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Purpose: To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas. Methods: As part of a larger study, 663 females (ages 50–74) living in rural Indiana and Ohio and not up‐to‐date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self‐report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed. Results: Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test. Conclusions: Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD‐only to increase adherence to recommended CRC screening. [ABSTRACT FROM AUTHOR]

Currently, there are no known human biomonitoring studies that concurrently examine biomarkers of dicamba and 2,4-D. We sought to compare biomarkers of exposure to herbicides in pregnant women residing in the US Midwest before and after the adoption of dicamba-tolerant soybean technology using urine specimens obtained in 2010–2012 from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (N = 61) and in 2020–2022 from the Heartland Study (N = 91). Specific gravity-standardized concentration levels for each analyte were compared between the cohorts, assuming data are lognormal and specifying values below the LOD as left-censored. The proportion of pregnant individuals with dicamba detected above the LOD significantly increased from 28% (95% CI: 16%, 40%) in 2010–2012 to 70% (95% CI: 60%, 79%) in 2020–2022, and dicamba concentrations also significantly increased from 0.066 μg/L (95% CI: 0.042, 0.104) to 0.271 μg/L (95% CI: 0.205, 0.358). All pregnant individuals from both cohorts had 2,4-D detected. Though 2,4-D concentration levels increased, the difference was not significant (p-value = 0.226). Reliance on herbicides has drastically increased in the last ten years in the United States, and the results obtained in this study highlight the need to track exposure and impacts on adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10–18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization. [ABSTRACT FROM AUTHOR]

Communication quality in the hospital impacts outcomes like satisfaction, depression, and anxiety for families, and assessment tools must be efficient and reliable. We developed the Quick FICS-5 and -10, shorter versions of the 30-item Family Inpatient Communication Survey (FICS). The Quick FICS were developed from the original FICS study of hospitalized patients 65+ and their surrogates. The development sample came from the original FICS-30 scale. The validation sample came from a randomized controlled trial of surrogates for adult ICU patients. Participants were family members of patients on medical ICU or inpatient medicine services at three hospitals in a Midwest metropolitan area. We evaluated validity and reliability using factor analysis, internal consistency, and associations with surrogate psychological and decision-making outcomes. In the development sample of 364 patient/surrogate dyads, most surrogates were adult children (66.8%), female (70.9%), and white (68.9%). We identified 5-item and 10-item surveys. Exploratory factor analysis supported an overall communication score for the FICS-5 and FICS-10, as well as information and emotional support subscales for the FICS-10. There was high internal reliability (Cronbach's alpha was 0.83 for the FICS-5 and 0.90 for the FICS-10; information and emotional support subscales were 0.89 and 0.75 respectively). There was good predictive validity when comparing FICS scores to outcomes six to eight weeks after discharge, including anxiety (P = -0.13; P = 0.0234), and satisfaction with the hospital stay (P = 0.48; P < 0.0001). Similarly, the validation sample (n = 188) revealed Cronbach's alpha ranging from 0.81 to 0.93 and significant correlations (P < 0.05) with concurrent distress, anxiety, depression, and decision regret. The Quick FICS offers efficient, valid, and reliable evaluation of communication quality in the hospital that can be useful for research and quality improvement. [ABSTRACT FROM AUTHOR]