Implementation of a Spanish-language, direct-to-patient primary aldosteronism testing program
Bibliographic record
Abstract
CONTEXT: Primary aldosteronism (PA) is a common, targetable cause of hypertension and cardiovascular risk, but <2% of eligible patients are tested, and Hispanic/Latino patients are underrepresented in PA research and care. OBJECTIVE: We expanded a nationwide, direct-to-patient PA testing program to reach Spanish-speaking adults. METHODS: Spanish-speaking adults with PA testing indications were recruited from Boston, New York, Miami, Houston, and Los Angeles/San Diego. Participants underwent virtual medical history review in Spanish and local phlebotomy for PA testing, with laboratory interpretations communicated to patients and clinicians. Participants were followed up at 6 months. The primary outcome was the frequency of a positive PA test. Secondary outcomes included clinical PA testing, initiation of aldosterone-targeted therapies, and quality of life. RESULTS: The study population (N = 155) spoke fluent Spanish, with 77.4% reporting limited English proficiency. Of the participants, 30.3% tested positive for PA. Leading PA testing indications were family history of premature hypertension or stroke and sleep apnea. Among participants who tested positive and provided follow-up (n = 29), 10.3% underwent additional testing for PA, and 10.3% started a mineralocorticoid receptor antagonist. Participants cited access to care and clinician dismissal of results as barriers to clinical action; however, study participation was positively rated to enhance health awareness and interest in research participation. CONCLUSION: This Spanish-language, direct-to-patient PA testing program effectively reached patients for testing, identified possible PA in over 30%, and influenced downstream care. Language-concordant PA testing initiatives can help to address the high prevalence of hypertension and PA in the US Hispanic/Latino population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".