Screening Questions Research Articles

Enhancing early detection of autistic spectrum disorder in children using machine learning approaches

Diagnosing Autism Spectrum Disorder (ASD) presents a multifaceted challenge, demanding accurate and efficient screening methods. Applying machine learning techniques offers a promising avenue for enhancing diagnostic accuracy and efficiency. This research investigates the efficiency of machine learning in distinguishing individuals with ASD from those without, utilizing a comprehensive dataset comprising screening questions, demographic factors, and ASD related diagnostic classifications. We applied chi-square feature selection technique and also tested Random Forest, Logistic Regression, Gradient Boosting Classifier, and Extra Trees Classifier. Each model showed optimal performance and exhibit high precision, recall, and F1-score for both ASD-positive and ASD-negative instances. Additionally, AUROC curves further validated the models’ exceptional discriminatory abilities, with exceptional results. Our findings highlight the potential of machine learning algorithms for enhancing ASD diagnosis accuracy and efficiency in clinical settings. Further research and validation on larger datasets are required to understand the importance of machine learning methods in ASD diagnosis.

Food insecurity and fruit and vegetable consumption in Belgium

Abstract Background Food insecurity is a substantial and growing concern in many high-income countries. Yet, representative data on the extent of the issue in the general Belgian population is lacking. This study aims to assess the extent of food insecurity in Belgium, identify those at risk of food insecurity, and explore the relationship between food insecurity and fruit and vegetable consumption. Methods We used data from the Belgian National Food Consumption Survey 2022-2023, a representative sample of the Belgian population aged 3 years and older (n = 2,800). Food insecurity was assessed using the 3 screening questions derived from the USDA Household Food Security Survey Module. Frequencies of fruit and vegetable consumption were obtained from a food propensity questionnaire. Prevalence of food insecurity was estimated using post-stratification weights. Logistic regression models were used to determine the association between frequency of fruit and vegetable consumption and food insecurity, adjusting for gender, household composition, educational attainment, and income. Results Preliminary results indicate that 12.6% of population experienced some form of food insecurity. Those who experienced food insecurity consumed fruit and vegetables less frequently than others, after adjustment for other socio-economic variables (ORs>4.00, p-values>0.05). Conclusions This study confirms that food insecurity is a substantial concern in Belgium. Food insecurity should be routinely monitored at the national level. Experiencing food insecurity appears to be negatively associated with the consumption of healthy foods such as fruits and vegetables and thus with the overall quality of the diet. Further research should be supported to identify effective strategies to reduce food insecurity in Belgium. Policy attention should be given to ensure financial accessibility to healthy foods and their attractiveness, especially for people experiencing food insecurity. Key messages • Food insecurity is an major concern in Belgium and should be routinely monitored. • Financial accessibility to healthy foods should be improved, especially for those facing food insecurity.

Poor psychosocial status and cardiovascular risk factors are associated with depression or anxiety

Abstract Background Depression and anxiety are rising in South Africa but their associations with psychosocial and cardiovascular risk factors (CVRFs) remain under explored. This study determined the associations of depression and anxiety traits with poor psychosocial wellbeing, risky lifestyle behaviours and cardiometabolic diseases. Methods In a population-based cross-sectional study, data were collected via administered questionnaires, clinical examinations and biochemical assessments. Depression and anxiety traits were ascertained via the Patient Health Questionnaire-9 and Generalised Anxiety Disorder screening questions. Multivariable logistic regressions determined the associations with depression and anxiety traits; the basic model comprised sociodemographic factors, physical inactivity, tobacco smoking and alcohol misuse (CAGE ≥2). Psychosocial and cardiometabolic variables were entered individually in separate models. Results Among 678 participants, median age 52 years and mainly women (81%), prevalence of depression scores ≥10 were 14.2% (men:12.7%, women:14.6%, p = 0.498) and anxiety scores ≥10 were 10.2% (men:10.3%, women:10.2%). In the basic regression models, depression, but not anxiety, was associated with being separated, living as married/widowed vs. single (OR:2.01, 95%CI:1.02-3.94), and alcohol misuse (2.07, 1.13-3.78). Depression and anxiety were associated with decreasing social support (depression: 1.09, 1.04-1.12; anxiety: 1.09, 1.04-1.14), and increasing number of adverse life events. Hypertension (1.76, 1.07-2.90, p = 0.025), diabetes (1.98, 1.03-3.82, p = 0.041) and dyslipidaemia (1.97, 1.01-3.85, p = 0.048) were associated with depression but not anxiety. Conclusions The high burden and associations of depression and anxiety traits with poor psychosocial wellbeing suggest a need for holistic care approaches. The associations of depression traits with CVRFs warrant screening and care of depression in the presence of cardiometabolic diseases and alcohol misuse. Key messages • The high burden of depression and anxiety traits in South Africa is associated with poor social support and quality of life, and increasing adverse life events experienced. • The associations of depression traits with hypertension, diabetes, dyslipidaemia, and alcohol misuse highlight the need for integrated management strategies.

Protective Effects of Authenticity Against Depression, Suicide, and Burnout among Surgeons.

Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons. Members of the department of surgery at a large academic medical center were sent an anonymous survey between April to May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire (PHQ9), burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool. Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living scores (ALS) correlated with reduced burnout (r=-0.21, p=0.047) and depression (r=-0.37, p=0.0002). Conversely, higher Accepting External Influence (AEI) were associated with increased depression (r=0.23, p=0.023) and higher Self-Alienation (ASA) were associated with increased burnout (r=0.43, p<0.0001) and depression (r=0.48, p<0.0001). While authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p=0.029 and p=0.010 respectively) of a positive ASQ. ALS increased with advancement in professional rank (p=0.007), while AEI (p=0.0001), ASA (p=0.003), depression (p=0.014), and ASQ (p=0.02) decreased. In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession.

Differential utilization of the online patient portal for completion of health-related social needs screening during routine gynecologic cancer care.

Telehealth technologies offer efficient ways to deliver health-related social needs (HRSN) screening in cancer care, but these methods may not reach all populations. The authors examined patient characteristics associated with using an online patient portal (OPP) to complete HRSN screening as part of gynecologic cancer care. From June 2021 to June 2023, patients in a gynecologic oncology clinic completed validated HRSN screening questions either (1) using the OPP (independently before the visit) or (2) in person (verbally administered by clinic staff). The authors examined the prevalence of HRSN according to activated OPP status and, in a restricted subgroup, used stepwise multivariate Poisson regression to identify associations between patient and visit characteristics and using the OPP. Of 1616 patients, 87.4% (n=1413) had an activated OPP. Patients with inactive OPPs (vs. activated OPPs) more frequently reported two or more needs (10% vs 5%; p<.01). Of 986 patients in the restricted cohort, 52% used the OPP to complete screening. The final multivariable model indicated that patients were less likely to use the OPP if they were Black (vs. White; adjusted relative risk [aRR], 0.70; 95% confidence interval [CI], 0.59-0.83); not employed (vs. employed; aRR, 0.81; 95% CI, 0.68-0.97), or had low measures of OPP engagement (aRR, 0.80; 95% CI, 0.68-0.92). New versus established patients were 21% more likely to use the OPP (aRR, 1.21; 95% CI, 1.06-1.38). Differential use of the OPP suggested that over-reliance on digital technologies could limit the ability to reach those populations that have social factors already associated with cancer outcome disparities. Cancer centers should consider using multiple delivery methods for HRSN screening to maximize reach to all populations.

Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study.

Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message-based screening protocols before such approaches can be implemented at the population level. This study aimed to examine sources of selection bias in a texting-based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eβ=0.99; P<.001) and 0.3% (eβ=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Findings from this study highlight the feasibility of text message-based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups.

Preventive healthcare practice by allied health professionals: Results from a cross-sectional survey in rural and regional Victoria

ObjectivesTo describe the frequency of preventive healthcare practice (assess, advice, refer for support) provided by allied health professionals (AHPs) practicing in regional and rural healthcare settings to address smoking, diet and physical inactivity. To identify factors that influence the delivery of preventive healthcare practice. MethodsAHPs working in public healthcare services in the Loddon Mallee region of Victoria were surveyed. Clinicians reported on the proportion of clients where they had provided preventive care. Likert scale questions measured factors influencing preventive healthcare practice. ResultsIn total, 115 clinicians completed the survey. AHPs reported that they assess for smoking and physical activity behaviours but not diet. Preventive health practice that included providing advice or referrals for follow-on support was rarely undertaken. Availability of screening tools and automated referral letters increased the likelihood of preventive healthcare practice. ConclusionsGreater attention to addressing modifiable lifestyle behaviours by AHPs might be warranted to match the rates of risk factors in rural and regional Victoria. Integrating support systems, for example, embedding screening questions within clinical assessments can assist preventive healthcare practice. Implication for public healthMany AHPs are not promoting healthy behaviours to prevent poor health. We present some strategies that could potentially improve this.

Abstract A110: The CaRE2 health equity center Contact Registry: Engaging underrepresented community participants in cancer research

Abstract Background: One of the most common barriers in community participant engagement in cancer research is lack of information, and at times, not being invited to participate. Contact Registries serve as a valuable tool to address this challenge, as they connect community members with cancer health research opportunities. Potential participants can choose to participate in studies they find of interest and are prime candidates for. The Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center, Community Outreach Core (COC), developed a contact registry designed to engage Black/African American (B/AA) and/or Hispanic/Latinos/a (H/L) individuals in ongoing research studies conducted across our bicoastal center institutions which includes the University of Southern California Norris Comprehensive Cancer Center, the University of Florida, and the Florida Agricultural &amp; Mechanical University. The CaRE2 Contact Registry was implemented in August 2022 by the CaRE2 COC, with the primary objective to increase the number of underrepresented minority individuals participating in cancer research. Methods: Individuals are recruited into the registry utilizing both in-person and online methods. Information is provided in English and Spanish, and data is stored on REDCap. For in-person enrollment, a consent form and OPT-IN survey is completed; our online recruitment utilizes additional screening questions to ensure eligibility. The COC in Florida and Los Angeles promote the registry at local community events and through social media accounts and website (https://care2healthequitycenter.org/the-care2-contact-registry/). A $10.00 physical or electronic gift card is provided as compensation. Results: As of April 30th, 2024, 1,328 individuals have enrolled in the Registry, with participants from FL (887 = 69.5%) and CA (389 = 30.5%); with 737 participants being B/AA (57.8%), 506 H/L (39.7%), 26 non-Hispanic White (2.0%), and 6 individuals self-identified as other race/ethnicity (0.5%). We enrolled 873 female (68.5%) and 402 male (31.5%) participants. A total of 90.4% of enrollees are willing to participate in health research involving surveys, 23% in health research studies requiring saliva (24.1%), hair (23.4%), or blood (22%) sample donations. When registrants were asked for future research interest 99.9% responded Yes. Conclusion: Community participants have a high interest in engaging in research studies regardless of race/ethnicity if its via surveys, attending focus groups, and/or joining community forums. There is greater hesitancy when asked to provide biospecimens (blood, hair or saliva). Mechanisms to understand the reasons for this hesitancy, and address them, to appropriately incentivize individuals about donation of biospecimens are needed. Community efforts that connect potential enrollees to cancer studies of interest can support increased participation in cancer research among B/AA and H/L communities. Citation Format: Carolina Aristizabal, Eduardo Ibarra, Fern Webb, IIeana Guzman, Brooke Hensel, John Luque, Rosa Barahona, Diana Wilkie, Mariana C Stern, Sandra Suther, Lourdes Baezconde-Garbanati. The CaREhealth equity center Contact Registry: Engaging underrepresented community participants in cancer research [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A110.

Factors Associated with Advance Care Planning Engagement Among Community‐Dwelling Older Adults: A Cross‐Sectional Study

ABSTRACTAimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community‐dwelling older adults.DesignA cross‐sectional study was conducted with 262 community‐dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.MethodsValidated self‐reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.ResultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.ConclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community‐dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community‐dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.ImpactUnderstanding factors associated with advance care planning engagement among community‐dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community‐dwelling older adults in advance care planning.Reporting MethodThe STROBE statement checklist was used as a guide to writing the manuscript.Patient or Public ContributionThe study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Child life specialists predict successful MRI scanning in unsedated children 4 to 12years old.

It can be challenging for children to cooperate for a magnetic resonance imaging (MRI) exam. General anesthesia is often used to ensure a high-quality image. When determining the need for general anesthesia, many institutions use a simple age cutoff. Decisions on the necessity for anesthesia are often left to schedulers who lack training on determination of patient compliance. The study aimed to evaluate whether screening questions administered by certified child life specialists (CCLS) could successfully predict which children could complete an MRI without sedation. This is a retrospective, institutional review board approved study. Data was collected as part of a quality improvement program, where a CCLS screened 4- to 12-year-old children scheduled for MRI scanning using a questionnaire. Parent responses to the screening questions, CCLS's recommendation for scheduling the MRI awake, start and end time for the MRI scan, and scan success were recorded. A predictive model for the CCLS's recommendation was developed using the child's age, estimated scan length, scan difficulty, and the parent's responses to the screening questions. The primary outcome measure was a successfully completed MRI not requiring additional imaging under anesthesia. Of the 403 screened children, 317 (79%) were recommended to attempt the MRI without anesthesia. The median age of participants was 7 (IQR 4-17) years. Overall, 309 of 317 (97.5%) participants, recommended by the CCLS for the program, met the primary outcome of successful MRI completion on their first attempt. The multivariable regression model which included clinical information about the child's age, estimated scan length, scan difficulty, and four of the six parent screening questions had excellent performance (area under the curve = 0.89). Information collected by the CCLS via screening along with the child's age, the estimated scan length, and difficulty can help predict which children are likely to successfully complete a non-sedate MRI.

The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action

BackgroundMalnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly.MethodsBased on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years.ResultsSurveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients.ConclusionWe recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study.

Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.

Impact of temporomandibular disorder symptoms among 15-year-old girls.

Many adolescents, especially girls, report temporomandibular disorder (TMD) symptoms that may impact their daily life. At 19 different schools participating in the preventive program with dental nurses of FRAMM (Fluoride, Advise, Arena, Motivation, Food), at the Västra Götaland Region in Sweden, 15-year-old girls were invited to a cohort study about symptoms of TMD that also included headaches. Three hundred twenty-nine girls attended the study and answered a questionnaire regarding TMD symptoms and their consequences such as sick leave from school and consumption of analgesics. The girls were asked about the symptom's influence on their daily life, about their general health, use of regular medication, physical activity, and they answered the PHQ4 regarding experienced symptoms of anxiety and depression. There was a significant correlation between TMD symptoms and sick leave with 31% of the girls having stayed home due to symptoms. Of the girls who answered affirmative in the screening questions (3QTMD), nearly half the group had stayed at home due to their symptoms, 24% had consulted a physician, 42% had used analgesics weekly and 59% reported that they felt the symptoms negatively affected their school performance. The girls who had regular medication had more TMD symptoms. Anxiety and depression were associated with TMD symptoms. The study showed that TMD symptoms had a negative impact on the 15-year-old girls' daily life resulting in sick leave from school, consumption of analgesics, and experiences of negative impacts on their behavior and performance at school.

Using Natural Language Processing on Expert Panel Discussions to Gain Insights for Recruitment, Retention and Intervention Adherence for Online Social Support Interventions on a Stage II-III Clinical Trial Among Hispanic and African American Dementia Caregivers.

We applied natural language processing (NLP) to a corpus extracted from 4 hours of expert panel discussion transcripts to determine the sustainability of a Stage II-III clinical trial of online social support interventions for Hispanic and African American dementia caregivers. Prominent topics included Technology/hard to reach populations, Training younger populations, Building trust, Privacy and security issues, Simplification of screening questions and recruitment procedures, Understanding participants' needs, Planning strategies and logistics, Potential recruitment places, Adjusting intervention size downwards to engage elderly participants, Targeting different generations, Internet-based interventions by age range, and Providing step-by-step instructions and an overview of the entire research process during recruitment. The application of NLP to qualitative data on a dementia caregiving clinical trial provides useful insights for recruitment, retention, and adherence to guidelines for such interventions serving Hispanic and African American dementia caregivers.

Household food insecurity among persons with disabilities in Canada: Findings from the 2021 Canadian Income Survey.

Income-related food insecurity is an important determinant of health. Persons with disabilities are at a higher risk of experiencing household food insecurity (HFI) than those without disabilities. The main objectives of this study were to estimate the prevalence of HFI for persons with different types, numbers, and severity of disabilities, and to examine sociodemographic correlates of HFI among this group. Data from the 2021 Canadian Income Survey (CIS) were used. Disability status was assessed using the short version of the Disability Screening Questions module for one randomly selected household respondent. The Household Food Security Survey Module measured HFI as marginal, moderate, or severe. Weighted descriptive and multivariable analyses were conducted to estimate the prevalence of HFI and analyze the association between various socioeconomic factors and HFI among the study sample. Among CIS participants with disabilities (30% of the total CIS sample: 31 million persons), 26% reported some level of HFI, including 8% with severe HFI. The prevalence of HFI was 13% among those without disabilities. The prevalence of HFI was highest among those with learning, memory, cognition, and seeing disabilities (each at 36%). Levels of HFI were higher for those with more severe disabilities and with a greater number of disabilities. For persons with disabilities, the odds of HFI were two times higher, compared with persons without disabilities (adjusted odds ratio [AOR]: 2.5 [95% confidence interval (CI): 2.2, 2.7]), after adjustment for a range of sociodemographic covariates. Persons with disabilities who were in the lowest income quintile (AOR: 4.0 [95% CI: 3.2, 4.9]) and aged 45 to 54 (AOR: 2.9 [95% CI: 2.1, 4.1]) had the highest odds of HFI, compared with other persons with disabilities living in wealthier households and those aged 65 and older, respectively. Other risk factors included being in a one-parent household, living in the Prairies, and living in a dwelling not owned by the household. HFI prevalence among CIS participants with disabilities was higher than for persons without disabilities, even after adjustment for well-documented sociodemographic risk factors. Consistent monitoring of HFI among persons with disabilities can help inform any ongoing or newly developed poverty reduction strategies for this population.

Social Needs Screening Via Electronic Tablet in Pediatric Primary Care.

(1) Assess whether health-related social needs (HRSN)/caregiver mental health concerns (CMHC) disclosure rates differ when screening questions are administered on paper versus electronic tablet. (2) Evaluate whether changes in need identification alters referral rates to social work and our medical-legal partnership (MLP). We conducted a retrospective review of HRSN/CMHC screening in publicly insured patients 0-18 years presenting for well-child visits in three primary care practices. Our primary outcome was HRSN/CMHC disclosure rate, comparing the proportion of positive HRSN/CMHC screens during the 11 months before and after screening modality change. Generalized estimating equations and interrupted time series (ITS) were used to assess changes over time. Mediation analyses assessed the indirect effect of HRSN/CMHC disclosure during the electronic screening period on changes in referrals to social work/MLP. A total of 16,151 patients had paper-based HRSN/CMHC screens; 13,019 patients had electronic screens. Overall, 11% of paper-based screens identified ≥1 need, compared to 26% of electronic screens (p<0.001). All three practices saw an increase in disclosure rate after transition from paper to electronic screening (odds ratio [OR] range 1.54 to 4.24). Using ITS, two of three practices had significantly increased odds of need disclosure with electronic screens compared to paper (OR 3.0, 95% confidence interval [CI] 2.5, 3.6; and OR 1.7, 95%CI 1.2, 2.4). Increased HRSN/CMHC disclosure rates from transitioning to electronic screening mediated increased referrals to social work/MLP. Electronic screening was associated with an increased HRSN/CMHC disclosure rate compared to paper, which led to increased referrals to social work/MLP.

Investigation of screening questions to identify insomnia in cancer patients

The high prevalence of insomnia in cancer patients leads to a significant reduction in the quality of life of those affected. A detailed record of symptoms therefore plays an essential role for further course of treatment. Which screening instruments enable identification of cancer patients with insomnia is the subject of this single-arm nonrandomized study. During the data collection period, cancer patients meeting the following criteria: self-reported tiredness and/or trouble falling or staying asleep or sleeping too much in an electronic patient-reported outcome measurement were enrolled. For further analysis, focus was placed on the Patient Health Questionnaire Depression Scale (PHQ-8), the Minimal Documentation System (MIDOS2) and the Insomnia Severity Index (ISI). Frequency, correlation, and variance analyses were conducted to identify likely predictors of insomnia. Our findings indicate a closer correlation between the screening question pertaining to sleep disorders and the ISI, compared to the question on tiredness and the ISI. The initial recording of sleep-related parameters plays an essential role for cancer patients in order to identify and treat modifiable factors as promptly as possible. For an initial assessment, we recommend asking about trouble falling or staying asleep or sleeping too much.

Help-Seeking from Victim Services, Personal Networks, and Reporting to Police: Stalking Victim Behaviors from the 2019 NCVS Supplemental Victimization Survey.

Understanding the predictors of stalking victimization, help-seeking behaviors of stalking victims, and their reporting to police can help law enforcement and advocates improve systems and ensure they are accessible and useful to victims. Existing stalking research focuses heavily on campus-based stalking, non-nationally representative populations, and/or dated data collection methods, such as the 2006 National Crime Victimization Survey, Supplemental Victimization Survey (NCVS-SVS), an instrument that has been updated according to current stalking definitions. This study employs the latest 2019 NCVS-SVS to analyze its new stalking screening questions and additional variables. We identified predictors of (a) stalking victimization, (b) help-seeking from victim-serving agencies, (c) help-seeking from personal networks, and (d) reporting to police. Predictors of stalking victimization included younger age, identifying as female, identifying as not heterosexual, household incomes below $50,000, and any college attendance. Victims who knew their offenders (intimate or non-intimate) were more likely than victims of stranger stalking to seek help from victim-serving agencies and personal networks. Younger victims were more likely to seek help from personal networks. None of the variables we examined predicted reporting to police. This study shows the characteristics of stalking victims have stayed consistent over time but highlights an ongoing need for resources for victims of stranger stalking, who may not know about or be able to access stalking services that are offered by intimate partner violence agencies. Future research around stalking victim characteristics should focus on populations that are newly included in national stalking data, such as those who identify as transgender and sexual identity minorities.

A survey exploring ophthalmologists' attitudes and beliefs in performing immediate sequential bilateral cataract surgery in Singapore.

To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care. An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed. Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico-legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%). This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore.

Associations Between Social Determinants of Health and Outcomes of Chronic Medical Conditions.

Social determinants of health, such as food insecurity, can significantly impact patient welfare, potentially increasing the prevalence of chronic illnesses while hindering their management, as shown in previous data collected by the National Health and Nutrition Examination Survey. This study aimed to investigate the association between food insecurity and other social determinants of health with hyperlipidemia, type 2 diabetes mellitus (T2DM), and hypertension. To that end, self-reported data on food security from clinical encounters and biological data from medical records were collected. This study utilized electronic medical record data from 349 patients aged between 18 and 85 years who answered two standard food insecurity screening questions. Each patient's current diagnoses and lab values, including blood pressure, fasting low-densitylipoprotein (LDL) cholesterol, and hemoglobin A1c (HbA1c), were then collected. Among patients facing food insecurity (n = 48), 55% were diagnosed with hypertension (p = 0.019), 45% with hyperlipidemia, and 27% with T2DM (p = 0.005). By comparison, these values for food-secure patients were 39%, 54%, and 13%, respectively (n = 301, p > 0.05). Regarding control of these chronic illnesses, hypertension (defined as blood pressure >135/85 mmHg per American Academy of Family Physicians (AAFP) guidelines) was observed in 12% of food-secure patients (n = 301, p > 0.05) and 42% of food-insecure patients (n = 48, p = 0.0204), whereas differences in control of hyperlipidemia and T2DM were insignificant. These results suggest that food-insecure patients are more likely to be diagnosed with hypertension and T2DM but are less likely than food-secure patients to be diagnosed with hyperlipidemia. Consistent with previous research, this study highlights the potentially increased health risks for patients experiencing food insecurity and calls for further efforts to screen patients for social determinants of health.