Universal Screening Research Articles

Universal screening of colorectal tumors for lynch syndrome: a survey of patient experiences and opinions

BackgroundLynch syndrome represents the most common hereditary cause of both colorectal and endometrial cancer. It is caused by defects in mismatch repair genes, as well as EPCAM. Universal screening of colon tumors for Lynch syndrome via microsatellite instability (MSI) and/or immunohistochemistry (IHC) can identify patients and families at risk to develop further cancers and potentially impact surveillance and treatment options. The approach to implementation of universal screening, taking ethical considerations into account, is critical to its effectiveness, with patient perspectives providing valuable insight.MethodsPatients whose colon tumors underwent universal screening at Penn State Hershey Medical Center over a period of 2.5 years were mailed a survey on universal screening in 2017. Along with the survey, they received a recruitment letter and a summary explanation of research. The survey included both multiple choice and free-response questions that covered topics including respondent knowledge of Lynch syndrome, attitudes toward universal screening and experiences with the screening protocol as implemented.ResultsSixty-six of 297 possible patients (22.2%) responded to the survey, including 13 whose screening results raised concern for Lynch syndrome. 75.8% of respondents supported universal tumor screening without informed consent. 92.4% preferred receiving screening results regardless of outcome. Respondents described benefits to screening for themselves and their families.ConclusionsWhile broadly supporting universal tumor screening without informed consent, respondents also wanted more information shared about the screening policy, as well as their results. These patient preferences should be one of many factors considered when implementing universal screening and can also inform practices regarding both tumor profiling and universal genetic testing, which is becoming more prevalent.

Utilizing Continuous Glucose Monitoring for Early Detection of Gestational Diabetes Mellitus and Pregnancy Outcomes in an Asian Population.

We explored the potential value of continuous glucose monitoring (CGM) in early pregnancy in predicting gestational diabetes mellitus (GDM) and pregnancy outcomes. The study recruited 103 multiethnic Asian pregnant women with overweight or obesity from a hospital-based, prospective cohort. All of them had worn blinded CGM devices in early pregnancy and underwent the universal GDM screening at 24-28 gestation weeks. Models were selected based on early pregnancy risk factors and CGM-derived parameters to compare their respective predictive values for GDM and pregnancy outcomes. Eighteen GDM cases were ascertained. CGM-derived novel parameters demonstrated greater performance (e.g., area under the curve: 0.953 vs. 0.722) for predicting incident GDM compared with the model using traditional risks. Such novel CGM-derived parameters significantly differentiated primary cesarean and large-for-gestational age babies. Our data suggest CGM's potential clinical utility in the first trimester for predicting GDM and adverse pregnancy outcomes, particularly in individuals with overweight or obesity.

Risk of adverse perinatal outcomes with violence in pregnancy.

To examine the association between physical, sexual, or physiological harm in pregnancy and perinatal outcomes in a large, contemporary birth cohort. This retrospective cohort study used California-linked vital statistics and hospital discharge data from 2016 to 2020. We included singleton, non-anomalous births with a gestational age of 23-42weeks. Violence in pregnancy was identified using International Classification of Disease, Tenth Revision (ICD-10) codes. Chi-square tests and multivariable Poisson regression models were used to evaluate associations of violence in pregnancy with perinatal outcomes. A total of 1,728,478 pregnancies met inclusion criteria, of which 3,457 (0.2%) had reported violence in pregnancy. Compared to those without violence in pregnancy, individuals who experienced violence had an increased risk of non-severe hypertensive disorders (aRR = 1.36, 95% CI 1.22, 1.51), preeclampsia with severe features (aRR = 1.34; 95% CI 1.11, 1.61), chorioamnionitis (aRR = 1.68; 95% CI 1.48, 1.91), anemia (aRR = 1.59; 95% CI 1.50, 1.68), antepartum hemorrhage (aRR = 2.17; 95% CI 1.19, 3.95), and postpartum hemorrhage (aRR = 1.65; 95% CI 1.48, 1.85). Violence in pregnancy was also associated with increased risk of Apgar score < 7 at 5 min (aRR = 1.37; 95% CI 1.11, 1.71) and neonatal hypoglycemia (aRR = 1.26; 95% CI 1.07, 1.48). Violence experienced in pregnancy is associated with an increased risk of adverse perinatal outcomes. Understanding how universal screening and early recognition of violence in pregnancy may reduce disparities in maternal morbidity for this understudied population is critical.

Donor-derived infections-Insights from Singapore, Japan, and Thailand.

Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor-derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia. We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand. Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV-1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT-PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported. The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region.

Cost-benefit analysis of serological and nucleic acid testing for hepatitis B virus in blood donors in southern China

BackgroundMost Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine blood donor screening for HBV infection since 2015, and a few centers upgraded MP to individual donation (ID) NAT screening recently, raising urgent need for cost-benefit analysis of different screening strategies. In an effort to prevent transfusion-transmitted infections (TTIs) for HBV, cost-benefit analyses of three different screening strategies: HBsAg alone, HBsAg plus MP NAT and HBsAg plus ID NAT were performed in blood donors from southern China where HBV infection was endemic.MethodsMP-6 HBV NAT and ID NAT were adopted in parallel to screen blood donors for further comparative analysis. On the basis of screening data and the documented parameters, the number of window period (WP) infection, HBV acute infection, chronic hepatitis B infection (CHB) and occult hepatitis B infection (OBI) was evaluated, and the potential prevented HBV TTIs and benefits of these three strategies were predicted based on cost-benefit analysis by an estimation model.ResultsOf 132,323 donations, the yield rate for HBsAg-/DNA + screened by ID NAT (0.12%) was significantly higher than that by MP NAT (0.058%, P < 0.05). Furthermore, the predicted transfusion-transmitted HBV cases prevented was 1.25 times more by ID NAT compared to MP-6 NAT. The cost-benefit ratio of the universal HBsAg screening, HBsAg plus ID NAT and HBsAg plus MP NAT were 1:58, 1:27 and 1:22, respectively.ConclusionsUniversal HBsAg ELISA screening in combination with HBV ID NAT or MP-6 NAT strategies was highly cost effective in China. To further improve blood safety, HBsAg plus HBV DNA ID NAT screening should be considered in HBV endemic regions/countries.

Population mental health science: Guiding principles and initial agenda.

A recent American Psychological Association Summit provided an urgent call to transform psychological science and practice away from a solely individual-level focus to become accountable for population-level impact on health and mental health. A population focus ensures the mental health of all children, adolescents, and adults and the elimination of inequities across groups. Science must guide three components of this transformation. First, effective individual-level interventions must be scaled up to the population level using principles from implementation science, investing in novel intervention delivery systems (e.g., online, mobile application, text, interactive voice response, and machine learning-based), harnessing the strength of diverse providers, and forging culturally informed adaptations. Second, policy-driven community-level interventions must be innovated and tested, such as public efforts to promote physical activity, public policies to support families in early life, and regulation of corporal punishment in schools. Third, transformation is needed to create a new system of universal primary care for mental health, based on models such as Family Connects, Triple P, PROmoting School-community-university Partnerships to Enhance Resilience, Communities That Care, and the Early Childhood Collaborative of the Pittsburgh Study. This new system must incorporate valid measurement, universal screening, and a community-based infrastructure for service delivery. Addressing tasks ahead, including scientific creativity and discovery, rigorous evaluation, and community accountability, will lead to a comprehensive strategic plan to shape the emergent field of public mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the Outcomes in Patients with Colorectal Cancer Using the Malnutrition Universal Screening Tool: A Systematic Review.

The current systematic review aimed to evaluate the Malnutrition Universal Screening Tool (MUST) for its effectiveness in determining patient outcomes (length of hospital stay, postoperative complications, infection rates, and survival) for colorectal cancer. Utilizing a comprehensive search strategy, this review mined literature up to December 2023 from the PubMed, Scopus, and Embase databases. The focus was on identifying studies that scrutinize the prognostic value of MUST in relation to hospital outcomes in colorectal cancer contexts. Adherence to PRISMA guidelines ensured a systematic approach, encompassing various study designs and outcome measures. Among the seven studies incorporating 1950 patients, a significant correlation emerged between MUST scores and key hospital outcomes. Specifically, patients categorized as high MUST risk faced longer hospital stays, with a mean length of stay for high-risk patients extending up to 26.6 days compared to 14 days for those at lower risk. The prevalence of postoperative complications was substantially higher in the high-risk group, with up to 41.4% of high MUST risk patients experiencing severe complications (Clavien-Dindo 3-5) compared to 8.5% in the low-risk category. Notably, the review found that high MUST scores were strongly predictive of increased postoperative complications and a prolonged hospital stay, underscoring the tool's critical predictive utility for quality of life and use in clinical settings. Therefore, MUST's capability to predict longer hospital stays and a higher incidence of postoperative complications among high-risk patients highlights its essential function in preoperative evaluations and supports the integration of MUST into routine clinical assessments.

Comparison between Friedewald's and Sampson's formulas in the estimation of high levels of measured LDL-cholesterol in youth with obesity

Background and aimTo assess the performance of Friedewald's and Sampson's formulas in relation to high or borderline-high levels of measured LDL-Cholesterol (LDL-C) in youths with overweight/obesity (OW/OB). Methods and resultsA cross-sectional study was performed in 1694 youths (age 5–17 years) with OW/OB observed in Italian centers of Messina (group 1) and Naples (group 2). LDL-C levels were both measured and calculated using Friedewald's (LDL-CF) and Sampson's (LDL-CS) formulas. The two groups were similar for sex, age, BMI, BMI Z-score, and measured LDL-C. Levels of LDL-CF and LDL-CS were higher in group 1 than group 2. In the overall sample, 9.9 % youths had measured LDL-C ≥130 mg/dL and 27.8 % ≥ 110 mg/dL, without differences between centers. The two formulas showed comparable high sensitivity and specificity in relation to levels of measured LDL-C ≥130 mg/dL or ≥110 mg/dL. However, LDL-CF showed a higher positive predictive value than LDL-CS. ConclusionsBoth formulas estimate with high accuracy measured LDL-C levels in youths with OW/OB. Therefore, calculated LDL-C can be a useful tool for universal screening when direct LDL-C measurement is not available. The Friedewald's formula is more feasible in clinical practice for simplicity of calculation.

EPIDEMIOLOGY OF BREAST CANCER IN THE ARAB REGION BETWEEN 1999 AND 2024: A NARRATIVE REVIEW

Breast cancer (BC) poses a significant health challenge in both developed and developing countries, with limited research in the Arab region compared to the West. The aim of this review was to provide a comprehensive perspective on breast cancer incidence and mortality trends between 1999 and 2024, considering diverse socio-cultural and economic factors.A thorough literature review was conducted using sources such as PubMed, Medline, and recent WHO publications. Findings revealed that the incidence of breast cancer in the Arab world increased gradually during the period studied. However, the incidence of breast cancer among women in the Arab region was lower than the global average, and the mortality rate among women with breast cancer in the Arab region was lower than the global average. Age-standardized incidence and mortality rates have increased since 1990.The country-specific data showed that the more developed Arab countries tended to have a higher burden of breast cancer. Factors such as urbanization, increased life expectancy, and adoption of westernized lifestyles have been associated with the observed increase in breast cancer rates. Despite promising breast cancer screening initiatives, most Arab countries lack a structured universal screening program and participation rates are very low.The increasing incidence and burden of BC in the Arab region is remarkable, especially considering the limited resources of developing countries in this region. Appropriate strategies such as expansion of screening programs and careful resource management are needed to effectively manage the burden of BC.

Universal Screening for hsCRP in Patients with Atherosclerotic Disease: A Major Therapeutic Opportunity.

Universal Screening for hsCRP in Patients with Atherosclerotic Disease: A Major Therapeutic Opportunity.

Association between Subclinical Hypothyroidism and Adverse Pregnancy Outcomes in Assisted Reproduction Technology Singleton Pregnancies: A Retrospective Study.

Background/Objectives: Women with subclinical hypothyroidism (SCH) were reported to be at an increased perinatal risk. We aimed to investigate the relationship between SCH and perinatal outcomes in singleton pregnancies resulting from assisted reproduction technology (ART). Methods: We retrospectively examined the perinatal outcomes of ART singleton pregnancies in women who underwent thyroid function screening before conception and delivered at our hospital from January 2020 to July 2023. We defined SCH as thyroid-stimulating hormone (TSH) levels > 2.5 mU/L and normal free T4 levels. The patients were categorized into three groups: normal thyroid function (group A), SCH without levothyroxine therapy (group B), and SCH with levothyroxine therapy (group C). The risks of preterm birth, preeclampsia, fetal growth restriction, manual placental removal, and blood loss at delivery were compared among the three groups. Results: Out of the 650 ART singleton deliveries, 581 were assigned to group A, 34 to group B, and 35 to group C. The preterm birth rate at <34 weeks was significantly higher in group B and significantly lower in group C than in group A. The rate of preterm delivery at <34 weeks increased in correlation with TSH levels. Levothyroxine therapy was the significant preventive factor for preterm birth at <34 weeks. Conclusions: The preterm birth rate before 34 weeks was significantly higher in the SCH group. Levothyroxine therapy is a significant protective factor against preterm birth before 34 weeks. Universal screening for thyroid function and appropriate hormone therapy in pregnant women may help reduce perinatal risks, including preterm birth.

Overall mortality for community-dwelling adults over 50years at risk of malnutrition.

It is well reported that malnutrition in acute care is associated with poorer health outcomes including increased mortality. However, the consequences of malnutrition on survival in community settings is uncertain. Malnutrition in people 65years or over is often cited. Nevertheless, this study includes both middle-aged and older adults as current public health policy is highlighting the need to increase disease-free life years and is moving away from just extending life to increase overall longevity. The aim of this study is to describe the association of the risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) with mortality in community-dwelling middle-aged and older adults. We used the UK Biobank to investigate the association between those at risk of malnutrition and mortality in participants aged ≥50years. MUST identified risk of malnutrition and linked data to national death registries confirmed mortality. Years of life lost (YLL) and Cox proportional hazard models with hazard ratios (HR) and confidence intervals (CI) described risk associated with all-cause mortality. There were 502408 participants recruited, 117830 were ≤50years leaving 384578 eligible participants. Based on MUST scores 63495 (16.5%) were at risk of malnutrition with 401 missing some data and excluded. Incidence of mortality for at risk participants was 755 per 100000 person-years, corresponding to 153476 YLL. Of those at risk of malnutrition, 9.5% died versus 7.8% at low risk. Initial survival analysis reported an increased risk of mortality (HR 1.29, 95% CI: 1.25 to 1.33) that decreased after adjusting for confounders (HR 1.14, 95% CI: 1.11 to 1.18) in those at risk of malnutrition versus those at low risk. Risk of malnutrition was associated with increased overall mortality. Modest effect sizes are demonstrated but are supportive of public health policies, which advocate wide-scale community, based nutritional screening for middle-aged and older adults.

Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: ‘Progress toward hepatitis B elimination in Canada’

Hepatitis B virus (HBV) infection affects &gt;290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a &gt;90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

A neural network approach to predict opioid misuse among previously hospitalized patients using electronic health records.

Can Electronic Health Records (EHR) predict opioid misuse in general patient populations? This research trained three backpropagation neural networks to explore EHR predictors using existing patient data. Model 1 used patient diagnosis codes and was 75.5% accurate. Model 2 used patient prescriptions and was 64.9% accurate. Model 3 used both patient diagnosis codes and patient prescriptions and was 74.5% accurate. This suggests patient diagnosis codes are best able to predict opioid misuse. Opioid misusers have higher rates of drug abuse/mental health disorders than the general population, which could explain the performance of diagnosis predictors. In additional testing, Model 1 misclassified only 1.9% of negative cases (non-abusers), demonstrating a low type II error rate. This suggests further clinical implementation is viable. We hope to motivate future research to explore additional methods for universal opioid misuse screening.

Introduction of universal transvaginal cervical length measurement does not decrease spontaneous preterm delivery rate compared to universal transabdominal screening with reflex cut‐off: A pre‐post study

AbstractObjectivesThe objective of our study is to examine cervical length measurements, identification of short cervix, vaginal progesterone use, and rate of spontaneous preterm delivery before and after departmental transition to a universal transvaginal ultrasound screening protocol from a universal transabdominal screening protocol.MethodsThis is a retrospective observational pre–post study examining the year prior to and year following a transition to a universal transvaginal ultrasound screening protocol to assess cervical length at the time of the anatomy survey. Prior to this transition, universal transabdominal cervical length screening was performed, with reflex transvaginal ultrasound measurement if transabdominal measurement was &lt;35 mm or was unable to be obtained.ResultsA total of 1760 charts were reviewed; 962 charts were from the pre‐transition/transabdominal year and 798 charts were from the post‐transition/transvaginal year. In the post‐transition/transvaginal year, cervical length less than 20 mm was identified in 1.5% of cases, compared to 0.7% of cases in the pre‐transition/transabdominal year (p = 0.114). There was no difference in the rate of spontaneous preterm delivery between the two groups (5.1% in the pre‐transition/transabdominal year vs. 6.9% in the post‐transition/transvaginal year; p = 0.111).ConclusionsIn this pre‐post study, introduction of a universal transvaginal cervical length screening did not decrease spontaneous preterm delivery rates or detection of short cervix &lt;20 mm, compared to a protocol of universal transabdominal cervical length screening with reflex to transvaginal for measurement &lt;35 mm.

The clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.

Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, i.e., coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996 this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM). The pathophysiologic mechanisms underlying CCM include impaired beta-adrenergic membrane function and circulating proinflammatory and cardiotoxic substances. In 2005, the first diagnostic criteria for CCM were introduced enabling greater sensitivity and accuracy of diagnosis. Since 2005, advancements in echocardiographic methods and better understanding of the pathophysiology of cardiac dysfunction in patients with cirrhosis necessitated revision of CCM criteria. Changes in CCM criteria included removal of blunted contractile or heart rate response on stress testing and addition of global longitudinal systolic strain. Refinement of criteria for diastolic dysfunction were also incorporated into the new diagnostic approach. Since 2020, the prevalence of the disorder and clinical considerations for pre-transplant, peritransplant, and post-transplant patients with cirrhosis have been further evaluated and CCM was found to adversely impact clinical outcomes during all three phases of care. Future research considerations should address the timing of universal echocardiographic screening for patients with cirrhosis, utility of biomarkers in aiding CCM diagnosis, impact of CCM on right heart function, and role of anti-remodeling agents post-liver transplant (post-LT).

Lynch syndrome screening in patients with young-onset extra-colorectal Lynch syndrome-associated cancers.

Lynch syndrome (LS) is a hereditary cancer syndrome caused by pathogenic germline variants in mismatch repair (MMR) genes, which predisposes to various types of cancers showing deficient MMR (dMMR). Identification of LS probands is crucial to reduce cancer-related deaths in affected families. Although universal screening is recommended for colorectal and endometrial cancers, and age-restricted screening is proposed as an alternative, LS screening covering a broader spectrum of cancer types is needed. In the current study, we elucidated the rate of dMMR tumors and evaluated the outcome of LS screening in young-onset extra-colorectal LS-associated cancers. Immunohistochemistry for MMR proteins were retrospectively performed in a total of 309 tissue samples of endometrial, non-mucinous ovarian, gastric, urothelial, pancreatic, biliary tract, and adrenal cancers in patients < 50years of age. Clinicopathological information and the results of genetic testing were obtained from medical charts. There were 24 dMMR tumors (7.8%) including 18 endometrial, three ovarian, two urothelial, and one gastric cancer. Co-occurrence of colorectal cancer and family history of LS-associated cancers was significantly enriched in patients with dMMR tumors. Among the 16 patients with dMMR tumors who were informed of the immunohistochemistry results, five with endometrial and one with urothelial cancer were diagnosed as LS with positive pathogenic variants in MMR genes. We report the outcome of immunohistochemistry for MMR proteins performed in multiple types of young-onset extra-colorectal LS-associated cancers. Our study demonstrates the feasibility of a comprehensive LS screening program incorporating young-onset patients with various types of extra-colorectal LS-associated cancers.

Translation, cross-cultural adaptation and validation of the universal Welch Emotional Connection Screen using primary and bilingual Spanish-speaking coders of videotaped mother-child interactions

IntroductionUsing clear explicit translatable language, we translated the Welch Emotional Connection Screen into a new universal language instrument, the English uWECS. In this study, we had two aims: Aim 1 was to establish concurrent validity of the uWECS by comparing scores coded by primary Spanish-speaking coders using the Spanish translation of the uWECS to scores coded by bilingual, secondary Spanish-speaking coders using the oWECS. Aim 2 was to establish the criterion-related validity in terms of oWECS and uWECS performance in tracking change in autonomic emotional connection (AEC) during the course of an intervention among preschool aged children.MethodsWe created a library of 52 five-minute Spanish-speaking mother-child videos that were collected during a randomized controlled trial of Mother-Child Emotional Preparation intervention (MCEP). The videos were collected at two time points, at enrollment and at a 6-month follow-up. The subsample of Primary Spanish-Speaking dyads from the MCEP study were coded by two independent teams of coders. We trained primary English-speaking (bilingual Spanish) coders on the oWECS, using the original training program. A different team of primary Spanish-speaking coders coded the same cases using the novel uWECS guide and trained briefly for reliability with the Spanish uWECS translation materials.ResultsWe found that the Spanish oWECS and Spanish uWECS ratings from the baseline and 6-month follow-up observations were robustly correlated, with intraclass correlations ranging from .81 to .84 and all p-values&amp;lt;.001, thus demonstrating sound concurrent validity for the uWECS. The oWECS and uWECS scores also achieved parallel results when evaluating the efficacy of the MCEP for primary Spanish-speaking dyads. Both the AEC scores of the oWECS [F(1, 27) = 4.31, p &amp;lt; .05] and the scores of the uWECS [F(1,27) = 4.06, p &amp;lt; .05] similarly demonstrated significant change post intervention, thus demonstrating sound criterion-related validity of the uWECS.DiscussionThese findings demonstrate that the uWECS can be used to measure parent/child AEC in linguistically diverse populations and cultures.

Nutritional Assessment in Outpatients with Heart Failure.

Heart failure (HF) is associated with significant alterations in body composition, including malnutrition due to insufficient intake, chronic inflammation and increased energy expenditure. Identifying the prevalence of malnutrition and the risk of sarcopenia in patients with HF is crucial to improve clinical outcomes. This cross-sectional, single-center, observational study involved 121 outpatients diagnosed with HF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Rating (SGA). Sarcopenia was screened using the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls) questionnaire and diagnosed based on the European Working Group in Older People (EWGSOP2) criteria and functionality with the Short Performance Battery (SPPB) test. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. The study found that 10.7% had cardiac cachexia and 45.4% of deceased patients had been in this condition (p = 0.002). Moderate-to-high risk of malnutrition was identified in 37.1%, 23.9%, and 31.4% of patients according to the MNA, MUST, and SGA tests, respectively. According to the GLIM criteria, 56.2% of patients were malnourished. Additionally, 24.8% of patients had a high probability of sarcopenia, and 57.8% were not autonomous according to SPPB. Patients with less than 30% quadriceps muscle contraction were at a high risk of sarcopenia. There is a high prevalence of malnutrition among outpatients with HF, which is associated with worse prognosis, increased risk of sarcopenia, and greater frailty. These findings underscore the importance of early nutritional and functional assessments in this population to improve clinical outcomes.

The Prevalence of Chronic Hepatitis B Infection and Associated Factors Among Pregnant Women in Southeast of Iran

Background: Hepatitis B virus (HBV) infection is a significant global public health issue. Although infant immunoprophylaxis effectively reduces viral transmission, mother-to-child transmission during pregnancy, often associated with intrauterine infection, remains a major route of HBV infection. Objectives: The aim of this study was to determine the prevalence of maternal HBV infection, identify its associated factors, and measure viral load in Hepatitis B surface antigen (HBsAg)-positive pregnant women in Zahedan, Iran. Methods: This cross-sectional study included data from pregnant women who were referred to the Central Laboratory of Zahedan, Iran, for routine pregnancy tests between August and December 2019. Data were collected during the first prenatal visit along with HBsAg testing. Hepatitis B surface antigen testing was repeated for HBsAg-positive women at 24 - 28 weeks of gestation. If the patient remained HBsAg-positive, serum viral load was determined. Factors associated with HBV infection were identified using multiple logistic regression models. Results: A total of 1,474 pregnant women participated in this study. Among them, 24 (1.6%, 95% CI: 0.9% - 2.2%) were HBsAg-positive, with 17 (71%) of these patients being unaware of their infection. The mean viral load in infected women was (11.1 ± 3.2) × 107 IU/mL. Only 13.3% of pregnant women were vaccinated against HBV. Maternal tobacco use, family history of HBV infection, previous history of HBV infection, and history of nonalcoholic fatty liver disease were significantly associated with HBV infection (P &lt; 0.05). Conclusions: The prevalence of HBV infection remains high among pregnant women, and vertical transmission poses a major challenge in the elimination of HBV infection in southeastern Iran. In addition to active-passive immunoprophylaxis, universal screening of all pregnant women for HBV infection and the use of peripartum antiviral therapy in HBsAg-positive pregnant women with high viral loads are warranted.