Screening decisions—choosing a costly action that reveals information about an unknown quality—can be crucial in various situations, such as hiring workers or designing policies. Choosing whether to screen can be difficult because it requires recognizing and trading off the benefits of information with the costs of getting it. We investigate whether people recognize when the benefits of screening dominate its costs and what causes them to choose otherwise. Our online experiment simulates a hiring scenario with an initial trial task. Participants can first reveal candidates’ quality at a small cost and then choose which candidate to hire. Most participants choose the dominated task that does not reveal the candidates’ quality, and this mistake persists even with experience and feedback. We show that this insufficient screening is driven by failures to anticipate inference and plan the full strategy.

Despite more than 90% of cases arising in the community, malnutrition is under-recognised in UK primary care. Current screening tools such as the Malnutrition Universal Screening Tool identify malnutrition once it is already established and are inconsistently implemented. As a result, malnutrition is detected late, after functional decline and avoidable harm have already occurred. Our narrative review highlights that existing malnutrition prediction tools were largely developed in hospital populations, show variable accuracy, and have not been validated for community use. Emerging machine-learning models demonstrate feasibility but are similarly limited. We outline the urgent need for automated, data-driven prediction models drawing on routinely collected primary-care data – such as weight trajectories, comorbidities, medications, and biochemistry markers – to identify individuals at future risk of malnutrition. A proactive, electronic health record-embedded approach could shift practice from reactive diagnosis to early intervention, with the potential to improve outcomes and reduce inequalities.

In low-prevalence settings, the epidemiological yield of screening strategies for controlling vancomycin-resistant enterococci (VRE) outbreaks has not been fully established. We retrospectively analysed a prolonged VRE outbreak at a 536-bed tertiary-care hospital in Japan from 2010 to 2021 to evaluate sequential screening strategies across epidemic phases and to identify risk factors for VRE acquisition. Hospital-wide, admission-based, antimicrobial exposure-based, passive, and haemodialysis-targeted screening strategies were implemented over time. Screening yields were compared longitudinally, and a retrospective case–control study was performed using data from the initial hospital-wide screening phase. Molecular epidemiology was assessed by pulsed-field gel electrophoresis (PFGE). In total, 169 VRE-positive patients were identified, including seven infections and 162 asymptomatic carriers. Hospital-wide screening in the early epidemic phase showed the highest positivity rate (0.91%), whereas targeted strategies consistently yielded lower rates (0.09–0.34%). Haemodialysis, specific oral care practices, and prior exposure to carbapenems, glycopeptides, and piperacillin/tazobactam were independently associated with VRE acquisition. PFGE revealed substantial genetic diversity, suggesting sustained nosocomial transmission with repeated introductions. Early broad-based screening may be epidemiologically efficient in the initial phase of VRE outbreaks in low-prevalence settings, followed by adaptive refinement for long-term control.

This study examined the incidence, type of electrocardiogram abnormalities, and associated risk factors in healthy paediatric athletes. A single-centre retrospective cohort study was conducted on a local male youth competitive soccer programme, ages 11–18. The primary outcome was the incidence of electrocardiogram abnormalities. The secondary outcomes were recurrence and the type of electrocardiogram abnormalities. Covariables were age, race, family history, and current medications. Statistical analysis program was used for analysis. There was a total of 368 electrocardiograms reviewed from 2021–2024, of which 68 (18.5%) had at least one abnormality. 182 unique athletes were screened. A higher proportion of multi-racial and African American athletes had electrocardiogram abnormalities (p-value 0.02). In our sample of healthy paediatric athletes, electrocardiogram abnormality incidence was similar to that noted in other studies. There were no significant cardiac findings noted after further evaluation on any of the athletes with abnormal electrocardiogram findings. Our data support that universal electrocardiogram screening of healthy paediatric athletes is not beneficial.

People with severe mental illness (SMI) die 10–20 years earlier than the general population, largely due to non-communicable diseases (NCDs) such as hypertension and diabetes and risk factors such as hypercholesterolaemia. This cross-sectional study gathered data from people with SMI from three national mental health institutions in South Asia. Data was collected based on the WHO Stepwise approach to NCD risk factor surveillance and the prevalence of screening, diagnosis and treatment for diabetes, hypertension, and hypercholesterolaemia was assessed. Logistic regression models assessed the associations of sociodemographic characteristics with NCD screening. Three thousand nine hundred and eighty nine participants were recruited. Screening prevalence varied by country and disease, with hypertension being the most commonly screened NCD (Bangladesh = 52.5% [50.0–55.1], India = 43.1% [40.3–45.9], Pakistan = 60.9% [58.2–63.5]), and cholesterol was the least common (Bangladesh = 4.1% [3.2–5.2], India = 14.8% [12.9–17.0], Pakistan = 9.6% [8.1–11.3]). Characteristics such as BMI, age and education level were positively associated with screening, and females were more likely to be screened than males. There are low levels of screening for NCDs among individuals with SMI accessing tertiary institutions in South Asia, with significant sociodemographic disparities. Standardised screening protocols tailored to South Asian populations could mitigate the increased risk of NCDs in this population.

Identifying studies for inclusion in realist syntheses using title and abstract screening is challenging given the need to unearth explanatory insights to build context–mechanism–outcome configurations. Such insights may only be uncovered through full-text paper reading. To address this issue, a novel approach for identifying studies has been developed called Reverse Chronology Quota Record Screening (RCQRS). Results of database searches are screened in reverse chronology, and in stages, to fill quotas matching the requirements of the review. RCQRS may be beneficial in any of the following circumstances: (a) the timeframe to complete the synthesis is short; (b) the scope of inquiry is not fully defined, (c) the availability of suitable literature is beyond the screening capacity of the reviewers; or (d) the availability of literature is sparse and reviewers seek to extrapolate insights from other areas. In contrast to RCQRS, exhaustive title and abstract screening (i.e., screening entire database results) may hamper study selection due to being overwhelming in volume and time-intensive, resulting in a causally thin cohort of papers for analysis. RCQRS used in stages, and in conjunction with other search strategies (e.g., hand searching, backward citation tracking, and expert solicitation) can support creative, robust analytical insights with causally rich extrapolations. Using the Horizon-EU funded SERENITY study on deprescribing in palliative care as a case example, the benefits and limitations of RCQRS are explored. Finally, a checklist template is offered for teams who wish to reflect on, and transparently report, the use of RCQRS in their realist synthesis.

Social disadvantage can result in healthcare gaps and primary care may be a suitable healthcare context to identify unmet social needs. A variety of screening tools exists but none of them is consolidated in clinical practice. After reviewing the available instruments, we conducted a rigorous translation and trans-cultural adaptation into Italian language of the EveryONE social need screening tool questionnaire of the American Academy of Family Physicians. The translated questionnaire was piloted among 45 patients consecutively recruited in two general practices in the northern Italian city of Modena in 2023 and obtained excellent scores in comprehension and acceptability. The cross-cultural adaptation presented in this study is a first step towards a complete validation. A full validation study is needed to safely adopt EveryONE in routine general practice and to evaluate its effects on health provision.

Introduction: Hundreds of millions of patients worldwide are infected with Healthcare-Associated Infections (HAIs) each year causing deaths and significant financial losses to health systems. HAIs incidence in Indonesia (2021) reached 15.74%, far above in developed countries (4.8-15.5%). At Premier Bintaro Hospital (RSPB), the number of High Care Unit (HCU) patients at risk of HAIs reached 51% in the January - June 2023 period. The aim of this research is to reduce the risk of HAIs in HCU patients at RSPB. Methods: The HAIs risk identification was conducted on all HCU patients when first admitted using the SIRS (Systemic Inflammatory Response Syndrome) and REDS (Risk Emergency Department Scoring) criteria. Based on the screening results, interventions were applied through environmental modifications, implementation of HAIs care bundle, and nurse allocation based on colour codes: At risk of infection as RED, and no risk of infection as GREEN. The risk monitoring was conducted using HAIs scoring. Results: The research was conducted in the January - June 2023 period on 206 patients. It was found that 51% of the patients were at risk of HAIs. After interventions, the number reduced to 39%. In addition, there were zero incidents of HAIs during that period. Conclusions: To control the risk of HAIs in HCUs, the implementation of risk screening & scoring and interventions such as environmental modifications, nurse allocation, and HAIs care bundle, have shown to be effective strategies. This is evident from the decrease in the number of patients at risk of HAIs.

Recommendations for hospital is to continue implementing risk control of HAIs by regularly assessing the risk, applying interventions, and consistently monitoring the risk as efforts in continuously reducing the HAIs risks. For future research, it is recommended to expand the sample of patients and extend the period to implement risk control of HAIs even further.

Acknowledgements: We are very grateful to all members of CCU team at Premier Bintaro Hospital for their contribution in implementing the methods and strategies of HAIs risk control in this study.

What are the consequences of selective emigration from a closed regime? To answer this question, I focus on socialist East Germany and leverage an emigration reform in 1983 that led to the departure of about 65,200 citizens. Analyzing panel data on criminal activity in a difference-in-differences framework, I demonstrate that emigration can be a double-edged sword in contexts where it is restricted. Emigration after the reform had benefits in the short run and came with an initial decline in crime. However, it created new challenges for the regime as time passed. Although the number of ordinary crimes remained lower, border-related political crimes rose sharply in later years. Analysis of emigration-related petitioning links this result to a rise in demand for emigration after the initial emigration wave. These findings highlight the complexities of managing migration flows in autocracies and reveal a key repercussion of using emigration as a safety valve.

We analysed the early results of a screening and management protocol of imported female genital schistosomiasis (FGS) among migrant women from endemic countries. In total we screened 136 women, from which 39 had suspicion of FGS (serology-positive test and clinical signs and symptoms compatible). Median age was of 42.7 years [interquartile range (IQR 35–45)], median time living in the Europe (EU) was of 14 years (IQR 10–19) and all of them were coming from a West African country, mainly Senegal (17 out of 39; 43.6%). All of them had 1 or more clinical genitourinary findings [median 5 (IQR 2–6)], being the most prevalent pelvic pain, vaginal discharge and menstrual disorders. According to the protocol, colposcopy and cytology examination was performed in 11 participants, from whom 7 had findings compatible with FGS and 5 had low-grade cervical dysplasia with human papillomavirus (HPV)-negative results. After specific treatment with praziquantel (PZQ), we observed a high rate of resolution of clinical signs and symptoms, serology clearance at the 12th month of follow-up. Colposcopy lesions of 3 women assessed at the end of follow-up were fully resolved. Our findings and previous research support the implementation of management protocols of FGS in non-endemic countries, in spite of the knowledge gaps that still remain. Clinical trials need further assessment to determine the efficacy of PZQ, new diagnostic tools and the interaction between FGS, HPV and cervical cancer.