Expert Committee Research Articles

Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.

Development and validation of Tamil version of CARIES-QC questionnaire among socially marginalized school children in Chennai City.

The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC), which was developed to assess dental caries-specific Child Oral Health Related Quality of Life (COHRQoL), has been translated into few world languages. To develop and validate the Tamil version of Caries Impacts and Experience Questionnaire for Children (CARIES-QC). This cross-sectional study was conducted among socially marginalized school children in Chennai City. The initial translation of the English CARIES-QC questionnaire to Tamil was made by two independent translators followed by an expert committee discussion to derive a prefinal version of the Tamil questionnaire. Subsequently, content validation was performed by bilingual subject experts followed by preliminary pilot testing among 30 school children aged 8-10 years studying in Adidravidar Welfare High School, Chennai, to produce the final version of the questionnaire. Convergent validity, discriminant validity, and test-retest reliability of the translated questionnaire were tested among 191 children. The content validation process revealed that the translated version had relevant questions and content coverage (Scale-wise Content Validity Index score = .91). The children with and without dental caries had mean CARIES-QC scores of 5.39 + 3.7 and 3.71 + 5.1, respectively, and their statistically significant difference (p-value = .04) between them indicates the scale's satisfactory discriminant validity. The Cronbach's alpha was .87 indicating the questionnaire's good internal consistency. The newly developed Tamil CARIES-QC questionnaire is a valid and reliable tool for assessing COHRQoL among Tamil-speaking school children.

Septal Perforation Quality of Life questionnaire (SEPEQOL): validation of a new instrument to assess patients undergoing endoscopic repair of a nasal septal perforation

PurposeNasoseptal perforations (NSP) are a clinically heterogeneous group of disorders with a wide range of available treatments. Patient-reported outcome measures (PROMs) can provide valuable insights for assessing clinical and surgical outcomes. This study aims to develop and validate a novel-specific questionnaire for patients with NSP.MethodsA multi-centre prospective observational study was conducted at two tertiary referral hospitals. “Septal Perforation Quality of Life” (SEPEQOL) was developed by a committee of experts. The psychometric properties, including reproducibility, reliability, validity, and responsiveness, were assessed.ResultsThe study included 96 symptomatic NSP patients and 30 healthy controls. SEPEQOL internal consistency was satisfactory [Cronbach´s α = 0.7843; 95% confidence interval (CI), 0.702–0.856]. Test-retest reliability was excellent, demonstrated by the absolute intraclass correlation (ICC = 0.974; 95% CI, 0.935–0.989, P-value < 0.001) and Bland-Altman plot (line bias = 1.6 ± 4.57; 95% CI -0.54–3.74, P-value < 0.001). The mean total SEPEQOL score was higher before surgery (25.16 ± 1.65) compared to 6-months after the procedure (13.72 ± 11.39), with a mean difference of 12.19 [standard deviation (SD) 10.76], P-value < 0.001.ConclusionsSEPEQOL is reliable, consistent, valid, and sensitive to change over time. SEPEQOL assesses the impact of health-related quality of life on NSP and its management in clinical practice. Moreover, it is easy to apply in clinical settings with minimal burden.

Methodological process of cross-cultural adaptation of the survey "The Public Opinion Survey on Human Attributes-Stuttering (POSHA-S)" to spanish-chilean

Introduction: the Public Opinion Survey on Human Attributes-Stuttering is a survey designed to assess the general population's attitudes toward stuttering in comparison to a variety of human conditions or attributes. Its purpose is to inquire about people's beliefs and reactions to this condition. Objective: to describe the methodological process of cross-cultural adaptation of the Public Opinion Survey of Human Attributes-Stuttering from North American English to Chilean Spanish. Methods: quantitative, cross-sectional, correlational and cross-cultural adaptation study. With criterion method and back-translation, consisting of the following stages: 1) translation of the original survey into Spanish-Chilean; 2) construction of a consensus version based on both translations; 3) back-translation of the consensus version into English; 4) review by a committee of experts and construction of the pre-test version and; 5) pilot testing of the pre-test version to a random sample of 30 participants.Results: a semantically equivalent survey to the original instrument was generated and a pre-test version was made available. The latter version was applied to a pilot sample.Conclusion: the Public Opinion Survey of Human Attributes-Stuttering was cross-culturally adapted from its original North American English to Chilean Spanish through a rigorous and strict methodological process. In addition, the pre-test version preserved the conceptual and semantic properties of the original instrument, which could contribute to improving future awareness, public education and advocacy activities on stuttering

Enterprise Resource Planning Implementation: Challenges and Barriers

The goal of this study is to ascertain how Enterprise Resource Planning (ERP) adoption software is affected in small and medium-sized businesses in Jordan by the problems and barriers represented by (low knowledge of ERP, misperception, lack of resources, financial worries, and employee resistance). The following titles of employees in Jordanian small and medium-sized businesses' departments of information technology made up the study population: (Department Manager, Assistant Department Manager, Head of Department, and Software Officer). To accomplish the goals of the study, the investigator employed a basic random sample of the study population, wherein (160) questionnaires were distributed and (152) were retrieved. The descriptiveanalytic approach was employed in conjunction with various statistical techniques, the most notable of which was the "T" test for one sample (One SampleT–test), and the statistical package program was utilized for statistical analysis and testing of hypotheses. Use SPSS. The study's conclusions include the existence of a statistically significant relationship between Jordanian SMEs' software implementation and their lack of resources, financial concerns, and inadequate ERP understanding. On the other hand, misperception and employee resistance had no statistically significant effect on the implementation of software in Jordanian SMEs. In light of this, the study made several recommendations, the most significant of which is the establishment of an independent committee of senior management experts in information systems and information technology to monitor a variety of data regarding the readiness and effectiveness of the software. As well as involving the user in the ERP implementation from the beginning, because operations management may clearly and effectively benefit from the end-user's assistance in formulating operations that accurately and firmly fulfil daily work needs

Development of the Brazilian version of the Performance of Upper Limb scale for children and adolescents with Duchenne muscular dystrophy

BackgroundDuchenne muscular dystrophy (DMD) is one of the most common and disabling childhood genetic diseases. The course of DMD involves progressive muscular degeneration and weakness, leading to functional decline. The Performance of the Upper Limb scale (PUL) is a specific instrument designed to assess the upper limb function of patients with DMD. ObjectiveTo adapt the PUL cross-culturally to Brazilian Portuguese (PUL-Br) and assess the convergent validity, structural validity, inter-rater reliability, and internal consistency for Brazilian patients with DMD MethodsThe cross-cultural adaptation involved six steps: translation to Brazilian Portuguese, Brazilian Portuguese translation synthesis, back-translation to English, back-translation synthesis, an expert committee review, and a pre-final version test (n = 12). The convergent validity of the PUL-Br was evaluated by examining its correlation to the Motor Function Measure scale (MFM) using 30 patients with DMD. Confirmatory factor analysis was conducted to assess structural validity. Intraclass correlation coefficient (ICC) verified the PUL-Br interrater reliability. Cronbach's alpha was calculated to verify internal consistency. ResultsThe PUL was cross-culturally adapted to Brazilian Portuguese. A strong and positive correlation was found between the PUL-Br total score and the total score on the MFM (r = 0.83; 95% CI: 0.67, 0.91). The PUL-Br showed a satisfactory fit of the data to the three-factor model, excellent inter-rater reliability (ICC: 0.94), and good internal consistency (Cronbach's: 0.91). ConclusionThe PUL-Br is valid and reliable for assessing the upper limb function of Brazilian patients with DMD.

Update on the Role of Chest Imaging in Cystic Fibrosis.

Cystic fibrosis is a genetic disease with multisystem involvement and associated morbidity and mortality that are most directly related to progressive lung disease. The hallmark findings of cystic fibrosis in the lungs are chronic inflammation and infection, leading to progressive loss of pulmonary function and often requiring lung transplant. Predominant lung findings include mucous plugging, bronchiectasis, and air trapping, often with associated atelectasis, consolidation, and emphysema; these findings form the basis of several clinical scoring systems that are used for imaging assessment. Recently, there have been major breakthroughs in the pharmacologic management of cystic fibrosis, including highly effective modulator therapies that directly target the underlying cystic fibrosis transmembrane conductance regulator molecular defect, often leading to remarkable improvements in lung function and quality of life with corresponding significant improvements in imaging markers. The authors review current guidelines regarding cystic fibrosis with respect to disease monitoring, identifying complications, and managing advanced lung disease. In addition, they discuss the evolving role of imaging, including current trends, emerging technologies, and proposed updates to imaging guidelines endorsed by international expert committees on cystic fibrosis, which favor increased use of cross-sectional imaging to enable earlier detection of structural changes in early disease and more sensitive detection of acute changes in advanced disease. It is important for radiologists to be familiar with these trends and updates so that they can most effectively assist clinicians in guiding the management of patients with cystic fibrosis in all stages of disease. ©RSNA, 2024.

Muslim-friendly tourist destination image in travel and hospitality industry: Conceptualization and scale development

The image of a place is subjective and open to change: it depends on an individual's perspective and cultural background. Notwithstanding years of research on destination image, no attempt has been made so far to evaluate the Muslim-Friendly Tourist Destination Image (MFTDI) in the travel and hospitality industry, in which Muslim visitors not only evaluate cognitive and emotional attributes but also Muslim-friendly attributes. In this research a qualitative research and literature review was carried out to develop the items of the proposed scale. The study began with a pilot study in which a committee of experts, and focus groups reduced the topic quantitatively and qualitatively. A follow-up quantitative assessment was then carried out to evaluate and authenticate the suggested scale, using two studies (n1 = 481 and n2 = 269). The significance of the proposed scale was conceptually justified. The scale measured reliability, discriminant validity, convergent validity, and external validity. As a result, the outcomes suggest that the 31 items to be considered fall into three factor categories: cognitive, emotional, and Muslim-friendly qualities. Finally, this paper assesses the article's significant implications for theory and practice, as well as its limitations.

Legal regulation of vacations of medical workers in Ukraine according to labor legislation

The relevance of this scientific research lies in clarifying the nature and features of the legal regulation of vacations for medical workers in Ukraine. The purpose of this study is to determine the specifics of the legal regulation of the types of vacations that may be granted to medical workers. The methodological basis of the study was general scientific and special legal methods of knowledge, in particular theoretical, formal, dogmatic, and comparative legal methods. The results of the study are that the rest time of a medical worker is proposed to be understood as a period of release from professional duties for the restoration of work capacity and professional development. Several features of the legal regulation of medical workers’ vacations have been identified. Please note that additional vacation may be assigned to medical workers of various specialties along with the main vacation. Additional vacations lasting 7 to 25 days are granted to medical workers of certain specialties who work in certain healthcare institutions due to harmful or special working conditions. Additional vacations are established for such medical workers as psychiatrists, pathologists, resuscitators, anesthesiologists, obstetricians, epidemiologists, doctors of medical and social expert commissions, bureaus of forensic medical examinations, and health care institutions for the fight against AIDS. It is emphasized that specific categories of medical workers have the right to additional vacation in connection with the experience of continuous work in rural areas or at another place of work. Also, medical workers have the right to use all types of additional social vacations, established for all categories of workers in Ukraine. The study concludes that a special Ukrainian law "On the Status of Medical Workers" would improve the legal regulation of medical workers’ labor relations. Taking into account the provisions of the current legislation, an author’s definition of the term "medical worker" has been formulated

German version of the engagement of aperson with dementia scale: translation and initial application experiences.

Assessment tools for engagement in people with dementia often rely on self-reported measures which restricts their use in people with severe cognitive limitations. The Engagement of aPerson with Dementia Scale (EPWDS) is avalid and reliable tool to assess behavioral and emotional expressions and responses of engagement in people with dementia through observation; however, the EPWDS is not yet available in the German language. 1)Translation and cross-culturally adaptation of the original English version of the EPWDS into the German language (EPWDS-GER) and 2)to gain insights into assessing data with the newly developed instrument. International recommendations were followed to cross-culturally adapt the English original version of the EPWDS into the German language in 5steps: translation by three independent translators, synthesis, back translation, expert committee review (N = 10) and test of the prefinal version in nursing practice (N = 22) on a5-point Likert scale to assess comprehensibility, practicability and suitability of the EPWDS-GER. The EPWDS-GER achieved high ratings for the five subscales on ease of understanding, ease of answering and importance of single items for assessing engagement. Average agreement for all items ranged from 3.86 to 4.43 (SD = 0.68-1.29). Overall rating of EPWDS-GER resulted in amean agreement of 4.18 (SD = 0.73) for suitability and of 4.09 (SD = 0.81) for practicability. The EPWDS-GER is an easy to use tool for measuring behavioral and emotional expressions and responses of engagement of aperson with dementia and can now be utilized in clinical practice and research.

Transcultural adaptation and validation of the 4-Domain Sports PROM into Italian

ObjectivesThis work aims to evaluate and validate the process of cross-cultural adaptation and validation of the 4-Domain Sports PROM (4-DSP) into Italian, assessing its understandability and reproducibility in all questionnaire domains for Italian-speaking patients. MethodsCross-sectional study, level of evidence II. The questionnaire was self-administered by 100 patients (80 males and 20 females) who had undergone anterior cruciate ligament (ACL) reconstruction and had a one-year minimum follow-up. The mean age and standard deviation (SD) was 31.20 ​± ​12.65 years. According to their level of sports participation, 51% were recreational, 31% were regional, 12% were national, and 6% were international athletes. All patients filled in the 4-DSP questionnaire without direct supervision of their trainer/coach or researcher. All data were collected and processed anonymously. The translation and cultural adaptation of the 4-DSP involved six phases: (1) translation, (2) synthesis, (3) back-translation, (4) pre-test, (5) expert committee review and (6) final version approval by the author of the original version for publication. ResultsThe cross-cultural validation of the questionnaire 4-DSP into Italian presented a global Cronbach's alpha of 0.65, Conceptual equivalence to translation and relevance were 99.09% and 99.81%, respectively, and the percentage of agreement was 99.09%. ConclusionThe cross-culturally validated version of the 4-DSP into Italian proved to be adequately understandable and reproducible in all questionnaire domains and can be safely and reliably used in Italian-speaking patients. Level of evidenceStudy level II.

Validation of Autism Stigma Knowledge – Questionnaire (ASK-Q) for Brazilian Portuguese

BackgroundLow levels of knowledge among health professionals about autism spectrum disorders (ASD) can impair the care provided to people with autism. In Brazil, there are still no validated instruments that assess the knowledge of pharmacy students and pharmacists regarding ASD. ObjectiveThis study aimed to carry out the cross-cultural adaptation of the Autism Stigma Knowledge Questionnaire (ASK-Q) into Brazilian Portuguese and to evaluate the evidence of content validity. MethodsThis study was conducted in two stages, as recommended in the literature. Stage 1 corresponded to cross-cultural adaptation carried out in six phases (translation of the ASK-Q, synthesis of the translations, evaluation by a committee of experts, evaluation by the target audience of pharmacy students and pharmacists, reverse translation, and evaluation by the author of the original instrument). Step 2 corresponds to the assessment of content validity evidence. ResultsThe instrument presented semantic, idiomatic, conceptual, and cultural equivalences, and the author considered the adaptation adequate. Content validity had an adequate coefficient (0.89). The ASK-Q was cross-culturally adapted to the Brazilian context according to the main theoretical framework. ConclusionsFuture studies will be conducted to evaluate other evidence for the validity of the ASK-Q-Brasil. These studies will be fundamental in assessing knowledge about ASD.

Digitalising Clinical Guidelines: The Challenge of Patient's Preferences.

Will digitalised clinical guidelines be compatible with individualised and personalised patient care if the disease definitions and classifications used within them contain embedded preferences? Taking bone health as a case study, we found the dominant definition of osteoporosis installs the consensus preference judgement of a 1992 International Expert Committee in the form of a threshold cut-off on the bone mineral density continuum. We found that subsequent UK clinical guidelines follow suit on this diagnostic threshold, but also endorse preference-sensitive thresholds for interventions to prevent fractures, including ones underpinned by cost-effectiveness analysis. The resulting pre-emption of patient's preferences needs to be removed if 'computable' guidelines are to be reconcilable with personalised care. The challenges to be met in digitalisation therefore include major conceptual ones as well as the technical ones that are currently the almost exclusive focus.

A Multi-Year Study of Mycotoxin Co-Occurrence in Wheat and Corn Grown in Ontario, Canada.

Mycotoxin emergence and co-occurrence trends in Canadian grains are dynamic and evolving in response to changing weather patterns within each growing season. The mycotoxins deoxynivalenol and zearalenone are the dominant mycotoxins detected in grains grown in Eastern Canada. Two potential emerging mycotoxins of concern are sterigmatocystin, produced by Aspergillus versicolor, and diacetoxyscirpenol, a type A trichothecene produced by a number of Fusarium species. In response to a call from the 83rd Joint Expert Committee on Food Additives and Contaminants, we conducted a comprehensive survey of samples from cereal production areas in Ontario, Canada. Some 159 wheat and 160 corn samples were collected from farms over a three-year period. Samples were extracted and analyzed by LC-MS/MS for 33 mycotoxins and secondary metabolites. Ergosterol was analyzed as an estimate of the overall fungal biomass in the samples. In wheat, the ratio of DON to its glucoside, deoxynivalenol-3-glucoside (DON-3G), exhibited high variability, likely attributable to differences among cultivars. In corn, the ratio was more consistent across the samples. Sterigmatocystin was detected in some wheat that had higher concentrations of ergosterol. Diacetoxyscirpenol was not detected in either corn or wheat over the three years, demonstrating a low risk to Ontario grain. Overall, there was some change to the mycotoxin profiles over the three years for wheat and corn. Ongoing surveys are required to reassess trends and ensure the safety of the food value chain, especially for emerging mycotoxins.

Качество научного руководства соискателями ученых степеней (о проблемах, возникающих при назначении двух научных руководителей / консультантов соискателям ученой степени кандидата / доктора наук)

Purpose. Analyze the role and place of the scientific supervisor and scientific consultant in the training of scientific workers. Properly organized scientific supervision/consulting is one of the important factors contributing to the preparation of a quality dissertation research. The article presents an analysis of the appointment of scientific supervisors/consultants to candidates for the academic degree of candidate/doctor of science. Based on the materials of the Higher Attestation Commission, the authors conducted a substantive and statistical analysis of certification cases with two scientific supervisors/consultants for the period 2018–2023, and identified their unreasonable appointments. Methodology: dialectics, abstraction, analysis, synthesis, deduction, formal legal method, comparative law method. Conclusions. It is concluded that it is necessary to justify the appointment of two scientific supervisors/consultants by dissertation councils and to increase control over such cases by the Higher Attestation Commission Expert councils and the Higher Attestation Commission Presidium. Scientific and practical relevance. Justification for the appointment of two scientific supervisors/consultants will allow dissertation councils, Higher Attestation Commission Expert councils and the Higher Attestation Commission Presidium to focus on the problem of the appropriateness of their appointment. This approach will improve the quality of dissertations without harming interdisciplinary research conducted and supported by the state, reduce the number of people unreasonably claiming the title of professor, and increase the prestige of a researcher.

Effective Privacy Protection Strategies for Pregnancy and Gestation Information From Electronic Medical Records: Retrospective Study in a National Health Care Data Network in China.

Pregnancy and gestation information is routinely recorded in electronic medical record (EMR) systems across China in various data sets. The combination of data on the number of pregnancies and gestations can imply occurrences of abortions and other pregnancy-related issues, which is important for clinical decision-making and personal privacy protection. However, the distribution of this information inside EMR is variable due to inconsistent IT structures across different EMR systems. A large-scale quantitative evaluation of the potential exposure of this sensitive information has not been previously performed, ensuring the protection of personal information is a priority, as emphasized in Chinese laws and regulations. This study aims to perform the first nationwide quantitative analysis of the identification sites and exposure frequency of sensitive pregnancy and gestation information. The goal is to propose strategies for effective information extraction and privacy protection related to women's health. This study was conducted in a national health care data network. Rule-based protocols for extracting pregnancy and gestation information were developed by a committee of experts. A total of 6 different sub-data sets of EMRs were used as schemas for data analysis and strategy proposal. The identification sites and frequencies of identification in different sub-data sets were calculated. Manual quality inspections of the extraction process were performed by 2 independent groups of reviewers on 1000 randomly selected records. Based on these statistics, strategies for effective information extraction and privacy protection were proposed. The data network covered hospitalized patients from 19 hospitals in 10 provinces of China, encompassing 15,245,055 patients over an 11-year period (January 1, 2010-December 12, 2020). Among women aged 14-50 years, 70% were randomly selected from each hospital, resulting in a total of 1,110,053 patients. Of these, 688,268 female patients with sensitive reproductive information were identified. The frequencies of identification were variable, with the marriage history in admission medical records being the most frequent at 63.24%. Notably, more than 50% of female patients were identified with pregnancy and gestation history in nursing records, which is not generally considered a sub-data set rich in reproductive information. During the manual curation and review process, 1000 cases were randomly selected, and the precision and recall rates of the information extraction method both exceeded 99.5%. The privacy-protection strategies were designed with clear technical directions. Significant amounts of critical information related to women's health are recorded in Chinese routine EMR systems and are distributed in various parts of the records with different frequencies. This requires a comprehensive protocol for extracting and protecting the information, which has been demonstrated to be technically feasible. Implementing a data-based strategy will enhance the protection of women's privacy and improve the accessibility of health care services.

Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia

BackgroundMulti-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia.MethodsA qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance.FindingsThe principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation.ConclusionsPrincipled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world

ObjectiveApolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are predictors of cardiovascular disease (CVD) risk; therefore, current recommendations for CVD risk assessment and management advocate that patients receive testing for ApoB and Lp(a) in addition to the standard lipid panel. However, US guidelines around ApoB and Lp(a) testing have evolved over time and vary slightly by expert committee. The objective of this analysis was to estimate the number of insured individuals in the USA who received any component of a lipid test, or ApoB and/or Lp(a) testing, during 2019. MethodsWe conducted a cross-sectional analysis to estimate the prevalence of any component of a lipid test, ApoB, and/or Lp(a) in the USA using four different claim data sources (including Medicaid, Medicare, and commercially insured enrollees). Prevalence estimates were age-, sex-, payor-, and region-standardized to the 2019 US Annual Social and Economic Supplement of the Current Population Survey. We also described the clinical profile of patients who received lipid testing between 2019 and 2021 (cohort analysis) in Optum claims database. Enrollees were grouped into four non-mutually exclusive cohorts based on their completion of any component of the lipid panel, ApoB, Lp(a), or ApoB and Lp(a). ResultsIn the prevalence cohort, over a third (38 %) of insured adults in the USA underwent testing for any component of a lipid panel in 2019. This proportion was higher for individuals aged ≥65 years compared to younger adults (62% vs 31 %). The proportion of ApoB and Lp(a) testing represented only <1 % of testing for any component of a lipid panel. In the cohort analysis, we found that lipid testing increased with age and comorbidities. ConclusionThese data should be considered by guideline-issuing agencies and organizations to develop education campaigns encouraging more frequent use of tests beyond the standard lipid panel.

Cross-cultural adaptation and psychometric properties of the Malay version of parenting and child tooth brushing assessment (M-PACTA)

BackgroundMalaysian preschool children continue to exhibit a high prevalence of dental caries and poor oral hygiene. There is a need to gain an in-depth understanding of oral hygiene habits and design suitable interventions to improve oral hygiene in early childhood.ObjectiveTo cross-culturally adapt and determine the psychometric properties of the Malay-translated Parenting and Child Tooth Brushing Assessment questionnaire (M-PACTA).MethodologyThis cross-sectional study involved face and content validation, and forward and back-translation of PACTA. The M-PACTA was then tested for reliability and construct validity on 150 Malaysian parents of children aged 5 to 6 years old.ResultsFace validity indicated that the M-PACTA items were clear and easy to understand. For content validity, some words had to be modified in accordance with the recommendations of the expert committees to make it more coherent to Malaysians. Some statements in the parental knowledge scales were modified according to the guidelines applicable in Malaysia. The content comparison of the back translation with the adapted PACTA revealed that all items were semantic and linguistically equivalent. Exploratory factor analyses of M-PACTA suggested a two-factor structure for three scales including child behaviour scale (‘non-compliance’ and ‘avoidance behaviour’), parental attitudes (‘lack of concern’ and ‘attitude of care’), and parental knowledge (‘general tooth brushing knowledge’ and ‘awareness of tooth brushing care’) while for the parental strategy scale, three-factor structure was extracted including ‘routine positive methods’, ‘uncommon positive methods’, and ‘negative methods’. Internal consistencies for all scales were good (α > 0.9).ConclusionM-PACTA did not replicate the construct of the original PACTA. Nonetheless, M-PACTA demonstrated good construct validity, internal consistency reliability, and test-retest reliability within Malaysian context.

Historical Development of Diagnostic Criteria for NF2-related Schwannomatosis.

NF2-related schwannomatosis (NF2; previously termed neurofibromatosis type 2) is a tumor-prone disorder characterized by development of multiple schwannomas and meningiomas. The diagnostic criteria of NF2 have been regularly revised. Clinical criteria for NF2 were first formulated at the National Institutes of Health Consensus Conference in 1987 and revised in 1990. Revised criteria were also proposed by the Manchester group in 1992 and by the National Neurofibromatosis Foundation (NNFF) in 1997. The 2011 Baser criteria improved the sensitivity of diagnostic criteria, particularly for patients without bilateral vestibular schwannomas. Revisions to the Manchester criteria were published in 2019, with replacement of "glioma" by "ependymoma," removal of "neurofibroma," addition of an age limit of 70 years for development of vestibular schwannomas, and introduction of molecular criteria, which led to the most widely used criteria. In 2022, the criteria were reviewed and updated by the international committee of NF experts. In addition to changes in diagnostic criteria, the committee recommended the use of "schwannomatosis" as an umbrella term for conditions that predispose to schwannomas. Each type of schwannomatosis was classified by the gene containing the disease-causing pathogenic variant. Molecular data from NF2 patients led to further clarification of the diagnostic criteria for NF2 mosaic phenotypes. Given all these changes, the diagnostic criteria of NF2 may be confusing. Herein, to help healthcare professionals who diagnose NF2 conditions in the clinical setting, we review the historical development of diagnostic criteria.