schools. During a 10-week period from 3 March to 21 May 2021, schoolchildren and staff from 17 primary schools in Munich participated in the sentinel surveillance, cohort study. Participants were tested using the Salivette® system, testing was supervised by trained school staff, and samples were processed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). We included 4433 participants: 3752 children (median age, 8 [range, 6–13] years; 1926 girls [51%]) and 681 staff members (median age, 41 [range, 14–71] years; 592 women [87%]). In total, 23,905 samples were processed (4640 from staff), with participants representing 8.3% of all primary schoolchildren in Munich. Only eight cases were detected: Five out of 3752 participating children (0.13%) and three out of 681 staff members (0.44%). There were no secondary cases. In conclusion, supervised Salivette® self-sampling was feasible, reliable, and safe and thus constituted an ideal method for SARS-CoV-2 mass screenings in primary schoolchildren. Our findings suggest that infectious activity among asymptomatic primary schoolchildren and staff was low. Primary schools appear to continue to play a minor role in the spread of SARS-CoV-2 despite high community incidence rates.

Study on the Reliability and Accuracy of Scolioscope, a New Digital Scoliometer.

Early detection of scoliosis with school screening and quick, easy, and reliable assessment of its progress are of paramount importance in the management of patients. There have been several tools described, with the most common being the analog scoliometer. Most recently, smartphone applications have entered this area with and without the use of sleeves for the device. There is no research that has evaluated the accuracy of measurements both left and right in either digital or analog devices. In this study, we evaluated the reliability and validity of a new digital scoliometer called the Scolioscope. Thirty subjects were included for the intra-rater reliability study. ICC values >0.9 were calculated both for same-day and between-day measurements. The device was highly accurate with an average difference from the ones set on the sine bar of 0.03° for right-side measurements and 0.18° for the left. These measurements suggest a highly accurate and reliable tool.

Supplemental Material for Timing and Frequency of Screening in Schools: A Latent Variable Analysis of Behavioral Stability Over Time

Supplemental Material for Timing and Frequency of Screening in Schools: A Latent Variable Analysis of Behavioral Stability Over Time

Severe Visual Impairment in Schools (A PEEK Study)

Childhood visual impairment is a major public health concern. The global financial burden of childhood-onset blindness is greater than that of adult-onset blindness due to the longer span of living. The importance of good vision for education and socialisation from an early age has prompted the adoption of vision screening in schools by many national eye care programmes in Zimbabwe. Therefore, the aim and purpose of this study were to determine the prevalence of visual impairment and the pattern of eye conditions affecting school children screened during the course of the “Portable Eye Examination Kit (PEEK) project.” The study was a retrospective review that utilized data that was collated and analysed from the PEEK project dashboard from June 2019 to December 2020 by well-trained eye health care providers. The sample size was 4591 school-going children aged between 5 to 20 years of age recruited from the Harare and Bulawayo schools. Results showed that 58% did not have any eye problems while 24% had a red watery and itchy eye, 10% had a red eye, 2% had lid and globe issues and 2% had strabismus. The visual acuity results showed that the majority of participants, 2/3, had a good vision as they recorded a Snellen acuity test score of 6/9 or better. In addition, 1/5 had mild visual impairment, and about 2% of the participants were legally blind. 15% of the participants recruited in this study had moderate to severe visual impairment.

Strategy for treatment of sport related injury utilizing a medical screening in school

Strategy for treatment of sport related injury utilizing a medical screening in school

Cost-Effectiveness of photoscreeners in screening at-risk amblyopia in Indian children.

Amblyopia is the most common cause of preventable vision impairment in children. This study tried to evaluate the cost-effectiveness of photoscreeners in identifying refractive errors making children at risk of amblyopia. This was designed as a prospective, open-label, randomized controlled study to compare the cost-effectiveness of photoscreeners (2WIN Adaptica and Plusoptix) versus autorefractor and Mohindra retinoscopy to identify the at-risk amblyopia. This study was conducted from October 2018 to December 2018 in coordination with Nanna Kannu school screening project and children in the age group of 5-11 years were included in the study. The photoscreening was done by lay screeners. A supervising ophthalmologist collated all data. Cost-effectiveness was calculated for the individual instruments and compared. The average time is taken for each instrument to record the refractive error was calculated and compared with the Mohindra retinoscopy. Number of children included in this study was 2910. The mean age of the children was 7.82 + 0.65 years. The mean time taken for 2WIN Adaptica was 6 sec, Topcon -10 s, and Plusoptix -4 s. Plusoptix showed the minimal time for screening a child when compared to all other methods. The Plusoptix and 2WIN Adaptica were shown to be cost-effective when compared to Mohindra retinoscopy (P < 0.05). Photoscreening using Plusoptix and 2WIN Adaptica with lay screeners was < seven times the cost incurred and five times faster than the trained optometrists using either autorefractor or Mohindra retinoscopy and thus more cost-effective in screening a large number of young children with at-risk amblyopia at the community level.

Spine pathologies detections: users’ requirements, technological development and first results.

For spinal pathologies, especially scoliosis, early detection is essential to limit symptoms during growth and health impacts at skeletal maturity. Currently, school screening campaigns or annual medical visits are the main means of ensuring this detection. It is possible to attain a screening sensitivity of 93.8% and a sensibility of 99.2% by combining a Forward Bending Test, a scoliometer and Moiré’s topography, but due to a lack of time, of trained professionals or of access to specific tools, a majority of children are not screened.The objective of this research is to define the specifications of a massive and easy-to-use screening tool through a qualitative study to address this issue. A review of the literature, interviews and discussions with health professionals, particularly physiotherapists, helped to define the needs. Five physiotherapists and a pediatric rehabilitation physician were interviewed during semi-structured interviews. To extract the main categories of ideas and opinions expressed, the data were analyzed and coded using grounded theory. This step was intended to help us define requirements. The first results of the subsequently selected technical solution, a depth camera, and the associated software development will be presented. This prototype software for spine detection was developed and tested on an adult body.The interviews highlighted the relevance of a new tool for spine and back analysis. A tool that would provide processed information with high reliability and accuracy, combined with low cost and low processing time would be ideal for health professionals. To complement the tools already used by professionals, a solution that could give a dynamic visualization of the spine curve will be valuable. The solution developed uses a Kinect sensor capturing the patient’s back. The current software development allows the dynamic extraction of the spine line for the patient during the anterior flexion test (Adam’s test).

Role of teachers in screening of ocular disorders in school children: A multistage school screening program

Purpose: The aim of the study was to find out whether teachers can be introduced as an effective tool in ocular screening of school children and to list out various causes of visual impairment and ocular abnormalities in school children and provide appropriate measures. Method: A multistage school screening program from August to December 2019 in Trivandrum included 33,990 students from 52 schools. Five stages of the study were training of selected teachers, screening by teachers in the school, comprehensive examination by the hospital team in schools, detailed evaluation of referred children in the hospital, and corrective measures by pediatric ophthalmologists in our hospital. A total of 1480 children were selected randomly from the children identified as normal by teachers to detect false negatives. The pattern of ocular disorders children was analyzed. Results: Out of 33,990 students, 6343 students who were detected to have ocular disorders by teachers (18.6%) were examined by our team. 74.2% (4707 students) of them were confirmed to have ocular problems. Thus teachers were able to identify the eye problems correctly (true positives) in 74.2% children, 25.8% being false positives. True positives include refractive errors (73.4%), allergic conjunctivitis (7.9%), strabismus (1.9%), amblyopia (0.098%), pediatric cataract (0.08%), etc. Out of 1480 randomly selected children, 8 (0.54%) children were false negatives (none had refractive errors). Spectacles were given to 2484 children free of cost. Conclusion: Simplicity of multistage screening, ease of its application, time and cost effectiveness, wider coverage, utility as a continuous process in coming years signifies that introducing teachers as primary vision screeners at their schools is an innovative community-based strategy to address the challenges of childhood blindness in resource-constrained settings.

Nuancing Movement and Stasis in Berlin School Films

Nuancing Movement and Stasis in Berlin School Films Angelica Fenner (bio) Olivia Landry. Movement and Performance in Berlin School Cinema. Bloomington: Indiana University Press, 2018. 215 pages. $75.00 cloth. $32.00 paperback. Olivia Landry’s ambitious monograph offers new frameworks for reading that intriguing German film movement scholars and critics have come to refer to as the “Berlin School.” These films, produced between the late 1990s and the contemporary moment (assuming that school is not yet out), continue to captivate cineasts for their auteurist mode of production, the discerning gaze they cast upon rapid social change in twenty-first-century Germany, and their loosely shared aesthetic and stylistic affinities that include dedramatized storytelling and open endings. The author references no fewer than twenty-five films in building a case for movement and performance as conceptual categories that enhance our understanding of this cinema’s broader significance. While some scholars have applied the label of “slow cinema,” Landry maintains that what is at stake is less a matter of tempo than of heightened tension between movement and stasis. There is so much stasis, even stupor, in these films that movement comes to assume an entirely different valence and significance than in much plot-driven film. Whereas dialogue and action sweep the storyline forward in the Deleuzian action-image, in the Berlin School [End Page 93] films, Landry argues, movement is uncoupled from character motivation and conventional causality and is grasped by the spectator on its own terms as phenomenological or performative. Yet, what does it mean to assert that movement is effectively staged for the viewer? For whom else, if not the camera and, by extension, the viewer is movement proffered? Here, the thoughtfully prepared monograph could make more explicit earlier on a key distinction not so much explained as assumed, namely that between acting and performance. Acting in film is understood as predicated upon heightened artifice, potentially rehearsed innumerable times until a particular take meets the director’s expectations and is spliced into the larger syntagma. In turn, it is the long take, a prevailing technique in Berlin School cinema, that enables acting to be perceived as performance, involving e/motion sustained without the interventions of the cut. In chapter 1, Landry points to liveness and presence as qualities associated with Berlin School screen performance, often underscored through remediations such as photographs and closed-circuit television surveillance footage, with the latter’s televisual associations subconsciously eliciting a sense of cotemporality between diegetic and spectatorial realities. The second chapter goes on to read liveness through the notion of presence developed in performance and theater studies—an apt recourse given the propensity of actors in Berlin School films also working on the German stage. Building on Claudia Breger’s compelling case for “an aesthetics of presence” in twenty-first-century German cinema, Landry targets dance in particular as a vehicle featured in fully half the films tackled in her study.1 Dance coaxes forth the exhibitionism associated with performance, and these films consistently capture the dancing body as a whole, rather than as fragmented parts, and do so in a sustained take from beginning to end of the dance. The artifice of movement overall that is revealed through unchoreographed performance is, I suggest, also attributable to the palpable self-consciousness and awkwardness that these free, uncharted moves elicit from the actor. Chapter 3, Landry’s lengthiest, draws inspiration from Volker Pantenburg’s “automobilized gaze,” exploring what she coins as a shared “point of sense” that scenes shot within a car convey to the spectator.2 Such scenes bind immobility in the vehicle’s interior to heightened mobility in and mastery of the space beyond the windshield, doubling as film screen. As potential allegory of late stage capitalism, the car wrecks ubiquitous across Berlin School cinema could be said to exemplify the narrative culmination of an un relenting acceleration that intensifies to the point of self-destruction. [End Page 94] Landry posits the automobile as a veritable cinema machine, one whose destruction via the unexpected crash not only troubles our conventions of cinematic perception but also enacts a radical deterritorialization, literally veering off the beaten track to enact new flight lines in...

Access to school-based eye health programs: a qualitative case study, Bogotá, Colombia.

ABSTRACTObjectives.To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia.Methods.We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework.Results.Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children.Conclusion.Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.

Development and Validation of the Digital Addiction Scale for Teenagers (DAST)

We present the development and validation of the Digital Addiction Scale for Teenagers (DAST), describing the pilot study ( N = 40 students) and main study ( N = 4493) with Estonian students aged 11–19, in spring 2020. Our aim was to create a scale suitable for psychoeducational assessment of teenagers’ behaviour and feelings towards digital devices. We used the mixed research framework . Half of the study sample was collected before the coronavirus crisis (Sample I: 1972 students) and the rest during a distance-learning period (Sample II: 2521 students). We found that factor structure in both subsamples were similar. The DAST shows a negative relationship with emotional school engagement and life satisfaction and positive correlations with school burnout, learning difficulties and screen time. We discuss potential uses of the scale for assessing health-related digital competences.

Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary?

Introduction and aim of the study: We aim to determine whether the changes in the spine in scoliogenesis of idiopathic scoliosis (IS), are primary/inherent or secondary. There is limited information on this issue in the literature. We studied the sagittal profile of the spine in IS using surface topography. Material and methods: After approval of the ethics committee of the hospital, we studied 45 children, 4 boys and 41 girls, with an average age of 12.5 years (range 7.5–16.4 years), referred to the scoliosis clinic by our school screening program. These children were divided in two groups: A and B. Group A included 17 children with IS, 15 girls and 2 boys. All of them had a trunk asymmetry, measured with a scoliometer, greater than or equal to 5 degrees. Group B, (control group) included 26 children, 15 girls and 11 boys, with no trunk asymmetry and scoliometer measurement less than 2 degrees. The height and weight of children were measured. The Prujis scoliometer was used in standing Adam test in the thoracic (T), thoraco-lumbar (TL) and lumbar (L) regions. All IS children had an ATR greater than or equal to 5 degrees. The Cobb angle was assessed in the postero-anterior radiographs in Group A. A posterior truncal surface topogram, using the “Formetric 4” apparatus, was also performed and the distance from the vertebra prominence (VP) to the apex of the kyphosis (KA), and similarly to the apex of the lumbar lordosis (LA) was calculated. The ratio of the distances (VP-KA) for (PV-LA) was calculated. The averages of the parameters were studied, and the correlation of the ratio of distances (VP-KA) to (VP-KA) with the scoliometer and Cobb angle measurements were assessed, respectively (Pearson corr. Coeff. r), in both groups and between them. Results: Regarding group A (IS), the average height was 1.55 m (range 1.37, 1.71), weight 47.76 kg (range 33, 65). The IS children had right (Rt) T or TL curves. The mean T Cobb angle was 24 degrees and 26 in L. In the same group, the kyphotic apex (KA (VPDM)) distance was −125.82 mm (range −26, −184) and the lordotic apex (LA (VPDM)) distance was −321.65 mm (range −237, −417). The correlations of the ratio of distances (KA (VPDM))/(LA (VPDM)) with the Major Curve Cobb angle measurement and scoliometer findings were non-statistically significant (Pearson r = 0.077, −0.211, p: 0.768, 0.416, respectively. Similarly, in the control group, KA (VPDM))/(LA (VPDM) was not significantly correlated with scoliometer findings (Pearson r = −0.016, −p: 0.939). Discussion and conclusions: The lateral profile of the spine was commonly considered to be a primary aetiological factor of IS due to the fact that the kyphotic thoracic apex in IS is located in a higher thoracic vertebra (more vertebrae are posteriorly inclined), thus creating conditions of greater rotational instability and therefore greater vulnerability for IS development. Our findings do not confirm this hypothesis, since the correlation of the (VP-KA) to (VP-KA) ratio with the truncal asymmetry, assessed with the scoliometer and Cobb angle measurements, is non-statistically significant, in both groups A and B. In addition, the aforementioned ratio did not differ significantly between the two groups in our sample (0.39 ± 0.11 vs. 0.44 ± 0.08, p: 0.134). It is clear that hypokyphosis is not a primary causal factor for the commencing, mild or moderate scoliotic curve, as published elsewhere. We consider that the small thoracic hypokyphosis in developing scoliosis adds to the view that the reduced kyphosis, facilitating the axial rotation, could be considered as a permissive factor rather than a causal one, in the pathogenesis of IS. This view is consistent with previously published views and it is obviously the result of gravity, growth and muscle tone.

From barriers to implementation: Advancing universal mental health screening in schools

In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.

Universal Depression Screening in Schools—Promises and Challenges in Addressing Adolescent Mental Health Need

Universal Depression Screening in Schools—Promises and Challenges in Addressing Adolescent Mental Health Need

Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents

Adolescent major depressive disorder (MDD) prevalence has nearly doubled in the past decade. The US Preventive Services Task Force endorses universal adolescent MDD screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment. To evaluate the effectiveness of universal adolescent MDD screening in the school setting in an effort to reduce disparities and improve MDD identification and treatment initiation. This randomized clinical trial, conducted from November 6, 2018, to November 20, 2020, compared the usual school practice of targeted or selected screening based on observable behaviors of concern with universal MDD screening. Students within an identified school were randomized by grade to 1 of the 2 study groups. Study groups were compared using mixed-effects logistic regression. Participants included students in grades 9 through 12 enrolled at 1 of the 14 participating Pennsylvania public high schools. In targeted screening, students with behaviors prompting concern for MDD were referred to the Student Assistance Program (SAP), mandated in all Pennsylvania schools. The SAP determined follow-up recommendations. In universal screening, all students completed the Patient Health Questionnaire-9 (PHQ-9); students with positive scores proceeded to SAP. The universal screening group could also have targeted referral to SAP for concerning behavior independent of the PHQ-9. The primary outcome was initiation of MDD treatment or services based on data collected by school SAP teams during the academic year. A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity. In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern. ClinicalTrials.gov identifier: NCT03716869.

ECG evaluation in 11 949 Italian teenagers: results of screening in secondary school.

AimThere is lack of evidence regarding the screening role of ECG for sudden cardiac death (SCD) prevention. Our aim was to evaluate the prevalence of ECG abnormalities among teenagers according to sport participation and competitive status.MethodsEleven thousand nine hundred and forty-nine Italian pupils from 179 secondary schools (13–19 years) were consecutively enrolled. ECG abnormalities were divided into minor and major. Medical history, clinical examination and sport activity information were acquired. Further evaluations were suggested in case of major ECG abnormalities. Follow-up was performed at 2 years.ResultsN = 1945 (16%) pupils had ECG abnormalities. Major ECG abnormalities were detected in 13% of the cohort, minor in 34%. ECG abnormalities were more common in nonathletes compared with athletes. A diagnosis of cardiac disease was reached in 25 (1.6%) of the pupils with major ECG abnormalities.ConclusionECG abnormalities are common among young populations and more prevalent in nonathletes. Among pupils with major ECG abnormalities 1.6% had a cardiac disease diagnosis. Our results are in line with the data supporting ECG screening in the general young population.