Sociodemographic and Visual Outcomes of Juvenile Idiopathic Arthritis Uveitis: IRIS® Registry Study.

Purpose: Understanding sociodemographic factors associated with poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis may help inform practice patterns. Patients and Methods: Retrospective cohort study on patients <18 years old who were diagnosed with both juvenile idiopathic arthritis and uveitis based on International Classification of Diseases tenth edition codes in the Intelligent Research in Sight Registry through December 2020. Surgical history was extracted using current procedural terminology codes. The primary outcome was incidence of blindness (20/200 or worse) in at least one eye in association with sociodemographic factors. Secondary outcomes included cataract and glaucoma surgery following uveitis diagnosis. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazards models. Results: Median age of juvenile idiopathic arthritis-associated uveitis diagnosis was 11 (Interquartile Range: 8 to 15). In the Cox models adjusting for sociodemographic and insurance factors, the hazard ratios of best corrected visual acuity 20/200 or worse were higher in males compared to females (HR 2.15; 95% CI: 1.45-3.18), in Black or African American patients compared to White patients (2.54; 1.44-4.48), and in Medicaid-insured patients compared to commercially-insured patients (2.23; 1.48-3.37). Conclusion: Sociodemographic factors and insurance coverage were associated with varying levels of risk for poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis.

Artificial Intelligence and Diabetic Retinopathy: AI Framework, Prospective Studies, Head-to-head Validation, and Cost-effectiveness.

Current guidelines recommend that individuals with diabetes receive yearly eye exams for detection of referable diabetic retinopathy (DR), one of the leading causes of new-onset blindness. For addressing the immense screening burden, artificial intelligence (AI) algorithms have been developed to autonomously screen for DR from fundus photography without human input. Over the last 10 years, many AI algorithms have achieved good sensitivity and specificity (>85%) for detection of referable DR compared with human graders; however, many questions still remain. In this narrative review on AI in DR screening, we discuss key concepts in AI algorithm development as a background for understanding the algorithms. We present the AI algorithms that have been prospectively validated against human graders and demonstrate the variability of reference standards and cohort demographics. We review the limited head-to-head validation studies where investigators attempt to directly compare the available algorithms. Next, we discuss the literature regarding cost-effectiveness, equity and bias, and medicolegal considerations, all of which play a role in the implementation of these AI algorithms in clinical practice. Lastly, we highlight ongoing efforts to bridge gaps in AI model data sets to pursue equitable development and delivery.

Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry.

PURPOSE: To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. DESIGN: Retrospective cohort study. PARTICIPANTS: American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. METHODS: Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. MAIN OUTCOME MEASURES: Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. RESULTS: The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). CONCLUSIONS: Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Development and Validation of the Self-Compassion Scale for Youth.

We present a series of studies on the development and validation of the Self-Compassion Scale-Youth version (SCS-Y), which is intended for use with early adolescents in middle school. Study 1 (N = 279, Mage = 12.17) describes the selection of 17 items out of a pool of 36 potential items, with three items each representing the subscales of self-kindness, mindfulness, common humanity, self-judgment, isolation, and two items representing over-identification. Using state-of-the-art psychometric analyses ideal for examining multidimensional constructs like self-compassion-bifactor exploratory structural equation modeling (bifactor-ESEM)-findings supported the use of a general self-compassion score and six subscale scores. Study 2 cross-validated the factor structure of the SCS-Y with a second sample of youths (N = 402, Mage = 12.43). Study 3 found support for the test-retest reliability of the SCS-Y (N = 102, Mage = 12.52). Study 4 (N = 212, Mage = 12.18) established construct validity for the SCS-Y by demonstrating that SCS-Y scores were significantly associated with mindfulness, happiness, life-satisfaction, depression, resilience, and achievement goal orientation in expected directions. Overall, findings suggest that the SCS-Y is a reliable and valid measure of self-compassion for use with youths.

UK Guideline for the use of post-exposure prophylaxis for HIV following sexual exposure.

We present the British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis after sexual exposure (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of HIV infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. Other areas included are the possible impact on sexual behaviour, cost-effectiveness, and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.

Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study.

BACKGROUND: Little is known about the mental health of gay men and lesbians living in Europe. AIMS: To compare psychological status, quality of life and use of mental health services by lesbians and gay men with heterosexual people. METHOD: Cross-sectional study in England and Wales using 'snowball' sampling. PARTICIPANTS: 656 gay men, 505 heterosexual men, 430 lesbians and 588 heterosexual women. Gay men were more likely than heterosexual men to score above threshold on the Clinical Interview Schedule, indicating greater levels of psychological distress (RR 1.24, 95% CI 1.07-1.43), as were lesbians compared with heterosexual women (RR 1.30, 95% CI 1.11-1.52). Gay men and lesbians were more likely than heterosexuals to have consulted a mental health professional in the past, deliberately harmed themselves and used recreational drugs. Lesbians were more likely to have experienced verbal and physical intimidation and to consume more alcohol than heterosexual women. CONCLUSIONS: Awareness of mental health issues for gay men and lesbians should become a standard part of training for mental health professionals, who need to be aware of the potential for substance misuse and self-harm in this group and of the discrimination experienced by many lesbians.

Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial.

BACKGROUND: An advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future. AIMS: To evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital. METHOD: In a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission. RESULTS: Fifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services. CONCLUSIONS: Users' advance instruction directives had little observable impact on the outcome of care at 12 months.

Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial.

OBJECTIVE: To assess the effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy. DESIGN: Parallel group, cluster randomised, controlled trial of an educational package on cognitive behaviour therapy. SETTING: General practices in north London. PARTICIPANTS: 84 general practitioner principals and 272 patients attending their practices who scored above the threshold for psychological distress on the hospital anxiety and depression scale. INTERVENTION: A training package of four half days on brief cognitive behaviour therapy. MAIN OUTCOME MEASURES: Scores on the depression attitude questionnaire (general practitioners) and the Beck depression inventory (patients). RESULTS: Doctors' knowledge of depression and attitudes towards its treatment showed no major difference between intervention and control groups after 6 months. The training had no discernible impact on patients' outcomes. CONCLUSION: General practitioners may require more training and support than a basic educational package on brief cognitive behaviour therapy to acquire skills to help patients with depression.