Short-changing the future: The systemic gap between psychology internship stipends and living wages.

Introduction: Providing doctoral internship stipends below living wages may harm interns, the clinical services they provide, and the field of health service psychology as a whole. This study evaluated the extent to which doctoral psychology internship stipends from the 2021-2022 training year for APA-accredited, APPIC-member programs in the US are consistent with living wages in the geographic region where sites are located. Methods: We obtained data reflecting internship sites' geographic location and stipends for the 2021-2022 academic year. Using the Massachusetts Institute of Technology Living Wage Calculator, we computed a living wage for the county in which each internship site is located. Descriptive statistics, discrepancies, ratios, and correlations were calculated to reflect the associations between internship sites' stipends and their local living wages. Results: The average internship stipend was $31,783, which was lower than the average living wage by $2,091. Stipends ranged widely, from a low of $15,000 to a high of $94,595-reflecting a six-fold difference in wages. Although internship sites in higher cost of living areas paid higher stipends, over two-thirds (67.0%) of sites did not pay a stipend that equaled or exceeded a living wage. Ninety-eight sites (15.3%) had deficits of over $10,000 when comparing their stipends to local living wages, with $33,240 as the highest deficit. Discussion: Eliminating obstacles to educating health service psychologists by decreasing the financial burden of training will likely have subsequent critical benefits towards bridging the workforce gap between mental healthcare service needs and available providers, ultimately leading to improved population health.

Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study.

BACKGROUND: Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. OBJECTIVE: This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. METHODS: Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). RESULTS: Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. CONCLUSIONS: Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.

Outcomes up to age 36 months after congenital Zika virus infection-U.S. states.

BACKGROUND: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Obesity and In Vitro Fertilization.

Obesity is a highly prevalent chronic disease with a significant effect on reproductive-age women. The clinical implications of obesity on fertility and pregnancy are well studied citing ovulatory dysfunction, hormonal imbalances, higher miscarriage rates, and increased maternal and neonatal risks. For this reason, many patients with obesity seek reproductive specialists to help build their families. Despite this literature base, the effect of weight loss interventions prior to assisted reproductive technology (ART) is lacking. This review aims to outline the impact of obesity on ART, specifically in vitro fertilization (IVF). Response differences to treatment protocols compared with normal weight counterparts, limitations of access to care, and the mixed results of weight-reduction strategies prior to fertility treatment will be addressed. The known data surrounding benefits of lifestyle modification, pharmacologic therapies, and surgical interventions for obesity prior to IVF are outlined and found to emphasize a need for further research to determine the optimal approach for infertility patients with obesity.

Eating when depressed, anxious, bored, or happy: An examination in treatment-seeking adults with overweight/obesity.

Emotions that differ in valence are uniquely associated with eating. In our previous study with an online sample of adults with overweight/obesity, eating in response to depression was the type of emotional eating most closely associated with negative psychosocial correlates (Braden et al., 2018). The current study extended this research by examining associations between emotional eating types (eating in response to depression, anxiety, boredom, happiness) and psychological correlates among treatment-seeking adults. The present study was a secondary analysis of adults (N = 63; 96.8% female) with overweight/obesity and self-identified emotional eating who completed a baseline assessment for a behavioral weight loss intervention. Emotional eating in response to depression (EE-depression), anxiety/anger (EE-anxiety/anger), and boredom (EE-boredom) were assessed with the revised Emotional Eating Scale (EES-R), and positive emotional eating (EE-positive) was assessed with the positive emotions subscale of the Emotional Appetite Questionnaire (EMAQ). The Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Difficulties in Emotion Regulation Scale (DERS), and Patient Health Questionnaire-9 (PHQ-9; depressive symptoms) were also administered. Frequencies showed the most endorsed emotional eating type was EE-depression (44.4%; n = 28). Four multiple regression analyses examined associations between emotional eating (EE-depression, EE-anxiety/anger, EE-boredom, and EE-positive) and dependent variables (EDE-Q, BES, DERS, and PHQ-9). Results showed that depression was the emotional eating type most closely related to disordered eating, binge eating, and depressive symptoms. Eating in response to anxiety was closely related to emotion regulation difficulties. Positive emotional eating was related to less depressive symptoms. Exploratory analyses showed that lower levels of positive emotional eating were related to higher depressive symptoms among adults with greater emotion regulation difficulties. Researchers and clinicians may consider tailoring weight loss treatment based on unique emotions that trigger eating.

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity.

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1-9, and sessions 10-16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.

Zika-Associated Birth Defects Reported in Pregnancies with Laboratory Evidence of Confirmed or Possible Zika Virus Infection - U.S. Zika Pregnancy and Infant Registry, December 1, 2015-March 31, 2018.

Zika virus infection during pregnancy can cause serious birth defects of the brain and eyes, including intracranial calcifications, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities (1,2). The frequency of these Zika-associated brain and eye defects, based on data from the U.S. Zika Pregnancy and Infant Registry (USZPIR), has been previously reported in aggregate (3,4). This report describes the frequency of individual Zika-associated brain and eye defects among infants from pregnancies with laboratory evidence of confirmed or possible Zika virus infection. Among 6,799 live-born infants in USZPIR born during December 1, 2015-March 31, 2018, 4.6% had any Zika-associated birth defect; in a subgroup of pregnancies with a positive nucleic acid amplification test (NAAT) for Zika virus infection, the percentage was 6.1% of live-born infants. The brain and eye defects most frequently reported included microcephaly, corpus callosum abnormalities, intracranial calcification, abnormal cortical gyral patterns, ventriculomegaly, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities. Among infants with any Zika-associated birth defect, one third had more than one defect reported. Certain brain and eye defects in an infant might prompt suspicion of prenatal Zika virus infection. These findings can help target surveillance efforts to the most common brain and eye defects associated with Zika virus infection during pregnancy should a Zika virus outbreak reemerge, and might provide a signal to the reemergence of Zika virus, particularly in geographic regions without ongoing comprehensive Zika virus surveillance.

Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram.

The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1-19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5-29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2-93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7-178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration.

Inadequate Bowel Preparation in Pediatric Colonoscopy-Prospective Study of Potential Causes.

OBJECTIVES: Inadequate bowel preparation (IBP) for colonoscopy leads to missed diagnosis, longer anesthesia time, higher chance of complications and increased costs. Adult studies have demonstrated that patient characteristics such as male gender and obesity are associated with IBP. Little is known about factors affecting bowel preparation in children. Our aim was to determine factors associated with IBP in children. METHODS: We prospectively enrolled children undergoing outpatient colonoscopy. Quality of bowel preparation was assessed using Boston Bowel Preparation Scale (BBPS) score (range 0-9). Data collected included patient demographics, indication, and type of insurance. Patients were divided into two groups based on BBPS score-adequate (BBPS score > 5) and inadequate (BBPS score < 5) and groups were compared using Student t-test and chi-square test. Possible predictors were analyzed using multivariate logistic regression models. RESULTS: A total of 334 children were prospectively enrolled of whom 321 were studied further (age range 2-18 years; mean age 12.4 years; 60.4% female; 85.9% Caucasian). The mean BBPS score was 6.8 (standard deviation of ±2). IBP was reported in 12.8% (41/321). Multivariable logistic regression analysis did not show statistical differences between the groups in studied patient factors including age, gender, obesity, race, insurance type, and indication for colonoscopy. CONCLUSION: Contrary to several adult studies, the results of our prospective study did not show any relationship between examined patient factors and IBP in children. Interestingly, IBP was less prevalent in our pediatric study compared to published adult data (12.8% vs 20-40%).

Impact of military culture and experiences on eating and weight-related behavior.

Disordered eating behaviors and obesity are becoming increasingly common among United States military personnel. However, little research has explored the role of the military environment as it may influence the development of disordered eating among personnel. The present qualitative analysis examined beliefs about how military experiences affected eating and weight-related behaviors. Military personnel who served within the last year and a year or more ago (n = 250) were recruited using Amazon's Mechanical Turk (mTurk). Data included in the present study consisted of participant responses to three open-ended questions, analyzed by means of content and thematic analysis. Analyses yielded eight themes: eating extremely quickly, strict mealtime regimens, the pressure to "make weight," food insecurity, difficulty after military, food quality/content, overeating behavior, and military superior maltreatment. The current study provides a preliminary examination of the role of the military culture and experiences in the development of unhealthy eating and weight-related behaviors and offers suggestions for future research and interventions.

Emotion regulation mediates relationships between perceived childhood invalidation, emotional reactivity, and emotional eating.

Dialectical Behavior Therapy (DBT) is informed by the biosocial model which suggests that emotional sensitivity and childhood invalidation interact to influence emotion dysregulation, leading to behavioral disorders. Although adapted DBT interventions have resulted in improved emotional eating, little research has been conducted to examine whether key aspects of the biosocial model apply to emotional eating. Adults (N = 258) were enrolled via Amazon's Mechanical Turk. Three separate mediation analyses were performed using Hayes' SPSS macro. Results showed that emotion regulation difficulties mediated the relationships between biosocial variables (i.e. perceived maternal and paternal invalidation and emotional reactivity) and emotional eating.

On being a client with posttraumatic stress disorder: Interactions with treatment providers and institutional barriers.

Premature dropout from psychological treatment for posttraumatic stress disorder (PTSD) is common. Little research has sought to understand perceptions of treatment and barriers to treatment in this population. This study analyzed anonymous posts among an online community of individuals with PTSD (93 forum users comprising 158 posts regarding treatment providers and 40 forum users comprising 50 posts regarding institutional barriers). Results indicated that individuals with PTSD desire greater clarity about expectations for treatment, collaboration toward treatment goals, open discussion of client-therapist boundaries, and increased validation among therapists in response to trauma disclosure. Individuals with PTSD also reported multiple systemic issues that were barriers to treatment including a lack of available services in their area, being placed on a waitlist for long periods of time, the cost of treatment as a financial burden, and poor crisis response in emergency rooms. Findings indicated areas of growth for treatment providers which will help inform future treatment studies in improving care and treatment adherence among individuals with PTSD.

Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating.

Emotional eating (EE), or eating in response to emotions, is related to depression, binge eating, and weight gain. Emotion regulation difficulties are a risk factor for EE. Working memory deficits may also be a risk factor for EE, as working memory is an important cognitive factor in emotion regulation. The current study is a secondary analysis that examined whether working memory moderated the relationship between emotion regulation and emotional eating. A college student sample completed measures of EE in response to depression, boredom, and anxiety/anger (Emotional Eating Scale), emotion regulation (Difficulties in Emotion Regulation Scale) and a working memory task (AOSPAN). Moderated regression analyses were conducted. Conditional moderation was observed, such that greater emotion regulation difficulties were associated with boredom EE, when working memory was one standard deviation (SD) below average. Moderation analyses were not significant when examining associations between working memory, emotion regulation difficulties, and depression and anxiety EE. Findings suggest that the correlates of boredom EE may be different than depression and anxiety/anger EE. Although the current study was cross-sectional, it is possible that individuals with poorer working memory and emotion regulation difficulties, especially in tandem, may be at increased risk for boredom EE.

Gastroschisis Trends and Ecologic Link to Opioid Prescription Rates - United States, 2006-2015.

Prevalence of gastroschisis, a serious birth defect of the abdominal wall resulting in some of the abdominal contents extending outside the body at birth, has been increasing worldwide (1,2). Gastroschisis requires surgical repair after birth and is associated with digestive and feeding complications during infancy, which can affect development. Recent data from 14 U.S. states indicated an increasing prevalence of gastroschisis from 1995 to 2012 (1). Young maternal age has been strongly associated with gastroschisis, but research suggests that risk factors such as smoking, genitourinary infections, and prescription opioid use also might be associated (3-5). Data from 20 population-based state surveillance programs were pooled and analyzed to assess age-specific gastroschisis prevalence during two 5-year periods, 2006-2010 and 2011-2015, and an ecologic approach was used to compare annual gastroschisis prevalence by annual opioid prescription rate categories. Gastroschisis prevalence increased only slightly (10%) from 2006-2010 to 2011-2015 (prevalence ratio = 1.1, 95% confidence interval [CI] = 1.0-1.1), with the highest prevalence among mothers aged <20 years. During 2006-2015, the prevalence of gastroschisis was 1.6 times higher in counties with high opioid prescription rates (5.1 per 10,000 live births; CI = 4.9-5.3) and 1.4 times higher where opioid prescription rates were medium (4.6 per 10,000 live births; CI = 4.4-4.8) compared with areas with low prescription rates (3.2 per 10,000 live births; CI = 3.1-3.4). Public health research is needed to understand factors contributing to the association between young maternal age and gastroschisis and assess the effect of prescription opioid use during pregnancy on this pregnancy outcome.

Informal caregiving experiences in posttraumatic stress disorder: A content analysis of an online community.

This study explored the experiences of individuals who self-identify as providing support to a friend, family member, or significant other with posttraumatic stress disorder (PTSD). We analyzed and coded a total of 345 posts from an online support forum, with reference to 13 categories (finances, life interference, venting/emotional expression, maltreatment, sexual behavior, distress, prevented expression, physical health, communication, no personal space, isolation, and compassion fatigue). Categories for coding were established a priori and based on previous literature about caregiving and supporting. Results suggested that informal PTSD caregivers experience concerns involving interpersonal relations, emotional turmoil, and barriers to care for themselves and the individual they are caring for. This study provides a preliminary examination of the experiences and concerns of PTSD caregivers. Implications and suggestions for future research are discussed.

Examining the Trade-off Between NICU Length of Stay and Postdischarge Monitoring: An Instrumental Variables Approach.

EXECUTIVE SUMMARY: Treatment of very low birth weight infants in a neonatal intensive care unit (NICU) can be expensive, particularly in rural areas, but may potentially reduce long-term treatment costs and improve short- and long-term health outcomes. Few studies look at this trade-off. We employed an instrumental variables approach (fuzzy discontinuity) based on changes in practice for the treatment of very low birth weight infants in a perinatal referral center's NICU in 2000-2001. The strategy of keeping infants in a NICU longer reduced the likelihood of discharge with an apnea/cardio monitor. The primary instrumental variables specification estimated that every additional 100 g of discharge weight reduced the likelihood of discharge with an apnea/cardio monitor by 4.8%. Extending an infant's length of stay (LOS) thus has important benefits. Greater expenses on days in the NICU are partially compensated by reduced monitoring post discharge. In contexts where postdischarge monitoring is particularly difficult or expensive, extending LOS may be cost effective and potentially improve outcomes.

Increasing Prevalence of Gastroschisis--14 States, 1995-2012.

Gastroschisis is a serious congenital defect in which the intestines protrude through an opening in the abdominal wall. Gastroschisis requires surgical repair soon after birth and is associated with an increased risk for medical complications and mortality during infancy. Reports from multiple surveillance systems worldwide have documented increasing prevalence of gastroschisis since the 1980s, particularly among younger mothers; however, since publication of a multistate U.S. report that included data through 2005, it is not known whether prevalence has continued to increase. Data on gastroschisis from 14 population-based state surveillance programs were pooled and analyzed to assess the average annual percent change (AAPC) in prevalence and to compare the prevalence during 2006-2012 with that during 1995-2005, stratified by maternal age and race/ethnicity. The pooled data included approximately 29% of U.S. births for the period 1995-2012. During 1995-2012, gastroschisis prevalence increased in every category of maternal age and race/ethnicity, and the AAPC ranged from 3.1% in non-Hispanic white (white) mothers aged <20 years to 7.9% in non-Hispanic black (black) mothers aged <20 years. These corresponded to overall percentage increases during 1995-2012 that ranged from 68% in white mothers aged <20 years to 263% in black mothers aged <20 years. Gastroschisis prevalence increased 30% between the two periods, from 3.6 per 10,000 births during 1995-2005 to 4.9 per 10,000 births during 2006-2012 (prevalence ratio = 1.3, 95% confidence interval [CI]: 1.3-1.4), with the largest increase among black mothers aged <20 years (prevalence ratio = 2.0, 95% CI: 1.6-2.5). Public health research is urgently needed to identify factors contributing to this increase.

Limitations in the classification of childhood-onset rheumatoid arthritis.

OBJECTIVE: Rheumatoid factor-positive polyarthritis (RF+ poly) is the juvenile idiopathic arthritis (JIA) category that resembles adult seropositive rheumatoid arthritis (RA). We studied children with RF+ and/or anticyclic citrullinated peptide antibody (anti-CCP)+ JIA to determine what proportion of those children meet International League of Associations for Rheumatology (ILAR) criteria for RF+ poly JIA and to assess for significant differences between children who meet RF+ poly criteria and those who are classified in other categories. METHODS: Charts of children with JIA who were RF+ and/or anti-CCP+ were reviewed. Children with RF+ poly JIA were compared to children in other categories. Statistical analysis was performed using chi-square, Fisher's exact test, and the Student's t-test. RESULTS: Of 56 children with RF+ and/or anti-CCP+ JIA, 34 (61%) met ILAR criteria for RF+ poly JIA. Twelve children had RF-/anti-CCP+ JIA with low anti-CCP titers. When these 12 children were excluded, there were few significant differences between children who met criteria for RF+ poly and those who were classified in other categories. The American College of Rheumatology/European League Against Rheumatism criteria for RA identified more RF+ children than did the ILAR RF+ poly classification (100% vs 77%). CONCLUSION: A number of children with RF+ arthritis were excluded from the RF+ poly JIA classification, though many demographic features and disease measures were similar to those of children who met criteria for RF+ poly JIA. We propose prioritization of RF/anti-CCP positivity over specific exclusions, along with inclusion of anti-CCP, in future revisions of the JIA classification criteria, to improve the sensitivity of diagnosing childhood-onset RA.