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Background: The suicide rate among adolescents has been increasing rapidly over the past several years. Local problem: Adequate screening for suicide risk in this population, particularly youth of color, is lacking. Methods: The Ask Suicide-Screening Questions (ASQ) tool was implemented at two adolescent-focused health clinics in a large U.S. city. Interventions: This project followed the Ottawa Model of Research Use. Participating clinicians were surveyed before and after receiving an educational module on suicide risk screening, the ASQ tool, and clinical pathways. Clinicians were also asked about the feasibility and acceptability of the ASQ tool in their practice. An electronic medical records software was used to gather data on patients newly screened for suicide risk using the ASQ tool. Results: Among eligible patients, 40.2% were screened using the ASQ tool during the 4-month duration of the project. Most clinicians reported that using the tool was feasible within their practice (66%) and 100% endorsed its acceptability (i.e., reporting that they were comfortable screening for suicide and that the ASQ was easy to use). Conclusions: The ASQ may be a promising screening tool for clinicians to use to address the mental health needs of at-risk youth. This project supports the universal acceptability and feasibility of its use in inner-city primary care clinics. [ABSTRACT FROM AUTHOR]

Sabrina Shahid, Mahdi Sadeghi Medical Education, King’s College London, London, UKCorrespondence: Sabrina Shahid, Email sabrina.shahid@kcl.ac.uk

Hedayatullah Ehsan,1,2 Nazera Ahmadzai,3 Zarlasht Orfani,2 Bibi Marwa Rezayee,2 Moqadasa Wally,2 Sardara Daftani2 1Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan; 2School of Stomatology, Kabul University of Medical Sciences, Kabul, Afghanistan; 3Department of Pediatric Dentistry, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Hedayatullah Ehsan, Email hedayatullahehsan@gmail.com

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0-14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014-1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010-1.013; RR = 1.002, 95% CI = 1.001-1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.

Abstract Background A complementary feeding (CF) period is necessary for nutritional and developmental reasons. Preterm children encounter more feeding problems than their term counterparts in the CF period. The goal of this study was to develop a nutritional risk screening tool specific to preterm children (the NRSP) in outpatient settings in the CF period, with the expectation of providing a standardised process to determine feeding problems and subsequently offering targeted nutritional advice. Methods This study was a 2-phase study consisting of the development and evaluation phases. In the development phase, the items of the NRSP were initially developed based on references and the Delphi expert consultation method. Second, 329 preterm individuals with corrected ages from 5 to 36 months were enrolled. The participating preterm children were interviewed with the NRSP and anthropometric measurements, and underwent intellectual developmental tests and biochemistry detection (haemoglobin, red blood cell count, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, serum iron, vitamin D). Third, preterm children’s anthropometric parameters were remeasured 1 month (for infants whose corrected age was 5–11 months) or 3 months (for children whose corrected age was 12–36 months) after the interview. Data in the development phase were analysed via univariate and binary logistic regression analysis sequentially to assign scores for items of the NRSP and to generate the models to predict underweight, stunting, and microcephaly of the NRSP. In the evaluation phase, another 605 preterm individuals were recruited to undergo the interview, anthropometric measurements, intellectual developmental tests, and biochemistry detection as in the development phase. Interrater reliability, test-retest reliability, area under the curve (AUC), accuracy, sensitivity, specificity, the positive/negative predictive value (P/NPV), the positive/negative likelihood ratio (LR+/−), and the correlation coefficient by Spearman’s correlation analysis (rs) were used to assess the reliability and validity of the NRSP. Finally, anthropometric parameters, biochemistry levels, and intellectual development quotients (DQs) from the development and evaluation phases between the high- and low-risk groups classified by the NRSP were compared using a t-test. Results The κ coefficients of the interrater and test-retest reliability of the NRSP were all above 0.600, which meant that the reliability of the NRSP was moderate to substantial. The NRSP exhibited relatively higher efficiency in predicting underweight and stunting, with AUCs, accuracies, specificities, and NPVs near to or greater than 0.900, sensitivities above 0.600, PPVs above 0.400, LR + s near to or greater than 10, and rss above 0.400. On the other hand, the NRSP manifested a weaker ability in predicting microcephaly, with most of the values of validity indicators lower than those of underweight and stunting prediction. Z scores of body weight, body length and head circumference, as well as DQs, were all higher in the low-risk groups than in the high-risk groups. There were no significant differences with respect to biochemistry levels between the high- and low-risk groups. Conclusion The NRSP shows moderate to substantial reliability and validity in predicting underweight, stunting, and microcephaly. Health care staff should shed light on improving the feeding practices of preterm children with high nutritional risk classified by the NRSP to facilitate their physical growth and intellectual development. More research is expected to promote the NRSP models.

Abstract Background The Clock Drawing Test (CDT) is used as a quick-to-conduct test for the diagnosis of dementia and a screening tool for cognitive impairments in neurological disorders. However, the association between the pattern of CDT impairments and the location of brain lesions has been controversial. We examined whether there is an association between the CDT scores and the location of brain lesions using the two available scoring systems. Method One hundred five patients with brain lesions identified by CT scanning were recruited for this study. The Montreal Cognitive Assessment (MoCA) battery including the CDT were administered to all partcipants. To score the CDT, we used a qualitative scoring system devised by Rouleau et al. (1992). For the quantitative scoring system, we adapted the algorithm method used by Mendes-Santos et al. (2015) based on an earlier study by Sunderland et al. (1989). For analyses, a machine learning algorithm was used. Results Remarkably, 30% of the patients were not detected by the CDT. Quantitative and qualitative errors were categorized into different clusters. The classification algorithm did not differentiate the patients with traumatic brain injury ‘TBI’ from non-TBI, or the laterality of the lesion. In addition, the classification accuracy for identifying patients with specific lobe lesions was low, except for the parietal lobe with an accuracy of 63%. Conclusion The CDT is not an accurate tool for detecting focal brain lesions. While the CDT still is beneficial for use with patients suspected of having a neurodegenerative disorder, it should be cautiously used with patients with focal neurological disorders.

Abstract Background Non-alcoholic fatty liver disease (NAFLD) has been associated with type 2 diabetes, but its relationship with pre-diabetes is still unknown. This study aims to determine whether pre-diabetes is associated with NAFLD, followed by establishing a NAFLD predictive nomogram for lean Chinese pre-diabetics with normal blood lipids. Methods Datasets from 3 previous studies, 1 (2774 pre-diabetics with normal blood lipids for training, 925 for validation), 2 (546 for longitudinal internal validation, post-5-year follow-up), and 3 (501 from another institution for external validation), were used. Kaplan-Meier determined cumulative NAFLD hazard, and least absolute shrinkage and selection operator regression analysis uncovered its risk factors. Multivariate logistic regression analysis constructed the nomogram, followed by validation with receiver operating characteristic curve, calibration plot, and decision curve analyses. Results NAFLD incidence increased with diabetes progression, and pre-diabetics had higher cumulative risk versus non-diabetics, even for lean individuals with normal blood lipids. Six risk factors were identified: body mass index, total cholesterol, alanine aminotransferase:aspartate aminotransferase, triglyceride:high density lipoprotein cholesterol, fasting blood glucose and γ-glutamyl-transferase. The nomogram yielded areas under the curve of 0.808, 0.785, 0.796 and 0.832, for respectively, training, validation, longitudinal internal validation, and external validation, which, along with calibration curve values of p = 0.794, 0.875, 0.854 and 0.810 for those 4 datasets and decision curve analyses, validated its clinical utility. Conclusions Lean pre-diabetic Chinese with normal blood lipids have higher NAFLD risk versus non-diabetics. The nomogram is able to predict NAFLD among such individuals, with high discrimination, enabling its use for early detection and intervention.

Background Body mass index (BMI) is a widely used surrogate tool to screen for obesity/adiposity, but it cannot differentiate between lean and fat mass. Thus, alternative tools to detect excess adiposity should be identified. Aim This study aimed to compare the performance of BMI, waist circumference (WC) and waist-to-height ratio (WtHR) in predicting Malaysians with excess body fat defined by dual-energy X-ray absorptiometry (DXA). Subjects and methods A total of 399 men and women aged ≥40 years were recruited from Klang Valley, Malaysia. The body composition of the subjects, including body fat percentage, was measured by DXA. The weight, height, WC and WHtR of the subjects were also determined. Results BMI [sensitivity = 55.7%, specificity = 86.1%, area under curve (AUC) = 0.709] and WC (sensitivity = 62.7%, specificity = 90.3%, AUC = 0.765) performed moderately in predicting excess adiposity. Their performance and sensitivity improved with lower cut-off values. The performance of WHtR (sensitivity = 96.6%, specificity = 36.1, AUC = 0.664) was optimal at the standard cut-off value and no modification was required. Conclusion The performance of WC in identifying excess adiposity was greater than BMI and WHtR based on AUC values. Modification of cut-off values for BMI and WC could improve their performance and should be considered by healthcare providers in screening individuals with excess adiposity.

Introduction: Groin pain is one of the prevalent injuries in soccer players.1 Since groin pain takes time to heal and affects the performance of the players, it is necessary to monitor the groin condition regularly to prevent its onset and reccurence. The Groin Injury Screening Questionnaire (GISQ) was developed in Norway to evaluate the groin condition for soccer players.2 GISQ has already been translated in several language, but not into Japanese. Objectives: To develop the Japanese version of the GISQ (GISQ-J), and to examine its validity and reliability. Moreover, to investigate the relationship between a history of groin pain and GISQ-J scores. Study design: Cross-sectional study Methods: The GISQ-J, translated with permission from the original author, was distributed twice to 114 Japanese high school and university soccer players by Google Forms. The second response was given within 72 hours of the first 79 80 response, recalling the condition of the groin at the time of the first response. The GISQ-J is a 100-point scale, with a higher score indicating better groin conditions. Cronbach's α was calculated to assess the validity of each GISQ-J scale, and the intraclass correlation coefficient (ICC) was calculated to evaluate the reliability. In addition, an unpaired t-test was used to compare GISQ-J scores by the presence or absence of a history of groin pain. Results: A total of 60 soccer players (52.6%) responded. Cronbach's α for each scale ranged from 0.71 to 0.97, and the ICC from 0.72 to 0.86. Those with a history of groin pain (n=14) had significantly lower GISQ-J scores than those without (n=46)(p<0.05). Conclusions: The GISQ-J showed good validity and reliability on each scale. The GISQ-J scores were poor with a history of groin pain, suggesting that the GISQ-J may be useful in the evaluation of groin conditions in Japanese soccer players. [ABSTRACT FROM AUTHOR]

BackgroundThe growing number of older and oldest-old patients often present in the emergency room (ER) with undiagnosed geriatric syndromes posing them at high risk for complications in acute care.ObjectiveTo develop and validate an ER screening tool (ICEBERG) to capture 9 geriatric domains of risk in older patients.Design, setting, and participantsFor construct validity we performed a chart-based study in 129 ER patients age 70 years and older admitted to acute geriatric care (pilot 1). For criterion validity we performed a prospective study in 288 ER patients age 70 years and older admitted to acute care (pilot 2).ExposureIn both validation steps, the exposure was ICEBERG test performance below and above the median score (10, range 0–30).Outcome measures and analysisIn pilot 1, we compared the exposure with results of nine tests of the Comprehensive Geriatric Assessment (CGA). In pilot 2, we compared the exposure assessed in the ER to following length of hospital stay (LOS), one-on-one nursing care needs, in-hospital mortality, 30-day re-admission rate, and discharge to a nursing home.Main resultsMean age was 82.9 years (SD 6.7; n = 129) in pilot 1, and 81.5 years (SD 7.0; n = 288) in pilot 2. In pilot 1, scoring ≥10 was associated with significantly worse performance in 8 of 9 of the individual CGA tests. In pilot 2, scoring ≥10 resulted in longer average LOS (median 7 days, IQR 4, 11 vs. 6 days, IQR 3, 8) and higher nursing care needs (median 1,838 min, IQR 901, 4,267 vs. median 1,393 min, IQR 743, 2,390). Scoring ≥10 also increased the odds of one-on-one nursing care 2.9-fold (OR 2.86, 95%CI 1.17–6.98), and the odds of discharge to a nursing home 3.7-fold (OR 3.70, 95%CI 1.74–7.85). Further, scoring ≥10 was associated with higher in-hospital mortality and re-hospitalization rates, however not reaching statistical significance. Average time to complete the ICEBERG tool was 4.3 min (SD 1.3).ConclusionOur validation studies support construct validity of the ICEBERG tool with the CGA, and criterion validity with several clinical indicators in acute care.

Background: The inability to focus light onto the retina, known as refractive error, is a significant cause of correctable visual impairment. Unfortunately, students' ocular complaints often go unnoticed due to a lack of awareness. To address this issue, a questionnaire with high sensitivity and reasonable specificity was developed for teachers to identify students with refractive error. Methods: A questionnaire with surrogate indicators for refractive error in children was used and the data was analysed using SPSS. Significant markers were scored and a ROC curve determined a suitable cut-off. Sensitivity and specificity were calculated based on this cut-off. Results: The questionnaire was developed using five variables that had a 65% probability of identifying refractive error, including copying errors, copying from peers, eye squeezing, previous use of glasses, and eye deviation. A cut-off score of 5.5 out of 14 achieved 90% sensitivity and 50% specificity in detecting refractive errors. Conclusion: This study created a tool with five markers that demonstrated good internal consistency and content validity, it had an average sensitivity and specificity of 84% and 63%, respectively. The tool is twice as likely to identify someone with refractive error than someone without it.

Summary: Despite the high sensitivity of the STOP‐Bang questionnaire [snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender] questionnaire (SBQ), which is widely used to screen individuals at high risk of obstructive sleep apnea (OSA), few studies have evaluated the discrimination related to sex in the SBQ. Therefore, our study aimed to assess whether SBQ performance is gender‐related and modified by changing body mass index (BMI) and neck circumference (NC) cut‐off values. A total of 470 patients attended the sleep centres. They were divided into moderate‐to‐severe OSA and non‐moderate‐to‐severe OSA groups based on the apnea–hypopnea index (AHI) and the results of the SBQ screening. The predictive performance of the SBQ screening instrument was evaluated by 2 × 2 contingency tables and discriminatory ability, which was estimated from the area under the curve (AUC) obtained from receiver operating characteristic curve. Our results suggest that when screening for moderate‐to‐severe OSA, the original SBQ has higher sensitivity and lower specificity for men; however, women have higher specificity and lower sensitivity. The SBQ achieved the maximum AUC of 0.783 for men and 0.634 for women when the BMI cut‐off value was established at 30 kg/m2 and the NC cut‐off value was established at 38 cm in men, and the BMI cut‐off value was established at 25 kg/m2 and the NC cut‐off value at 36 cm in women. Balancing the optimal sensitivity and specificity, the cut‐off value of the optimal modified SBQ total scores for men was determined to be ≥4 and ≥3 for women. [ABSTRACT FROM AUTHOR]

The estimation of prevalence using a screening tool is done frequently in epidemiology research. The tools used for the estimation are usually associated with a certain level of misclassification. Additional adjustments are required to eliminate the bias in the prevalence and the confidence interval (CI) estimate. A frequently used method for this correction is by modifying the upper and lower limits, using sensitivity and specificity, increasing the width of the CI. The issue is exaggerated with a minimal sample size. Zhou and Li recently developed a method to estimate the CI using the Edgeworth expansion of the logit transformed binomial proportion. This article introduces a specialised tool by re-estimating the confidence limits adjusting for misclassified measurements, and assesses their characteristics through a simulation. The paper provides evidence that the re-estimated new interval performs better in the presence of misclassification. [ABSTRACT FROM AUTHOR]

Objectives: To determine the usefulness of cardiovascular physical examination (CPE) as a screening tool in a lowresource setting for detecting congenital heart disease (CHD) in newborns delivered at the Maternity Unit of Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Design: A hospital-based cross-sectional study with a comparison group component. Setting: Maternity Unit of the KBTH, Accra, Ghana. Participants: Over eight months, newborns aged 1-14 days delivered at = 34 weeks' gestation at the Maternity Unit, KBTH, were recruited into the study. Intervention: Each newborn was examined using a set of CPE parameters for the presence of congenital heart disease. Those with suggestive features of CHD had a confirmatory echocardiogram test. Main Outcome Measure: Abnormal CPE features and their corresponding echocardiogram findings. Results: A total of 1607 were screened, with 52 newborns showing signs of CHD on CPE, of which 20 newborns were proven on echocardiogram to have congenital heart disease. Abnormal CPE parameter that was associated with CHD was murmur (P=0.001), dysmorphism (p=0.01), newborns with chest recessions (p=0.01) and lethargy (p=0.02). CPE's sensitivity, specificity, and positive and negative predictive values were 95%, 60.7%, 36.5% and 98,1%, respectively. The most common acyanotic CHD found was isolated atrial septal defect (ASD), followed by patent ductus arteriosus (PDA). The only cyanotic CHD found was a case of tricuspid atresia. Conclusion: Cardiovascular physical examination at birth is an effective and inexpensive screening tool for detecting CHD in newborns, which can easily be utilised in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: Dysphagia can have serious health implications including choking and respiratory infection leading to poorer quality of life. People with intellectual disabilities are at higher risk of dysphagia related health complications and early death. Robust dysphagia screening tools are vital for this population. Method: A scoping review and appraisal of the evidence for dysphagia and feeding screening tools for use with people with intellectual disabilities was undertaken. Results: Seven studies (using six screening tools) met the review inclusion criteria. Mostly studies were limited by no defined dysphagia criteria, no verification of tools with a gold reference standard (e.g., videofluoroscopic examination) and lack of participant diversity (small samples, narrow age range, severity of intellectual disability or limited settings). Conclusions: There is urgent need for development and rigorous appraisal of existing dysphagia screening tools to meet the needs of a wider range of people with intellectual disabilities (particularly mild‐to‐moderate severity) and in wider settings. [ABSTRACT FROM AUTHOR]

Introduction: Advances in mobile computing platforms and the rapid development of wearable devices have made possible the continuous monitoring of patients with mild cognitive impairment (MCI) and their daily activities. Such rich data can reveal more subtle changes in patients’ behavioral and physiological characteristics, providing new ways to detect MCI anytime, anywhere. Therefore, we aimed to investigate the feasibility and validity of digital cognitive tests and physiological sensors applied to MCI assessment. Methods: We collected photoplethysmography (PPG), electrodermal activity (EDA) and electroencephalogram (EEG) signals from 120 participants (61 MCI patients, 59 healthy controls) during rest and cognitive testing. The features extracted from these physiological signals involved the time domain, frequency domain, time-frequency domain and statistics. Time and score features during the cognitive test are automatically recorded by the system. In addition, selected features of all modalities were classified by tenfold cross-validation using five different classifiers. Results: The experimental results showed that the weighted soft voting strategy combining five classifiers achieved the highest classification accuracy (88.9%), precision (89.9%), recall (88.2%), and F1 score (89.0%). Compared to healthy controls, the MCI group typically took longer to recall, draw, and drag. Moreover, during cognitive testing, MCI patients showed lower heart rate variability, higher electrodermal activity values, and stronger brain activity in the alpha and beta bands. Discussion: It was found that patients’ classification performance improved when combining features from multiple modalities compared to using only tablet parameters or physiological features, indicating that our scheme could reveal MCI-related discriminative information. Furthermore, the best classification results on the digital span test across all tasks suggest that MCI patients may have deficits in attention and short-term memory that came to the fore earlier. Finally, integrating tablet cognitive tests and wearable sensors would provide a new direction for creating an easy-to-use and at-home self-check MCI screening tool. [ABSTRACT FROM AUTHOR]

Background: Movement disorders are frequent in patients with inborn errors of metabolism (IEMs) but poorly recognized, particularly by nonmovement disorder specialists. We propose an easy‐to‐use clinical screening tool to help recognize movement disorders. Objective: The aim is to develop a user‐friendly rapid screening tool for nonmovement disorder specialists to detect moderate and severe movement disorders in patients aged ≥4 years with IEMs. Methods: Videos of 55 patients with different IEMs were scored by experienced movement disorder specialists (n = 12). Inter‐rater agreements were determined on the presence and subtype of the movement disorder. Based on ranking and consensus, items were chosen to be incorporated into the screening tool. Results: A movement disorder was rated as present in 80% of the patients, with a moderate inter‐rater agreement (κ =0.420, P < 0.001) on the presence of a movement disorder. When considering only moderate and severe movement disorders, the inter‐rater agreement increased to almost perfect (κ = 0.900, P < 0.001). Dystonia was most frequently scored (27.3%) as the dominant phenotype. Treatment was mainly suggested for patients with moderate or severe movement disorders. Walking, observations of the arms, and drawing a spiral were found to be the most informative tasks and were included in the screening tool. Conclusions: We designed a screening tool to recognize movement disorders in patients with IEMs. We propose that this screening tool can contribute to select patients who should be referred to a movement disorder specialist for further evaluation and, if necessary, treatment of the movement disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: Alpha (a) thalassemia is an inherited condition that often cause public health problem in Malaysia. Thalassemia screening program plays extremely important roles for early detection. Therefore, it is important to accurately characterized molecular and hematologic parameters to determine the carrier genotype and prevent thalassaemia major or intermedia offspring. Objective: The objective of this study is to detect a-globin gene deletions and evaluate the haematological parameters among deletional a thalassemia patients in Hospital Universiti Sains Malaysia, Northeastern Malaysia. Result: 71 (33.2%) out of of 214 samples in this study, were detected with a thalassaemia deletional type. South-East Asian (SEA) (50.7%) was most common type a deletional thalassaemia detected. There was a significant difference between the median of Hb, MCV and MCH level of patients with and without a deletion. Conclusion: This study highlighted the importance of hematological parameter as well as Hb analysis to be used as a guide before proceed with molecular method in establishing a definitive diagnosis for proper management. [ABSTRACT FROM AUTHOR]

Misdiagnosis of bipolar I disorder (BP-I) as major depressive disorder (MDD) leads to increased healthcare resource utilization and costs. The cost-effectiveness of the Rapid Mood Screener (RMS), a tool to identify BP-I in patients with depressive symptoms, was assessed in patients diagnosed with MDD presenting with depressive episodes. A decision-tree model of a hypothetical cohort of 1000 patients in a US health plan was used to estimate the number of correct diagnoses and overall total, direct healthcare costs over a 3-year timeframe for RMS-screened versus unscreened patients. Model inputs included the prevalence of BP-I in patients diagnosed with MDD, RMS sensitivity/specificity, and the cost of misdiagnosing BP-I as MDD. Screening with the RMS resulted in 171, 159, and 143 additional correct BP-I or MDD diagnoses at Years 1, 2, and 3, respectively. Total healthcare plan cost savings were $1279 per patient in Year 1. Cumulative cost savings per patient for RMS screening versus no RMS screening were $2307 over 2 years and $3011 over 3 years. Scenario analyses showed that the RMS would remain cost-saving assuming a lower prevalence of BP-I (20% or 10%) versus the base case (24.3%). The RMS is a cost-effective tool to identify BP-I in patients who would otherwise be misdiagnosed with MDD. Screening with the RMS resulted in cost-savings over 3 years, with model results remaining robust even with lower prevalence of BP-I and reduced RMS sensitivity assumptions. [ABSTRACT FROM AUTHOR]

Despite the previous development of criteria for palliative screening tools, there remains a lack of validated and practical screening processes for the general hospitalized patient population for everyday clinical use. This quality improvement project's aim was to implement a practical institution-based adult inpatient palliative care screening tool embedded into the electronic medical record with an automated alert process to assist in identifying patients earlier within hospital admission. The project used a preimplementation and postimplementation design and followed the Plan-Do-Study-Act process to measure the effectiveness of the tool and alert process in decreasing time from admission to palliative care referral and impact on referring patterns. During the project period, 1851 palliative care referrals were completed, and minimal difference (0.6%) was noted in the average time from admission to referral preimplementation and postimplementation (P =.939). There was a 3.7% increase in referrals postimplementation and a shift in referring service patterns (P =.321). Although the expected outcome of earlier palliative referrals during admissions was not met, the development and implementation of the tool and alert process is a step toward the creation of a standard practical tool for the general hospitalized patient population. [ABSTRACT FROM AUTHOR]

In recent years, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), a screening tool for autism spectrum disorder (ASD), has been translated into various languages and made accessible for the assessment of children globally. This study aims to systematically review and identify the available translations of the M-CHAT-R that have been adapted for use in different cultures, to evaluate the translation and cultural adaptation process, to report on the methodologies and psychometric properties of the adaptations of the M-CHAT-R and to critically discuss the implications for clinical practice and future research. An electronic search was performed through four main databases, EBSCOhost, Google Scholar, PubMed and Elsevier, to identify eligible articles. The PRISMA guidelines were employed as the primary search strategy and reporting system, while the COSMIN checklist was used to evaluate the selected studies' psychometric properties and cultural validity. Thirteen studies were included in this systematic review. The evaluation of screening accuracy properties for all studies showed that the M-CHAT-R translations achieved reasonable to good screening accuracy and further highlighted that sensitivity and specificity values, which are not dependent on the prevalence rate, are more appropriate measures than other psychometric properties to reflect the validity of the M-CHAT-R. The review of methodologies and results showed that the M-CHAT-R might be equally effective as the original tool in screening children aged up to 48 months, but future research is required to obtain more normative data. The large discrepancies among sample sizes and differences in population settings with ambiguous translations and adaptations highlighted the need for a more in-depth adaptation process for future cross-cultural validation studies.

Abstract Background The life expectancy of people with severe mental illness (SMI) is shorter than those without SMI, with multimorbidity and poorer physical health contributing to health inequality. Screening tools could potentially assist the optimisation of medicines to protect the physical health of people with SMI. The aim of our research was to design and validate a medicines optimisation tool (OPTIMISE) to help clinicians to optimise physical health in people with SMI. Methods A review of existing published guidelines, PubMed and Medline was carried out. Literature was examined for medicines optimisation recommendations and also for reference to the management of physical illness in people with mental illness. Potential indicators were grouped according to physiological system. A multidisciplinary team with expertise in mental health and the development of screening tools agreed that 83 indicators should be included in the first draft of OPTIMISE. The Delphi consensus technique was used to develop and validate the contents. A 17-member multidisciplinary panel of experts from the UK and Ireland completed 2 rounds of Delphi consensus, rating their level of agreement to 83 prescribing indicators using a 5-point Likert scale. Indicators were accepted for inclusion in the OPTIMISE tool after achieving a median score of 1 or 2, where 1 indicated strongly agree and 2 indicated agree, and 75th centile value of ≤ 2. Interrater reliability was assessed among 4 clinicians across 20 datasets and the chance corrected level of agreement (kappa) was calculated. The kappa statistic was interpreted as poor if 0.2 or less, fair if 0.21–0.4, moderate if 0.41–0.6, substantial if 0.61–0.8, and good if 0.81–1.0. Results Consensus was achieved after 2 rounds of Delphi for 62 prescribing indicators where 53 indicators were accepted after round 1 and a further 9 indicators were accepted after round 2. Interrater reliability of OPTIMISE between physicians and pharmacists indicated a substantial level of agreement with a kappa statistic of 0.75. Conclusions OPTIMISE is a 62 indicator medicines optimisation tool designed to assist decision making in those treating adults with SMI. It was developed using a Delphi consensus methodology and interrater reliability is substantial. OPTIMISE has the potential to improve medicines optimisation by ensuring preventative medicines are considered when clinically indicated. Further research involving the implementation of OPTIMISE is required to demonstrate its true benefit. Trial registration This article does not report the results of a health care intervention on human participants.

A systematic screening of patients with a need for post-acute care is a helpful support for interprofessional discharge planning teams. We aimed to test self-care abilities, measured by the self-care index (SPI) as predictors of post-acute care transfer and to update the existing SPI prediction model.

• "CARE" is an electronic health (e-health) application (app) which assesses frailty with its frailty module and risk of falls with its mobility module. • Both CARE frail state and CARE high risk of falls were significantly associated with incident falls among participants in the NuAge study. • A greater association with incident falls and recurrent falls was observed with the CARE high risk of falls than with the CARE frail state. • These results suggest that the CARE app may be useful for screening older populations for the risk of falls. "CARE" is an electronic health (e-health) application (app) which assesses frailty with its frailty module and risk of falls with its mobility module. This study examines and compares the risk of incident falls (i.e., ≥1, ≥2 and severe falls) among older people in Quebec classified as "frail" and those classified as being at a high risk of falls by the CARE app. A subset of men and women (n = 1151; 74.2 ± 4.2 years; 52.8 % female) who participated in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) were selected for this study. Pre-frail and frail states using the CARE frailty scale as well as high risk of falls estimated by CARE mobility module were determined at baseline. Pre-frail and frail states were merged in a single "frail state" group. Incident falls (i.e., ≥1, ≥2 and severe falls) were annually recorded over a 3-year follow-up. Both CARE frail state (Odd ratio (OR) ≥1.89 with P ≥ 0.040) and high risk of falls estimated by the CARE mobility module (OR) ≥3.32 with P ≥ 0.023) were significantly associated with incident falls (i.e., at least one fall) and recurrent falls (i.e., at least two falls). A greater association with these fall outcomes was observed with the high risk of falls than with the frail state. No significant association between the high risk of falls and severe falls was found (OR = 1.71 with P = 0.227), whereas that was the case with frail state (OR = 3.08 with P = 0.003). Frail state determined by the CARE frailty module and high risk of falls determined by the CARE mobility module were both significantly associated with fall outcomes, a greater association being shown with the CARE high risk of falls and with CARE frail state for severe falls. These results suggest that the CARE app may be useful for screening older people for the risk of falls. [ABSTRACT FROM AUTHOR]

Abstract Background Dating abuse (DA) is prevalent and consequential, but no brief DA screening tools are available for use in pediatric or other settings. This study was designed to determine the sensitivity, specificity, and predictive values of the MARSHA-C, which is a three-item DA victimization screening tool. Methods The participants were 224 U.S. youth ages 11–21 years old (20% male, 77% female, 3% non-binary gender). Youth completed an online questionnaire about adolescent relationship abuse. The survey included the Measure of Adolescent Relationship Harassment and Abuse (MARSHA), which is a comprehensive DA measurement instrument normed on a nationally representative sample. Of 34 DA victimization items from the MARSHA, the three most prevalent items were hypothesized to have good predictive validity of the full scale score as a brief, screening version (MARSHA-C). The sensitivity, specificity, positive predictive value, and negative predictive value of the MARSHA-C to identify victims of DA was calculated. Results Using the MARSHA as the reference standard, the cutpoint of 1 on the MARSHA-C screening tool was identified as optimal. The MARSHA-C had a sensitivity of 84%, a specificity of 91%, and positive predictive value of 91%. Thus, for youth who endorse ≥ 1 MARSHA-C items, there is a 91% probability that they have experienced DA in the past year. Exploratory analyses by demographic subgroups suggest that the predictive validity of the MARSHA-C is approximately equivalent for females and males, younger and older adolescents, Asian, Black, Latinx, Multiracial and White youth, and heterosexual and lesbian, gay, and bisexual youth. Conclusions The MARSHA-C can be used to detect DA among 11–21-year-old youth via online surveys for research purposes, or in clinical care settings to facilitate proactive patient counseling or parent-oriented anticipatory guidance.

Abstract Background The term “frailty” might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the frailty assessment method utilised. We aimed to examine the diagnostic accuracy of several screening tools for frailty defined by the phenotype model in older Japanese adults. Methods This cross-sectional study included 1,306 older Japanese adults aged ≥ 65 years who underwent physical check-up by cluster random sampling as part of the Kyoto-Kameoka Study in Japan. We evaluated the diagnostic accuracy of several screening instruments for frailty using the revised Japanese version of the Cardiovascular Health Study criteria as the reference standard. These criteria are based on the Fried phenotype model and include five elements: unintentional weight loss, weakness (grip strength), exhaustion, slowness (normal gait speed), and low physical activity. The Kihon Checklist (KCL), frailty screening index (FSI), and self-reported health were evaluated using mailed surveys. We calculated the non-parametric area under the receiver operating characteristic curve (AUC ROC) for several screening tools against the reference standard. Results The participants’ mean (standard deviation) age was 72.8 (5.5) years. The prevalence of frailty based on the Fried phenotype model was 12.2% in women and 10.3% in men. The AUC ROC was 0.861 (95% confidence interval: 0.832–0.889) for KCL, 0.860 (0.831–0.889) for FSI, and 0.668 (0.629–0.707) for self-reported health. The cut-off for identifying frail individuals was ≥ 7 points in the KCL and ≥ 2 points in the FSI. Conclusions Our results indicated that the two instruments (KCL and FSI) had sufficient diagnostic accuracy for frailty based on the phenotype model for older Japanese adults. This may be useful for the early detection of frailty in high-risk older adults.

Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with quality of life (QoL). The methods for assessing HMB are not suited for clinical practice. We analyzed the validity of a combined visual analog scale (VAS) tool assessing the intensity of menstrual bleeding (VASInt) and its impact on activities of daily living (VASImp) to identify women with HMB. Materials and Methods: Analysis conducted in the data set used to validate the Spanish HMB screening tool SAMANTA questionnaire. A logistic regression analysis was used to construct the model. Reference standard was the pictorial blood loss assessment chart (PBAC). The performance of the HMB-VAS and the SAMANTA questionnaire was compared. Correlation with SAMANTA questionnaire, PBAC, and other QoL measurements was assessed. Results: The resulting function (HMB-VAS score?=?10.86???VASInt score +2.48???VASImp score) showed a slightly lower accuracy versus the SAMANTA questionnaire (86.8% vs. 87.9%) but a similar area under the curve: 0.9396 versus 0.943, respectively (p?=?0.6605). The cutoff point was established as 700. After rounding the regression coefficients, the resulting function (11???VASInt +2???VASImp) showed 87.6% accuracy. The correlation of HMB-VAS with the SAMANTA questionnaire was strong (r: 0.79819; p?0.0001), whereas the correlation was moderate to strong with the PBAC (0.59299; p?

IntroductionThe success of diabetes prevention based on early treatment depends on high-quality screening. This study compared the diagnostic properties of currently recommended screening strategies against alternative score-based rules to identify those at high risk of developing diabetes.MethodsThe study used data from ELSA-Brasil, a contemporary cohort followed up for a mean (standard deviation) of 7.4 (0.54) years, to develop risk functions with logistic regression to predict incident diabetes based on socioeconomic, lifestyle, clinical, and laboratory variables. We compared the predictive capacity of these functions against traditional pre-diabetes cutoffs of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), and glycated hemoglobin (HbA1c) alone or combined with recommended screening questionnaires.ResultsPresenting FPG > 100 mg/dl predicted 76.6% of future cases of diabetes in the cohort at the cost of labeling 40.6% of the sample as high risk. If FPG testing was performed only in those with a positive American Diabetes Association (ADA) questionnaire, labeling was reduced to 12.2%, but only 33% of future cases were identified. Scores using continuously expressed clinical and laboratory variables produced a better balance between detecting more cases and labeling fewer false positives. They consistently outperformed strategies based on categorical cutoffs. For example, a score composed of both clinical and laboratory data, calibrated to detect a risk of future diabetes ≥20%, predicted 54% of future diabetes cases, labeled only 15.3% as high risk, and, compared to the FPG ≥ 100 mg/dl strategy, nearly doubled the probability of future diabetes among screen positives.DiscussionCurrently recommended screening strategies are inferior to alternatives based on continuous clinical and laboratory variables.

A survey conducted among general neurologists in the Netherlands revealed that patient referral for device-aided therapies (DAT) in Parkinson's disease (PD) is suboptimal due to a lack of clear and objective referral criteria. Less than half of the respondents considered the eligibility criteria for DAT to be clear, and a similar minority felt they had sufficient expertise to determine eligibility. The survey also found that general neurologists ranked treatment-resistant tremor and cognitive impairment as particularly relevant factors for deep brain stimulation (DBS), which may negatively impact referrals for other DATs. The study suggests that implementing a user-friendly and validated screening tool could improve the timely referral for DAT without over-referral. [Extracted from the article]

Hot-melt extrusion (HME) is used for the production of solid protein formulations mainly for two reasons: increased protein stability in solid state and/or long-term release systems (e.g., protein-loaded implants). However, HME requires considerable amounts of material even at small-scale (>2 g batch size). In this study, we introduced vacuum compression molding (VCM) as a predictive screening tool of protein stability for potential HME processing. The focus was to identify appropriate polymeric matrices prior to extrusion and evaluation of protein stability after thermal stress using only a few milligrams of protein. The protein stability of lysozyme, BSA, and human insulin embedded in PEG 20,000, PLGA, or EVA by VCM was investigated by DSC, FT-IR, and SEC. The results from the protein-loaded discs provided important insights into the solid-state stabilizing mechanisms of protein candidates. We demonstrated the successful application of VCM for a set of proteins and polymers, showing, in particular, a high potential for EVA as a polymeric matrix for solid-state stabilization of proteins and the production of extended-release dosage forms. Stable protein-polymer mixtures with sufficient protein stability after VCM could be then introduced to a combination of thermal and shear stress by HME and further investigated with regard to their process-related protein stability. [ABSTRACT FROM AUTHOR]

In Indonesia, adequate screening instruments for the early detection of attention deficit and hyperactivity disorder (ADHD) in primary school students is not available prior to the study. We aimed to assess the Indonesian version of the Conners 3 Teacher Rating Scale (Conners 3-T) in an Indonesian setting and assess the prevalence of ADHD in primary school children. The study participants comprised 314 primary school students aged 6-12 years old. Conners 3-T was translated from English to Bahasa Indonesia and back-translated into English. Those students suspected of ADHD were further diagnosed by a senior child psychologist for diagnosis. The results showed that Conners 3-T has a good psychometric quality (a = .96). The quality and accuracy of the screening tool with Receiver Operating Characteristic analysis showed a discrimination value (Area Under Curve) of 75.5%, cut-off value of = 35 with sensitivity value of .67 and specificity of .62. Conclusion: This study indicated that Conners 3T had good sensitivity and specificity as a screening tool. We also found that 45.85% of children were suspected of ADHD symptoms. Further thorough psychological evaluation for diagnostic purposes revealed 8.09% of these children were diagnosed with ADHD. We concluded that the prevalence of children with ADHD in Indonesia is within the common range, and we recommend using the Indonesian Conners 3-T to screen children suspected of ADHD in Indonesia. [ABSTRACT FROM AUTHOR]

Early discharge has been a target of cost-control efforts given the growing demand for joint replacement surgeries. A multisystem medically-based risk-assessment tool known as the Outpatient Arthroplasty Risk Assessment (OARA) score has shown high predictive ability for safe early discharge following an outpatient lower extremity arthroplasty utilizing a score threshold ≤79. Shoulder arthroplasties have been shown to have lower associated medical risks than lower extremity arthroplasties. An OARA score threshold of 110 was recently shown to be safe for same-day discharge (SDD) following shoulder arthroplasties in a series of 422 patients. The purpose of this study is to re-examine the OARA score threshold for shoulder arthroplasties by evaluating its effectiveness in selecting patients for SDD utilizing a larger population of patients. We hypothesize that the OARA score threshold for shoulder arthroplasty will remain higher than the established threshold for lower-extremity arthroplasty. A retrospective review was performed on 734 consecutive patients who underwent a primary anatomic or reverse total shoulder arthroplasty between April 2018 and December 2020 by a single surgeon. As standard practice, all patients were counseled preoperatively regarding SDD and given the choice to stay overnight. Medical history, length of stay, 30- and 90-day readmissions, and 90-day emergency room and urgent care visits were obtained from medical records. Analysis of variance testing, Chi-square testing, and screening test characteristics compared the performance of OARA scores to that of the American Society of Anesthesiologists Physical Status. A receiver operating characteristic analysis was completed to determine the optimal OARA score threshold for safe SDD. The receiver operating characteristic analysis showed that 102.5 was the optimal preoperative OARA score threshold for safe SDD following a shoulder arthroplasty. The OARA score cutoff of ≤102.5 points demonstrated a sensitivity of 87.0% for identifying SDD patients. OARA scores ≤102.5 also showed a negative predictive value of 80.6% but remained incomprehensive with a specificity of 28.5% (P <.0001) and a positive predictive value of 39.2. Patients with OARA scores ≤102.5 were over 4 times less likely to have a 90-day emergency room visit (P <.001) than those with scores >102.5. There was no difference in 30-day and 90-day readmission rates for patients with OARA scores ≤102.5, ≤110, and ≤79 and American Society of Anesthesiologists Physical Status ≤2. A preoperative OARA score threshold of ≤102.5 is effective and conservative in screening patients for SDD following a shoulder arthroplasty, with low rates of 90-day emergency room visits and readmissions. This threshold is a useful screening tool to identify patients that are not good candidates for SDD. [ABSTRACT FROM AUTHOR]

Background and Objectives Care partners of hospitalized older adults report their caregiving needs are not being addressed. The Care Partner Hospital Assessment Tool (CHAT) is a feasible and appropriate tool for practitioners' use with care partners in the hospital setting. This article explores the face validity and acceptability of the CHAT among care partners of hospitalized older adults. Research Design and Methods A qualitative descriptive study was used to identify common themes among care partners' responses from semistructured interviews. The CHAT was administered to care partners of older adults admitted to a medical–surgical unit in an academic medical center in Madison, WI, from October 2021 to January 2022. A semistructured, follow-up interview was completed by the same care partners after discharge. Interviews were transcribed and coded for themes to capture overall impressions of the CHAT. Care partners addressed the usefulness, comfort, content, and complexity of the CHAT. Results Twelve care partners participated in the study. Care partners reported that the CHAT was easy to understand and complete, was judged to be useful to both the care partner and older adult, and helped identify care partner needs. Care partners suggested ways to improve the tool including administration, additional content areas to include, and modes of delivery. Discussion and Implications The results establish the face validity of the CHAT and support the acceptability of the tool for use with care partners of hospitalized older adults. [ABSTRACT FROM AUTHOR]

Objective: Malnutrition is often underestimated in the context of cancer therapy: the dietary trends initiated by patients after diagnosis are usually neither known to nor evaluated by the medical staff. Here, we propose a combined screening instrument evaluating malnutrition and dietary trends. Methods: The validated screening tool NRS-2002 was combined with a four-item questionnaire assessing whether (1) patients preferred certain foods, (2) avoided certain foods, (3) used dietary supplements or followed a special diet since the time of cancer diagnosis. The screening tool was routinely used by cancer patients in the daily practice of three oncological departments. The presented analysis was performed retrospectively and anonymized. Results: Overall, 102 cancer patients undergoing systemic therapy (CP), 97 undergoing radiation therapy (RP), and 36 head–neck cancer patients (HNP) were screened. The CP cohort showed a higher rate of malnutrition (50.00%) than the HNP (28.13%) or RP (26.80%) cohort. Overall, diet changes were observed in 33.63% of all patients. Avoiding meat, stimulants, or hard and edgy food was often mentioned in free text answers, while patients reported a preference for fruit and vegetables. Nutritional supplements were used by 28.76% of the patients. While dietary changes were common, only 6.64% of the patients mentioned adhering to a specific cancer diet. Conclusion: Malnutrition is still underestimated nowadays. Diet trends, especially avoiding certain foods, are common in cancer patients, while adhering to a specific cancer diet is an exception. Diet trends should be assessed and addressed to avoid or aggravate malnutrition. [ABSTRACT FROM AUTHOR]

Background: The validated SAMANTA questionnaire allows identification of women with heavy menstrual bleeding (HMB); that is, with excessive menstrual bleeding that interferes with quality of life (QoL). We assessed its value for monitoring HMB treatment in clinical practice. Material and Methods: This is a prospective observational study conducted between December 2018 and March 2021 in consecutively recruited women with HMB attending gynecologists' offices who started a hormonal treatment. Sociodemographic characteristics were recorded at enrollment. At baseline and month 12, we assessed the HMB (SAMANTA questionnaire), the global impression of menstrual bleeding severity in patients (PGI-S) and clinicians (CGI-S), and the QoL (SF36). At month 12, we assessed the global impression of menstrual bleeding change in patients (PGI-C) and clinicians (CGI-C). Changes in SAMANTA questionnaire score at month 12 were compared with the presence of amenorrhea and changes in blood loss, menstrual period duration, and PGI-S, PGI-C, CGI-S, and CGI-C. Results: The study included 371 women aged 41.2 ± 6.5 years, 87% of whom were using the levonorgestrel intrauterine system. The SAMANTA questionnaire score significantly decreased in 97.3% of women. The decrease was greater in women reporting a reduction in blood loss, shorter menstrual bleeding duration, or a strong improvement in menstrual bleeding severity (PGI-S and CGI-S) or amount (PGI-C and CGI-C) (p < 0.001 for all), but not amenorrhea. SF-36 domains improved significantly; changes being inversely associated with changes in the SAMANTA questionnaire score. Conclusions: The SAMANTA questionnaire seems a valuable tool for monitoring hormonal treatment for HMB. ClinicalTrials.gov identifier NCT03751800. [ABSTRACT FROM AUTHOR]

Background: One in seven couples are impacted by infertility in the UK, and female infertility is often associated with several health conditions impacted by nutrition. Despite many studies aimed at identifying the critical role of nutrition in infertility, there is currently no screening tool that identifies nutritional risk factors for infertility. Aim: To propose a self‐administered screening tool to identify women who would benefit from nutritional intervention to promote fertility. Methods: A narrative review was carried out to identify and summarise modifiable nutritional risk factors that can influence female fertility, including comorbidities that can influence nutrition intake, absorption, and metabolism. Key Findings: A nutrition screening tool outlining modifiable nutrition risk factors potentially improving female fertility has been proposed, comprising of BMI, medical history and quality of diet and lifestyle which would aid in designing evidence based dietetic services for female infertility. The key points from the paper: Nutrition plays a critical role in managing infertility; however, there is currently no screening tool that identifies nutritional risk factors for infertility. We identify and summarise modifiable nutritional risk factors influencing female fertility and propose a self‐administered screening tool to identify women who would benefit from nutritional intervention to promote fertility. [ABSTRACT FROM AUTHOR]

The body roundness index (BRI) was developed to provide a more accurate numerical quantifier of body roundness. The capability of BRI to predict body fat and visceral adipose tissue provides an impression that it may be capable of relating to cardiometabolic risks. This present study utilized the 8th National Nutrition Survey to determine the validity of BRI to screen for abnormal blood lipids among Filipino adults. The area under the receiver-operating characteristics curve (AUC) was used as the validity measure. BRI had AUCs of 0.641 (95% CI: 0.627-0.655) in men and 0.635 (95% CI: 0.621-0.649) in women. In terms of criterion validity, the AUCs of BRI were compared to the AUCs of widely accepted anthropometric indices - namely, body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). BRI significantly outperformed WHR in men, BMI in women, and WC in both sexes in screening abnormal blood lipids. Therefore, BRI had a discriminative capability to screen for abnormal blood lipids among Filipino adults. The optimal BRI cut-off points for screening abnormal blood lipids were identified as 2.71 for men and 3.44 for women based on [a] the maximum Youden Index value and [b] a rule that sensitivity should be greater than specificity. Filipino adults whose BRI exceeds the sex-specific cut-off points for screening abnormal blood lipids might consider further screening or diagnosis of abnormal blood lipids for effective case management. [ABSTRACT FROM AUTHOR]

Neuropathic pain (NP) is a common condition that impacts life negatively. This type of pain responds poorly to treatment. Neuropathic Pain Symptom Inventory (NPSI) is a common instrument used for the assessment of NP response to the treatment. The current study aims to validate the Persian version of NPSI (PV-NPSI). The current study has been conducted on 162 patients experiencing pain from neuropathic ornon-neuropathic origin. The Persian version of NPSI was proposed through standard protocol and responded to by patients twice: at baseline within an interval of 3 hours and then again within 1 month. Its correlation with the patient global impression of change (PGIC) and the clinical global impression of change (CGIC) was assessed. In addition, the validity and reliability of the PV-NPSI was evaluated. The reliability Cronbach's alpha of PV-NPSI was 0.834 and test-retest intraclass-coefficient was calculated as 0.983 (95% confidence interval [CI]: 0.977-0.988; p <.001). In addition, the measured coefficient sensitivity to change based on PGIC and CGIC was 0.859 for both. Receiver operating characteristic (ROC) curve for the diagnosis of NP revealed area under curve (AUC) of 0.936 (p <.001; 95%CI: 0.894-0.978). Based on the current study's findings, the PV-NPSI is a reliable and valid means for the differentiation of NP from the other types of pain in patients with several musculoskeletal pain complaints, but we cannot determine a cutoff point for it. Also, this questionnaire can be efficiently used for the assessment of response to NP treatment. [ABSTRACT FROM AUTHOR]

It is important to identify children who are struggling with emergent literacy skills as early as possible to provide them with the support they need to prevent future academic failure. Screening tools administered in groups are more cost-effective than those administered individually, but few are available in Portugal. The goal of this study was to explore the psychometric properties (difficulty, reliability, and validity) of a group emergent literacy screening test for Portuguese-speaking children. The test includes two phonological awareness tasks, one vocabulary task, and one concepts of print task. The sample comprised 1379 children from pre-K (n = 314), kindergarten (n = 579), and first grade of primary education (n = 486). Measures of emergent literacy, reading and writing skills, and academic achievement were used to test the validity of the screening test. The Rasch model results suggest that the tasks were suitably difficult for the kindergarten group, but had varying levels of difficulty for pre-K and first grade. Reliability was adequate for the tasks with an appropriate level of difficulty. Scores for the screening test were highly correlated with measures of literacy and with academic achievement. These findings suggest that the presented emergent literacy screening test is valid and reliable, making it a useful tool for practice and research. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to compare the results of hearing tests performed using the uHear application with those of standard audiometry in Thai people in Bangkok. Methods: From December 2018 to November 2019, a prospective observational study was conducted involving Thai participants aged between 18 and 80 years. All participants were tested using standard audiometry and the uHear application in a soundproof booth and in a typical hearing environment. Results: This study included 52 participants (12 males and 40 females). The Bland–Altman plot with the Minimal Clinical Meaningful Difference of 10 dB between standard audiometry and the uHear in a soundproof booth found agreement at 2000 Hz. The uHear in a soundproof booth showed high sensitivity at all frequencies (82.5%–98.9%) and high specificity at 500 and 1000 Hz (85.7%–100%). uHear in a typical hearing environment showed high sensitivity at 4000 and 6000 Hz (97.6%) and high specificity at 500 and 1000 Hz (100%). When considering the pure‐tone average, uHear in a soundproof booth showed high sensitivity (94.7%) and specificity (90.7%), whereas, in a typical hearing environment, uHear showed poor sensitivity (34%) and high specificity (100%). Conclusion: uHear was accurate for hearing loss screening at 2000 Hz in a soundproof booth. However, uHear in a typical hearing environment lacked accuracy. The uHear application in a soundproof booth can be used to screen hearing loss in some situations where standard audiometry is impossible. Level of Evidence: II. We compared accuracy of standard audiometry with uHear application in soundproof room and in typical environment. The results showed uHear application was accurate for hearing loss screening only at 2000 Hz in soundproof booth. uHear in typical environment was lack of accuracy. uHear may have good sensitivity when testing in low noise or soundproof rooms. [ABSTRACT FROM AUTHOR]

Breeding for less digestible starch in wheat can improve the health impact of bread and other wheat foods. The application of forward genetic approaches has lately opened opportunities for the discovery of new genes that influence the digestibility of starch, without the burden of detrimental effects on yield or on pasta and bread-making quality. In this study we developed a high-throughput in vitro starch digestibility assay (HTA) for use in forward genetic approaches to screen wheat germplasm. The HTA was validated using standard maize and wheat starches. Using the HTA we measured starch digestibility in hydrothermally processed flour samples and found wide variation among 118 wheat landraces from the A. E. Watkins collection and among eight elite UK varieties (23.5 to 39.9% and 31.2 to 43.5% starch digested after 90 min, respectively). We further investigated starch digestibility in fractions of sieved wholemeal flour and purified starch in a subset of the Watkins lines and elite varieties and found that the matrix properties of flour rather than the intrinsic properties of starch granules conferred lower starch digestibility. [ABSTRACT FROM AUTHOR]

About two third of oral cancer cases present at advanced stages, emphasizing the need for screening tools for early diagnosis. Raman spectroscopy (RS) can prove an appropriate tool for early diagnosis as biochemical changes occur before morphological changes. Due to limitations with study of early oral cancer stages in human subjects, we performed a sequential carcinogenesis study in animal model. In the present study, we aim to probe early biochemical changes occurring during DMBA induced oral carcinogenesis in hamster buccal pouch model, using serum RS (SRS). Serum being systemic biofluid can reflect the true in vivo state, is minimally invasive and offers advantages of remote diagnosis and serial sampling. The female Syrian golden hamsters were treated with 0.5% DMBA and retro‐orbital blood collection was performed every week for a period of 14 weeks. An increase in classification efficiency as the DMBA treatment progressed, with distinct classification of >70% seen as early as week 5 (W5), appreciably early to development of visual changes (W8–W10) was observed. Furthermore, the early treatment weeks (W1–W4) and healthy condition (W0) show no misclassifications with weeks exhibiting frank tumours (W9–W14), demonstrating efficacy of SRS to stratify healthy versus carcinogen exposure. The findings suggest that as oral carcinogenesis progresses, biochemical alterations in serum such as increasing protein and loss of lipid content can be detected by RS, highlighting the feasibility and utility of SRS in early oral cancer diagnosis. To our knowledge, this is the first study exploring the ex vivo sequential approach to gain insights into oral cancer progression. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is defined as a clinically and genetically diverse cluster of illnesses involving conflict in carbohydrate and protein metabolism. Periodontitis is a complex condition with several causes. The interaction between these two conditions appears to be cyclical as well as bidirectional. Gingival crevicular blood obtained through routine periodontal oral assessment could be utilised for blood glucose estimation. Aim: To examine the efficacy of gingival crevicular blood elicited during routine periodontal probing, as a reliable source for screening of diabetes mellitus, and to compare it with finger capillary blood and venous capillary blood in chronic periodontitis patients. Materials and Methods: This cross-sectional, in-vivo, clinical study was conducted in the Department of Periodontology at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from January 2021 to January 2022. The study included 50 patients, who were diagnosed with chronic periodontitis in the age range ≥30 years, and met the inclusion and exclusion criteria. A prior detailed history was compiled. The clinical parameters recorded were sulcus bleeding index, plaque index, gingival index, probing pocket depth, and clinical attachment level. Each patient's blood samples were collected from three different sites, Gingival Crevicular Blood (GCB) collected from gingival crevice, Finger Capillary Blood (FCB) collected from finger bed and and Venous Capillary Blood (VCB) collected from forearm for determining the blood glucose levels. Glucose levels were compared by oneway Analysis of Variance (ANOVA). Karl Pearson's correlation was used for the comparison. Statistical Package for Social Sciences (SPSS) version 26.0 was used for statistical analysis and p-value ≤0.05 was considered as statistically significant. Results: The mean Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) was 5.5±0.61 mm and 6.76±0.82 mm, respectively. The mean Plaque Index (PI) and Gingival Index (GI) score was 1.41±0.25 and 1.45±0.21, respectively. The mean GCB, FCB, and VCB glucose level of the subjects were 171.58±85.63 mg/dL, 179.14±80.31 mg/dL and 186.96±87.57 mg/dL, respectively. There was no statistical difference seen among the three methods, thus, either of the methods can be used for measuring blood glucose levels for screening of diabetes mellitus in chronic periodontitis patients (p-value=0.66). Posistive correlation between FCB and VCB (r-value=0.976, p-value <0.001). VCB and GCB, when correlated showed strong positive and highly statistically significant results (r-value=0.934, p-value <0.001). Similarly, GCB and FCB showed a positive correlation (r-value=0.920, p-value <0.001) which was statistically highly significant. Conclusion: The results suggested that, the efficacy of gingival crevicular blood when compared with finger capillary blood and venous capillary blood glucose levels showed positive correlation, suggesting either can be used in dental clinics for diabetic screening purpose without any extra invasive procedures. [ABSTRACT FROM AUTHOR]

Childhood obesity is growing at an alarming rate and results in significant health issues in children. Current guidelines for preventing obesity include behavior modification, screening for obesity, and providing education on nutrition and physical activity. However, much of the literature suggests primary care providers (PCPs) are not using or adhering to guidelines recommended to combat childhood obesity due to a variety of barriers. The purpose of this study was to examine the use of a screening tool for PCPs during well-child visits to screen and prevent childhood obesity in an extensive family practice in the Northwestern United States. A retrospective chart review was performed to determine if school-aged children were screened consistently for obesity. The screening tool was implemented in the clinic by each of the eight PCPs to identify children who are obese/overweight. A post-intervention chart review was completed to determine if providers improved how they screened for childhood obesity. The study concluded with statistical significance (p ≤ 0.05) that the screening tool increased how providers documented during well-child visits. Identifying at-risk children for obesity is the first step in reducing rates of childhood obesity. Implementing an evidenced- based screening tool shows promise in identifying and addressing obesity behaviors during well-child visits. It has the potential to improve provider efficacy in obesity prevention, and influence nutrition and physical activity behaviors in children. [ABSTRACT FROM AUTHOR]