Higher Cutoff Scores Research Articles

Differences in the factor structure of the Eating Attitudes Test-26 in female adolescent patients with eating disorders before and after treatment

ObjectiveThe Eating Attitudes Test-26 (EAT-26) is considered the screening instrument of choice to identify eating disorders (ED) symptoms in clinical and community populations, showing a classical three-factor structure. This study assessed whether the factor structure of the EAT-26 in patients with ED was stable at admission and discharge from inpatient treatment.MethodsWe administered the EAT-26 to 207 female adolescents with ED at both admission and discharge.ResultsFactor structure of the EAT-26 at admission comprised of four factors and at discharge three factors and 15-item version of the EAT, producing two factors, was considerably more stable at both admission and discharge. Cutoff score of 23 in the EAT-15 better defined patients as improved at discharge than the cutoff score of 20 in the EAT-26.ConclusionDifferent factor structures of the EAT are found in the same population of young females with ED during the acute stage of illness vs. symptomatic improvement. In addition, shorter versions of the EAT with higher cutoff scores may better differentiate between improved and not improved patients at discharge. Findings suggest that using the EAT-15 is more effective for evaluating a population with clinical characteristics of ED.

AGENT-BASED SIMULATION FOR UNIVERSITY STUDENTS ADMISSION: MEDICAL COLLEGES IN JORDAN UNIVERSITIES

Medical colleges are considered one of the most competitive schools compared to other university departments. Most countries adopted the particular application process to ensure maximum fairness between students. For example, in UK students apply through the UCAS system, and most of USA universities use either Coalition App or Common App, on the other hand, some universities use their own websites. In fact, a Unified Admission Application process is adopted in Jordan for allocating the students to the public universities. However, the universities and colleges in Jordan are evaluating the applicants by using merely the centralized system without considering the socioeconomics factor, as the high school GPA is the essential player their selection mechanism. In this paper, the authors will use an Agent Based model (ABM) to simulate different scenarios by using Netlogo software (v. 6.3). The authors used different parameters such as the family-income and the high school GPA in order to maximize the utilities of the fairness and equalities of universities admission. The model is simulated into different scenarios. For instance, students with low family income and high GPA given them the priority in studying medicine comparing with same high school GPA and higher family-income, as a results, after several rotations of the simulation the reputation of medical schools are identified based on students’ preferences and seats’ allocated as it shows that high ranking universities are mainly allocated with have high cut-off GPA score.

Eleven years of data on the Jefferson Scale of Empathy – medical student version: Japanese norm data and tentative cutoff scores

BackgroundMore and more studies investigate medical students’ empathy using the Jefferson Scale of Empathy (JSE). However, no norm data or cutoff scores of the JSE for Japanese medical students are available. This study therefore explored Japanese norm data and tentative cutoff scores for the Japanese translation of the JSE-medical student version (JSE-S) using 11 years of data obtained from matriculants from a medical school in Japan.MethodsParticipants were 1,216 students (836 men and 380 women) who matriculated at a medical school in Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants prior to the start of the program. Data were summarized using descriptive statistics and statistical tests were performed to show the norm data and tentative cutoff scores for male and female students separately.ResultsThe score distributions of the JSE-S were moderately skewed and leptokurtic for the entire sample, with indices -0.75 and 4.78, respectively. The mean score (standard deviation) for all participants was 110.8 (11.8). Women had a significantly higher mean score (112.6) than men (110.0; p < 0.01). The effect size estimate of gender difference was 0.22, indicating a small effect size. The low and high cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.ConclusionsThis study provides JSE-S norm data and tentative cutoff scores for Japanese medical school matriculants, which would be helpful in identifying those who may need further training to enhance their empathy.

A noninvasive model discriminating significant histological changes in treatment-naive chronic hepatitis B patients with normal ALT

BackgroundTraditionally part of chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) are recommended to antiviral therapy referring to liver biopsy. However, liver biopsy is an invasive method with various potential complications. A noninvasive model was established in the study to evaluate liver histology and to identify the need of antiviral therapy.MethodsA total of 614 liver biopsied CHB patients with ALT less than upper limit of normal from 2 centers were retrospectively analyzed. They were divided into a training cohort and a validation cohort. A noninvasive model to predict the significant liver histological changes was established and validated.ResultsThe results of analysis showed that ALT, Age, platelet (PLT) and liver stiffness (LS) were independent risk factors for significant liver injury. The model was established based on the 4 indexes, with the area under the curve of 0.85 and 0.87 in training cohort and validation cohort. Meanwhile, 2 cut-off scores were selected. By applying the low cut-off score (− 0.207), patients without significant liver injury could be identified with high accuracy, with negative predictive value of 72.7% and 73.7% in training and validation cohorts. By applying the high cut-off score (0.537), the presence of significant liver injury could be diagnosed with high accuracy, with positive predictive value of 90.3% and 88.8% in the training and validation cohorts. By applying the model, liver biopsy would have been avoided in 87.6% (538/614) patients, with correct prediction in 87.9% (473/538).ConclusionThe novel noninvasive model composed of ALT, Age, PLT, LS can correctly assess liver histology in CHB patient with normal ALT, which helps to determine the need of antiviral therapy without liver biopsy.

Incident portal vein thrombosis in liver transplant recipients in New Zealand: Predictors of risk and validation of portal vein thrombosis risk index calculator.

The risk of spontaneous portal vein thrombosis (PVT) is increased in patients on the waiting list for liver transplantation and increases perioperative risks. A predictive PVT risk-index (PVT-RI) calculator has been proposed to determine the risk of incident PVT. We performed a retrospective analysis on adult liver transplant recipients at the NZ Liver Transplant Unit between January 1998 and February 2020. Variables reviewed included age at listing and transplantation, wait time from listing to transplant, indication for listing, gender, ethnicity, etiology of liver disease, listing MELD score, hepatocellular carcinoma (HCC), moderate-to-severe ascites, hepatic encephalopathy (>grade 2), transjugular intrahepatic portosystemic shunt (TIPSS), spontaneous bacterial peritonitis (SBP), and diabetes. Incident PVT was determined by imaging of patients while on the waiting list and assessment at transplantation. A total of 553 out of 706 patients met the inclusion criteria. Of those 553, 18 (3.3%) patients had incident PVT. The PVT-RI calculator was not validated in our cohort with only one of those 18 (6%) patients having a score of >4.6 (high risk cut-off score). Longer waiting time for transplant and listing for liver failure rather than HCC were independent predictors of the risk of incident PVT. There was no statistically significant difference in the incidence of PVT in viral vs. non-viral and cholestatic vs. non-cholestatic etiology of chronic liver disease. Patients with longer waiting times on the transplant waiting list should be monitored regularly for PVT.

Hierarchical Properties and Functional Staging of the Fugl-Meyer Assessment Lower Extremity Scale

<h3>Research Objectives</h3> This study aimed (1) to investigate the hierarchical properties of FMA-LE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-LE and its relationships to low (0–21), high (22–34) FMA-LE cut-off scores. <h3>Design</h3> Secondary analysis of cross-sectional data. <h3>Setting</h3> Outpatient rehabilitation settings. <h3>Participants</h3> The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The 17-item FMA-LE assesses lower extremity motor function including reflex activity, movement within and outside synergy patterns, and speed/coordination. It has two subscales: Lower Extremity and Speed/Coordination, which are scored on a 3-level ordinal scale (0 = none; 1 = partial; 2 = full). The total summed score of 34 points indicates normal function. <h3>Results</h3> Overall, the item difficulty hierarchical order of the FMA-LE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, and movement with little/no synergies. The ‘normal reflex activity', ‘knee flexion to 90° (hip at 0°)', ‘coordination/speed' items represented the most difficult items. The two-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress. We further provided the functional staging for the clinical interpretation across all FMA-LE scores. <h3>Conclusions</h3> Our findings suggest that the FMA-LE items reflect the lower extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.

The added value of signal detection theory as a method in evidence-informed decision-making in higher education: A demonstration

Signal Detection Theory (SDT) is rarely used in higher education, yet has much potential in informing decision-making. In this methodological paper, we describe the potential of SDT for different higher education contexts and demonstrate its practical application. Both the commonly used regression analyses and SDT analyses provide information on the accuracy of a predictor, and thus which instrument(s) to use. SDT analyses, in addition, provide information on the effects of setting specific cut-off scores on outcomes of interest. SDT provides the sensitivity and specificity information for the chosen instrument(s) at specific cut-off scores (criteria in SDT). This allows for evidence-informed, deliberate choice of cut-off scores to steer toward desired outcomes. Depending on how undesirable false positives and false negatives are considered in a specific situation, a lower or higher cut-off score can be deemed adequate. Using SDT analyses in our example, we demonstrate how to use the results to optimize “real-life” student selection. However, selection is only one of many decision-making practices where SDT is applicable and valuable. We outline some of the areas within higher education decision-making and quality assurance, where SDT can be applied to answer specific questions and optimize decision-making.

Reliability and validation of the Thai version of the Cumberland Ankle Instability Tool (CAIT-THA)

Purpose This study aimed to provide a version of Cumberland Ankle Instability Tool (CAIT) for the Thai younger adult population and examine psychometric properties and determine the cut-off score. Methods CAIT-Youth Thai version was modified to CAIT Thai version (CAIT-THA). To validate the CAIT-THA psychometric properties, 72 with chronic ankle instability (CAI) and 72 without (age 23.45 ± 4.45 years) were recruited. The validation was carried out by using internal consistency (Cronbach’s alpha), concurrent validity (Spearman’s rank correlation coefficient), discriminative validity (Receiver Operating Characteristic (ROC) curve), and test-retest reliability (intraclass correlation coefficient; ICC). A cut-off score was determined via Youden’s index. Results Validation showed good internal consistency (Cronbach’s alpha = 0.837), and concurrent validity (Spearman’s rank correlation coefficient = 0.762 and 0.731 for right ankle and left ankle, respectively). Test-retest reliability was excellent with ICC (2,1) of 0.945 (95% CI = 0.93–0.96). A cut-off score of ≤ 25, determined by ROC curve and Youden’s index, was distinguished between participants with and without CAI. CAIT-THA obtained 97.2% sensitivity, 94.4% specificity, 0.03 negative, and 17.5 positive likelihood ratios. Conclusion CAIT-THA is a validated tool that can be used in Thai younger adults. Clinicians and researchers can confidently use a score of ≤ 25 to determine the presence of CAI. IMPLICATIONS FOR REHABILITATION The Cumberland Ankle Instability Tool Thai version (CAIT-THA) questionnaire is available for Thai young adults. The CAIT-THA had high sensitivity, specificity, and positive and negative likelihood cut-off ratio scores for discrimination between chronic ankle instability (CAI) and non-CAI. The CAIT-THA questionnaire may be used in rehabilitation and research settings for the identification and management of CAI conditions.

Training and assessment of musculoskeletal ultrasound and injection skills-a systematic review.

To examine how residents are trained and assessed in musculoskeletal US (MSUS), MSUS-guided and landmark-guided joint aspiration and injection. Additionally, to present the available assessment tools and examine their supporting validity evidence. A systematic search of PubMed, Cochrane Library and Embase was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and studies published from 1 January 2000 to 31 May 2021 were included. Two independent reviewers performed the search and data extraction. The studies were evaluated using the Medical Education Research Quality Instrument (MERSQI). A total of 9884 articles were screened, and 43 were included; 3 were randomized studies, 21 pre- and post-test studies, 16 descriptive studies and 3 studies developing assessment tools. The studies used various theoretical training modalities, e.g. lectures, anatomical quizzes and e-learning. The practical training models varied from mannequins and cadavers to healthy volunteers and patients. The majority of studies used subjective 'comfort level' as assessment, others used practical examination and/or theoretical examination. All training programs increased trainees' self-confidence, theoretical knowledge, and/or practical performance, however few used validated assessment tools to measure the effect. Only one study met the MERSQI high methodical quality cut-off score of 14. The included studies were heterogeneous, and most were of poor methodological quality and not based on contemporary educational theories. This review highlights the need for educational studies using validated theoretical and practical assessment tools to ensure optimal MSUS training and assessment in rheumatology.

A Novel Clinical Score Predicting the Presence of Fatty Pancreas.

Background: Fatty pancreas (FP) has become an increasingly encountered entity in recent years. Several studies have shown an association with several disease states. Aims: we aimed to generate a simple non-invasive scoring model to predict the presence of FP. Method: We performed a retrospective cross-sectional analysis at Galilee Medical Center. Inclusion criteria included patients who underwent endoscopic ultrasound (EUS) for hepatobiliary indications and who had either hyperechogenic pancreas consistent with FP or no sonographic evidence of fatty pancreas. Results: We included 569 patients. Among them, 78 patients had FP by EUS and 491 patients did not have FP. On univariate analysis, obesity (odds ratio (OR) 5.11, p < 0.0001), hyperlipidemia (OR 2.86, p = 0.0005), smoking (OR 2.02, p = 0.04), hypertension (OR 2.58, p = 0.0001) and fatty liver (OR 5.94, p < 0.0001) were predictive of FP. On multivariate analysis, obesity (OR 4.02, p < 0.0001), hyperlipidemia (OR 2.22, p = 0.01) and fatty liver (OR 4.80, p < 0.0001) remained significantly associated with FP. We developed a diagnostic score which included three parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the OR estimate. A low cut-off score of ≤1 was associated with a negative predictive value (NPV) of 98.1% for FP, whereas a high cut-off score of ≥2 was associated with a positive predictive value (PPV) of 35–56%. Conclusion: We recommend incorporating this simple score as an aid to identify individuals with FP.

Sensitivity and specificity of the Posttraumatic Stress Disorder Checklist for DSM-5 in a Canadian psychiatric outpatient sample.

The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is a widely used, self-report measure that is employed to assess PTSD symptom severity and determine the presence of probable PTSD in various trauma-exposed populations. The PCL-5 is often administered in clinical settings as a screening tool for PTSD, with a suggested cutoff score of 33 indicating a probable PTSD diagnosis. Recent research indicates that a higher cutoff may be required in psychiatric samples. In the present study, we aimed to determine the sensitivity and specificity of the PCL-5 in a Canadian outpatient psychiatric sample and establish an optimal cutoff score for detecting probable PTSD in this sample. Participants were 673 individuals who reported a history of trauma exposure and were assessed using a semistructured interview and self-report measures. Individuals diagnosed with PTSD (N = 193) reported a mean PCL-5 score of 56.57, whereas individuals without PTSD (N = 480) reported a mean score of 33.56. A score of 45 was determined to be the optimal cutoff score in this sample, balancing sensitivity and specificity while detecting a probable diagnosis of PTSD. Consistent with findings in other psychiatric samples, these findings indicate that in an outpatient psychiatric sample with a history of exposure to a variety of trauma types, a higher cutoff score is required to determine probable PTSD. In addition, given the estimated rate of false positives even with a higher cutoff, follow-up diagnostic assessments are recommended.

Blood Levels of Glutamine and Nitrotyrosine in Patients with Chronic Viral Hepatitis.

PurposeOxidative stress is involved in pathogenesis of chronic viral hepatitis. Glutamine is an antioxidant, but there is a controversy about its risk-benefits. Nitrotyrosine is an oxidative stress marker. This observational cross-sectional study was designed to compare blood levels of glutamine and nitrotyrosine in treated versus untreated chronic viral hepatitis patients.Patients and MethodsFive groups (n = 250) were included: hepatitis B untreated (HBV), hepatitis C untreated (HCV), HBV treated (HBVT), and HCV treated (HCVT) groups plus a normal control group. Liver function tests and blood levels of glutamine, nitrotyrosine, viral loads, and HBsAg were measured.ResultsBlood levels of glutamine and nitrotyrosine in all patient groups significantly increased compared with normal controls with non-significant differences in-between. Both tests showed significant large correlations with HBV-DNA or HCV-RNA test positivity, high accuracies, and cutoff scores with high sensitivities and specificities. The viral loads and HBsAg levels were significantly lower in treated versus untreated groups. However, they poorly correlated with levels of glutamine and nitrotyrosine in all patient groups.ConclusionBlood levels of glutamine and nitrotyrosine significantly increased in treated and untreated chronic viral hepatitis B and C patients compared with normal controls. Both tests showed high accuracies and cutoff scores with high sensitivities and specificities. However, they did not differ significantly in treated versus untreated patients. To our knowledge, this is the first data showing elevation of glutamine and nitrotyrosine in treated and untreated chronic viral hepatitis. A prospective longitudinal study with repeated measurements of glutamine and nitrotyrosine is recommended to verify if they can predict response to treatment. Study of other oxidative stress markers is also advised to clarify if the elevated nitrotyrosine could be an oxidative stress marker in these patients, and whether the increased glutamine could act as an antioxidant or as a predictive agent for deleterious consequences.

Reliability and Validity of the Czech Version of the Pittsburgh Sleep Quality Index in Patients with Sleep Disorders and Healthy Controls.

Objectives Psychometric properties of the Czech version of the Pittsburgh Sleep Quality Index (PSQI-CZ) have been evaluated only in patients with chronic insomnia, and thus, it is unclear whether PSQI-CZ is suitable for use in other clinical and nonclinical populations. This study was aimed at examining the validity and reliability of the PSQI-CZ and at assessing whether the unidimensional or multidimensional scoring of the instrument would be recommended. Methods A total of 524 adult subjects from the Czech population participated in the study. The internal consistency of PSQI was evaluated using Cronbach's alpha. The known-group validity was tested using the Kruskal-Wallis H test to verify the difference between patients with sleep disorders and healthy control sample. For testing the structural validity, a cross-validation approach was used with both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). For EFA, the maximum likelihood method with direct oblimin rotation and parallel analysis was used. Results The internal consistency of PSQI-CZ items was moderate (α = 0.75). Receiver operating characteristic (ROC) curve analysis showed high specificity (0.79) and moderate sensitivity (0.64) using an optimal cut-off score of 10. The EFA revealed a 3-factor structure with factors labelled as “sleep duration and efficiency,” “sleep disturbances and quality,” and “sleep latency.” The CFA showed that the emerged 3-factor model had a partly acceptable fit, which was better than other previously supported models. Conclusions A high cut-off score of 10 is recommended to define poor sleep quality. Given the inconsistency of structural analyses, alternative scoring was not recommended. However, the individual components in addition to a total score should be interpreted when assessing sleep quality. We recommend editing and verifying the PSQI-CZ translation.

A validated score predicting common bile duct stone in patients hospitalized with acute calculus cholecystitis: a multi-center retrospective study

Concomitant common bile duct (CBD) stone in the setting of acute calculous cholecystitis (ACC) should be suspected once abnormal liver indices are noticed. We aimed to identify predictors of CBD stone in patients hospitalized with ACC. We performed a retrospective multi-center, case-controlled, study from 1st of January 2016 until the 31th of December 2018. Inclusion criteria included patients with an established diagnosis of ACC based on clinical, laboratory and radiological criteria and who had an endoscopic ultrasound (EUS) for suspected CBD stone. One-hundred and twelve patients were included, of these fifty-three patients (47.3%) were diagnosed with CBD stone by EUS. In univariate analysis, Age (OR 1.038, P = 0.001), total bilirubin (mg/dl) (OR 1.429, P = 0.02) and CBD width (mm) by US (OR 1.314, P = 0.01) were statistically significant in predicting CBD stone and remained significant in multivariate regression analysis. We developed a diagnostic score that included these three parameters, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of 0 was associated with sensitivity of 100% for CBD stone, whereas a high cut-off score of 3 was associated with sensitivity of 10% and specificity of 96.6% with a positive predictive value of 67% (ROC of 0.7558). We validated this score with an independent cohort (ROC of 0.7416) with a sensitivity of 46.6%, a specificity of 91.5% and a PPV of 87.1%. We recommend incorporating this score as an aid for stratifying patients with ACC into low or high probability for concomitant CBD stone.

Development of a Model to Predict Portal Vein Thrombosis in Liver Transplant Candidates: The Portal Vein Thrombosis Risk Index.

Portal vein thrombosis (PVT) is associated with inferior pretransplantation and posttransplantation outcomes. We aimed to create a predictive model to risk stratify transplant candidates for PVT. Data on adult transplants in the United States during the Model for End-Stage Liver Disease (MELD) era through September 2016 were reviewed. We constructed and validated a scoring system composed of routine, readily available clinical information to predict the development of incident PVT at 12months from transplantation listing. A total of 66,568 liver transplant candidates were dichotomized into 2 groups to construct (n=34,751) and validate (n=31,817) a scoring system. In general, the derivation and validation cohorts were clinically similar. Although nonalcoholic steatohepatitis was a significant predictor of incident PVT (hazard ratio, 1.29; 95% confidence interval, 1.08-1.54; P<0.001), age, MELD score, and moderate-to-severe ascites were also associated with increased risk. African American race was associated with decreased risk. A scoring system (PVT risk index [RI]) of these 5 variables had an area under the curve of 0.71 and 0.70 in both derivation and validation cohorts, respectively. By applying the low cutoff score of 2.6, incident PVT could be accurately excluded (negative predictive value 94%). Using the high cutoff score of 4.6 (positive predictive value 85%), PVT could be diagnosed with high accuracy. The PVT-RI predicts which candidates awaiting lifesaving liver transplantation will and will not develop future PVT. Although this scoring system will require prospective validation, it provides a powerful new tool for the clinician when risk stratifying cirrhosis patients prior to liver transplantation for future PVT development.

Choosing the most appropriate existing type 2 diabetes risk assessment tool for use in the Philippines: a case-control study with an urban Filipino population

BackgroundAs the prevalence of type 2 diabetes (T2DM) increases in low- to middle-income countries, the burden on individuals and health care systems also increases. The use of diabetes risk assessment tools could identify those at risk, leading to prevention or early detection of diabetes. The aim of this study was to evaluate the appropriateness of 6 existing T2DM risk screening tools in detecting dysglycemia in Zamboanga City, Philippines.MethodsThis study used a case-control design in an urban setting in the southern Philippines. There were 200 participants in two groups: 1) those diagnosed with diabetes (n = 50; recruited from diabetes clinics) and 2) those with no previous diagnosis of diabetes (n = 150; recruited from community locations). Participants completed six tools (the Finnish Diabetes Risk Score [FINDRISC], the Canadian Diabetes Risk Score [CANRISK], the Indian Diabetes Risk Score [IDRS], the American Diabetes Association [ADA] risk score, an Indonesian undiagnosed diabetes mellitus [UDDM] scoring system, and a Filipino tool). Scores were compared to fasting plasma glucose levels, which are recommended in Philippines clinical practice guidelines as a valid, available, and low cost option for T2DM diagnosis. Appropriateness of tools was determined through accuracy, sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratios.ResultsThe Filipino tool had the highest specificity (0.73) and PPV (0.27), but lowest sensitivity (0.68). The IDRS and Indonesian UDDM tool had the highest NPV at 0.96, but were not amongst the highest in other scores. The CANRISK tied for highest area under the receiver operating characteristic (ROC) curve (AUC), AUC (0.80), but other scores were not noteworthy. Overall, the FINDRISC was the most effective with highest sensitivity (0.94), tied for highest AUC (0.80), and with middle scores in other variables (specificity: 0.45, PPV: 0.20, NPV: 0.95), when using the published cut-off score of 9. When increasing the cut-off score to 11, specificity increased (0.71) and sensitivity was not greatly affected (0.86).ConclusionsOur results suggest that the FINDRISC is more suitable than other known diabetes risk assessment tools in an urban Filipino population; effectiveness increased with a higher cut-off score.

Clarification of the cut-off score for Zung\u2019s self-rating depression scale

BackgroundZung’s Self-rating Depression Scale (SDS) is an established norm-referenced screening measure used to identify the presence of depressive disorders in adults. Despite widespread usage, issues exist concerning the recommended cut-off score for a positive diagnosis. First, confusion arising from the conversion of raw scores to index scores had resulted in a considerably higher cut-off score than that recommended being used by many researchers. Second, research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] and Australia [BMC Psychiatry. 17:329; 2017] had suggested that the current recommended cut-off is lower than ideal, at least in those countries.MethodTo explore these matters further, sensitivity and specificity figures for alternative cut-off points were examined in positive clinical and negative community samples respectively. The positive clinical sample (n = 57) consisted of adults receiving treatment from a medical professional for some kind of depressive disorder, whose diagnosis was positively confirmed using the Patient Health Questionnaire (PHQ). The negative community sample (n = 172) was derived from a representative sample of adults whose absence of any depressive disorder was similarly confirmed by the PHQ.ResultsMathematical models, including Youden’s Index and the Receiver Operating Characteristics Curve, suggest that the recommended cut-off (a raw score of 40) is indeed too low. More detailed comparisons, including consideration of the likely numbers of false positives and negatives given prevalence rates, confirm that, ironically, the incorrect SDS cut-off score mistakenly applied by many researchers (a raw score of 50) would appear to provide far greater accuracy.ConclusionsResearch in China [Chin J Nervous Mental Dis. 12:267-268; 2009] has resulted in an elevated SDS cut-off score of 42 being used in many Chinese studies. Research by Dunstan and Scott [BMC Psychiatry. 17:329; 2017] in an Australian context, suggested that a greater increase, to a raw score of 44 might be required. Based on this study, an even larger adjustment is required. Specifically, we recommend the use of an SDS raw score of 50 as the cut-off point for clinical significance.

Validation of a brief mental health screening tool for common mental disorders in primary healthcare.

Integrating care for common mental disorders (CMDs) such as depression, anxiety and alcohol abuse into primary healthcare (PHC) should assist in reducing South Africa (SA)'s quadruple burden of disease. CMDs compromise treatment adherence, health behaviour change and self-management of illnesses. Appropriate identification of mental disorders in primary care can be facilitated by brief, easy-to-administer screening that promotes high specificity. To establish the criterion-based validity of a seven-item Brief Mental Health (BMH) screening tool for assessing positive symptoms of CMDs in primary care patients. A total of 1 214 participants were recruited from all patients aged ≥18 years visiting 10 clinics as part of routine care in the Newcastle subdistrict of Amajuba District in KwaZulu-Natal Province, SA, over a period of 2 weeks. Consenting patients provided basic biographical information prior to screening with the BMH tool. PHC nurses remained blind to this assessment. PHC nurse-initiated assessment using the Adult Primary Care (APC) guidelines was the gold standard against which the performance of the BMH tool was compared. A specificity standard of 80% was used to establish cut-points. Specificity was favoured over sensitivity to ensure that those who did not have CMD symptoms were excluded, as well as to reduce over-referrals. Of the participants, 72% were female. The AUD-C (alcohol abuse) performed well (area under the curve (AUC) 0.91 (95% confidence interval (CI) 0.88 - 0.95), cut-point ≥4, Cronbach alpha 0.87); PHQ-2 (depression) performed reasonably well (AUC 0.72 (95% CI 0.65 - 0.78), cut-point ≥3, alpha 0.71); and GAD-2 (anxiety) performance was acceptable (AUC 0.69 (95% CI 0.58 - 0.80), cut-point ≥3, alpha 0.62). Using the higher cut-off scores, patients who truly did not have CMD symptoms had negative predictive values (NPVs) of &gt;90%. Overall, 26% of patients had CMD positive symptoms relative to 8% using the APC guidelines. Using a higher specificity index, the positive predictive value and NPV show that at higher cut-point values the BMH not only helpsidentify individuals with alcohol misuse, depression and anxiety symptoms but also identifies a majority of those who do not have symptoms (true negatives), thus not overburdening nurses with false positives needing assessment. Research is needed to assess whether use of such a short and valid screening tool is generalisable to other clinic contexts as well as how mental health screening should best be introduced into routine clinic functioning and practice.

A Validated Score Assessing the Risk of an Intra-Abdominal Abscess in Patients with Crohn's Disease Presenting at the Emergency Department.

A majority of acutely ill Crohn's disease [CD] patients who present to Emergency Department [ED] will undergo an abdominal CT to rule out disease complications. We aimed to generate a simple non-invasive scoring model to predict the presence of an intra-abdominal abscess in CD patients in the ED. We performed a retrospective case-control study at four Israeli hospitals from January 1, 2010 to May 30, 2018. Inclusion criteria included patients with an established diagnosis of CD that had cross-sectional abdominal imaging performed. A total of 322 patients were included, and 81 [25%] were diagnosed with an intra-abdominal abscess. In univariate analysis, ileo-colonic location (odds ratio [OR] 1.88, p = 0.0148), perianal CD [OR 7.01, p = 0.0004], fever [OR 1.88, p = 0.0247], neutrophil-to-lymphocyte ratio [OR 1.12, p < 0.0001], and C-reactive protein [OR 1.10, p < 0.0001] were significantly associated with abscess formation, whereas current use of corticosteroids was negatively associated with abscess formation [OR 0.46, 95% CI, 0.2-0.88, p = 0.0192]. We developed a diagnostic score that included five parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of ≤7 was associated with a negative predictive value [NPV] of 93% for abscess formation, whereas a high cut-off score of >9 was associated with a positive predictive value of 65%. We validated this score with an independent cohort [area under the curve of 0.881 and NPV of 98.5%]. We recommend incorporating this score as an aid for stratifying acutely ill CD patients in the ED with low or high probability of the presence of an intra-abdominal abscess.

Psihometrijske karakteristike skale dentalnog straha na srpskoj populaciji

Introduction. Between 6 and 15% of the adult population throughout the world faces with the fear of dentists. Fear of dentists directly correlates with the pain experienced during previous visits to the dentist. Objective. The aim of the study was to assess the validity, reliability and factor structure of the Serbian version of the Dental Fear Survey on a sample of university and high school students. Method. Two hundred and fifty students and high school students participated in the study and completed the Serbian version of the Dental Fear Survey. Results. This study's sample showed excellent internal consistency (Cronbach's Alpha = 0.98). Descriptive statistics and multinomial logistic regression were calculated; a significance level of p < 0.05 was used for all tests. A high fear cut-off point score was determined by calculating the receiver operating characteristic (ROC) curve for the DFS. The ROC curve indicated that a DFS score ≥ 47 corresponds to a sensitivity of 86.1% and a specificity of 88.2%. A large number of participants (n = 102; 40.8%) reported no fear of going to the dentist. The factor analyses resulted in three factors: first represents fear of certain stimulus or situation, second represents anticipatory fear which causes dentist avoidance, and third stands for psychological excitement caused by dental procedures. Conclusion. DFS satisfies all the criteria of successful validation among Serbian population of university and highschool students. The Serbian version of the DFS will be helpful for the evaluation of fear of dental procedures within this population. DFS is an easily applicable, short and reliable instrument and it can enable physicians to assess fear and anxiety symptoms in a targeted and precise manner.