Recommended Cutoff Point Research Articles

Measuring Discharge Readiness: Psychometric Evaluation of Instruments for Patients After Abdominal Surgery.

Background and Purpose: Discharge readiness is an important aspect of quality care improvement but is poorly understood among clinicians. This study aims to develop and validate an abdominal surgery discharge readiness instrument (ASDRI). Methods: Through quantitative methods, ASDRI was crafted from qualitative exploration, literature review, and theoretical foundation. The psychometric analysis involved 344 patients with abdominal surgery aged 18 years and above using SmartPLS 4.0.9 software version. Results: The validated ASDRI contains both convergent and discriminant validities. The Average Variance Extracted (AVE) values for all the constructs were above the recommended cutoff point (AVE = 0.4) and demonstrated acceptable reliability (CA = 0.64 - 0.936; CR = 0.81 - 0.95). Conclusions: The ASDRI, comprising 28 items across five factors, emerges as a valid and reliable tool for assessing discharge readiness after abdominal surgery, emphasizing patient-centered discharge planning.

Intraoperative transit time flow measurement predicts maturation of radiocephalic arteriovenous fistulas

ObjectiveThe arteriovenous fistula (AVF) is the first choice for gaining vascular access for hemodialysis. However, 20% to 50% of AVFs fail within 4 months after creation. Although demographic risk factors have been described, there is little evidence on the intraoperative predictors of AVF maturation failure. The aim of this study was to assess the predictive value of intraoperative transit time flow measurements (TTFMs) on AVF maturation failure. MethodsIn this retrospective cohort study, intraoperative blood flow, measured using TTFM, was compared with AVF maturation after 6 weeks in 55 patients. Owing to its significantly higher prevalence and risk of nonmaturation, the radiocephalic AVF (RCAVF) was the main focus of this study. A recommended cutoff point for high vs low intraoperative blood flow was determined for RCAVFs, using a receiver operating characteristic curve. ResultsThe average intraoperative blood flow in RCAVFs was 156 mL/min. Patients with an intraoperative blood flow equal or lower than the determined cutoff point of 160 mL/min, showed a 3.03 times increased risk of AVF maturation failure after 6 weeks, compared with patients with a higher intraoperative blood flow (P < .001). ConclusionsThe intraoperative blood flow in RCAVFs measured by TTFM provides an adequate means of predicting AVF nonmaturation 6 weeks after surgery. For RCAVFs, a cutoff point for intraoperative blood flow of 160 mL/min is recommended for maximum sensitivity and specificity to predict AVF maturation failure after 6 weeks.

The predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting.

We aimed to explore the predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting. Trauma patients admitted to Shenzhen University General Hospital from July 2018 to December 2022 were included in this study. They were divided into the massive transfusion group and the non-massive transfusion group according to the blood transfusion volume within 24h. Basic information about patients was collected. Glasgow Coma Scale (GCS), focused assessment with sonography for trauma (FAST), and injury severity score (ISS) were performed. The receiving operating characteristic (ROC) curve was used to compare the predictive value of four trauma transfusion scores for early massive blood transfusion in the pre-hospital setting. A total of 475 patients were enrolled, 43 received massive blood transfusions and 29 died within 24h. The sensitivity and specificity of the four trauma hemorrhage scores in predicting the need for massive blood transfusions in trauma patients at their recommended cutoff points were all high. Among the four scores, the area under the ROC curve was larger for the assessment of blood consumption (ABC) score (0.864) and smaller for the trauma-induced coagulopathy clinical score (TICCS) score (0.795, p > 0.05). All four pre-hospital trauma hemorrhage scores have a high predictive value in assessing massive blood transfusion in trauma patients.

Accurate SARC-F Score in Patients with Liver Disease.

SARC-F is a well-accepted screening tool for sarcopenia. A SARC-F value of 1 point is reported to be more discriminating in identifying sarcopenia than 4 points (recommended cutoff point). The prognostic impact of the SARC-F score was investigated in patients with liver disease (LD, n = 269, median age = 71 years, 96 hepatocellular carcinoma (HCC) cases). Factors associated with SARC-F ≥ 4 points and SARC-F ≥ 1 point were also examined. In the multivariate analysis, age (p = 0.048), and Geriatric Nutritional Risk Index (GNRI) score (p = 0.0365) were significant factors linked to SARC-F ≥ 1 point. In our patients with LD, the SARC-F score is well correlated with the GNRI score. The 1-year cumulative overall survival ratio in patients with SARC-F ≥ 1 (n = 159) and SARC-F 0 (n = 110) was 78.3% and 90.1% (p = 0.0181). After excluding 96 HCC cases, similar tendencies were found (p = 0.0289). In the receiver operating curve (ROC) analysis based on the prognosis for the SARC-F score, the area under the ROC was 0.60. The sensitivity was 0.57, the specificity was 0.62, and the optimal cutoff point of the SARC-F score was 1. In conclusion, sarcopenia in LDs can be affected by nutritional conditions. A SARC-F score of ≥1 is more useful than a score of 4 in predicting the prognosis of patients with LD.

Cross-cultural adaptation, reliability, and validation of the Spanish perceived physical literacy instrument for adolescents (S-PPLI)

Background/ObjectivesThe aim of this study was to examine the reliability and validity of the Spanish Perceived Physical Literacy Instrument (S-PPLI) questionnaire in Spanish adolescents. MethodThe participants of this study were 360 Spanish adolescents (aged 12–17 years) from three secondary schools in the Region of Murcia (Spain). A cultural adaptation process of the original version of the PPLI questionnaire was developed. Confirmatory factor analysis was applied to test the three-factor structure of physical literacy. Intraclass correlation coefficients were computed to estimate the test-retest concordance. ResultsUsing a confirmatory factor analysis, the factor loading of all items above the standard of 0.40 ranged from 0.53 to 0.77, suggesting that the observed variables sufficiently represented the latent variables. Analyses for convergent validity showed average variance extracted values that ranged from 0.40 to 0.52 and composite reliability values higher than 0.60. All the correlations were below the recommended cutoff point of 0.85, which indicated that the three physical literacy factors achieved adequate discriminant validity. Intraclass correlation coefficients ranged from 0.62 to 0.79 (p < 0.001 for all items), which indicated moderate/good reliability. ConclusionsOur results suggest that the S-PPLI is a valid and reliable measure of physical literacy among Spanish adolescents.

Prognostic Impact of the SARC-F Score in Gastrointestinal Advanced Cancers.

Simple SummaryThere have been few reports with regard to the relevance between the SARC-F score and the prognosis in patients with gastrointestinal advanced cancers, and we aimed to elucidate these issues (n = 421, median age = 73 years). During the follow-up period, 145 patients (34.4%) died. The 1-year cumulative overall survival rate in patients with SARC-F ≥ 4 (recommended cutoff point, n = 103) and SARC-F < 4 (n = 318) was 33.9% and 61.6% (p < 0.0001). In the multivariate analysis for the overall survival, total lymphocyte count ≥ 1081/μL (p = 0.0014), the SARC-F score ≥ 4 (p = 0.0096), Glasgow prognostic score 1 (p = 0.0147) and 2 (p < 0.0001), ECOG-PS 2 (p < 0.0001), and 3 (p < 0.0001) and 4 (p < 0.0001) were independent predictors. In the receiver operating characteristic curve analysis on the prognostic value of the SARC-F score, the sensitivity/specificity was 0.59/0.70, and the best cutoff point of the SARC-F score was two. The SARC-F score appears to be useful in patients with gastrointestinal advanced malignancies.We sought to elucidate the prognostic impact of the SARC-F score among patients with gastrointestinal advanced malignancies (n = 421). A SARC-F score ≥ 4 was judged to have a strong suspicion for sarcopenia. In patients with ECOG-PS 4 (n = 43), 3 (n = 61), and 0–2 (n = 317), 42 (97.7%), 53 (86.9%) and 8 (2.5%) had the SARC-F score ≥ 4. During the follow-up period, 145 patients (34.4%) died. All deaths were cancer-related. The 1-year cumulative overall survival (OS) rate in patients with SARC-F ≥ 4 (n = 103) and SARC-F < 4 (n = 318) was 33.9% and 61.6% (p < 0.0001). In the multivariate analysis for the OS, total lymphocyte count ≥ 1081/μL (p = 0.0014), the SARC-F score ≥ 4 (p = 0.0096), Glasgow prognostic score (GPS) 1 (p = 0.0147, GPS 0 as a standard), GPS 2 (p < 0.0001, GPS 0 as a standard), ECOG-PS 2 (p < 0.0001, ECOG-PS 0 as a standard), ECOG-PS 3 (p < 0.0001, ECOG-PS 0 as a standard), and ECOG-PS 4 (p < 0.0001, ECOG-PS 0 as a standard) were independent predictors. In the receiver operating characteristic curve analysis on the prognostic value of the SARC-F score, the sensitivity/specificity was 0.59/0.70, and best cutoff point of the SARC-F score was two. In conclusion, the SARC-F score is useful in patients with gastrointestinal advanced malignancies.

Psychometric Properties at Indonesian Version of the Sport Anxiety Scale-2: Testing on Elite Athletes of Papua, Indonesia

This study aims to adapt and validate the Indonesian version of the Sport Anxiety Scale-2 (SAS-2Id). Data were obtained from a total of 268 (male = 154 and female = 114) elite athletes of Papua Indonesia with an age range of 16 to 43 years (M = 22.40 ± 5.01). Furthermore, language adaptation and validation were carried out through a forward-backward translation process using confirmatory factor analysis (CFA). An internal consistency approach was used to test for the reliability based on Construct Reliability (CR). The results evaluating the fit of the models showed that the SAS-2Id fits based on RMSEA, CFI, TLI, and PNFI. The three dimensions of SAS-2Id had standardized coefficient values from .77 to .81, with a significant p-value of ≤ .001. The SAS-2Id item factor loading values ranged from .51 to .88, indicating that it is above the recommended threshold (≥ .50). Furthermore, the reliability test carried out using the internal consistency approach discovered that the dimensions of worry (AVE = .60) and concentration disruption (AVE = .50) were above the recommended cutoff points. In contrast, the somatic dimension had the lowest value (AVE = .35). However, from the other two reliability test parameters, it was discovered that the CR and Cronbach's Alpha values were from .73 to .88 and .71 to .88, respectively, which indicated good reliability values. Therefore, the psychometric property at the Indonesian version of the SAS-2 is a valid and reliable measuring instrument for anxiety levels.

Abstract 061: Comparison Of Diagnostic Methods For Diabetes Diagnosis In Patients With Heart Failure: A National Health And Nutrition Examination Survey Analysis

Introduction: The use of hemoglobin A1c (HbA1c) to screen for diabetes in patients with cardiovascular disease has shown low sensitivity, and the currently recommended cutoff point may leave many patients undiagnosed. The objective of the study was to examine the degree of agreement among current diagnostic methods for diabetes, including HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) among community-dwelling heart failure (HF) patients. Methods: We included 237 HF participants (20+ years) without history of diabetes or diabetes medication use, using data from the 2005-2016 National Health and Nutrition Examination Survey cycles. Diagnostic criteria for diabetes were based on the American Diabetes Association (ADA) guidelines: (1) HbA1c ≥ 6.5%, (2) FPG ≥ 126 mg/dL, and (3) 2hPG after OGTT ≥ 200 mg/dL. The sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve for HbA1c and FPG were examined against the OGTT (FPG ≥ 126 mg/dL and/or 2hPG ≥ 200 mg/dL) as the reference method. Results: Included participants had a mean age of 65±1 (SE) years, 45.5% were female, and 12.5% were non-Hispanic black. Among included participants, 50 patients were newly diagnosed with diabetes based on ADA guidelines. Hemoglobin A1c alone identified only 27.0% of patients, whereas the OGTT identified 90.1% of patients. The area under the ROC curve, assessing HbA1c performance for the diagnosis of diabetes defined by OGTT, was 0.76 (95% CI, 0.67-0.84). Sensitivity and specificity using the HbA1c cutoff at ≥ 6.5% were 19.1% and 97.5%, respectively. The Youden’s J statistic for HbA1c was maximized at 5.8-5.9% (69.9-64.3% sensitivity and 63.9-70.1% specificity). Conclusion: Our data show that identification of diabetes among HF patients was inadequate on the basis of HbA1c screening alone. Our findings suggest diabetes screening on the basis of the OGTT or an HbA1c cutoff point of 5.8-5.9%.

Examining the optimal cutoff values of HADS, PHQ‐9 and GAD‐7 as screening instruments for depression and anxiety in irritable bowel syndrome

BackgroundSelf‐rating scales are frequently used to screen for anxiety and depression in patients with irritable bowel syndrome (IBS). Different cutoff values are recommended in literature, and guidelines have suggested the use of other screening instruments over time. The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cutoff scores for these instruments.MethodsIrritable bowel syndrome patients (n = 192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS‐A and HADS‐D subscale), Patient Health Questionnaire‐9 (PHQ‐9) and Generalized Anxiety Disorder‐7 (GAD‐7). Agreement at different cutoff points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient.Key ResultsHospital Anxiety and Depression Scale (HADS)‐D and PHQ‐9 scores, and HADS‐A and GAD‐7 scores showed high correlations (rs = 0.735 and rs = 0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cutoff points from literature were compared (PHQ‐9 cutoff ≥10, HADS‐D cutoff ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cutoff points from literature were compared (GAD‐7 cutoff ≥10, HADS‐A cutoff ≥8). Even higher agreements were found when higher HADS cutoff values were chosen, with impact on sensitivity and specificity.Conclusions & InferencesCustom cutoff values deem the HADS subscales (HADS‐D and HADS‐A) concordant to PHQ‐9 and GAD‐7 scores. The choice of a cutoff value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

TEMPS-A (short version) plays a supplementary role in the differential diagnosis between major depressive disorder and bipolar disorder.

Early differential diagnosis between patients with major depressive disorder (MDD) and bipolar disorder (BD), and subsequently providing appropriate treatments are essential. There has been increased interest regarding the association between affective temperaments and mood disorder diagnosis. Our aim was to analyze the diagnostic validity of affective temperaments assessed by the short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), in mood disorder patients. Inpatients with MDD (n = 146) or BD (n = 128) completed the short version of TEMPS-A, and their depressive and manic symptom severities were evaluated. Data of MDD and BD patients were compared by univariable and multivariable analyses. Of the five affective temperament dimensions, substantially higher hyperthymic, irritable, and cyclothymic temperament scores were found in BD patients than in MDD patients. Using a multivariable logistic regression model built using the severities of depressed and manic conditions, and the five affective temperament subscale scores as independent variables, we identified two factors statistically associated with BD diagnosis (anxious temperament and cyclothymic temperament). The recommended cutoff point for the 12 items evaluating cyclothymic temperament to differentiate BD from MDD was 8 or more 'True' items (sensitivity: 35.9%, specificity: 87.7%). Our design was cross-sectional, and therefore, there was a possibility of longitudinal diagnostic conversion of patients from MDD to BD. Cyclothymic and anxious temperaments on the short version of TEMPS-A, identified as diagnostic differentiating factors between MDD and BD, may play supplementary roles in the early identification of BD.

Assessment of Nutritional Status Based on Head Circumference among the Rajbanshi Children of North Bengal, India.

Malnutrition during childhood is still prevalent in parts of the world, with over three-quarters of the world’s malnourished children living in Southern Asia including India. Childhood malnutrition is a serious concern because it can affect the growth potential and the risk of morbidity and mortality in later life. Head circumference (HC) is one measure for evaluating the nutritional status of children during the first years of life when brain and skull are still growing. The present study assesses the nutritional status of Rajbanshi children in North Bengal by using WHO (2007) recommended cutoff points for head circumference. Age-combined mean HC was slightly higher among boys (46.8 cm) than girls (45.7 cm). We found the expected gradual increase of mean values with rising age of the children. The overall prevalence of age- and sex-combined malnutrition according to WHO cutoffs was 20.5%, 18.8% among boys and 22.2% among girls. The difference between boys and girls was not statistically significant. Regular monitoring of the physical status of children who are at risk of malnutrition is recommended.

Prevalence of Anemia and Associated Factors among Secondary School Adolescent Girls in Jimma Town, Oromia Regional State, Southwest Ethiopia.

Background Anemia defined as a low blood hemoglobin concentration is public health importance. The adolescence age group is the most neglected in public health and nutrition research as priorities are usually given to pregnant women, lactating mothers, and their children less than 2 years. Current Ethiopian Food and Nutrition policy included adolescent girls in the most at-risk group for nutritional demands; however, only a few published studies have assessed a deficiency of anemia and associated factors to tackle the intergenerational cycle of malnutrition. Objective To assess the prevalence of anemia and associated factors among high school adolescent girls in Jimma town. Methods Data were collected from 528 secondary school adolescent girls by a school-based cross-sectional study design in Jimma town from 1/1/2019 to 1/2/2019, southwest Ethiopia. A multistage sampling technique was used to select the study participants. A portable battery-operated HemoCue Hb 301+ analyzer was used to measure the hemoglobin level, and then reading was classified as normal Hb ≥ 12 g\\dl and anemic if the hemoglobin value <12 g/dl based on the WHO 2011 recommended cutoff points after adjustments to altitude was made. Bivariate analysis at p value ≤0.25 was considered as a candidate for multivariable logistic regression. Multivariable logistic regression was done to control for confounders and to identify factors independently associated with anemia. Level of statistical significance was declared at p < 0.05. Results A total of 528 adolescent girls were included in the study yielding a response rate of 95.8%. The prevalence of anemia was found to be 26.7%, 95% CI (22.7, 30.50). In multivariate logistic regression analysis, those living separately from their family (AOR = 4.430, 95% CI (2.20, 8.90)), low dietary diversity score (AOR = 3.57, 95% CI (1.88, 6.75)), menstrual bleeding more than 5 days (AOR = 2.25, 95% CI (1.17, 4.33)), and low economic status (AOR = 2.16, 95% CI (1.17, 4.33)) were positively associated factors with anemia and only having at least a secondary school in mother's educational status AOR = 0.43, 95% CI (0.18, 0.97) was negatively associated with anemia in the study area. Conclusion Prevalence of anemia among school adolescent girls was moderate public health importance according to the World Health Organization prevalence estimation of anemia. The living condition of the adolescent girls, dietary diversity score, duration of menses, and low economic status were positive predictor variables, whereas mothers who are being secondary school and above was a protective factor for anemia. Therefore, iron-rich and diversified food consumption should be given attention.

Internet addiction severity and risk for psychopathology, serious mental illness, and suicidalities: a cross-sectional study

BackgroundInternet addiction is a major global concern and health burden, compounded by the advances of Internet Plus and artificial intelligence. There is controversy on the question of recognising some types of internet addiction as mental illness, largely because there is no consensus on its link to mental health outcomes. We investigated the associations between internet addiction severity and several mental health outcomes including four psychopathologies, serious mental illness, and suicidalities. MethodsIn this cross-sectional study, all first-year undergraduate students enrolled in Sichuan University (Chengdu, China) during 2015–18 were invited to participate in the study survey. Participants were required to finish the whole questionnaire (online) by Oct 31 of their enrolment year. We excluded participants who did not respond completely, did not complete the questionnaire by the deadline, were not aged 15–23 years, or who provided obviously dishonest information (eg, selecting the same choice for all questions or several users having the same unique ID). The severities of internet addiction were categorised using Young's 20-item internet addiction test (normal 0–30 points, mild 31–49, moderate 50–79, and severe 80–100). The four psychopathologies were defined according to the recommended cutoff points of the 15-item Patient Health Questionnaire (high somatic symptom severity), the 9-item Patient Health Questionnaire (clinically significant depression), and the Symptom Checklist-90 (psychoticism and paranoia). Serious mental illness was screened using the 6-item Kessler Psychological Distress Scale (cutoff 12–13 points), and lifetime suicidal ideation, planning, and attempts were measured with the Suicidal Behaviours Questionnaire-Revised. Prevalence among student demographics or internet addiction severity groups was compared with the χ2 test, adjusted odds ratios (ORs) of mental health outcomes in addiction severity groups were compared using binary logistic regression adjusted for demographic confounders (ie, age, sex, and enrolment year), and interactions between psychopathologies were assessed using a two-tailed alpha of 0·05. Findings37 187 undergraduate students enrolled in the university during the study years. 34 140 (91·8%) of them agreed to participate and accessed the online survey system, and 32 269 (86.8%) responded fully. 12 254 (38·0%) students had mild internet addiction, 2057 (6·4%) had moderate addiction, and 67 (0·2%) had severe addiction. The prevalence and risks of the four psychopathologies and their comorbidities, serious mental illness, and suicidalities increased significantly with internet addiction severity (p values from 0·0003 to <0·0001), and most increments in risk were large (ORs increasing more than four times, except for suicidalities) for students with moderate and severe internet addiction. Prevalence of clinically significant depression, most strongly associated with internet addiction after adjustment for demographics and psychopathologies, increased from 1·0% (95% CI 0·9–1·2) for students with no addiction to 4·9% (4·5–5·3) for those with mild addiction, 24·8% (22·9–26.7) for those with moderate addiction, and to 56·7% (44·5–68·9) for those with severe addiction. Risk for the three addiction groups compared with the no-addiction group increased accordingly (OR 4·2 [95% CI 3·6–5·0] for mild, 18·9 [15·7–22·9] for moderate, and 59·9 [33·5–107·2] for severe addiction). Prevalence of the four psychopathologies increased from 4.1% (3·8–4·4) in students with no addiction to 36.8% (34·7–38·9) in those moderately addicted and to 67.2% (55·6–78·7) for those severely addicted. Similarly, prevalence increased from 25.0% (24·4–25·6) to 67·5% (65·6–69·6) and 71·6% (60·6–82·7) for suicidal ideation, from 2·6% (2·4–2·8) to 16·5% (14·9–18·1) and 32·8% (21·3–44·4) for suicidal plans, and from 0·5% (0·4–0·6) to 3·6% (1·1–1·5) and 11·9% (4·0–20·0) for suicidal attempts. InterpretationOur study format does not allow us to identify possible causal relationships between internet addiction and mental health comorbidities, but allows us to compare the prevalence and risk of these outcomes through our large population size (to our knowledge, the largest to date in such a study) and methodology. Internet addiction was strongly associated with several adverse mental health outcomes, supporting the validity of defining moderate and severe, but not mild, internet addiction as mental illness. FundingNational Scientific and Technical Fund of China (grant 81571305), Department of Science and Technology of Sichuan Provincial Government (grant 2019YFS0153), and 1.3.5 Project for Disciplines of Excellence, West China Hospital.

Construção e validação de cartilha educativa para promoção da alimentação saudável entre pacientes diabéticos

Objective: To describe the process of construction and validation of the content of an educational booklet aimed at teaching about healthy eating for patients with diabetes mellitus. Methods: This is a methodological research with a bibliographical study that carried out the development and validation of the material by experts. The seven experts were specialized in diabetes and/or had at least two years of experience in the field: two nurses, one physiotherapist and four nutritionists. The booklet items evaluated were objective, content, language, relevance, illustrations, layout, and motivation and culture. Each item was analyzed separately using a Likert scale. The analysis of the validation of the educational technology was carried out using the Content Validity Index (CVI) with a recommended cutoff point higher than 0.78. Results: The educational booklet presented an overall CVI of 0.96. Only two items presented CVI values below the adopted limit. The experts recommended changes in the appearance and content for the refinement of the booklet that were included in the final version. Conclusion: The educational booklet for nutritional guidance of patients with diabetes mellitus was constructed and validated in terms of appearance and content by experts and should, therefore, be considered to improve adherence to nutritional therapy. Thus, the material will support professionals and patients with diabetes in overcoming the difficulties that permeate nutrition-related self-care for disease control.

Using Anthropometric Indicator to Identify Hypertension in Adolescents: A Study in Sarawak, Malaysia.

This cross-sectional study was conducted to determine the predictive power of anthropometric indicators and recommend cutoff points to discriminate hypertension among adolescents in Sarawak, Malaysia. A total of 2461 respondents aged 12-17 years participated in this study with mean age of 14.5±1.50 years. All anthropometric indicators had significant area under the ROC curve, with body mass index (BMI) and waist circumference (WC) ranging from 0.7 to 0.8. The best anthropometric indicators for predicting hypertension for boys were WC, BMI, and waist-to-height ratio (WHtR). For girls, BMI was the best indicators followed by WHtR and WC. The recommended BMI cutoff point for boys was 20 kg/m2 and 20.7 kg/m2 for girls. For WC, the recommended cutoff point was 67.1 cm for boys and 68.2 cm for girls. BMI and WC indicators were recommended to be used at the school setting where the measurement can easily be conducted.

Validation and Reliability of the Korean Version of the Sport Anxiety Scale-2.

The main purpose of the present study was to examine the validation and reliability of the Korean version of the Sport Anxiety Scale (SAS-2Kr) by evaluating its factorial invariance across gender. A total of 303 Korean collegiate athletes (198 males and 105 females) from 9 sports participated in the study, and they completed the demographic questionnaire and the SAS-2Kr containing 15 items to measure multidimensional trait anxiety and individual differences in the cognitive and somatic anxiety experienced by athletes. The results of this study indicated that the construct validity in the SAS-2Kr was well established in that the values of the standardized factor loadings, composite reliability, and average variance extracted values were above the recommended cutoff points. The multiple-sample confirmatory factor analyses showed the SAS-2Kr could be generalizable across gender in college samples. The results also indicated that the SAS-2Kr supported the original 3-factor model of SAS-2 in English consisting of somatic anxiety, worry, and concentration disruption, and thus this study provides useful information for researchers to understand the athletes’ tendency to experience anxiety reactions in sport situations. Suggestions for future research on competitive trait anxiety are provided in the discussion section.

Dysmobility syndrome: is exercise a key component in its prevention and treatment?

Dysmobility syndrome (DS) represents a cluster of six factors (some of them major public health problems) with a shared pathogenesis used to identify older adults at risk of a wide range of adverse health outcomes. This commentary discusses the role of exercise, a type of physical activity, in the prevention and treatment of this condition. To accomplish the purpose of this commentary, we contextualize DS providing its definition, risk factors and recommended cutoff points for each factor. We further provide the current prevalence of DS and its impact on the health of older adults. This commentary also provides information on the benefits of exercise on each of the recommended factors in isolation. We end the commentary with a brief research agenda that we believe will help establish exercise as a treatment approach for DS. The prevalence of DS is of great concern, and this condition has been found to be associated with a large array of adverse health outcomes including falls, a major public health problem. Based on the identified factors comprising DS, the current literature provides substantial evidence of the benefits of exercise to prevent this condition. However, to the best of our knowledge, no studies have been carried out to examine the effects of exercise on DS. While the value of DS over and above other more established measures such as frailty may be questionable, the DS criteria at least provide a great opportunity for early identification of important deficits that can compromise independency and quality of life later in life.

\u201cHypothyroidism screening during first trimester of pregnancy\u201d

BackgroundSubclinical hypothyroidism is defined as an elevated thyroid-stimulating hormone level with a normal thyroxin level without signs or symptoms of hypothyroidism. Although it is well accepted that overt hypothyroidism has a deleterious impact on pregnancy, recent studies indicate that subclinical hypothyroidism may affect maternal and fetal health. Studies suggest an association between miscarriage and preterm delivery in euthyroid women positive for anti-peroxidase antibodies and/or anti-thyroglobulin antibodies. A proposal of a new set-point to diagnose SCH was recently published. The aim of this research was to determine the optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of our clinical area and to determine the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies.MethodsThis cross-sectional study determines the cutoff point for SCH screening and evaluates its usefulness to detect TPO Ab using the Receiver Operating Characteristics (ROC) curve. Prevalence of SCH was calculated using as cut-off 2.5 mIU/L, 4 mIU/L, and our TSH 97.5th percentile. The ability to detect positive anti-thyroglobulin antibodies (TG Ab) and anti-thyroid peroxidase antibodies (TPO Ab) in patients with levels of TSH >97.5th percentile was determined by ROC curves.ResultsThe mean, range and standard deviation of TSH was 2.15 ± 1.34 mIU/L (range 0.03–8.82); FT4 was 1.18 ± 0.13 ng/dL (range 0.94–1.3); TG Ab was 89.87 ± 413.56 IU/mL (range 0.10–4000); and TPO Ab was 21.61 ± 46.27 IU/mL(range 0.10–412.4). The ROC. analysis of the ability of the TSH level to predict the presence of positive TPO Ab found an AUC of 0.563.ConclusionIn our population, the TSH cutoff value for gestational SCH screening is 4.7 mIU/L. Using the SEGO recommended 2.5 mIU/L TSH cut-off point, the prevalence of SCH is 37%. Applying the ATA 2017 recommended cutoff point of 4 mIU/L, the prevalence of SCH is 9.6%. Finally, when the cut-off of 4.7 mIU/L (our 97.5th centile) was used, the SCH prevalence is 5%. TSH levels in the first trimester of pregnancy are not useful to detect TPO Ab.

Psychomotor Vigilance Test and Its Association With Daytime Sleepiness and Inflammation in Sleep Apnea: Clinical Implications.

Excessive daytime sleepiness (EDS) is a key symptom of obstructive sleep apnea (OSA). The Psychomotor Vigilance Task (PVT) has been suggested as an objective easy-to-use, inexpensive alternative to the Multiple Sleep Latency Test (MSLT) to measure EDS. In patients with OSA, physiological sleepiness, but not subjective EDS (Epworth Sleepiness Scale [ESS]), has been associated with increased levels of the sleep- inducing proinflammatory cytokine interleukin-6 (IL-6). The goal of this study was to assess the association of PVT with objectively measured sleepiness (MSLT) and subjectively measured sleepiness (ESS) and IL-6 levels in patients with OSA. We studied 58 untreated patients with OSA who underwent an 8-hour in-laboratory polysomnography for 4 consecutive nights. MSLT, PVT, and 24-hour serial profiles of IL-6 were assessed on the fourth day. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times, and median of 1/reaction time. ESS was assessed on day 1 of the study. Higher ESS scores were significantly associated with greater number of lapses (β = .34, P = .02) and lower values of 1/RT (β = -.36, P = .01) and slowest 10% RTs (β = -.30, P = .04). No significant association was observed between PVT and MSLT, nor PVT and IL-6 levels. Our findings suggest that PVT is associated with subjectively assessed daytime sleepiness, but not with physiological sleepiness nor IL-6 levels in patients with OSA. It appears that ESS and PVT may be useful in predicting risks associated with impaired performance, such as traffic accidents, in patients with OSA.