Objective: To consider the challenges of communicating COVID-19 directives to culturally and linguistically diverse (CALD) communities in Australia, and present evidence-based solutions to influence policy and practice on promoting relevant health behaviours; to advance participatory research methodologies for health behaviour change. Type of program or service: We present a case study of a participatory research collaboration between CALD community leaders and health behaviour change scientists during the COVID-19 crisis. The goal was to better understand the role of community leaders in shaping health behaviours in their communities and how that role might be leveraged for better health outcomes. Methods: This article is the culmination of a series of dialogues between CALD community and advocacy leaders, and health behaviour change scientists in July 2020. The academic authors recruited 12 prominent CALD community leaders, conducted five semi-structured dialogues with small

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Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions: The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool. Clin Endosc 2020 Nov 6. [Epub ahead of print]

Objective: To consider the challenges of communicating COVID-19 directives to culturally and linguistically diverse (CALD) communities in Melbourne and Australia, and present evidence-based solutions to influence policy and practice on promoting relevant health behaviours. Type of program or service: We reflect on the experiences of CALD communities during the COVID-19 crisis, and particularly the role of community leaders in shaping health behaviours in their communities. Methods: This article draws on a series of dialogues between CALD community and advocacy leaders, and health behaviour change scientists in July 2020. We present the challenges experienced, and solutions offered, by CALD leaders in communicating health information throughout the pandemic and consider the importance of behavioural and implementation science in reducing inequities in healthcare communication. Results: During the Covid-19 pandemic, CALD leaders have played a critical role in filling gaps in government messaging by providing up-to-date health advice and cultivating community support for relevant health behaviours (e.g., physical distancing, testing, hand hygiene). Nevertheless, attempts to communicate recommended health behaviours may not be reaching, and/or understood by, all members of CALD communities. In synthesizing the accounts of CALD leaders, three key findings emerged: first, partnerships between CALD leaders, communities and government are key, including the establishment of a national CALD advisory group on COVID-19; second, shifting knowledge into action requires moving beyond disseminating information to designing tailored solutions to reflect the diversity in our society; and third, the diverse needs and circumstances of people and communities must be at the centre of health communication and behaviour change strategies. Implementation science is needed to action the solutions offered by CALD leaders for equity of access and outcomes in COVID-19 health support. Lessons learnt: Insights from behavioural and implementation science can inform communication strategies that help align human behaviour with the recommendations of health experts. This coupled with sustained partnership and collaboration with CALD communities, understanding the cultural context and the appropriate tailoring and delivery of communications will ensure health related messages are not lost in translation. These lessons should be applied not only to the current pandemic but to post-pandemic social and economic recovery.

Patients who were older at beginning of follow up, had lower CD4 counts around the time of OPSCC diagnosis, and moderate HIV viral control during follow-up had an increased risk of OPSCC. Other HPV-related diseases such as SCCA and condyloma did not increase the risk for OPSCC.

Typical audiometric screening criteria should be modified in the veteran population to improve cost efficiency of diagnosis. Observation is the primary management strategy in the veteran population because of age.

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Background:Minimal disease activity (MDA) is a treat-to-target strategy (T2T) objective in psoriatic arthritis (PsA). MDA criteria, include physical function, traditionally assessed via the Health-Assessment Questionnaire Disability Index (HAQ-DI). It is of interest to assess the performance of more current physical function instruments such as the Patient-Reported Outcomes Measurement Information System-Physical Function Profile (PROMIS-PF).Objectives:To assess the interchangeability of the HAQ-DI with the PROMIS-PF in the calculation of MDA in PsA.Methods:Longitudinal PsA data were collected including HAQ-DI and PROMIS-PF in a PsA cohort. MDA definitions were built substituting the HAQ-DI criterion with the PROMIS-PF short form 4a (PROMIS-PF4a) or with the PROMIS-PF computer adaptive test (PROMIS-PF Bank). We assessed agreement/accuracy between HAQ-DI based and PROMIS-PF based MDA definitions at each visit and longitudinally through the kappa statistic/ROC curve analysis.Results:One hundred participants contributed 352 observations with up to five visits. Mean (SD) age was 52 (12) years, 60% were female, and 43% were in MDA at baseline. Kappa statistic for PROMIS-PF based MDA reflected almost perfect agreement with HAQ-DI MDA: kappa=0.94 (95% CI 0.90-0.97) for MDA PROMIS-PF Bank, and kappa=0.90 (95% CI 0.80-0.95) for MDA PROMIS-PF4a. Higher longitudinal agreement was seen between MDA HAQ-DI and MDA PROMIS-PF Bank versus MDA PROMIS-PF4a between consecutive visits: kappa ranged between 0.81-0.94 versus 0.72-0.84, respectively (Table 1). Area under ROC curve for predicting MDA HAQ-DI was 0.97 for MDA PROMIS-PF Bank and 0.95 for MDA PROMIS-PF4a (Figure 1).Table 1.Agreement between HAQ-DI based MDA and PROMIS-PF based MDA definitions at each visit and longitudinallyAgreementVisit 1Visit 2Visit 3Visit 4MDA HAQ-DI andMDA PROMIS-PF4aKappa95% CIN0.91(0.80-0.98)860.93(0.82-1.00)810.92(0.80-1.00)720.83(0.66-0.96)58MDA HAQ-DI andMDA PROMIS-PF4aKappa95% CIN0.91(0.81-0.98)860.98(0.90-1.00)820.94(0.84-1.00)730.93(0.82-1.00)58Longitudinal agreementVisit 1 to visit 2Visit 2 to visit 3Visit 3 to visit 4N/AMDA HAQ-DI state change withMDA PROMIS-PF4a state changeKappa95% CIN0.75(0.47-0.95)710.84(0.58-1.00)670.72(0.37-0.94)51N/AMDA HAQ-DI state change with MDA PROMIS-PF Bank state changeKappa95% CIN0.81(0.49-1.00)720.94(0.75-1.00)680.84(0.48-1.00)52N/A*Bias corrected 95% CI were calculated using bootstrapping with 2000 repetitions of individual patients.^MDA state changes are defined as transitions in the respective MDA state between designated consecutive visits.Abbreviations: CI confidence interval; N number of observations; HAQ-DI Heath Assessment Questionnaire-Disability Index; PROMIS-PF4a Patient Reported Outcomes Measurement Information System Physical Function form 4a; PROMIS-PF Bank Patient Reported Outcomes Measurement Information System Physical Function Bank administered as a computer adaptive test; MDA HAQ-DI Minimal disease activity includes the HAQ-DI ≤0.5 criterion; MDA PROMIS-PF4a includes the PROMIS-PF4a ≥41.3 criterion; MDA PROMIS-PF Bank includes the PROMIS-PF CAT ≥41.3 criterion.Figure 1.Areas under receiver operative characteristic curve to predict HAQ-DI based MDA using MDA PROMIS-PF4a or MDA PROMIS-PF Bank at each visit and overall using all observations (from left to right: visit 1, 2, 3, 4, and overall across visits)Conclusion:Excellent agreement was seen between HAQ-DI and PROMIS-based MDA definitions statically and longitudinally. The PROMIS-PF Bank and PROMIS-PF4a are accurate replacements for the HAQ-DI in calculating MDA state in PsA.References:[1]Schalet BD, et al. J Gen Intern Med 2015Disclosure of Interests:Erin Chew: None declared, Jamie Perin: None declared, Thomas Grader-Beck Grant/research support from: Abbvie, Celgene, Consultant of: Novartis, Lilly, Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service.