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Background: It is unclear what the best strategy is for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among residents of homeless shelters and what individual factors are associated with testing positive for the virus. We sought to evaluate factors associated with testing positive for SARS-CoV-2 among residents of homeless shelters and to evaluate positivity rates in shelters where testing was conducted in response to coronavirus disease 2019 (COVID-19) outbreaks or for surveillance., Methods: We conducted a retrospective chart audit to obtain repeated cross-sectional data from outreach testing done at homeless shelters between Apr. 1 and July 31, 2020, in Toronto, Ontario, Canada. We compared the SARS-CoV-2 positivity rate for shelters where testing was conducted because of an outbreak (at least 1 known case) with those tested for surveillance (no known cases). A patient-level analysis evaluated differences in demographic, health and behavioural characteristics of residents who did and did not test positive for SARS-CoV-2 at shelters with at least 2 positive cases., Results: One thousand nasopharyngeal swabs were done on 872 unique residents at 20 shelter locations. Among the 504 tests done in outbreak settings, 69 (14%) were positive for SARS-CoV-2 and 1 (0.2%) was indeterminate. Among the 496 tests done for surveillance, 11 (2%) were positive and none were indeterminate. Shelter residents who tested positive for SARS-CoV-2 were significantly less likely to have a health insurance card (54% v. 72%, p = 0.03) or to have visited another shelter in the last 14 days (0% v. 18%, p < 0.01). There was no association between SARS-CoV-2 positivity and medical history or symptoms., Interpretation: Our findings support testing of asymptomatic shelter residents for SARS-CoV-2 when a positive case is identified at the same shelter. Surveillance testing when there are no known positive cases may detect outbreaks, but further research should identify efficient strategies given scarce testing resources., Competing Interests: Competing interests: Tara Kiran is the Fidani Chair in Improvement and Innovation at the University of Toronto. She is supported as a clinician scientist by the Department of Family and Community Medicine at the University of Toronto and at St. Michael’s Hospital. At the time of the study, she was also supported by the Canadian Institutes of Health Research and Health Quality Ontario as an embedded clinician researcher. No other competing interests were declared., (© 2021 Joule Inc. or its licensors.)

Abstract: In most countries, only high-risk women are screened for gestational diabetes mellitus (GDM). In addition, a onetime early screening test may miss GDM as it may be diagnosable between 24 and 28 weeks. Thus, it is preferable to have alternative tests to classify women as high risk for GDM and keep them under regular follow-up. A total of 120 women with singleton pregnancies and established maternal and/or pregnancy-related risk factors for GDM and who provided informed consent were subjected to an obstetric ultrasound scan at/or after 24 weeks' gestation followed by administration of a 2-hour 75-g oral glucose tolerance test. Various ultrasound markers were determined/measured. Each ultrasound GDM marker was assigned 1 point to create the ultrasound gestational diabetes screening (UGDS) score. All ultrasound GDM markers positively correlated to the disease (P < 0.0001). The strongest independent predictor of GDM was an immature appearance of placenta (relative risk, 49.09; 95% confidence interval, 7.04-342.28; P < 0.0001). Receiver operator characteristics showed an area under the curve of 96.9%, confirming good ability of the UGDS to discriminate between positive and negative oral glucose tolerance test. A UGDS score of 4, providing diagnostic efficiency of 92%, sensitivity of 93.2%, specificity of 92%, positive predictive value of 85.4%, and negative predictive value of 96.4%, is proposed by this study. This study suggests that ultrasound markers significantly vary in GDM compared with normal pregnancy women and that UGDS is a good predictor of GDM. The UGDS may be considered an adjunct to current screening tools for GDM., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)