Screening In Clinical Settings Research Articles

Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review.

The Centers for Disease Control and Prevention recommends everyone between 13-64 years be tested for HIV at least once as a routine procedure. Routine HIV screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up routine HIV screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006-2020 in English. The search identified 383 Citations; we screened 220 and excluded 163 (outside the time limit, irrelevant, or outside the U.S.). Of the 220 screened articles, we included 35 and disqualified 155 (did not meet the eligibility criteria). We organized eligible articles under two themes: financial benefits/barriers of routine HIV screening in healthcare settings (9 articles); and Cost-effectiveness of routine screening in healthcare settings (26 articles). The review concluded drawing recommendations in three areas: (1) Finance: Incentivize healthcare providers/systems for implementing HIV routine screening and/or separate its reimbursement from bundle payments; (2) Personnel: Encourage nurse-initiated HIV screening programs in primary care settings and educate providers on CDC recommendations; and (3) Approach: Use opt-out approach.

Magyar Afázia Szűrőteszt: új szűrőeljárás a poststroke aphasia gyors felismerésére

Although aphasia screening tools are widely used internationally, in Hungarian, to date, there have been no aphasia screening tests with reported psychometric properties available. (1) To provide an overview of the international practice and the tools of post-stroke aphasia screening. (2) To present a recently developed aphasia screening test in Hungarian. The Hungarian Aphasia Screening Test comprises five tasks assessing speech comprehension and production, and takes 5-10 minutes to complete. The test is easy to score and needs little equipment, therefore it can be useful in any clinical setting that allows for quick test administration and diagnostics. Based on results of two studies, we evaluate the psychometric properties and the diagnostic accuracy of the test, and determine three impairment severity ranks (mild, moderate, severe aphasia) for the test. The severity ranks were defined based on results of 70 people with post-stroke aphasia (35 women; average age: 61.4 years; average postonset: 12.6 months). The test has high diagnostic accuracy, a sensitivity of 92.5% and a specificity of 88.5%. It shows acceptable structural and concurrent (MR = 0.68) validity as well as good internal consistency (Mα = 0.74). The cut-off score for diagnosing aphasia is 17. The test can differentiate stroke patients with and without aphasia. With the use of the test, patients' aphasia can be rated as mild (score 14-17), moderate (score 9-13), or severe (score 0-8). Our results suggest that it is a reliable and valid screening tool. The test can detect the presence and quantify the severity of aphasia. We discuss the importance of aphasia screening in clinical settings and of the use of the Hungarian Aphasia Screening Test in the context of the international practices. Orv Hetil. 2022; 163(50): 2000-2008.

Diagnostic accuracy of the Stricker Learning Span and Mayo Test Drive Composite for amnestic Mild Cognitive Impairment.

AbstractBackgroundRemote assessment tools offer significant promise for aiding early detection of cognitive impairment. Mayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web‐based platform for remote self‐administered assessment that includes a computer adaptive word list memory test (Stricker Learning Span; SLS) and a measure of processing speed (Symbols Test). We examined the diagnostic accuracy of the SLS and a MTD composite (SLS max span, SLS trials 1–5 total correct, SLS delay correct, [Symbols correct item response time*‐1]) for amnestic mild cognitive impairment (aMCI). We also explored diagnostic accuracy for a broader group that included individuals with possible MCI (pMCI; see Figure 1).MethodsParticipants were recruited from the Mayo Clinic Study of Aging for this ancillary remote study. 226 were cognitively unimpaired (CU; concordant CU diagnosis by 3 independent raters). Fifty‐six participants had possible MCI (at least 1 of 3 raters indicated MCI) and 16 had a consensus diagnosis of aMCI. Primary outcome variables were SLS sum of trials, AVLT sum of trials, Symbols correct items response time, and MTD composite. Mean difference analyses used linear model ANOVAs (alpha = .05). Receiver operating characteristic (ROC) curves were applied; we derived optimal cutoff scores based on the Youden index method.ResultsBoth aMCI and possible MCI groups showed significantly lower performance than the CU group on SLS (Hedge’s g aMCI = ‐1.72, pMCI = ‐1.04), Symbols (Hedge’s g aMCI = 1.38, pMCI = 0.64), and MTD composite (Hedge’s g aMCI = ‐1.89, pMCI = ‐1.09); see Tables 1 and 2 (all p‘s<.01 even when additionally covarying age, education, sex). Total area under the curve was high for differentiating of CU vs. aMCI (MTD Composite = 0.91, SLS = 0.91) and acceptable for CU vs. pMCI (MTD Composite = 0.77, SLS = 0.77); see Table 2. Consistent with our flexible platform, a variety of device types were used to complete remote testing (32% smartphone, 12% tablet, 56% PC).ConclusionsMTD and the SLS show high diagnostic accuracy for aMCI. MTD is a flexible, brief, and easy‐to‐use remote cognitive assessment tool with great potential for scalable use in future studies seeking to maximize inclusion of individuals with aMCI in clinical trials or for cognitive screening in clinical settings.

Social determinants of health—to screen or not to screen? How, when, and what to do next are really the questions.

169 Background: Social determinants of health (SDOH) have a considerable impact on the health outcomes of chronically ill patients. Although the implementation of social needs screening in clinical settings has been studied, patient perspectives of discussing SDOH with health care providers has not been thoroughly investigated. This study sought to explore the experience and perspectives of limited-resource patients with cancer regarding SDOH discussions. Methods: This cross-sectional analysis used data from a nationwide survey distributed in May 2022 by Patient Advocate Foundation (PAF). The survey was fielded via email to patients who received PAF services in 2020. Inclusion criteria included a valid email, aged >19 and a current or previous cancer treatment. Frequencies and percentages were calculated for categorical variables. Questions focused on individual experiences with SDOH screening, conversations and expectation around information use and assistance. Results: A total of 481 survey respondents with cancer completed the survey. Most respondents were female (73%), aged 56-75 (52%), household income < $48,000 (66%), and insured (98%); 38% were Black, Indigenous or Persons of Color (BIPOC). The most common cancer types were hematologic (42%) and breast (34%); 30% were diagnosed < 2 years prior and 82% received treatment in past 6 months. One quarter (26%) stopped or delayed care in past 12 months due to cost and 66% reported that social needs interfered with treatment in past 12 months. Two-thirds (64%) reported conversations about social needs in the past 12 months. Transportation (36%), food insecurity (32%) and personal safety were the most cited nonmedical needs. Conversations were most often initiated by nurse/PA (30%), social worker (30%) or doctor (29%) and patients reported being ‘extremely comfortable’ being asked these questions by the same providers; doctor (54%), nurse/PA (48%), social worker (46%). Over half (53%) reported comfort with SDOH information being part of their medical record; 61% wanted to be asked SDOH questions face-to-face. If a social need was identified, patients trusted patient advocacy groups (64%), social worker (61%) and charitable non-profit organizations (49%) to help them locate assistance. Only 21% indicated knowledge of availability of needs navigation services. Conclusions: Although patients are open to sharing social issues with providers, our data suggests that conversations may not be routinely initiated in clinical settings. There is also a need to increase awareness of resources in response to SDOH screening. Challenges in trust and privacy persist when disclosing this information. Achieving health equity requires culturally responsive strategies to embed screening and referrals into workflow to ensure cancer patients’ needs are identified and they are linked to appropriate nonmedical resources and services.

Association between changes in loneliness identified through screening and changes in depression or anxiety in older adults.

Changes in loneliness are associated with corresponding changes in depression, anxiety, and general health in population surveys, but few studies have assessed these associations through repeated screening in clinical settings. Retrospective cohort study among individuals ≥age 65 in an integrated health care system who completed loneliness screening before two annual wellness visits, separated by a mean of 12.9 (SD 2.0) months, between 2013 and 2018. Their responses identified four subgroups: individuals who were persistently lonely; not lonely; experienced an increase (recently lonely); or decrease (previously lonely) in loneliness. Loneliness was assessed with a single item. Depression was assessed with the Patient Health Questionnaire-2. Anxiety was assessed with the Generalized Anxiety Disorder-2. Fair/poor general health was assessed by a single item. Linear mixed effects models assessed changes in outcomes after covariate adjustment. The cohort comprised 24,666 individuals (19.2% of older adults in the system). Mean age was 73.7 years (SD 6.4); 54.6% were female, and 11.6% were members of racial and ethnic minority groups. Of these individuals, 1936 (7.8%) were persistently lonely, 1687 (6.8%) were recently lonely, 1551 (6.3%) were previously lonely, and 19,492 (79.0%) were not lonely at either time point. After adjustment for sociodemographic, clinical and social variables, recent loneliness was associated with increases in depression (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.41-2.19) and anxiety (aOR 1.67, 95% CI 1.32-2.10). Previous loneliness was associated with decreases in depression (aOR, 0.46, 95% CI 0.36-0.58) and anxiety (aOR 0.69, 95% CI 0.54-0.90). Changes in loneliness were not associated with changes in general health. Changes in loneliness identified through screening were associated with corresponding changes in depression and anxiety. These findings support the potential value of identifying social risk factors in clinical settings among older adults.

Identifying facilitators, barriers, and strategies to implement social determinants of health screening, referral, and follow-up in the US: a scoping review protocol.

This review will assess the literature exploring facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral to community resources, and follow-up in clinical settings and clinical training curricula in the United States. Social determinants of health and social needs are a central cause of health inequity and poor health outcomes in the United States. Existing research primarily focuses on theoretical implications of social determinants of health on health outcomes, with a growing secondary focus on the development of screening tools that identify patients' specific unmet social needs. However, summative research has not yet focused on the barriers, facilitators, and strategies relating to the implementation of social determinants of health and social need screenings into routine clinical care. This scoping review aims to examine literature on the implementation of social determinants of health and social needs screening in clinical settings and clinical training curricula while also identifying gaps that require further exploration. This review will include relevant studies examining the facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral, and follow-up as they relate to human subjects. The literature must be in English from 2010 and focus on United States clinical health settings and curricula. We will search PubMed, CINAHL, and Embase databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular format in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Classification of Adolescent Psychiatric Patients at High Risk of Suicide Using the Personality Assessment Inventory by Machine Learning.

ObjectiveThere are growing interests on suicide risk screening in clinical settings and classifying high-risk groups of suicide with suicidal ideation is crucial for a more effective suicide preventive intervention. Previous statistical techniques were limited because they tried to predict suicide risk using a simple algorithm. Machine learning differs from the traditional statistical techniques in that it generates the most optimal algorithm from various predictors. MethodsWe aim to analyze the Personality Assessment Inventory (PAI) profiles of child and adolescent patients who received outpatient psychiatric care using machine learning techniques, such as logistic regression (LR), random forest (RF), artificial neural network (ANN), support vector machine (SVM), and extreme gradient boosting (XGB), to develop and validate a classification model for individuals with high suicide risk. ResultsWe developed prediction models using seven relevant features calculated by Boruta algorithm and subsequently tested all models using the testing dataset. The area under the ROC curve of these models were above 0.9 and the RF model exhibited the best performance. ConclusionSuicide must be assessed based on multiple aspects, and although Personality Assessment Inventory for Adolescent assess an array of domains, further research is needed for predicting high suicide risk groups.

136 Characterizing the medical and social complexity of Inuit children, youth, and their families from Nunavut who access care at an urban tertiary level paediatric hospital – A retrospective chart review of an Inuit child health clinic

Abstract Primary Subject area Social Paediatrics Background The Inuit Child Health Clinic is a consulting general pediatric outpatient clinic at an urban tertiary level paediatric designed to improve integration and coordination of care for Inuit children, youth, and their families from Nunavut. Characterizing medical and social complexity for this patient population will help to address existing gaps in health and social care, as well as contribute to the development of a culturally safe and sensitive determinants of health screening tool. Objectives To study and characterize the complexities that families cared for by the Inuit Child Health Clinic experience in navigating the health and community environments to identify gaps that exist within their care and understand how we can better support their unique needs. We define medical complexity similarly, referenced in existing literature as multi-system or multi-service involvement or prolonged stay in the city of the urban tertiary level paediatric hospital to access medical care. Design/Methods A retrospective chart review of patients (children and youth between the ages of 0-18 years old) and their caregivers that attended an outpatient general paediatric medicine clinic visit appointment with the Inuit Child Health Clinic between September 30, 2016, and September 30, 2019. A review of 59 patient charts were completed by 2 independent reviewers each for demographic information, medical complexity variables, and social complexity variables. This research has been approved by a local Research Ethics Board as well as the Nunavut Research Institute. Results There are high levels of medical and social complexity as evident through the high average number of healthcare services accessed, number of comorbidities, and number of admissions to hospital. We also found considerable inconsistencies with respect to documentation by providers on the social determinants of health of patients. Note: In collaboration with the Inuuqatigiit Centre for Inuit Children Youth and Families, Qikiqtani Inuit Association (QIA), Nunavut Tunngavik Incorporated (NTI), and the Department of Health in Nunavut, the results and knowledge will be shared and mobilized to reflect a narrative that is community-driven and comments on any possible gaps in social determinants of health screening in clinical settings. Furthermore, in collaboration with the Qaujigiartiit Health Research Centre, this work will inform and support the broader program evaluation of the Inuit Child Health Clinic to meet the needs of patients, families, caregivers, and healthcare professionals. Conclusion A multidisciplinary team approach that focuses on integrative care may be an effective and efficient means to promote communication and collaboration between multiple service providers that are often involved in providing care to this population that is put at-risk due to systemic health and social inequities. Improving social history taking and integrating more formal screening for social determinants of health within the Inuit Child Health Clinic practice should be considered.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

An important goal of the Ending the HIV Epidemic in the U.S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. These activities were divided into 3 core strategies: expansion of routine screening in healthcare settings, locally tailored HIV testing initiatives in nonhealthcare settings, and specific efforts to increase the frequency of testing for individuals with increased potential for acquiring HIV. Because HIV testing is such a crucial part of the core activities of the Centers for Disease Control and Prevention's HIV prevention programs, there are many examples of evidence-based programs and best practices for HIV testing in both clinical and nonclinical settings. This article reviews the evidence base for these strategies and some of the activities proposed under the Diagnose pillar to achieve the goal of diagnosing all HIV infections as early as possible. All other Ending the HIV Epidemic in the U.S. activities start with an awareness of HIV status, which is actually the indicator for which most health departments are closest to the proposed targets. There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U.S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.

Higher Levels of Circulating Osteoprogenitor Cells Are Associated With Higher Bone Mineral Density and Lean Mass in Older Adults: A Cross‐Sectional Study

ABSTRACTCirculating osteo progenitor (COP) cells are a heterogeneous population of cells that circulate within the peripheral blood with characteristics of the bone marrow mesenchymal stem and progenitor pool. Little is known about the behavior of this cell population in humans. The aim of this study was to identify whether a relationship exists between COP cells (as a percentage of the peripheral blood monocytic cells) and musculoskeletal morphometry and to identify if COP have potential clinical utility as a biomarker for osteoporosis. We recruited 57 older adults (median age: 69 years; IQR: 65, 75 years) living independently in the community and performed cross‐sectional analysis to identify associations between the percentage of COP cells and body composition parameters, and through receiver operating characteristic analysis, we evaluated their ability to act as a biomarker of osteoporosis. COP cells were moderately associated with whole‐body bone mineral density (BMD) (r = 0.323, p = 0.014) and bone mineral content (BMC) (r = 0.387, p = 0.003), neck of femur BMD (r = 0.473, p < 0.001), and BMC (r = 0.461, p < 0.001) as well as appendicular lean mass (ALM) (p = 0.038) and male sex (p = 0.044) in univariable analysis. In multivariable analysis controlling for age, gender, height, and weight, COP cells remained strongly associated with neck of femur BMD (p = 0.001) and content (p = 0.003). COP cells were also a good predictor of osteoporosis (dual‐energy X‐ray absorptiometry [DXA] T‐score < −2.5) at the neck of femur (cutoff: 0.4%; sensitivity: 100%; specificity 79%) and total body (cutoff: 0.35%; sensitivity: 80%; specificity: 81%). This study shows strong relationships between bone parameters and COP cell number and male sex. They also have potential as a biomarker of osteoporosis, which may provide a new tool for advanced detection and screening in clinical settings. Future larger evaluation studies should verify the cutoffs for biomarker use, and further explore the relationship between COP cells and muscle. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Examination Of Health Literacy Levels Of Mothers: An Interdisciplinary Study With A Child Developmental Perspective

Introduction and aim: When health literacy is considered in terms of family and especially mother, its importance increases even more. Because the health literacy of the mother and the health of the child are related to each other, the probability of the children of mothers with high health literacy to be healthy is also high. Considering this situation, it is emphasized that health literacy is an important concept for child development professionals, who are one of the health professionals working with children. Because child development professionals involve families and especially mothers in the process while working with children, health literacy can also affect mothers' involvement in the process. Determining the health literacy of mothers and handling it with a child development perspective; It is thought that it will also guide interdisciplinary research on health literacy. In this study, it is aimed to determine the health literacy of mothers and to discuss them with a child development perspective. Method: In the study, residing in Mamak district of Ankara were included 100 mothers. Mixed method was used in the research. Quantitative data were collected with the “Adult Health Literacy Scale”, and qualitative data were collected through the “Questionnaire Form”. Ethics committee approval was obtained before starting to collect data in the study. Afterwards, the participants were given detailed information about the research and consent forms were signed. The research was conducted on a voluntary basis. After the quantitative data were collected, they were processed into the SPSS package program, and whether the data showed normal distribution was examined with the kolmogrov smirnov test. Since the data showed a normal distribution, Anova and t tests, which are parametric tests, were used in the analysis of quantitative data. Qualitative data were analyzed by descriptive analysis method. Results: As a result of the research, it was found that the health literacy levels of the mothers differed significantly according to the variables of education level, education level of the spouse and having a chronic disease. It has been determined that mothers consult physicians for health issues, receive support from health professionals about their children's health problems, and explain the concept of health as physical, mental, social well-being and protection of health. Conclusions and recommendations: In line with the results obtained from the research; preparing early intervention programs as child developers to increase mothers' health literacy levels, conducting health literacy screening in clinical settings and including the assessment of mothers' health literacy in the child's assessment process, it may be recommended to plan studies involving fathers on health literacy.

Estimating Gains in HIV Testing by Expanding HIV Screening at Routine Checkups.

Objectives. To estimate gains in the prevalence of individuals who had ever been tested for HIV overall and by subpopulations from increases in the percentage of persons who had a routine checkup and were tested. Methods. We used data from the 2019 Behavioral Risk Factor Surveillance System to determine the prevalence of individuals who were ever tested for HIV and the prevalence of missed opportunities for HIV testing among those never tested in the United States. We assessed the effect of absolute percentage increases in having ever been tested among those who had a past-year routine checkup on increasing the overall prevalence of having ever been tested. Results. In 2019, 49.5% of US adults had ever been tested for HIV; 34.5% had a missed opportunity. A 50% increase in testing at routine checkups would increase the prevalence of having ever been tested to 84.0%. Increases in the prevalence of having ever been tested (≥ 85%) was highest among persons aged 35 to 54 years, Black persons, persons who were female at birth, persons with health insurance, and persons reporting HIV risk behaviors. Conclusions. Fully incorporating HIV screening into primary care would greatly increase the proportion of US adults who have been tested for HIV. Public Health Implications. Continued efforts to promote HIV testing, including implementing routine screening in clinical settings, will help ensure that all US adults know their HIV status.

Assessment of risk for food insecurity among African American urban households: utilizing cumulative risk indices and latent class analysis to examine accumulation of risk factors.

African American caregivers in low-income, urban communities have high rates of food insecurity. Unemployment, education, smoking, stress, and depressive symptoms are associated with household food insecurity. A cumulative risk model suggests that accumulation of risk may compound food insecurity risk, and certain risk factors are more likely to co-occur. This study utilizes two approaches to examine food insecurity risk among African American caregivers with an adolescent daughter-a cumulative risk index to examine accumulation of risk and food insecurity risk; latent class analysis (LCA) to determine if certain risk profiles exist and their relation to food insecurity risk. Caregivers completed surveys including demographic, psychosocial, and behavioral questions (to create a cumulative risk index) and a validated 2-item food insecurity screen. LCA was used to identify risk profiles. Logistic regression was used to examine relations between cumulative risk, risk profiles, and food insecurity risk. Each additional cumulative risk index factor was associated with a 54% increase in odds of risk of food insecurity. LCA identified three subgroups: high stress/depression (class #1), low education/low stress and depression (class #2), and low risk overall (class #3). Odds of food insecurity risk were 4.7 times higher for class #1, and 1.5 times higher for class #2 compared with class #3. This study contributes to understanding of how food insecurity risk relates to cumulative risk and risk profiles. Findings can be used to improve food insecurity risk screening in clinical settings, enhancing intervention/referral for food security risk and mental health among African American caregivers and their households.

The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review.

Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers’ reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers’ self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors

BackgroundSuicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. MethodData are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments. ResultsTwo distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization. These students have low levels of externalizing risk behaviors making them difficult to detect. The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance. Many of these students have low English fluency, and identify as sexual minority. LimitationsDue to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey. ConclusionUniversal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.

The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis.

Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard. We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman's correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment. Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman's rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (rs = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859-0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786-0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752. The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.

Computer-Aided Detection for Breast Cancer Screening in Clinical Settings: Scoping Review.

BackgroundWith the growth of machine learning applications, the practice of medicine is evolving. Computer-aided detection (CAD) is a software technology that has become widespread in radiology practices, particularly in breast cancer screening for improving detection rates at earlier stages. Many studies have investigated the diagnostic accuracy of CAD, but its implementation in clinical settings has been largely overlooked.ObjectiveThe aim of this scoping review was to summarize recent literature on the adoption and implementation of CAD during breast cancer screening by radiologists and to describe barriers and facilitators for CAD use.MethodsThe MEDLINE database was searched for English, peer-reviewed articles that described CAD implementation, including barriers or facilitators, in breast cancer screening and were published between January 2010 and March 2018. Articles describing the diagnostic accuracy of CAD for breast cancer detection were excluded. The search returned 526 citations, which were reviewed in duplicate through abstract and full-text screening. Reference lists and cited references in the included studies were reviewed.ResultsA total of nine articles met the inclusion criteria. The included articles showed that there is a tradeoff between the facilitators and barriers for CAD use. Facilitators for CAD use were improved breast cancer detection rates, increased profitability of breast imaging, and time saved by replacing double reading. Identified barriers were less favorable perceptions of CAD compared to double reading by radiologists, an increase in recall rates of patients for further testing, increased costs, and unclear effect on patient outcomes.ConclusionsThere is a gap in the literature between CAD’s well-established diagnostic accuracy and its implementation and use by radiologists. Generally, the perceptions of radiologists have not been considered and details of implementation approaches for adoption of CAD have not been reported. The cost-effectiveness of CAD has not been well established for breast cancer screening in various populations. Further research is needed on how to best facilitate CAD in radiology practices in order to optimize patient outcomes, and the views of radiologists need to be better considered when advancing CAD use.

Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System.

Clinical screening for basic social needs-such as food and housing insecurity-is becoming more common as health systems develop programs to address social determinants of health. Clinician attitudes toward such programs are largely unexplored. To describe the attitudes and experiences of social needs screening among a variety of clinicians and other health care professionals. Multicenter electronic and paper-based survey. Two hundred fifty-eight clinicians including primarily physicians, social workers, nurses, and pharmacists from a large integrated health system in Southern California. Level of agreement with prompts exploring attitudes toward and barriers to screening and addressing social needs in different clinical settings. Overall, most health professionals supported social needs screening in clinical settings (84%). Only a minority (41%) of clinicians expressed confidence in their ability to address social needs, and less than a quarter (23%) routinely screen for social needs currently. Clinicians perceived lack of time to ask (60%) and resources (50%) to address social needs as their most significant barriers. We found differences by health profession in attitudes toward and barriers to screening for social needs, with physicians more likely to cite time constraints as a barrier. Clinicians largely support social needs programs, but they also recognize key barriers to their implementation. Health systems interested in implementing social needs programs should consider the clinician perspective around the time and resources required for such programs and address these perceived barriers.

Food Insecurity Screening Among Families of Children With Diabetes.

Little is known about screening in clinical settings for food insecurity (FI) among households of children with diabetes. This study evaluated the acceptability and feasibility of an FI screening initiative in a pediatric diabetes clinic that was implemented to help diabetes dietitian educators tailor management plans for families of children with type 1 or type 2 diabetes facing FI. The initiative comprised three validated screening questions, a care algorithm, a community resource handout, and a poster. In total, 50 families of children and adolescents aged 0-18 years with type 1 or type 2 diabetes were screened for FI. In-person semi-structured interviews combining open-ended and Likert-scale questions were conducted with 37 of the screened families and the three diabetes dietitian educators who conducted the screening. Perceived barriers and facilitators of the screening initiative were identified using content analysis, and Likert-scale questionnaires rated interviewees' comfort level with the screening questions. A reflective journal kept by an onsite research interviewer also facilitated the data interpretation process. Most families felt comfortable answering the screening questions. Families with FI appreciated the opportunity to express their concerns and learn about affordable food resources. However, ∼20% of these families described stigma and fear of judgment by clinicians if they screened positive for FI. Diabetes educators also felt comfortable with the screening questions but reported lack of time to screen all families and to follow-up with resources after a positive screen. A self-reported intake form was recommended to ensure that everyone is systematically screened. A standardized and respectful method of assessing FI could help clinicians better tailor treatment plans and support for families of children with diabetes who face FI. Based on these findings, similar FI screening initiatives should be implemented in other clinical settings as part of routine clinical practice.