Preventive medicine
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Preventive medicine · Jan 2020
Use of lethal means restriction counseling for suicide prevention in pediatric primary care.
Suicide is the second-leading cause of death for adolescents in the United States. Counseling patients and families on safe storage of firearms and medications is an effective method of suicide prevention. We sought to determine the self-reported frequency of lethal means restriction (LMR) counseling among primary care pediatric providers working with adolescents who are at risk for suicide as well as factors associated with consistently employing LMR counseling. ⋯ While LMR counseling can reduce risk for completed suicide, most respondents do not consistently employ it. Those who have received training are more likely to counsel. Thus, LMR counseling should be a standard part of medical education for pediatricians.
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Preventive medicine · Jan 2020
Risk prediction of cervical abnormalities: The value of sociodemographic and lifestyle factors in addition to HPV status.
High-risk human papillomavirus (hrHPV) assessment as a primary screening test improves sensitivity but decreases specificity. Determining risk for cervical abnormalities and adapting policy accordingly may improve the balance between screening benefits and harms. Our aim is to assess the value of factors other than HPV in prediction of cervical abnormalities. ⋯ However, prediction based on hrHPV only does leave room for improvement. Future studies should therefore focus on women in the screening age range and search for other predictors to further enhance risk prediction. Adapting policy based on risk may eventually help optimise screening performance.
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The United States continues to face a public health emergency of opioid-related harm, the effects of which could be dramatically reduced through increased access to the opioid antagonist naloxone. Unfortunately, naloxone is too often unavailable when and where it is most needed, partly due to its continued status as a prescription medication. Although states and the federal Food and Drug Administration (FDA) have acted to increase access to naloxone, these changes are insufficient to address this unprecedented crisis. In this Commentary, we argue that FDA can and should immediately reclassify naloxone from prescription-only to over-the-counter status, a change that could save hundreds if not thousands of lives in the United States every year.
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Preventive medicine · Jan 2020
Comparative StudyUsing machine learning to predict opioid misuse among U.S. adolescents.
This study evaluated prediction performance of three different machine learning (ML) techniques in predicting opioid misuse among U. S. adolescents. Data were drawn from the 2015-2017 National Survey on Drug Use and Health (N = 41,579 adolescents, ages 12-17 years) and analyzed in 2019. ⋯ Prediction performance was similar across the four models (AUROC values range from 0.809 to 0.815). In terms of the AUPRC, the distributed random forest showed the best performance in prediction (0.172) followed by penalized logistic regression (0.162), gradient boosting machine (0.160), and artificial neural networks (0.157). Findings suggest that machine learning techniques can be a promising technique especially in the prediction of outcomes with rare cases (i.e., when the binary outcome variable is heavily lopsided) such as adolescent opioid misuse.
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Preventive medicine · Jan 2020
Randomized Controlled Trial Multicenter StudyEffects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial.
The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. ⋯ However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions. Trial registration number: Clinicaltrials.gov ID no.: NCT02132494.