Specific Cut-off Points Research Articles

Cost-effectiveness of glaucoma screening in cataract camps versus opportunistic and passive screening in urban India: A study protocol

India has an estimated 12 million people affected with glaucoma; however, no organised screening programme exists. Cases are usually detected opportunistically. This study documents the protocol for detecting glaucoma in suspects in cataract camps conducted by Shroff Charity Eye Hospital in North India. We report a cost-effectiveness alongside prospective study design of patients attending cataract camps where glaucoma screening will be integrated. The eligible population for glaucoma screening is non-cataract patients. Patients will undergo glaucoma screening by a trained optometrist using a pre-determined glaucoma screening algorithm. Specific diagnostic cut-off points will be used to identify glaucoma suspects. Suspected patients will be referred to the main hospital for confirmatory diagnosis and treatment. This group will be compared to a cohort of patients arriving from cataract camps conducted by the institute in similar areas and undergoing examination in the hospital. The third arm of the study includes patients arriving directly to the hospital for the first time. Cost data will be captured from both the screening components of cataract-only and glaucoma screening-integrated camps for screening invitation and screening costs. For all three arms, examination and treatment costs will be captured using bottom-up costing methods at the hospital. Detection rates will be calculated by dividing the number of new cases identified during the study by total number of cases examined. Median, average and range of costs across the three arms will be calculated for cost comparisons. Finally, cost-effectiveness analysis will be conducted comparing cost per case detected across the three arms from a quasi-societal perspective with a time horizon of 1 year . Ethics approval for the study has been obtained from the institutional ethics committee of the hospital. The study protocol will be useful for researchers and practitioners for conducting similar economic evaluation studies in their context.

Costs, cost-effectiveness and detection rate of glaucoma screening in cataract camps in urban India: A study protocol

India has an estimated 12 million people affected with glaucoma; however, no organised screening programme exists. Cases are usually detected opportunistically. This study documents the protocol for detecting glaucoma in suspects in cataract camps conducted by Shroff Charity Eye Hospital in North India. We report a prospective study design from patients attending cataract camps where glaucoma screening will be integrated. The eligible population for glaucoma screening is non-cataract patients. Patients will undergo glaucoma screening by a trained optometrist using a pre-determined glaucoma screening algorithm. Specific diagnostic cut-off points will be used to identify glaucoma suspects. Suspected patients will be referred to the main hospital for confirmatory diagnosis and treatment. This group will be compared to a cohort of patients arriving from cataract camps conducted by the institute in similar areas and undergoing examination in the hospital. The third arm of the study includes patients arriving directly to the hospital for the first time. Cost data will be captured from both the screening components of cataract-only and glaucoma screening-integrated camps for screening invitation and screening costs. For all three arms, examination and treatment costs will be captured using bottom-up costing methods at the hospital. Detection rates will be calculated by dividing the number of new cases identified during the study by total number of cases examined. Median, average and range of costs across the three arms will be calculated for cost comparisons. Finally, cost-effectiveness analysis will be conducted comparing cost per case detected across the three arms. This is the first such study conducted in India. The study protocol will be useful for researchers and practitioners for conducting similar economic evaluation studies in their context. The protocol publication will be a good step to ensure transparency of methods of reporting of economic evaluation studies in LMICs.

High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity.

To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents. Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated. The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group. BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

Molecular Remissions with Anti-CD22 Recombinant Immunotoxin Moxetumomab Pasudotox Are Associated with Improved Complete Remission Durations during Phase I and III Testing

BACKGROUNDHairy cell leukemia (HCL) is an indolent B-cell malignancy strongly expressing CD22, with high sensitivity to purine analog chemotherapy, but relapses frequently occur, associated with minimal residual disease (MRD). Targeted non-chemotherapeutic approaches have shown efficacy but leave MRD. Moxetumomab pasudotox is an anti-CD22 recombinant immunotoxin recently reported in relapsed/refractory HCL to achieve 57% and 51% complete remission (CR) rates in phase 1 and 3 testing, respectively. Eradication of MRD by bone marrow flow cytometry or immunohistochemistry was associated with improved CR duration. We have previously reported that Taqman real-time quantitative PCR (RQPCR), which amplifies patient- and HCL-specific B-cell immunoglobulin rearrangements (IGHV), can detect one HCL cell in 106 normal cells. In the present study we determined whether MRD eradication measured by RQPCR is associated with improved CR duration. METHODSA total of 28 patients achieving CR to moxetumomab pasudotox in phase 1 (n=18) and phase 3 (n=10) trials were studied at the National Institutes of Health by multicolor flow cytometry of the bone marrow aspirate (BMA) and blood. Patients received moxetumomab pasudotox at 40-50 mcg/Kg on days 1, 3 and 5 of 2-7 cycles (median 5) at 4-week intervals. Blood and bone marrow samples were obtained to determine CR. In addition to end of treatment, bone marrow samples for MRD were generally obtained every 6-12 months for 2.5 years, then every other year. Blood flow cytometry was obtained every 6 months for 2.5 years, then yearly. Follow-up (time since treatment initiation) was 26.9-121.8 (median 84) months. For this analysis, CR for each bone marrow time point was determined by standard criteria for all patients independent of specific data-reporting requirements and data cut-off time points. RQPCR testing for each patient required cloning the immunoglobulin heavy chain variable regions and designing sequence-specific primers and probes. RNA samples were made from PAXgene tubes of blood and sodium-heparin tubes of BMA. RESULTSWe found that BMA RQPCR was most sensitive, followed by BMA flow cytometry, blood RQPCR, and blood flow cytometry. Of the 28 patients studied, 12 (43%) achieved MRD-free CR by all 4 tests and 2 of 12 patients (17%) relapsed. Seven (25%) were MRD+ by BMA RQPCR but negative by the other 3 studies, and none relapsed. One patient RQPCR+ and flow-negative in both blood and BMA relapsed. Seven patients flow-negative but RQPCR+ in blood, flow+ in BMA, and either BMA RQPCR+ or RQPCR not done, all relapsed. One patient with BMA RQPCR not done and the other 3 studies positive relapsed. With respect to RQPCR of blood as a single test, 3 of 20 negative vs 8 of 8 positive patients relapsed (p<0.001). Median CR duration was 13.0 months in blood RQPCR+ patients, vs not reached in blood RQPCR-negative patients, 17 (85%) of whom remain in CR at 11.6-112.9 (median 53) months of follow-up. With respect to BMA status, 2 of 12 patients negative vs 9 of 16 patients positive by either flow or RQPCR relapsed (p=0.054), and the 12 BMA MRD-negative patients had longer CR duration than the other 16 patients (p=0.018). CONCLUSIONSRQPCR negativity of blood is strongly associated with prolonged CR duration after moxetumomab pasudotox and may be a useful measure of MRD when bone marrow studies cannot be done. Additional testing will be needed to determine if blood RQPCR can be used to determine the optimal number of cycles of immunotoxin to administer. BMA RQPCR, though more sensitive than blood RQPCR, was not as useful due to fewer patients being evaluable and more time needed for BMA-RQPCR+ patients to relapse. Additional testing and follow-up may determine if BMA RQPCR negativity will correlate significantly with CR duration. [Display omitted] DisclosuresYao:MedImmune: Employment. Marshall:MedImmume: Employment. Pastan:NIH: Patents & Royalties: Co-inventor on the NIH patent for Moxetumomab Pasudotox. Kreitman:NIH: Patents & Royalties: Co-inventor on the NIH patent for Moxetumomab Pasudotox.

Design and Validation of Mizaj Identification Questionnaire in Persian Medicine

Background: Paying attention to individual differences in presenting health directives is the most important properties of Persian Medicine (PM). Accordingly, individuals in each society are divided into nine Mizaj groups. Access to the standard diagnostic scale is one of the research priorities of PM. Objectives: The present study aimed at designing a preliminary self-administered Mizaj questionnaire, and assessed its reliability and validity. Materials and methods: For this exploratory sequential study, Mizaj identification indices were extracted using PM references, and people and PM experts’ interviews. The preliminary questionnaire was designed and the validity and reliability of the questionnaire were evaluated using weighted Kappa statistics (> 0.4), ICC and ROC curve, and determining the sensitivity and specificity of cut-off points. Results: Overall, 15 PM experts, and 221 volunteers participated in various stages of this study. Among 119 designed questions for 30 Mizaj identification indices, 60 items had acceptable reliability. The final questionnaire containing 20 items was extracted after the validity assessment. The sensitivity and specificity of this questionnaire at the specified cut-off points were 71% and 68% for warmness, 63% and 71% for temperance in warmness-coldness, 80% and 57% for coldness, 74% and 58% for wetness, 71% and 69% for temperance in wetness-dryness, and 78% and 85% for dryness, respectively. Conclusions: This is the first standard Mizaj identification questionnaire, which includes more dimensions of Mizaj identification and can be used for individuals aged 20 to 60 years old. This questionnaire is recommended for Mizaj identification researches and as a supplementary diagnostic scale for clinical activities of Persian Medicine practitioners.

Sex-specific echocardiographic reference values: the women's point of view.

: Clinical presentation, diagnosis and outcomes of cardiac diseases are influenced by the activity of sex steroid hormones. These hormonal differences explain the later development of heart diseases in women in comparison with men and the different clinical picture, management and prognosis. Echocardiography is a noninvasive and easily available technique for the analysis of cardiac structure and function. The aim of the present review is to underline the most important echocardiographic differences between sexes. Several echocardiographic studies have found differences in healthy populations between women and men. Sex-specific difference of some of these parameters, such as left ventricular (LV) linear dimensions and left atrial volume, can be explained on the grounds of smaller body size of women, but other parameters (LV volumes, stroke volume and ejection fraction, right ventricular size and systolic function) are specifically lower in women, even after adjusting for body size and age. Sex-specific differences of standard Doppler and Tissue Doppler diastolic indices remain controversial, but it is likely for aging to affect LV diastolic function more in women than in men. Global longitudinal strain appears to be higher in women during the childbearing age - a finding that also highlights a possible hormonal influence in women. All these findings have practical implications, and sex-specific reference values are necessary for the majority of echocardiographic parameters in order to distinguish normalcy from disease. Careful attention on specific cut-off points in women could avoid misinterpretation, inappropriate management and delayed treatment of cardiac diseases such as valvular disease and heart failure.

The usefulness of reticulocyte haemoglobin content, serum transferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1-16years.

This cross-sectional study, conducted on a population-based representative sample, evaluates the usefulness of reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin (sTfR-F index) to recognise iron deficiency (ID) without anaemia, provides specific cut-off points for age and gender, and proposes a new definition of ID. A total of 1239 healthy children and adolescents aged 1-16years were included. Complete blood count, iron biomarkers, erythropoietin, C-reactive protein, CHr, sTfR, and sTfR-F index were determined. ROC curves were obtained and sensitivity, specificity, predictive values, likelihood ratios, and accuracy for each specific cut-off points were calculated. Seventy-three had ID without anaemia. Area under the curve for sTfR-F index, sTfR and CHr were 0.97 (CI95% 0.95-0.99), 0.87 (CI95% 0.82-0.92) and 0.68 (CI95% 0.61-0.74), respectively. The following cut-off points defined ID: sTfR-F Index > 1.5 (1-5years and 12-16years boys) and > 1.4 (6-11years and 12-16years girls); sTfR (mg/L) > 1.9 (1-5years), > 1.8 (6-11years), > 1.75 (12-16years girls) and > 1.95 (12-16years boys); and CHr (pg) < 27 (1-5years) and < 28.5 (6-16years).Conclusions: CHr, sTfR and the sTfR-F indexare useful parameters to discriminate ID without anaemia in children and adolescents, and specific cut-off values have been established. The combination of these new markers offers an alternative definition of ID with suitable discriminatory power. What is Known: • In adults, reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin index (sTfR-F index) have been evaluated and recognised as reliable indicators of iron deficiency (ID). • Clinical manifestations of ID may be present in stages prior to anaemia, and the diagnosis of ID without anaemia continues to pose problems. What is New: • CHr, sTfR and the sTfR-F index are useful parameters in diagnosis of ID in childhood and adolescence when anaemia is not present. • We propose a new strategy for the diagnosis of ID in childhood and adolescence, based on the combination of these measures, which offer greater discriminatory power than the classical parameters.

Association of Serum TSH With Handgrip Strength in Community-Dwelling Euthyroid Elderly.

Despite apparent muscle weakness in overt or even subclinical hyperthyroidism, the effects of thyroid function in the reference range on muscle strength are unknown. To investigate the association of serum TSH and free T4 with handgrip strength (HGS) in euthyroid elderly. A nationally representative population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys. A total of 650 men aged ≥50 years and 533 postmenopausal women. HGS was measured using a digital grip strength dynamometer, and low muscle strength was defined based on the Korean specific cutoff point of HGS (28.9 and 16.8 kg in men and women, respectively). After adjustment for confounders, lower serum TSH but not free T4 was associated with lower HGS in men (P = 0.032). Compared with men with high-normal TSH, those with low-normal TSH consistently showed 5.0% lower HGS (P = 0.027), with a linear decrease in HGS across decreasing serum TSH quartiles (P for trend = 0.018). Men with low muscle strength had 22.0% lower serum TSH than those without (P = 0.015), and the odds for the risk of low muscle strength was 3.76 times higher among men with low-normal TSH than it was among those with high-normal TSH (P = 0.021). However, these associations were not observed in postmenopausal women. These results suggest that serum TSH level at the lower end of reference range may be associated with low muscle strength, especially in older men.

Relative value of serum pregnancy-associated plasma protein A (PAPP-A) and GRACE score for a 1-year prognostication: A complement to calculation in patients with suspected acute coronary syndrome.

The Global Registry of Acute Coronary Events (GRACE) study produced a scale for risk stratification in acute coronary syndromes (ACSs). Pregnancy-associated plasma protein A (PAPP-A) serum concentration was implicated as a marker of unstable atherosclerotic plaques. We hypothesized that the measurement of the concentration of PAPP-A on admission may improve the stratification of cardiovascular risk in suspected ACS patients. We studied 70 patients with chest pain suggesting ACS diagnosis on admission. Serum cardiac biomarkers and PAPP-A were measured on top of the standard biochemical panel, and the GRACE risk score was calculated. A 12-month follow-up was completed to major adverse cardiac events (MACE): death, myocardial infarction (MI), need for percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG), unplanned cardiovascular hospitalization. In hospital/6-month GRACE, low risk was found in 35 patients (50%)/37 patients (53%), intermediate risk in 23 patients (33%)/21 patients (30%) and high risk in 12 patients (17%)/12 patients (17%). Mean PAPP-A was 39.64 mlU/L (standard deviation - SD 24.2), and median PAPP-A values for in hospital/6-month GRACE were 21.49 mlU/L (quartile 1st; 3rd - 13.41; 32.65) and 22.61 mlU/L (14.03; 34.1) for low risk patients, 51.76 mlU/L (35.18; 59.99) and 51.76 mlU/L (28.9; 62.1) for intermediate risk patients, and 68.82 mlU/L (58.54; 83.76) for high risk patients. The PAAP-A concentration with specific cut-off points had 66.7% positive predictive value (PPV) and 95.5% negative predictive value (NPV) for death, 33.3% PPV and 80.6% NPV for MI, 71.4% PPV and 57.1% NPV for any event. Intermediate and high in hospital/6-months GRACE had 14.3%/15.2% PPV and 100%/100% NPV for death, 34.3%/33.3% PPV and 94.3%/91.9% NPV for MI, 74.3%/72.7% PPV and 65.7%/62.2% NPV for any event. The PAPP-A serum concentration represents a promising prognostic biomarker with significantly improved PPV. The GRACE score is superior to stratification based on PAPP-A with regard to combined cut-off point for 1-year mortality.

Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index

We assessed the predictive value of prostate specific antigen density to detect clinically significant prostate cancer, defined as prostate cancer grade group 2 or greater, in a series of men undergoing prostate biopsy with prostate specific antigen 4 to 10 ng/ml. We sought to define an optimum cutoff point for prostate specific antigen density and assess how race and body mass index affects prostate specific antigen density performance. We analyzed data on 2,162 men, of whom 56% were African American, with serum prostate specific antigen 4 to 10 ng/ml who underwent prostate biopsy. We compared the AUC between prostate specific antigen and prostate specific antigen density to predict clinically significant and any prostate cancer vs no cancer. We calculated the negative predictive value of prostate specific antigen density cutoff points ranging from 0.05 to 0.15 by every 0.01 step. We a priori defined the optimal cutoff point of prostate specific antigen density as a negative predictive value of 95% and tested whether the cutoff was sensitive to body mass index and race by comparing the negative predictive value across strata. Median prostate specific antigen was 5.6 ng/ml (IQR 4.8-7) and median prostate specific antigen density was 0.15 ng/ml/cc (IQR 0.1-0.22). Prostate specific antigen density improved the performance of prostate specific antigen to detect significant cancer (AUC 0.58 to 0.68) and any cancer (AUC 0.55 to 0.69, each p <0.001). We identified a prostate specific antigen density cutoff point of less than 0.08 ng/ml/cc with a 96% negative predictive value for grade group 2 or greater. This was largely unchanged among different races and body mass indexes. Regardless of race or body mass index men with prostate specific antigen density less than 0.08 were unlikely to harbor grade group 2 or greater disease when prostate specific antigen was 4 to 10 ng/ml. If validated, prostate specific antigen density is a simple inexpensive and available tool that can be used to identify men who can likely forego prostate biopsies, thus reducing the over detection and morbidity of unnecessary biopsies.

Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

ObjectiveTo examine the association between an overall maternal healthy lifestyle (characterized by a healthy body mass index, high quality diet, regular exercise, no smoking, and light to moderate alcohol intake)...

Validity of the third molar maturity index I3M for indicating the adult age in the Polish population

This study aimed to assess the application of Cameriere’s third molar maturity index (I3M) to select an individual of 18years or older (adult) from younger than 18years (minor) in a sample of Polish individuals. The final sample of 982 panoramic images aged between 15 to 24years was analyzed. The specific cut-off value of I3M<0.08 was analyzed. The specificity (Sp) and sensitivity (Se) for males were 91.2% and 86.2% respectively. The Sp and Se for females were 93% and 82.6% respectively. The probabilities of correctly classified individuals were 87.6% and 85.3%, and Bayes post-test probability was 96.3% and 97% in males and females respectively. Further analysis indicated the alternative cut-off value of I3M<0.07, which improved the specificity, 95.3%, and 94.7%, and worsen correct classification, 86.5%, and 84.4%, in males and females, respectively. Our results showed that the specific cut-off point of I3M<0.08 may be a useful tool for discriminating adults from minors in Poland.

Predictive model for distal junctional kyphosis after cervical deformity surgery

Background ContextDistal junctional kyphosis (DJK) is a primary concern of surgeons correcting cervical deformity. Identifying patients and procedures at higher risk of developing this condition is paramount in improving patient selection and care. PurposeThe present study aimed to develop a risk index for DJK development in the first year after surgery. Study Design/SettingThis is a retrospective review of a prospective multicenter cervical deformity database. Patient SamplePatients over the age of 18 meeting one of the following deformities were included in the study: cervical kyphosis (C2–7 Cobb angle>10°), cervical scoliosis (coronal Cobb angle>10°), positive cervical sagittal imbalance (C2–C7 sagittal vertical axis (SVA)>4 cm or T1-C6>10°), or horizontal gaze impairment (chin-brow vertical angle>25°). Outcome MeasuresDevelopment of DJK at any time before 1 year. MethodsDistal junctional kyphosis was defined by both clinical diagnosis (by enrolling surgeon) and post hoc identification of development of an angle<−10° from the end of fusion construct to the second distal vertebra, as well as a change in this angle by <−10° from baseline. Conditional Inference Decision Trees were used to identify factors predictive of DJK incidence and the cut-off points at which they have an effect. A conditional Variable-Importance table was constructed based on a non-replacement sampling set of 2,000 Conditional Inference Trees. Twelve influencing factors were found; binary logistic regression for each variable at significant cutoffs indicated their effect size. ResultsStatistical analysis included 101 surgical patients (average age: 60.1 years, 58.3% female, body mass index: 30.2) undergoing long cervical deformity correction (mean levels fused: 7.1, osteotomy used: 49.5%, approach: 46.5% posterior, 17.8% anterior, 35.7% combined). In 2 years after surgery, 6% of patients were diagnosed with clinical DJK; however, 23.8% of patients met radiographic definition for DJK. Patients with neurologic symptoms were at risk of DJK (odds ratio [OR]: 3.71, confidence interval [CI]: 0.11–0.63). However, no significant relationship was found between osteoporosis, age, and ambulatory status with DJK incidence. Baseline radiographic malalignments were the most numerous and strong predictors for DJK: (1) C2-T1 tilt>5.33 (OR: 6.94, CI: 2.99–16.14); (2) kyphosis<−50.6° (OR: 5.89, CI: 0.07–0.43); (3) C2–C7 lordosis<−12° (OR: 5.7, CI: 0.08–0.41); (4) T1 slope minus cervical lordosis>36.4 (OR: 5.6, CI: 2.28–13.57); (5) C2-C7 SVA>56.3° (OR: 5.4, CI: 2.20–13.23); and (6) C4_Tilt>56.7 (OR: 5.0, CI: 1.90–13.1). Clinically, combined approaches (OR: 2.67, CI: 1.21–5.89) and usage of Smith-Petersen osteotomy (OR: 2.55, CI: 1.02–6.34) were the most important predictors of DJK. ConclusionsIn a surgical cohort of patients with cervical deformity, we found a 23.8% incidence of DJK. Different procedures and patient malalignment predicted incidence of DJK up to 1 year. Preoperative T1 slope-cervical lordosis, cervical kyphosis, SVA, and cervical lordosis all strongly predicted DJK at specific cut-off points. Knowledge of these factors will potentially help direct future study and strategy aimed at minimizing this potentially dramatic occurrence.

Prevalence of dynapenia and presarcopenia related to aging in adult community-dwelling Mexicans using two different cut-off points.

To estimate the prevalence of dynapenia, presarcopenia, and sarcopenia in a Mexican community using two different cutoffs. This cross-sectional study included 724 subjects (521 women and 203 men) adults≥50years community-dwelling from Mexico City. We determined the prevalence of different muscle-related syndromes. Muscle strength was measured with handgrip strength and muscle mass was estimated by bioelectrical impedance. For the diagnosis of sarcopenia and presarcopenia, two criteria were used: (1) the cut-off points proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) and (2) the cut-off points less than two standard deviations for gender-specific mean of Mexicans young adults. Muscle mass decreases with age, but not as rapid as muscle strength. With the specific Mexican cut-off points, the general prevalences were: 27.4% for dynapenia (n=199), 12.8% for presarcopenia (n=93), and 6.6% for sarcopenia (n=48). In contrast, the prevalences were higher when we used the cut-off points for Caucasians (EWGSOP): 33.9% for dynapenia (n=246), 38.1% for presarcopenia (n=276), and 15.2% for sarcopenia (n=110). Diagnoses of dynapenia, presarcopenia, and sarcopenia should be estimated from cut-off points of the specific population; otherwise, it might be overestimated or underestimated. Early diagnosis of any of these conditions in community can prevent the occurrence of adverse effects.

Age effects on injury pattern of rear-seat child occupants in frontal crashes

This paper presents a study using 1997-2015 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) data to estimate the risk and body region distribution of injury for rear-seated children aged 4-18 using vehicle seat belts in frontal crashes and evaluate specific cut-off points for age as effect modifiers of the association between use of vehicle seat belts and their respectively significant injury. Logistic regression analyses were conducted to evaluate the factors affecting the injury risk for children aged 4-18. Results showed that seatbelt was the most common form of restraint for children older than four years of age seated in the rear seat. Children 8-12 years of age were at the highest risk of significant injury among children 4-18 years old. The risks of significant injury by body regions varied among children 4-18 years old due to the differences in anthropometry. Children 4-8 years of age appeared to be at increased risk of injury from using seat belts, whereas children 9-18 years of age experienced protective effects of using seat belts.

Age effects on injury pattern of rear-seat child occupants in frontal crashes

This paper presents a study using 1997-2015 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) data to estimate the risk and body region distribution of injury for rear-seated children aged 4-18 using vehicle seat belts in frontal crashes and evaluate specific cut-off points for age as effect modifiers of the association between use of vehicle seat belts and their respectively significant injury. Logistic regression analyses were conducted to evaluate the factors affecting the injury risk for children aged 4-18. Results showed that seatbelt was the most common form of restraint for children older than four years of age seated in the rear seat. Children 8-12 years of age were at the highest risk of significant injury among children 4-18 years old. The risks of significant injury by body regions varied among children 4-18 years old due to the differences in anthropometry. Children 4-8 years of age appeared to be at increased risk of injury from using seat belts, whereas children 9-18 years of age experienced protective effects of using seat belts.

Age of majority assessment in Dutch individuals based on Cameriere’s third molar maturity index

Radiological examination of the third molar is done in living individuals for estimation of chronological age, especially in the late adolescence. The aim of this study was to assess the application of Cameriere’s third molar maturity index (I3M) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor) in a sample of Dutch individuals. The sample consisted of panoramic images of 360 individuals aged between 14 and 22 years old. Three observers performed the measurements. Gender was not statistically significant in discriminating adults and minors. The highest value of the Youden index of the receiver operating curve analysis was for the value of I3M<0.08 in discriminating individuals as minor or adult. The specificity (Sp) and sensitivity (Se) results for females were 96.3% and 72.7% respectively. The Sp and Se for males were 95.0% and 84.0% respectively. The probabilities of correctly classified individuals were 83.3% and 88.9%, and Bayes post-test probability was 96.3% and 95.7% in females and males respectively. Obtained results showed that the specific cut-off point of I3M<0.08 may be a useful and reliable method for adult age assessment in a Dutch population.

Penentuan titik potong skor sindroma metabolik remaja dan penilaian validitas diagnostik parameter antropometri: analisis Riskesdas 2013

Background: The risk of death caused by non-communicable diseases is related to metabolic syndrome. Metabolic syndrome not only occurs in adults, but also occurs in adolescents. The problem of metabolic syndrome in adolescents shows the importance of early detection and management. Early detection of metabolic syndrome in adolescents can be done through non-invasive approaches such as anthropometric measurements. However, the definition of metabolic syndrome has so far not reached an agreement.Objective: This study aims 1) To know the intersection points of adolescent metabolic syndrome 2) To know the best anthropometry parameters for detecting metabolic syndrome in adolescents.Method: This study used cross sectional design, using Riskesdas 2013 survey data. The sample size of this study was 3273 adolescents aged 15-24 years. The analysis using receiver operating characteristic curve (ROC) indicated the accuracy of the score to diagnose metabolic syndrome, supported by area under the curve (AUC) results. The best parameters were seen from the largest AUC values, taking into account the sensitivity and specificity values.Results: The metabolic syndrome scores in general for Indonesian adolescents=2.21 (sensitivity=83%, specificity=84%). Specific cutoff point for women=2.02 (sensitivity=84%, specificity=85%), and for males=2.40 (sensitivity=86%, specificity=82%). The best anthropometric parameters for detecting metabolic syndrome in adolescents are abdominal circumference (AUC=0.77; sensitivity=71%, specificity=67%).Conclusion: Abdominal circumference has the best validity and can be used for early detection of the risk of metabolic syndrome in adolescents

The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry.

The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice.ResultsWe find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10–22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60–0.71). PDF and CUC do not suggest a specific cut-off point of clinical use.MethodsWe select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC).ConclusionsIn our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

Clinical assessment indicators of postpartum hemorrhage: A systematic review

Abstract Objective The assessment indicators of postpartum hemorrhage (PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention. Methods A systematic literature search of 9 databases was conducted according to inclusion and exclusion criteria using a comprehensive strategy. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) strategy was chosen as the tool for quality assessment of included studies, and data concerning the basic study characteristics and assessment indicators were extracted. Results Eleven studies were included in this review. The assessment indicators in different reports covered heart rate, blood pressure, placental and birth canal check, hemoglobin (Hb), hematocrit (HCT), coagulation function tests, hemodynamic parameters and arterial blood gas, but no data on the assessment of postpartum uterine contraction were found. The relationship between indicators and blood loss varies. The overall quality of 9 manuscripts was comparatively high or moderate, and 2 were rated as low. Conclusions The association between blood loss and clinical symptoms is not conclusive based on the present studies, and specific cut-off points could not be formulated to determine the approximate amount of blood loss. However, some cut-off points can be considered warning signs for the need of advanced interventions, such as heart rate, prothrombin time, and placental implantation. Further research on comprehensive assessment and cut-off points should be performed such that birth attendants can distinguish PPH as early as possible.