Identifying eating disorders at the earliest opportunity: Testing the reliability of an online eating disorder screener (IOI-S) in primary care and youth mental health settings.

AIM: Eating disorders (EDs) are associated with significant disease burden and unacceptably high mortality rates. Early intervention significantly improves prognosis and can prevent chronic suffering; however, large numbers of people with the illness are not being identified or managed in primary healthcare. The current study aimed to test the reliability of the face-to-face, clinician delivery of a previously validated, co-designed, online screening tool for eating disorders. METHODS: Individuals aged 14 and over who read, English were recruited from the community in either primary care (general practice) settings or headspace youth mental health centres. They completed the InsideOut Institute Screener (IOI-S) face-to-face, delivered verbally by the study researcher clinician and then online by self-report. The primary outcome was test-retest reliability as measured by two-way mixed effects model Intraclass Correlation Coefficient (ICC) with absolute agreement. RESULTS: A total of 83 participants aged 14-81 (M 36.2) completed the study in New South Wales and the Northern Territory, Australia, between April and November 2022. The ICC between successive iterations of the test was significantly positive (0.980), demonstrating strong internal validity and test-retest reliability of the scale. CONCLUSIONS: The IOI-S is an adaptive 6-item screening tool designed to 'start a conversation' and determine risk using gentle language conceived by individuals with lived experience. Originally designed for online use, the current study broadens its versatility to clinical settings. The screener performs equally well when delivered face-to-face in clinical practice. In conjunction with increased practitioner education and improved treatment referral pathways, broad implementation of the screener in early healthcare settings can support timely identification and intervention for those with EDs.

Evaluation of motor vehicle driving performance in patients with chronic diplopia.

BACKGROUND: Uncorrected diplopia is a condition that may make it unsafe for a person to operate a motor vehicle. In some jurisdictions, physicians are required by law to report the person with diplopia to the appropriate authority. METHODS: In this masked study, 10 patients of varying ages with stable diplopia of greater than 6 months' duration and 10 age-matched control subjects were placed in a driving simulator and evaluated on their performance. Various cues and threats, including near-accident situations, were presented; stimulus recognition and reaction times were recorded. RESULTS: No significant difference was found between the groups for either cue or threat recognition responses or reaction times. Increasing age was the factor most associated with poor response performance on all test measures (P < .001). Slowed response time in patients with poor binocular single vision was the only other significant association. CONCLUSION: Although response times were slower in subjects with poor binocular single vision scores, stimulus recognition responses were not significantly different; in our opinion, stimulus recognition is more relevant to driving performance and therefore chronic diplopia does not appear to be a contraindication for driving a motor vehicle.

So great a cloud of witnesses: the use of family systems process in forming pastoral identity and facilitating pastoral functioning.

Describes the use of genograms in units of Clinical Pastoral Education. Provides the reader with a theoretical base for viewing experiences in CPE as manifestations of family of origin factors. Reflects on how such connections can enrich recognitions of the power of transference in relationships and thus provide the caregiver with greater insight into how he or she may express ministry and caregiving activities.

Carrier detection in Sandhoff disease.

Three new cases of Sandhoff disease are reported. One infant was the second affected child in a large family. The parents, who were cousins, were part of a large kindred from an isolated community in northern Saskatchewan. We assayed total and heat-stable hexosaminidases in 38 other members of the kindred and found two distinct cohorts. Sixteen individuals had low total and low heat-stable hexosaminidase and were diagnosed as carriers of Sandhoff disease. The values for the remainder were within normal limits. In a retrospective study of data from more than 14,000 Ashkenazi Jews, who were screened for Tay-Sachs disease, six were identified as Sandhoff carriers. Our data indicate that carrier detection requires measurement of both total and heat-stable enzyme activity.