Screening For Risk Factors Research Articles

Exploring factors associated with first antenatal care booking among pregnant women in Northwestern Tanzania

Objectives: Pregnant women are advised to schedule their initial antenatal care (ANC) visit during the first trimester to detect and treat any medical issues as well as screen for risk factors that may affect the course and outcome of their pregnancy. Nonetheless, delayed first ANC presentation is typical, especially in Sub-Saharan Africa. This study sought to determine the timing of the first ANC booking and identify factors that influence the first ANC booking among pregnant women. Material and Methods: This was a cross-sectional study which was carried out from June–August 2023. Data were collected using a structured questionnaire. Data analysis was done using Epi Info 7.2 and STATA version 15.0 software. Independent factors for the first ANC booking were determined by multivariate logistic regression analysis using odds ratios, 95% confidence intervals, and a P-value cut-off of ≤0.05. Results: A total of 402 pregnant women were recruited for the study. The bulk of participants, 189 (47.0%), were between 25 and 34 years. More than half 279/402(69.4%) of the pregnant women booked their first ANC appointment beyond 12 weeks of gestation. The married pregnant women had almost four-fold booking ANC earlier compared to single women (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI] = 1.1–14.4, P = 0.036). Similarly, employed pregnant women were 2.8 times more likely to book their first ANC visits earlier as compared to self-employed women (AOR = 2.8, 95% CI = 1.3–5.8, P = 0.006). In addition, women receiving support from their family or partner were more likely to book their first ANC as recommended compared to those lacking such support (AOR = 0.5, 95% CI = 0.3–0.9, P = 0.022). Finally, those who planned pregnancy were 2 times more likely to book their first ANC visit within the recommended time, unlike those who did not (AOR = 2.3, 95% CI = 1.3–2.1, P = 0.03). Conclusion: Despite the known benefits of early antenatal appointments, many pregnant women delay their first visit, highlighting the need for targeted policies to address socioeconomic barriers and improve health-care access, thus encouraging timely ANC bookings and better maternal health outcomes.

Permutation Test for Image-on-Scalar Regression With an Application to Breast Cancer.

Image based screening is now routinely available for early detection of cancer and other diseases. Quantitative analysis for effects of risk factors on digital images is important to extract biological insights for modifiable factors in prevention studies and understand pathways for targets in preventive drugs. However, current approaches are restricted to summary measures within the image with the assumption that all relevant features needed to characterize an image can be identified and appropriately quantified. Motivated by data challenges in breast cancer, we propose a nonparametric statistical framework for risk factor screening that uses the whole mammogram image as outcome. The proposed permutation test allows assessment of whether a set of scalar risk factors is associated with the whole image in the presence of correlated residuals across the spatial domain. We provide extensive simulation studies and illustrate an application to the Joanne Knight Breast Health Cohort using the mammogram imaging data.

Determination of Recovery by Total Restitution or Compensation Using Multifrequency Vestibular Tests and Subjective Functional Scales in a Human Model of Vestibular Neuritis

Background: Vestibular Neuritis (VN) can induce unilateral acute vestibular syndrome (AVS). This study aimed to identify predictive factors of recovery from vestibular neuritis considering total restitution and/or compensation. Methods: In this longitudinal study, 40 patients were included. The initial assessment, performed within 36 to 72 h from the onset (T0), included medical history taking (general and specific), including screening for cardiovascular risk factors (CVRFs), and a battery of diagnostic vestibular tests, comprising the bithermal caloric test (BCT), video head impulse test (VHIT), and skull vibration-induced nystagmus (SVIN) test. All patients also completed a Dizziness Handicap Inventory (DHI). All assessments were repeated 90 ± 15 days later (T3). Subjective compensation criteria were based on the DHI total score, and objective compensation criteria were based on laboratory test results. Four groups of patients (A, B, C, D) were delineated by combining patients with normal vs. abnormal vestibular tests and patients with normal vs. abnormal DHI. Results: CVRFs (but not age or body mass index (BMI)) were associated with a poorer recovery of symptoms. The BCT (lateral semicircular canal paresis %), VHIT (lateral semicircular canal gain), and SVINT (nystagmus slow phase velocity) recovered to normal values in 20%, 20%, and 27% of patients, respectively, at T3. Conclusions: Vascular risk factors (hypercholesterolemia) are correlated with patients who do not recover their symptoms via either total restitution or compensation. There was no significant difference between high- and low-frequency vestibular tests in patients recovering from their symptoms. Some patients with objective recovery may continue to have persistent subjective symptoms.

Identifying high-risk central lines in critically ill children: a novel nurse-driven screening and mitigation intervention to reduce CLABSI

BackgroundDespite strong adherence to central line associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high. MethodsWe developed a novel screening tool that stratified patients' risk for CLABSI and considered risk-mitigation strategies. ResultsOf 1583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI free. Device utilization was stable across both units, declining by 22% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys. DiscussionsThis novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI-prevention processes in the PICU and PCICU. ConclusionsA novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.

Utility of the triglycerides/HDL cholesterol ratio in older adult patients in Colombia

Abstract Introduction Alterations in lipid metabolism are responsible for atherogenesis and an increased risk of atherosclerotic cardiovascular disease. The triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) is used to assess the risk of cardiovascular diseases; however, it has not been evaluated in older adults. The aim of the present study is to evaluate the TG/HDL-C ratio in elderly patients and analyze its correlation and discriminatory capacity with cardiovascular risk factors according to data from the SABE Colombia survey. Purpose Describe the sociodemographic characteristics, cardiovascular history, lifestyle, and cardiovascular risk score in the older adult population included in the SABE Colombia Study.Describes the distribution of triglyceride levels, cholesterol, and the TAG-HDL ratio in the older adult population included in the SABE Colombia Study. Evaluate the relationship between the TAG/HDL Cholesterol Index and cardiovascular risk factors such as hypertension, prediabetes, type 2 diabetes mellitus, cardiovascular disease, cerebrovascular disease Determine if there is a correlation and the degree of correlation between the TAG/HDL Cholesterol ratio and variables related to higher cardiovascular risk and stablish cutoff points of the triglyceride to HDL cholesterol ratio as indicators of the onset of risk factors Materials and Methods Cross-sectional study in adults aged 60 years and older included in the national SABE Colombia survey (National Survey of Health, Well-being, and Ageing conducted in Colombia in 2015), which included 244 municipalities from all departments of the country. A correlation test was performed to assess the presence and degree of correlation between the TAG/HDL index and cardiovascular risk factors, and ROC curve analysis was conducted to evaluate the performance of the TAG/HDL index in identifying risk factors. Results A total of 23,694 patients with the necessary information for the study were included. The median age was 69 years, 57.3% were women, and 34.3% were of white race. 23.5% had hypertension, and 16.4% had diabetes mellitus. 13.4% had a history of cardiovascular disease, and 2.5% had cerebrovascular disease. While the specific correlation between the index and different cardiovascular risk factors is generally low to moderate, good discriminatory capacity was found for diabetes and metabolic syndrome with the following values: diabetes, with an area under the curve (AUC) of 0.871 and a cut-off point of 9.17; and for metabolic syndrome, the AUC was 0.840, with a cut-off point of 8.81. Conclusions Our findings show that the TG/HDL ratio has intermediate correlation for different cardiovascular risk factors; however, it has excellent predictive ability for the presence of diabetes and metabolic syndrome. These findings are very useful in the clinical evaluation, screening, and detection of cardiovascular risk factors in the population aged 60 years and older in Colombia.Scatter plots of TAG/HDL ratio comparedROC curves for diabetes and metabolic s

Healthcare workers’ experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework

BackgroundIn emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.MethodsThis study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These findings will directly inform implementation strategies.ResultsThree themes were identified; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices.ConclusionsScreening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED.

Elucidation of pathophysiology of intracranial aneurysms based on metagenome analyses of oral bacteria

When intracranial aneurysms occur in arteries, this can lead to weakening of the arterial wall and subarachnoid haemorrhage, which can result in death. Intracranial aneurysms can’t be diagnosed without cerebrovascular imaging tests and there are few clues to indicate their presence. Neurosurgeon Assistant Professor Hirokazu Koseki, Department of Neurosurgery, The Jikei University School of Medicine, Japan, is looking for novel ways to predict the presence of intracranial aneurysms before they rupture. He is investigating the role of oral bacteria, which have been associated with cerebral haemorrhage and dementia, in order to clarify the relationship between oral bacteria and aneurysms. In unprecedented work, he and the team want to map this relationship based on severity of periodontal disease and will utilise metagenomic analysis of saliva to identify the bacterial strains that might contribute to the neuropathology. They will also take samples from the walls of the aneurysms to precisely decipher which bacterial strains can be directly associated with them. The work will enable researchers to establish simple and inexpensive targeted treatment for intracranial aneurysms and is also anticipated to have knock-on effects, being used for the screening of inherent risk factors for the occurrence of intracranial aneurysms. Although there are known risk factors, patients without any of the risk factors can still develop intracranial aneurysms or subarachnoid haemorrhages. Building on existing research that points to association between oral microbiology and neuropathology, Koseki is working to identify further risk factors that might help in diagnosing intracranial aneurysms in patients.

Adherence to Pediatric Screening.

Preventive screenings in children encourage maintenance of optimal cardiovascular health, but gaps may exist between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index, blood pressure, lipids, and blood glucose. We used 2010 to 2018 ambulatory visit data from children aged 2 to 12 years within CAPRICORN (Chicago Area Patient-Centered Outcomes Research Network), an electronic health record network in Chicago. This study included 87 549 children who attended 197 559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of body mass index, blood pressure, lipids, and/or hemoglobin A1c or fasting blood glucose measurements were assessed. We used generalized estimating equations to calculate proportion adherence for each metric overall and stratified by age, sex, race and ethnicity, and insurance status. Universal age-based screening prevalence (95% CI) per 100 eligible visits was 77.1 (76.8-77.3) for body mass index, 33.4 (33.1-33.7) for blood pressure, and 9.6 (9.3-9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible visits was 13.9 (12.2-15.9) for blood pressure, 6.9 (6.4-7.5) for lipids, and 13.3 (12.6-14.1) for blood glucose. Early screening of cardiovascular health risk factors could lead to earlier interventions, which could alter cardiovascular health trajectories across the lifetime. Low-to-moderate levels of adherence to universal age-based and risk-based cardiovascular health screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.

Health dialogue intervention versus opportunistic screening in primary care for type 2 diabetes and cardiovascular disease prevention in settings with low socioeconomic status (DETECT): study protocol for a pragmatic cluster-randomized trial

BackgroundMeta-analyses of randomized trials suggest that health checks and health promotion interventions targeting behavior change in primary care do not prevent cardiovascular morbidity and mortality in the general population. However, whether such interventions are more effective in high-risk populations, such as people living in low socioeconomic settings, remains unclear, as they have been poorly represented in previous trials. Therefore, we aim to evaluate the effectiveness, cost-effectiveness, and implementation of systematic screening followed by an individually oriented, lifestyle-focused, health dialogue intervention for prevention of type 2 diabetes and cardiovascular disease, as compared to opportunistic screening, in primary care in socioeconomically disadvantaged areas.MethodsUsing an overall pragmatic approach and a cluster-randomized design with two arms, we aim to enroll 3000 participants aged 50–59 years from 30 primary care centers (PCCs) with an above-average level of Care Need Index in Stockholm Region, Sweden. PCCs will be randomized (1:1) either to a health dialogue intervention, which includes inviting enlisted patients to a systematic screening of risk factors followed by an individually oriented lifestyle-focused health dialogue, or to opportunistic screening, which includes screening patients for a smaller set of risk factors during an appointment at their PCC taking place for other reasons. The main outcome will be change in systolic blood pressure during 6- and 12-month follow-ups. Additional short-term outcomes will be changes in other biological risk factors, health-related quality-of-life, and lifestyle habits, as well as process and implementation outcomes, and unintended side effects. The long-term effect on type 2 diabetes and cardiovascular disease incidence and mortality will be examined using regional and nationwide registers. Changes in systolic blood pressure and other health outcomes will be analyzed using mixed-effect generalized linear modeling and mixed-effect Cox regression to capture variability between and within PCCs. A health economic evaluation will assess resource use and costs in the short- and long-term.DiscussionThis trial of lifestyle-focused health dialogues and opportunistic screening in primary care in socioeconomically disadvantaged areas in the largest region of Sweden has the potential to yield valuable insights that could support evidence-based policymaking.Trial registrationClinicalTrials.gov (NCT06067178). Prospectively registered September 27, 2023.

Body composition estimates from bioelectrical impedance and its association with cardiovascular risk.

Screening for traditional risk factors of cardiovascular disease is well known in primary healthcare (PHC) settings. However, other risk factors through newer tools (such as bioelectrical impedance analysis [BIA]) could also be predictors of increased cardiovascular risk (CVR). Body composition estimates (body fat percentage, body water percentage, body lean mass) by BIA and its association to CVR have been studied with variable results. This study assesses the body composition estimates and their association with CVR in the South African PHC setting. A retrospective record analysis was conducted on a cohort of de-identified patients utilising the ABBY®Health Check Machine at a PHC facility in South Africa between May 2020 and August 2022. The ABBY Machine estimates body fat percentage (BF%) and body water percentage (BW%) estimates from BIA. Cardiovascular risk based on the Framingham-risk-score was stratified into high, medium and low CVR. An analysis of variance was used to determine mean differences of BF% and BW% among these groups. A total of 4008 records (n= 4008) were used in the final analysis. The majority of patients were female (70.1%) with a mean age of 33.6 years. Higher mean BF% (35.75% vs. 31.10% vs. 27.73%;p 0.0001) and lower mean BW% (49.46% vs. 53.15% vs. 56.18%;p= 0000) were found to be significantly associated with high CVR. This study demonstrated the use of newer technologies that could assist in the identification of CVR in low resource PHC settings.

The clinical and neuropsychological profiles of Alzheimer's disease with white matter hyperintensity in North China.

Patients with Alzheimer's disease (AD) often exhibit characteristic clinical manifestations, particularly neuropsychiatric symptoms. Previous studies have shown that white matter hyperintensity (WMH) is strongly associated with AD progression, as well as neuropsychiatric symptoms. The purpose of this study was to investigate the clinical and neuropsychological characteristics of AD patients with WMH. This retrospective study involved 104 18-fluorodeoxyglucose-positron emission computed tomography (18FDG-PET-CT)-defined AD patients treated at Tianjin Huanhu Hospital from January 2010 to December 2022. Cranial magnetic resonance imaging (MRI) provided semi-quantitative data on brain structure and WMH. Collect and analyze patient clinical data. Neuropsychological assessments were used to evaluate cognitive function and psychobehavioral traits. Among the 104 patients, 66 were in the WMH group (63.5%) and 38 in the non-white matter hyperintensity (non-WMH) group (36.5%). There were no significant differences in gender, age, age of onset, education, BMI, smoking, drinking, diabetes, coronary heart disease, dementia family history, fasting blood glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) between the two groups. The WMH group showed higher rates of hypertension, homocysteine (Hcy) levels, NPI, and CDR scores as compared to the non-WMH group (p < 0.05). MMSE and MoCA scores were significantly lower in the WMH group (p < 0.05). In the MMSE subitem analysis, patients in the WMH group showed a decrease in attention, recall, and language scores. In the MOCA subitem analysis, WMH patients had lower scores in executive function, naming, attention, language, abstraction, and orientation (p < 0.05). Furthermore, subgroup analysis of NPI showed a higher incidence of delusions, depression, and apathy in the WMH group (p < 0.05). According to the hierarchical analysis of mild, moderate and severe dementia groups, the hypertension, leukoencephalopathy, Hcy level, Fazekas total score, PWMH and DWMH scores in the severe dementia group were significantly higher than those in the mild and moderate dementia groups (p < 0.05). As the disease progresses, more and more patients show increased white matter hyperintensity. White matter lesions are closely correlated with cognitive decline and psychobehavioral symptoms in AD patients, and may be used as an indicator of disease progression. Priority should be given to early screening and prevention of WMH-related risk factors.

Evaluation of epicardial adipose tissue thickness and carotid intima-media thickness in children with Behçet's disease.

Behçet's disease (BD) is a systemic vasculitis affecting all sizes of arteries and veins. Approximately 5-10% of patients with BD are present during childhood. The chronic nature of the disease may lead to serious cardiovascular complications over time including early atherosclerosis. Increased levels of epicardial adipose tissue (EAT) and carotid intima-media thickness (CIMT) are considered early signs of subclinical atherosclerosis. Ongoing chronic inflammation may cause to increase in both EAT and CIMT. In this study, we aimed to evaluate CIMT and EAT in children with BD and determine their relationship with the clinical manifestations and course of the disease. This cross-sectional study evaluated 30 patients with juvenile-onset BD and age-sex-matched 20 healthy controls. The CIMT and EAT thickness were measured by the same paediatric cardiologist. The association between clinical features, baseline disease activity, disease duration, EAT thickness and CIMT was also evaluated. Thirty children with BD and 20 age-sex-matched healthy volunteers enrolled in the study. The most common BD-related feature was oral aphthous (n=30), followed by mucocutaneous findings (n=22). Uveitis was observed in 5 patients, vascular involvement in 4, neurological involvement in 4, and gastrointestinal involvement in 2. All patients were inactive at the time of evaluation. The EAT thickness was significantly higher in patients while CIMT levels revealed no significant differences. However, there was no correlation between disease duration, baseline disease activity, and EAT thickness. Increased EAT thickness may be a risk factor for early atherosclerosis in patients with BD. The EAT thickness was found to be significantly higher in paediatric BD patients. Confirmation of results in larger series may provide better insight into early screening for risk factors in these patients.

The potential of a nomogram risk assessment model for the diagnosis of abdominal aortic aneurysm: a multicenter retrospective study

The incidence of abdominal aortic aneurysm (AAA) is very high, but there is no risk assessment model for early identification of AAA in clinic. The aim of this study was to develop a nomogram risk assessment model for predicting AAA. The data of 280 patients diagnosed as AAA and 385 controls in The Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively reviewed. The LASSO regression method was applied to filter variables, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). The calibration capability of the model is evaluated by using bootstrap (resampling = 1000) internal validation and Hosmer–Lemeshow test. The clinical utility and clinical application value were evaluated by decision curve analysis (DCA) and clinical impact curve (CIC). In addition, a retrospective review of 133 AAA patients and 262 controls from The First Affiliated Hospital of Soochow University was performed as an external validation cohort. Eight variables are selected to construct the nomogram of AAA risk assessment model. The nomogram predicted AAA with AUC values of 0.928 (95%CI, 0.907–0.950) in the training cohort, and 0.902 (95%CI, 0.865–0.940) in the external validation cohort, the risk prediction model has excellent discriminative ability. The calibration curve and Hosmer–Lemeshow test proved that the nomogram predicted outcomes were close to the ideal curve, the predicted outcomes were consistent with the real outcomes, the DCA curve and CIC curve showed that patients could benefit. This finding was also confirmed in the external validation cohort. In this study, a nomogram was constructed that incorporated eight demographic and clinical characteristics of AAA patients, which can be used as a practical approach for the personalized early screening and auxiliary diagnosis of the potential risk factors.

Interpretable multitemporal liver function indicator model for prediction and risk factor analysis of drug induced liver injury

The occurrence of liver injury during cancer treatment is extremely harmful. The risk factors for drug.induced liver injury (DILI) in the pancreatic cancer population have not been investigated. This study aims to develop and validate an interpretable decision tree (DT) model for the early prediction of DILI in pancreatic cancer patients using multitemporal clinical data and screening for related risk factors. A retrospective collection of data was conducted on 307 patients, the training set (n = 215) was used to develop the model, and the test set (n = 92) was used to evaluate the model. The classification and regression trees algorithm was employed to establish the DT model. The Shapley Additive explanations (SHAP) method was used to facilitate clinical interpretation. Model performance was assessed using AUC and the Hosmer‒Lemeshow test. The DT model exhibited superior diagnostic efficacy, the AUC values were 0.995 and 0.994 in the training and test sets, respectively. Four risk factors associated with DILI occurrence were identified: delta.albumin, delta.ALT, and post (AST: ALT), and post.GGT. The multiperiod liver function indicator.based interpretable DT model predicted DILI occurrence in the pancreatic cancer population and contributes to personalized clinical management of pancreatic cancer patients.

Caring for a Child with a Cleft Lip and/or Palate: A Narrative Review.

Raising a child with healthcare needs places additional demands on caregivers. In 2012, Nelson and colleagues authored a review of 57 papers pertaining to parents' experiences of caring for a child with cleft lip and/or palate (CL/P). Thanks in large part to this review, available literature on this topic has grown considerably. The aim of the present review was to update and critically appraise recent literature, with the wider goal of assessing progress in the field and setting recommendations for future work. All original, peer-reviewed articles pertaining to the psychological adjustment of parents of children with CL/P living in high-income countries (published May 2009 to May 2024) were examined. A total of 126 articles were included. Findings were narratively synthesised according to three salient themes: Emotional Impact; Social Experiences; and Care Delivery. Recent research has built on Nelson et al.'s recommendations, addressing some prior gaps in knowledge. Nonetheless, some areas remained largely unexplored and critical methodological limitations were still evident. Recommendations for clinical practice include: improved informational resources for parents and non-specialist health professionals, regular audit of services in collaboration with parents and families, routine psychological screening for known risk factors and integrated psychological support from diagnosis onward. Recommendations for future research include the design of multicentre, prospective, longitudinal studies with sufficient sample sizes and appropriate control/reference groups, inclusion of families from diverse ethnic and socioeconomic backgrounds, further examination of factors contributing to psychological growth, the development and evaluation of psychological interventions, and cross-condition learning.

Psychiatric Disorders and Diabetes: Review of Guidelines for Collaborative Care.

Psychiatric disorders and diabetes are highly associated in psychiatric and primary care settings. The purpose of the current article is to examine the risk factors for diabetes among individuals being treated for psychiatric disorders in mental health care settings. Guidelines for promotion of healthy lifestyles, screening for risk factors, early identification and treatment of prediabetes, and collaborative care to manage the disease are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 7-10.].

P039 INTEGRATED SCREENING FOR HYPERTENSION AND DIABETES MELLITUS IN ROUTINE TUBERCULOSIS CARE IN DELHI, INDIA

Background: Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs) like hypertension and diabetes mellitus (DM). Bi-directional screening for TB and DM is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme. Objective: To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017. Methods: It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p&lt;0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening. Conclusion: Integrating screening for hypertension and DM and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.

Healthy Status in the Gymnastic Community in West Bandulan, Sukun, Malang

Obesity is a risk factor for various degenerative diseases such as diabetes mellitus and coronary heart disease. Obesity and all degenerative diseases could be prevented by implementing a healthy lifestyle, early detection of risk factors for degenerative diseases, and increasing knowledge about degenerative diseases. Therefore, this service activity aimed to form a healthy community with a program for three consecutive months. Activities included healthy exercise once a week, degenerative disease risk factors screening, and health education. Activities were carried out every Sunday morning for three months located in Bandulan Barat, Sukun District, Malang City. This activity was attended by 40 non-menopausal women. Health screening included waist circumference, random blood glucose, uric acid, cholesterol, and blood pressure. Of the 40 women examined, 39 suffered from central obesity, 6 suffered from hypertension, 4 suspected diabetes mellitus, 5 suffered from hyperlipidemia, and 4 of them suffered from hyperuricemia. As an intervention, participants received education about healthy lifestyles and degenerative diseases, the treatment of hypertension, hyperlipidemia, hyperuricemia, and diabetes mellitus. From healthy screening, central obesity was the most prevalent in this women's community. Healthy exercise community activities with health screening, and health education could be effective strategies for promotive and preventive activities to prevent degenerative obesity.

Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing.

Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.

Secondary Stroke Prevention in People With Schizophrenia.

People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke. In this retrospective cohort study, we used linked population-based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017. Outcomes were screening, treatment, and control of risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each outcome among people with and without schizophrenia, adjusting for age and other factors. Among 81 163 people with ischemic stroke, 844 (1.04%) had schizophrenia. Schizophrenia was associated with lower rates of screening for hyperlipidemia (60.5% versus 66.0%, adjusted relative risk [aRR] 0.88 [95% CI, 0.84-0.93]) and diabetes (69.4% versus 73.9%, aRR 0.93 [95% CI, 0.89-0.97]), prescription of antihypertensive medications (91.2% versus 94.7%, aRR 0.96 [95% CI, 0.93-0.99]), achievement of target lipid levels (low-density lipoprotein <2 mmol/L) (30.6% versus 34.6%, aRR 0.86 [95% CI, 0.78-0.96]), and outpatient specialist visits (55.3% versus 67.8%, aRR 0.78 [95% CI, 0.74-0.83]) or primary care physician visits (94.5% versus 98.5%; aRR 0.96 [95% CI, 0.95-0.98]) within 1 year. There were no differences in prescription of antilipemic, antiglycemic, or anticoagulant medications, or in achievement of target hemoglobin A1c ≤7%. People with stroke and schizophrenia are less likely than those without to receive secondary preventive care. This may inform interventions to improve poststroke care and outcomes in those with schizophrenia.