Screening Questions Research Articles

Improving Identification of Interpreter Need in the Pediatric Emergency Department.

Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart. Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider's note. Outcomes were tracked using statistical process control charts. All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%. Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.

Socialization Android-Based Electronic Screening Test Epidemiology (E-Steco 19) In Indonesia and Timor Leste

Introduction: A statement of being in good health is one of the prerequisites as a lecturer or employee at Kusuma Husada University, in which an employee must be declared in good health to prove that an employee is healthy and ready to work, without any serious unhealthy obstacles. Health checks by computerized epidemiology screening test will speed up the process and assist the doctor The development of health applications using the epidemiological screening test method for lecturers and Studends, at the Kusuma Husada University Health Clinic Indonesia Health screening tests quick and efficient in accordance with existing data, and give the result of employee health data directly. The purpose of this study is to make it easier to detect the health status of Kusuma Husada University lecturers and Studends, which is used for one of the prerequisites for a work contract with a health application using an epidemiological screening test method. Methods: Data collection was done by qualitative method and carried out from February to August 2022. lecturers and Studends data retrieval is done using a digital questionnaire (online). Sample of this research is a studends, and employee at Kusuma Husada University Indonesia, the results is used to make applications (e-Steco). Results: E-Steco 19 is an Android-based application that is used to detect a person's health using the screening test method. Data will be stored using Google Sheet and Google App Script. Thus, the data that has been collected from users who fill out a list of questions in the application can be downloaded and processed according to the needs. Data can be downloaded via the link. The e-Steco result can be processed in such a way that the data can be used as material for decision making. E-Steco 19 consists of 14 questions for health screening. Here we show the results of data processing from e-Steco 19 Result in the form of a pie chart. Results: The e-Steco 19 application has been completed and has also been running a test, so that it can make it easier to detect the health of lecturers and Studends, at Kusuma Husada University Indonesia. This application is still possible to be developed and used in Timor Leste University and Health Clinic.

The role of community pharmacists in optimising patient self-management of constipation: an inter-disciplinary consensus view

Constipation is a common gastrointestinal disorder that may occur as occasional (acute) episodes, but can also persist over longer periods of time. Patients usually self-diagnose and self-manage constipation with over-the-counter (OTC) medications, so in terms of medical advice/consultation, the pharmacist is often the first point of contact. Patients’ self-management of constipation helps to free up primary care resources to focus on more complex conditions. However, there is no clear guidance on the appropriate, practice-oriented approach to, and the limitations of, self-management of constipation. The objective of this article is to provide up-to-date clinical practice guidance for healthcare professionals, particularly community pharmacists, to assist in the day-to-day management of patients who present with constipation. Here, we discuss typical clinical factors (e.g. symptom duration, warning symptoms and treatment response) that help to distinguish whether constipation can be self-managed or if further medical assessment is required. We have also developed screening questions and a patient management algorithm to help pharmacists and pharmacy technicians make appropriate decisions when a patient presents with symptoms of constipation or requests advice after initiation of OTC medications.

FUNCTIONAL DISABILITY INVENTORY AND ASSOCIATIONS WITH RACE, ETHNICITY, INCOME AND FOOD INSECURITY

Abstract PURPOSE Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn’s Disease (CD) and ulcerative colitis (UC). Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity or about 13 million children. Louisiana has one of the higher rates of food insecurity in the country with over 249,000 children affected. Food insecurity has been associated with worse health outcomes in children including developmental risks, poor mental health, and poor educational outcomes. Functional Disability Inventory (FDI) is a measure of limitations in both physical and psychosocial functioning secondary to physical health. Our hypothesis is that patients in food insecure homes will have higher FDI scores compared to those in food secure homes. METHODS This study is a prospective study of newly diagnosed IBD patients seen by the Division of Pediatric Gastroenterology at Children’s Hospital of New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture’s food insecurity screening questionnaire and the American Academy of Pediatrics’ Food Insecurity 2-Question Screen. Disability scores were obtained at diagnosis using the FDI self-reporting questionnaire if older than 12 years of age or a parent form was completed for patients less than 12. RESULTS Our study consisted of 20 newly diagnosed pediatric IBD patients with an average age of 14.5 years. Nineteen (95%) patients had CD. Most patients were female (70%), non-Hispanic white (50%) with Medicaid (55%) as their primary insurance. Eight (40%) patients were African American and two (10%) were listed as other. Eight patients or their caregivers identified as living in a food insecure home (40%) and these patients averaged a FDI score of 10.2 The food secure group had an average FDI of 9.3. Non-Hispanic, white patients had an average FDI score of 10.5 while the minority patients had an average FDI of 8.5. Only two patients lived in an area with a median household income below poverty with an average FDI of 15.5. Ten patients lived below the state median income and had an average FDI was 8.2. Those patients living in areas above the state median income level, 8 total, had the highest FDI scores, 10.8. CONCLUSION Food insecurity had higher rates of disability scores compared to families from food secure homes. Families in higher income areas and who were non-Hispanic white had higher FDI scores compared to minority patients and those in lower income areas. Further data will be collected with changes in FDI through the first 6 months of diagnosis. Additional larger studies are needed to determine a relationship between FDI scores and food insecurity in pediatric IBD.

Iatrogenic Causes of Cardiac Tamponade Resulting From Surgical Procedures: An Overview.

Cardiac tamponade is one of the most severely life-threatening emergencies encountered, mainly because of its significant impact on the pumping capacity of the heart by compressing the cardiac chambers due to the rapid accumulation of blood, fluid, pus, or clots in the pericardial sac. These accumulations may be collected following traumas, malignancies, uremia, and many other medical conditions as well as surgical procedures. Numerous errors and medicolegal aspects have been identified in diagnosing and treating cardiac tamponade associated with cardiac-related procedures such as valve replacement surgeries, cardiac pacemaker implantation, pericardiocentesis, and other non-cardiac related procedures such as peri-hiatal surgeries. Patients taking anticoagulants or anticancer medications are especially susceptible to developing cardiac tamponade when undergoing surgical procedures, raising the question of preoperative screening to avoid errors. Misdiagnosis, treatment delay or failure to deliver the utmost quality of treatment, lack of complication screening and follow-ups for those at risk, surgeons rushing to complete cases, burnout, and other human factors are predispositions to the development of cardiac tamponade. Fortunately, most of these errors occurring within healthcare settings are avoidable and must be prevented for eliminating any risks toreduce the incidence and mortality of cardiac tamponade cases resulting from iatrogenic etiology. It is an intricate condition where precision and caution are crucial.

Prevalence of Vitiligo among Children and Adolescents in the United States

Background: Vitiligo is an autoimmune disorder that causes patchy loss of skin pigmentation. Up to 2.16% of pediatric patients may have vitiligo. This study estimated vitiligo point prevalence in children and adolescents (ages: 4–11 and 12–17 years) in the United States (US). Methods: An online, population-based survey of a nationally representative sample of individuals based on 2017 US Census Bureau estimates for age, race, Hispanic origin, income, and geographic region was conducted from December 2019 to March 2020. Parent/legal guardian proxies responded on behalf of their children or adolescents to vitiligo screening questions. Proxy-reported vitiligo status was adjudicated by expert dermatologists who reviewed photographs of vitiligo lesions uploaded by proxies using a teledermatology application. Estimated point prevalence (including diagnosed and undiagnosed vitiligo and its subtypes) was calculated for proxy-reported and clinician-adjudicated vitiligo. Results: There were 9,118 eligible proxy responses (5,209 children, mean age 7.7 years; 3,909 adolescents, mean age 14.4 years). The proxy-reported vitiligo prevalence (95% confidence interval) for children and adolescents was 1.52% (1.11–1.93) and 2.16% (1.66–2.65), respectively. The clinician-adjudicated prevalence (sensitivity analysis bounds) was 0.84% (0.83–1.23) and 1.19% (1.18–1.74), respectively. Approximately 69% of children and 65% of adolescents had nonsegmental vitiligo (clinician adjudicated) and up to 50% may be undiagnosed. Conclusion: Based on the clinician-adjudicated prevalence estimates, there were more than 591,000 cases of vitiligo in children and adolescents in the US in 2020. More than two-thirds had nonsegmental vitiligo and nearly half may be undiagnosed. Future studies should confirm these findings.

Gender differences in bullying among internal medicine residents.

To describe gender differences in experienced types of bullying, and resulting personal consequences, among internal medicine (IM) residents. Participants in this cross-sectional study included 21 212 IM trainees who completed a voluntary survey with their 2016 in-training exam that assessed bullying during residency training. The 2875 (13.6% of) trainees who reported experiencing bullying on a screening question were asked for additional details about types of bullying experienced and resulting personal consequences. Female and male trainees experienced bullying at similar rates (47% versus 53%, P = .08). Gender differences were seen in both the type of bullying experienced and the resulting personal consequences. Female trainees were more likely than their male counterparts to report bullying characterized as verbal (83% versus 77%, P<.001) and sexual (5% versus 2%, P<.001), whereas male trainees were more likely to experience physical (6% versus 4%, P = .03) and "other" bullying types (27% versus 22%, P < .001). Female trainees were more likely to report negative personal consequences than male trainees, and the most common resultant sequela reported was feeling burned out (63% versus 51%, P < .001). Gender differences exist in both the types and consequences of bullying experienced among this national sample of IM residents. These results should be considered by programs and institutions that are hoping to optimize the culture of their workplace and enhance safety in the learning environment.

Obstructive Sleep Apnea and Risk of Miscarriage

The purpose of this project was to evaluate whether screening positive on obstructive sleep apnea questionnaires in the first trimester of pregnancy was associated with miscarriage. This was a secondary analysis of a prospective observational cohort study of participants who were screened for sleep apnea during pregnancy with the Epworth Sleepiness Scale, Berlin Questionnaire, and novel items related to sleep and napping. This secondary analysis was IRB exempt. Our primary outcome was miscarriage in the index pregnancy. An association between responses to the sleep apnea screening questions with miscarriage of the index pregnancy was queried via Poisson regression. We found that gravidae who had elevated scores on both the Epworth Sleepiness Scale and the Berlin Questionnaire were more likely to experience miscarriage than those who had elevated scores on only one questionnaire or neither (p = 0.018). Gravidae who reported snoring (p = 0.042) or hypertension (p = 0.013) in the first trimester were more likely to experience miscarriage than gravidae who did not. Gravidae who reported napping in the first trimester were less likely to experience miscarriage (p = 0.045), even after adjusting for confounding variables (p = 0.007). In conclusion, we found that screening positive on both the Berlin Questionnaire and Epworth Sleepiness Scale was statistically significantly associated with miscarriage prior to adjustment for confounding variables, as did snoring and hypertension. After adjusting for confounding variables, only not napping was associated with miscarriage. Given the small sample size, further investigation into this topic is warranted.

Pain-related interference and pain-related psychosocial factors of three different subgroups of patients with chronic low back pain

BackgroundLow back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment. ObjectivesTo compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain). DesignCross-sectional study. MethodsA cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants’ characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups. ResultsA one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]. ConclusionParticipants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics.

SUSTAINABLE MARKETING IN HIGHER EDUCATION

SUSTAINABLE MARKETING IN HIGHER EDUCATION

Factors Affecting Customer’s Loyalty of Fitness Centers in Thailand

The purpose of this article is to investigate the determinants of customer’s loyalty of fitness centers in Thailand. The conceptual framework is presented on how satisfaction, relationship marketing, habits, and service quality affect customer loyalty. The samples (n = 400) were collected from online and offline questionnaires by convenience sampling with the screening questions. The study applied Multiple Linear Regression (MLR) to analyze the data. The results indicated that satisfaction, relationship marketing, habits, and service quality have significant effect on customer loyalty. The researcher also found that service quality significantly had highest effect on customer’s loyalty. Customer’s loyalty is affected by service quality, habits, relationship marketing and satisfaction respectively. Hence, the businesses are recommended to elevate these instruments to enhance their customers’ loyalty

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Teenage dating abuse, rape, and violence: The dermatologist's role.

Teenage dating abuse, rape, and violence are considered major public health problems that affect the lives of millions of teenagers in the United States. Dermatologists have traditionally become involved in these cases when confronted with patients who have unexplained bruising or other skin injuries and/or sexually transmitted diseases that raise the possibility that they could be victims of sexual abuse and violence. This contribution explores the role of the dermatologist in the diagnosis and management of teen dating abuse. We suggest some screening questions that might help to broach these serious issues with teen patients when the suspicion of dating abuse arises. We also provide a list of resources and hotlines that offer advice on how best to handle teen dating abuse. Some legal issues concerning the physician's role in managing teen dating abuse, rape, and violence are also discussed.

Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People.

Objective To investigate potential reasons for unusually high incidence of negative Methacholine Challenge Tests (MCT), following standardized MCT medication-hold protocol, in older people with physician-diagnosed asthma. Design An analysis of a longitudinal observational parent study of asthma. Setting Community-dwelling participants were evaluated in an outpatient clinic and at home. Participants Screening inclusion criteria for the parent study included 60 years of age or older, physician diagnosis of asthma, and a positive response to at least one of six asthma screening questions. Participants were enrolled in the study if they also demonstrate either: (1) a postbronchodilator administration response showing an increase of at least 12% and 200 mL in forced expiratory volume or an increase of at least 12% and 200 mL in forced vital capacity, or (2) an MCT result of PC20 ≤ 16 mg/mL (indicating bronchial hyper-responsiveness, MCT positive). Exclusion criteria included diagnosis of cognitive impairment or dementia, residing in a long-term care facility, more than 20 pack/ year smoking history or a history of smoking within the previous five years, inability to perform pulmonary function testing maneuvers, and a Prognostic Index score of greater than 10. Interventions Analysis of participant data for non-medication- and medication-exposure factors for association with negative MCT results. Results Anticholinergic burden and statin use were positively associated with negative MCT. Conclusion Medications not accounted for in medication-hold protocols, and concurrently in use, may impact clinical tests and outcomes.

Impact of Prediagnosis Risk of Major Depressive Disorder and Health-Related Quality of Life on Treatment Choice for Stage II-III Rectal Cancer

We hypothesized that depressive symptoms and health-related quality of life (HRQOL) reported by patients before their cancer diagnoses would be associated with treatment choice for stage II and III rectal cancer, specifically whether patients underwent surgery. The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey linked data set was used to identify patients with stage II-III rectal adenocarcinoma diagnosed between 2004 and 2013 who had completed the health outcomes survey within 36 months before their cancer diagnoses. Risk for major depressive disorder (MDD) was determined on the basis of responses to screening questions for depressive disorders. HRQOL was assessed using the Mental Component Summary and Physical Component Summary of the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey. Using univariable and multivariable analyses, we assessed for associations between health survey responses and ultimate treatment modality. We identified 142 evaluable patients, of whom 109 (76.8%) underwent surgery. Thirty patients (21.1%) met criteria for being at risk for MDD before their cancer diagnoses. Patients at risk for MDD underwent surgery less often than those not at risk (P = .0499), and this association strengthened after adjusting for patient characteristics (odds ratio, 0.17; 95% CI, 0.04 to 0.82; P = .027). There was a nonsignificant trend between higher Mental Component Summary scores (indicating higher self-reported mental HRQOL) and increased frequency of undergoing surgery (P = .081). There were no significant associations between the Physical Component Summary and treatment modality. In Medicare beneficiaries with stage II-III rectal cancer, those at risk for MDD underwent standard-of-care treatment with surgery less frequently. Further studies are warranted to assess the effect of mental health on clinical decision making in this patient population.

To screen or not to screen: Exploring and addressing effective screening processes for trauma among forced migrants

BackgroundExisting literature points to higher rates of trauma disorders for forced migrants than general or immigrant populations. The process of identification and screening for trauma in this population however is not straightforward and is actually controversial in some circles. Furthermore there are no definitive guidelines for mental health and social service providers on the “when” “who”, “what” “why”, “where”, and “how” of trauma screening. ObjectivesImportantly, few studies have included insights into the screening process from service providers and forced migrants themselves through participatory research methods. This study investigates effective screening processes for trauma and examines benefits and pitfalls of current practices from the perspectives of both migrants themselves as well as health service providers that serve them. DesignWe used a qualitative approach to identify and analyze key themes from focus group interviews with key informants (service providers and trauma experts providing social and medical services in the community) and forced migrants (from Cameroon, Ethiopia, Honduras, and Tanzania). ResultsOur results comprise forced migrant definitions of and approaches to coping with trauma, reservations about engaging with providers, positive experiences with and impacts of screening, limitations and negative aspects of screening, helpful screening practices, and effective tools and questions for screening. ConclusionsDrawing on these themes, we offer recommendations that may help inform future screening approaches and trauma-informed service provision. The study ultimately helps those in the field to reflect on current trauma screening practices for forced migrants and consider how new insights derived from rich discussions with migrants and their service providers may alter existing screening processes- which few

Evaluating fatigue in patients recovering from COVID-19: validation of the fatigue severity scale and single item screening questions

BackgroundFatigue is a common symptom in hospitalized and non-hospitalized patients recovering from COVID-19, but no fatigue measurement scales or questions have been validated in these populations. The objective of this study was to perform validity assessments of the fatigue severity scale (FSS) and two single-item screening questions (SISQs) for fatigue in patients recovering from COVID-19.MethodsWe examined patients ≥ 28 days after their first SARS-CoV-2 infection who were hospitalized for their acute illness, as well as non-hospitalized patients referred for persistent symptoms. Patients completed questionnaires through 1 of 4 Post COVID-19 Recovery Clinics in British Columbia, Canada. Construct validity was assessed by comparing FSS scores to quality of life and depression measures. Two SISQs were evaluated based on the ability to classify fatigue (FSS score ≥ 4).ResultsQuestionnaires were returned in 548 hospitalized and 546 non-hospitalized patients, with scores computable in 96.4% and 98.2% of patients respectively. Cronbach’s alpha was 0.96 in both groups. The mean ± SD FSS score was 4.4 ± 1.8 in the hospitalized and 5.2 ± 1.6 in the non-hospitalized group, with 62.5% hospitalized and 78.9% non-hospitalized patients classified as fatigued. Ceiling effects were 7.6% in the hospitalized and 16.1% in non-hospitalized patients. FSS scores negatively correlated with EQ-5D scores in both groups (Spearman’s rho − 0.6 in both hospitalized and non-hospitalized; p < 0.001) and were higher among patients with a positive PHQ-2 depression screen (5.4 vs. 4.0 in hospitalized and 5.9 vs. 4.9 in non-hospitalized; p < 0.001). An SISQ asking whether there was “fatigue present” had a sensitivity of 70.6% in hospitalized and 83.2% in non-hospitalized patients; the “always feeling tired” SISQ, had a sensitivity of 70.5% and 89.6% respectively.ConclusionsFatigue was common and severe in patients referred for post COVID-19 assessment. Overall, the FSS is suitable for measuring fatigue in these patients, as there was excellent data quality, strong internal consistency, and construct validity. However, ceiling effects may be a limitation in the non-hospitalized group. SISQs had good sensitivity for identifying clinically relevant fatigue in non-hospitalized patients but only moderate sensitivity in the hospitalized group, indicating that there were more false negatives.

Analyzing the Influence of Korean Celebrities as Brand Ambassadors toward Customer Loyalty in Indonesia

K-Wave, also known as Hallyu, has taken over Indonesia, particularly among millennials. It is getting more challenging to find luxury brands that do not hire K-pop stars or Korean celebrities as their global ambassadors. Due to their promising engagement, several brands in Indonesia are currently courting Korean celebrities to become brand ambassadors. It is important to note that customers may be aware that the artist may not use products from all of the brands. Consequently, brands in Indonesia continue to employ Korean celebrities as brand ambassadors. Developing strong brand loyalty is one strategy to achieve success in a market that is saturated with competitors and where the costs of switching from one seller to another are very low. To cultivate consumer loyalty, brands should give opportunities for consumers to engage in activities they enjoy. Young Indonesians were attracted to K-pop because it gave them a sense of escape and community. Whether through personality congruence between the company and the celebrity or through fan engagement, leveraging Korean celebrities to create customer loyalty for brands in Indonesia. This research mostly employs quantitative methods to collect data. A questionnaire-based online survey will serve as the research tool. Respondents were offered a series of questions requiring multiple-choice, likert-scale, and short-answer responses. The survey was made accessible to respondents via multiple online platforms. Due to the widespread circulation of survey links via the internet, a screening question was necessary to validate that respondents are qualified to finish the survey. The screening questions determined whether or not respondents had purchased products or services from the brand whose brand ambassadors are Korean celebrities. In order for their future survey response to be valid, the requirement must be met. According to the data analysis results, personality congruence and fan engagement have a significant impact on strengthening customer brand loyalty through brand attachment and brand love. The majority of respondents believe that Korean celebrities are attractive and that purchasing their endorsed products is a sort of support for them. The results of this study also indicated that the type of items purchased had no effect on consumer loyalty. Therefore, brands in Indonesia are not required to develop a marketing strategy that is especially targeted to their products. Implementing brand matching and gamification techniques, as well as developing an exclusive ecosystem for their products, are a few things Indonesian companies should do if they want to maximize the impact of Korean celebrities as brand ambassadors.

Practices of sickle cell disease genetic screening and testing in the prenatal population.

Genetic screening and testing are technologies historically underutilized in Black populations despite predicting diseases like sickle cell disease (SCD), which is predominantly found in Blacks. We surveyed prenatal patients to understand choices, beliefs and experiences surrounding genetic screening and testing, specifically for SCD. In this cross-sectional study, we surveyed 322 women during prenatal visits. Responses were analyzed to identify barriers to care and education about testing and screening for SCD. Patients rated whether they agreed or disagreed with statements regarding sickle cell health behaviors. We used χ2 tests to compare categorical variables by self-reported race. Binary logistic regression was used to determine the odds ratios and confidence intervals for each outcome. Women were a mean (SD) age of 33.3 (6.1). 42.9% of patients self-identified as White while 41.3% of patients self- identified as Black. Screening questions were adjusted for differences in race, insurance, and education levels to show significant differences in responses between Blacks and Whites for screening for SCD (p = 0.047, OR 95% CI = 0.455 [0.210-0.989]) and plans to meet with genetic counselors (p = 0.049, OR 95% CI = 0.299 [0.090-0.993]). The statements "if sickle cell is not in their family, then it is likely not in themselves or their children," was significantly different between Black and White populations (p = 0.011, OR 95% CI = 0.207 [0.081-0.526]). Our findings suggest gaps in screening, testing, education, and pregnancy management choices between Black and White patients. Research should focus on decreasing these healthcare gaps and improving education that address concerns about SCD for relevant populations.

Reliability of self-reported health literacy screening in spine patients

BACKGROUND CONTEXTLimited health literacy has previously been associated with increased health care utilization, worse general health status and self-reported health, and increased mortality. Identifying and accommodating patients with limited health literacy may offer an avenue towards mitigating adverse health outcomes and reduce unnecessary health care expenditure. Due to the challenges associated with implementation of lengthy health literacy assessments, the Brief Health Literacy Screening Instrument was developed. However, to our knowledge, there are no reports on the accuracy of this screening questionnaire, with or without the inclusion of sociodemographic characteristics, when predicting limited health literacy in orthopaedic spine patients. PURPOSETo evaluate the reliability and predictive accuracy of self-reported health literacy screening questions with and without the inclusion of sociodemographic variables in orthopaedic spine patients. STUDY DESIGNCross-sectional. PATIENT SAMPLEPatients seen at a tertiary urban academic hospital-based multi-surgeon spine center OUTCOME MEASURESBrief Health Literacy Screening Instrument (BRIEF), and the Newest Vital Sign (NVS) health literacy assessment tool. METHODSBetween December 2021 and February 2022, consecutive English-speaking patients over the age of 18 presenting as new patients to an urban, hospital-based outpatient spine clinic were approached for participation. A sociodemographic survey, the BRIEF, and the NVS Health Literacy Assessment Tool were administered verbally. Simple and multivariable logistic regression was utilized to assess the accuracy of each BRIEF question individually, and collectively, at predicting limited health literacy as defined by the NVS. Further regression analysis included sociodemographic variables (age, body mass index, race, ethnicity, highest educational degree, employment status, marital status, annual household income, insurance status, and self-reported health. RESULTSA total of 262 patients [mean age (years), 57 ± 17] were included in this study. One hundred thirty-four (51%) were male, 223 (85%) were White, and 151 (58%) were married. Patient BRIEF scores were as follows: 23 (9%) limited, 43 (16%) marginal, and 196 (75%) adequate. NVS scores identified 87 (33%) patients with possible limited health literacy. BRIEF items collectively demonstrated fair accuracy in the prediction of limited health literacy (area under the receiver operating characteristic curve, 0.76; 95% CI, 0.70−0.82). Individually, the fourth BRIEF item (“How confident are you in filling out medical forms by yourself?”) was the best predictor of limited health literacy (area under the receiver operating characteristic curve, 0.67; 95% CI, 0.60−0.73). The predictive accuracy of the BRIEF items, both individually and collectively, increased with the inclusion of sociodemographic variables within the logistic regression. Specific characteristics independently associated with limited health literacy were self-identified Black race, retired or disabled employment status, single or divorced marital status, high school education or below, and self-reported “poor” health. CONCLUSIONSLimited health literacy has implications for patient outcomes and health care costs. Our results show that the BRIEF questionnaire is a low-cost screening tool that demonstrates fair predictability in determining limited health literacy within a population of spine patients. Self-reported health literacy assessments may be more feasible in daily practice and easier to implement into clinical workflow.