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Background\ud \ud The paper-grip-test (PGT) involves pulling a small card from underneath the participant’s foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force).\ud Research question\ud \ud Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength?\ud Methods\ud \ud Reliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured.\ud Results\ud \ud Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83%±4% of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88% in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more.\ud Significance\ud \ud EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.

Background Rheumatoid arthritis (RA) is an autoimmune disorder characterized by bone and joint destruction, but other organ systems can also be involved. Recent studies have suggested that the disease may start in the lungs. Exhaled nitric oxide (FENO) is a marker of inflammation. The aims of the study were to compare the NO parameters between subjects with RA and healthy control subjects, and to examine whether the NO parameters correlated with lung function and disease activity in the subjects with RA. Methods Subjects with RA (n = 35) were recruited during their regular outpatient visits to the rheumatology department. The nitric oxide (NO) parameters: alveolar NO concentration (CANO), airway compartment diffusing capacity of NO (DawNO), and tissue concentration of NO in the airway wall (CawNO), were algorithmically estimated. Healthy subjects (n = 35) matched by age, gender and height were used as controls. Data are given in median, (quartile 25, 75). Wilcoxon Matched Pairs test was used for group comparisons. Mann-Whitney U test was used to make comparisons between any two groups and for pairwise comparisons. Correlations were tested with Spearman rank order correlation. Results CANO was significantly lower in the RA subjects compared with healthy subjects; 1.1 (0.5, 1.8) ppb versus 2.4 (2.0, 3.0) ppb, (p Conclusions There are significant differences between subjects with RA and matched healthy control subjects regarding the exhaled NO parameters. It is unclear if this can be explained by the pathogenesis of RA, consequences of long-term disease, and/or due to drug treatment.

Why consumers consistently rank hospital reputation as one of the most important factors when selecting health care services remains unknown. We hypothesized that this is explained by consumers associating reputation with objective quality. We performed a cross-sectional, US population-based survey of consumers (N = 23,410) exploring this association. A Spearman rank order correlation was used to measure the strength of this relationship. Subgroups of consumers more likely to associate the two was explored with multivariable logistic regression. Consumers commonly agree (56%) that a hospital's reputation is the same as its quality of health care. Consumers also associate hospital reputation with the belief that they will be less like to suffer a complication (ρ = 0.509) or die (ρ = 0.441), although the strength of these relationships were modest (all p < 0.01). Consumers who were male (OR: 0.84), Hispanic (OR: 0.82), African American (OR: 0.86), married (OR: 0.85), self-reported as healthy (OR: 0.67), and had a recent hospitalization (OR: 0.70) were less likely to believe that reputation and quality were equivalent (all p < 0.01). This data suggests that consumers link the construct of hospital reputation with objective health care quality, but this pattern of behavior is of concern, particularly when reputation does not align with objective data.

STUDY DESIGN A prospective cohort study. OBJECTIVE The aim of the present study was first to compare monthly measurements of low back pain (LBP) with quarterly and yearly retrospective measurements of LBP, and second to investigate possible bias effects for recall bias of LBP. SUMMARY OF BACKGROUND DATA LBP is a subjective experience often measured by a single rating of recalled pain over a certain time interval. However, retrospectively reported pain may be subject to recall bias. METHODS The agreement between monthly measurements of LBP and quarterly and yearly retrospective measurements of LBP was evaluated by Spearman rank order correlation coefficients, intraclass correlation coefficients, and Bland-Altman plots. Bias effects for recall bias were investigated by a linear regression model. RESULTS There were no statistical significant differences in mean values of monthly measurements of LBP compared with quarterly and yearly retrospective measurements of LBP on a group level. However, the Bland-Altman plots revealed that within individuals, the difference between monthly measurements of LBP and quarterly and yearly retrospective measurements of LBP was highly variable. For both quarterly and yearly recall, social support from colleagues and average LBP days were significantly associated with the recall bias. CONCLUSION The agreement of pain recall among workers in the current study seems to be good on a group level, but both between and within individuals, the difference between monthly and quarterly and yearly retrospective measurements was quite high. Factors that impacted the recall bias were social support from colleagues and average LBP days over the recall period. LEVEL OF EVIDENCE 3.

Objective Quantitative determination of fecal fat still is the gold standard for measuring malabsorption. We evaluated the importance of standardized food intake before and under the collection of feces. Material and Methods In a project, evaluating patients with suspected chronic pancreatitis (CP) and healthy volunteers (HC), stools were collected for 72 hours coupled to registration of nutritional intake over five consecutive days. Patient groups were created by a modified Layer score, which includes imaging findings, clinical parameters and pancreas function testing. Results We found 12 patients with CP, 11 patients without CP and 13 healthy individuals in our database. Median fecal fat in CP patients was 12 g/day, in non-CP patients 5 g/day and in healthy controls 5 g/day. Median fat absorption coefficient was 81% in those with chronic pancreatitis, 92% in those without CP and 92% in healthy controls. Corresponding median fat intake was 65 g/day, 68 g/day and 81 g/day in the respective groups. Spearman Rank Order Correlation between fecal fat (g/d) and fat absorption coefficient in all study subjects (n = 36) was good (-0.88 (p

Background:Limited data exist of tracking and changes in accelerometer-measured physical activity in children.Methods:Physical activity was assessed by accelerometers for 4 days in 167 children (boys, n = 90; girls n = 77) age 9.8 ± 0.6 years. Follow-up measurement was made 2.0 ± 0.1 yrs later (range 1.9−2.1 yrs). General physical activity (GPA) was defined as mean count/minute. Minutes of inactivity; light, moderate, and vigorous physical activity (LMVPA); moderate and vigorous physical activity (MVPA); and vigorous physical activity (VPA) per day were calculated both as absolute values and as percentage of total registration time.Results:Spearman rank order correlation indicated low tracking of MVPA and VPA in girls (r = .25−0.33, P < .05), and low-moderate tracking of GPA, inactivity, LMVPA, MVPA and VPA in boys (r = .23−0.40, P < .05). Time in inactivity increased at follow-up by 5%−14%. Most of the assessed physical activity variables were decreased at follow-up by 6% to 30%.Conclusions:Physical activity tracks at a low-moderate degree from age 10−12 years, which confirm previous investigations that have used self-report assessments. The low-moderate tracking of physical activity variables indicate that those who were most active initially remained most active. Increasing inactive behavior was observed and that several other physical activity variables were decreased at follow-up.

Several epidemiologic studies have reported that exposure to noise is associated with cardiovascular disease. The increased body weight is often associated with metabolic as well as increased blood pressure. The aim of this study is to investigate the correlation between the elevation of blood pressure and serum leptin hormones due to the effects of noise in the work place. A total of 80 volunteer males where included in this study with an age range between of 20 and 45 years, they were divided in two groups equally, the 1 st group were exposed to noise in the workplace while the 2 nd group were not. The individual noise exposure was determined by using a sound level meter. The range of noise was 80-100 dBA. Body Mass Index was also taken for each individual by a standard measure, blood pressure was measured by OMRON sphygmomanometer and serum leptin was measured through venous blood sample analysis enzyme linked immunosorbent assay. Spearman rank order correlation was used to examine the correlations between Blood pressure value (Systolic, Diastolic) and Leptin. All the relationships between parameters showed a positive correlation. Systolic and diastolic blood pressure values had a significant correlation to leptin hormone level in comparison to the control. There was a significant relation between leptin and blood pressure. leptin effects on the sympathetic nervous system may provide a partial explanation. Therefore, Leptin might have diverse cardiovascular actions.

Background Epilepsy is a chronic seizure disorder that affects numerous people worldwide. Community integration (CI) is the ultimate goal of rehabilitation of any chronic condition. There seems to be a dearth of research on CI among people living with epilepsy (PLWE). Aim The present study was designed to investigate on the level of satisfaction with CI and its associated factors in a Nigerian PLWE. Methodology This was a cross-sectional survey of 70 adult PLWE (28.6% females; mean age = 34.91 ± 16.21 years) consecutively recruited from three purposively selected specialized clinics in Anambra State of South-eastern Nigeria. The Reintegration to Normal Living Index was used to assess the level of satisfaction with CI among the participants. Data was analysed using Spearman Rank Order Correlation, Mann-Whitney U and Kruskal-Wallis tests at 0.05 level of significance. Results The total level of satisfaction with CI among PLWE was poor (59.76 ± 23.24). PLWE were severely restricted in nine out of the fourteen CI scores but were mildly or moderately restricted in the remaining five CI scores. The participants’ total level of satisfaction with CI significantly correlated with their annual (r = −0.319; p = 0.007), six-month (r = −0.275; p = 0.021) and one-month (r = −0.221; p = 0.025) episodes of seizures, and was significantly influenced by their occupational status (k = 12.15; p = 0.009) and highest educational attainment (k = 12.39; p = 0.006). Conclusion Generally, the total level of satisfaction with CI among PLWE was poor. There is need for interventional programmes aimed at integrating PLWE into their various communities with special emphasis laid on unemployed and less educated ones having high seizure frequency.

Item does not contain fulltext PURPOSE: To investigate the congruent validity of a structured interview protocol for assessing the preferences of seven children with autism spectrum disorder (ASD). METHOD: Using the structured interview protocol described by Green et al., parents were asked to provide a rank ordering of their child's preferred foods, drinks, toys and sensory stimuli. The resulting rank order was then compared to the results of a multiple-stimulus without replacement preference assessment by calculating the Spearman rank order correlation coefficients. RESULTS: The results revealed a high level of correspondence between the rank orderings of both assessments for four of the six participants for food and drink items and four of the seven participants for play items and sensory stimuli. CONCLUSION: Results support the use of the structured interview protocol to determine the preferences of children with ASD. Practical implications and directions for future research are discussed. 6 p.

Purpose To evaluate the association between office-hour central corneal thickness (CCT) and 24-hour intraocular pressure (IOP) fluctuation in patients with glaucoma. Design Observational case-control study. Methods Measurements of IOP were obtained every 2 hours during a 24-hour period from 52 untreated glaucoma patients and 29 age-matched normal control subjects housed in a sleep laboratory. Habitual IOP measurements were obtained using a pneumatonometer in the sitting positions during the diurnal/wake period (7 AM to 11 PM) and in the supine position during the nocturnal/sleep period (11 PM to 7 AM). CCT was measured in all subjects using ultrasound pachymetry once during office hours. The association between IOP fluctuation (peak IOP-trough IOP) during the 24-hour period and the office-hour CCT was assessed in both glaucoma patients and healthy age-matched controls using Spearman rank order correlation. Results There was no statistically significant correlation between IOP fluctuation and CCT in glaucomatous (P=0.405) and normal subjects (P=0.456). Conclusions Twenty-four-hour IOP fluctuations were not correlated with single CCT measurements taken during office hours in glaucoma patients.

The aim of this work was to determine the usefulness of the visibility of the dental pulp in lower third molars in forensic age estimation. Dental pulp visibility on lower third molars was assessed using a sample of 487 orthopantomograms. Intra and inter-observer agreement was determined using the Cohen’s kappa test. A descriptive analysis of the stages according to age was done. The relationship between age and stage attainment was assessed using Chi square test and the strength and direction of the linear relationship between pulp visualization stage and chronological age was evaluated using Spearman rank order correlation (rho). Equations for predicting an age above 21 years were developed using logistic regression. The level of significance was defined at p

A retrospective study was conducted, and 576 human immunodeficiency virus-infected children with total lymphocyte count (TLC) and CD4 count were recruited from China. Spearman rank order correlation and receiver-operating characteristic were used. An overall positive correlation was noted between TLC and CD4 count (prehighly active antiretroviral therapy [pre-HAART], r = 0.789, 6 months of HAART, r = 0.642, 12 months of HAART, r = 0.691, P = 0.001). TLC ≤ 2600 cells/mm(3) predicted a CD4 count of ≤ 350 cells/mm(3) with 82.9% sensitivity, 79.6% specificity pre-HAART. Meanwhile, the optimum prediction for CD4 count of ≤ 350 cells/mm(3) was a TLC of ≤ 2400 cells/mm at 6 months (73.6% sensitivity and 74.1% specificity) and 12 months (81.7% sensitivity and 76.5% specificity) of HAART. TLC can be used as a surrogate marker for predicting CD4 count of human immunodeficiency virus-infected children before and during HAART in resource-limited countries.

Objectives To establish relationships among transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR) variables in a sample of normal hearing neonates and young children, ranging in age from approximately 3 weeks to 4 years. Study Design Retrospective, non-randomized, cross-sectional analysis of clinical data obtained at a tertiary care medical center. Methods Pearson product moment and Spearman rank order correlation analyses to evaluate pairwise relationships between TEOAE variables, ABR variables and age; factor analysis, to identify the structural composition and dimensionality of these relationships. Results Significant pairwise correlations were obtained between variables within each test paradigm (TEOAEs, ABRs) and between ABR absolute and interpeak latencies with age. However, the most striking effect was the absence of strong correlations between ABR and TEOAE variables, indicating that these test measures provide independent information about auditory system integrity and sensitivity. Two factors, accounting for over 55% of the variance, characterized this data set: 1) a frequency-dependent OAE factor, which showed an inverse relation between biologic noise and whole wave percent reproducibility and half-octave band TEOAE amplitudes; and 2) a central nervous system (CNS) maturational factor, which showed an inverse relationship between age and certain absolute and interpeak ABR latency components. Conclusions TEOAE and ABR test results provide unique and functionally independent information about normal auditory system integrity and sensitivity. Therefore, a combination of both tests is well suited for use within a pediatric test battery. These results confirm that biologic noise and age at test differentially affect OAE and ABR test measures, and both effects require consideration during data acquisition and interpretation.

Previous methods for frequency domain analysis of the signal-averaged ECG (SAECG) have had low reproducibility. The reproducibility of time domain late potential analysis and spectral turbulence analysis was evaluated with 2 immediately consecutive SAECG recordings in 121 randomly selected subjects without heart disease (short-term) and also in 47 subjects after 1 month (long-term). A test was late potential positive if 2 or more of 3 variables were outside the reference limits and spectral turbulence positive if the score was 3 or 4. The short-term reproducibility was high for the filtered QRS duration (FQRSD), root mean square amplitude of the last 40 ms (RMS40) and high frequency low amplitude signals less than 40 μV (HFLAS40) of the time domain and total QRS duration (TQRSD), power spectral density of the last 40 ms and the late potential duration of time domain analogous analyses. The Spearman rank order correlation coefficients were 0.89, 0.88, and 0.84 and 0.97, 0.91 and 0.97, respectively. The reproducibility of the spectral score variables varied, and the correlation for the low slice correlation ratio was 0.71, spectral entropy 0.61, interslice correlation mean 0.58, and interslice correlation SD 0.28. A diagnostic inconsistency between 2 tests occurred in 0 (0%) subjects in late potential analysis if FQRSD was required for positivity, and in 7 (6%) otherwise, and in 9 (7%) of spectral turbulence analysis. If the spectral variable mean peaks per slice, with a correlation of 0.89, replaced interslice correlation SD in the spectral score, diagnostic inconsistency occurred in 0 (0%) subjects. The reproducibility seemed higher in women and in younger people but significantly only for interslice correlation subjects mean and HFLAS40. The long-term reproducibility did not differ significantly from short-term for any variable. In conclusion, the reproducibility was high in all time domain and time domain analogous variables. It varied among the spectral turbulence score variables and was very low for interslice correlation SD. The reproducibility of the spectral score improved substantially if this variable was replaced by mean peaks per slice.

Our study aimed to test the validity of a short, qualitative food frequency list (FFL) used in several German large scale surveys. In the surveys of the MONICA project Augsburg, the FFL was used in randomly selected adults. In 1984/85, a dietary survey with 7-day records (DR) was conducted within the subsample of men aged 45 to 64 (response 70%). The 899 DR were used to validate the FFL. Mean weekly food intake frequency and mean daily food intake were compared and Spearman rank order correlation coefficients and classification into tertiles with values of the statistic Kappa were calculated. Spearman correlations range between 0.15 for the item "Other sweets (candies, compote)" and 0.60 for the items "Curds, yoghurt, sour milk", "Milk including butter milk" and "Mineral water"; values for statistic Kappa vary between 0.04 ("White bread, brown bread, crispbread") and 0.41 ("Flaked oats, muesli, cornflakes" and "milk including butter milk"). With the exception of two items, FFL data can be used for analysis on group level. Analysis on individual level should be done with caution. It seems, as if some food groups are generally easier to ask for in FFL than others.

Influence of intrapair differences in birth weight (IDBW) on the patterns of postnatal growth of MZ and DZ twins from middle/late childhood to adolescence were studied in 49 MZ, 40 DZ male and 40 MZ, 35 DZ female pairs coming from the Wrocław Longitudinal Twins Study. Intrapair differences in the patterns in postnatal growth were expressed in several indices: average differences in standardized values (ASD Height, ASD Weight); absolute average differences in standardized values (ABSD Height, ABSD Weight); average Euclidean distances coefficient (EUCD Height, EUCD Weight); coefficient of shape differences (SHC Height, SHC Weight); measure of deviation (MD Height, MD Weight) and correlation coefficient for the standardized attained values (CORC Height, CORC Weight). Relationships between IDBW and indices were based on the means of Spearman Rank Order Correlation. Additionally for 40 MZ, 35 DZ male and 25 MZ, 18 DZ female pairs, the relationships between IDBW and intrapair differences in biological parameters derived from Preece Baines model 1, describing differences in time (DT1), height (DH1), velocity (DV1) at the beginning of the adolescent growth spurt, differences in time (DT2), height (DH2), velocity (DV2) at peak height velocity and differences in adult height (DAH) were examined. The results showed that only in MZ girls did dissimilarity in birth weights significantly impair the subsequent growth in stature. Furthermore, the results revealed that birth weight influences the parameter describing adult stature in MZ girls. It is concluded that the lack of relationship in DZ twins is due to their unique genotype, which strongly determines the postnatal growth. Three possible interpretations are given as explanations of the results obtained in this study: male excess neonates mortality, 'third factor' and programmed of growth in utero.

Aim: To examine associations between perceived social support, quality of life, psychopathological, demographic and clinical variables in long-term heart transplant survivors. Methods: Sixty six patients transplanted from 10.2 ±3.3 years completed the Interpersonal Support Evaluation List, Symptom Questionnaire and World Health Organization Quality of Life-BREF. Parameters of post-transplant medical course were retrieved. Spearman rank order correlation, Mann-Whitney U test, Kruskal-Wallis test and multiple regression analyses were performed. Results: At multiple regression analyses SQ depression significantly predicted Interpersonal Support Evaluation List (ISEL) total and appraisal scores (p = 0.005 and p = 0.047), indicating better satisfaction for support in patients with less depressive symptoms. Low levels of depression and being married or living as married were significantly associated with better ISEL belonging (p = 0.03 andp = 0.008) and self-esteem (p < < 0.001 and p = 0.038). Skin cancer significantly correlated with better tangible (p = 0.02) and total (p = 0.05) support. Social quality of life was positively associated with ISEL total (p < 5 0.01), appraisal (p < 0.05), belonging (p < 0.01) and tangible (p < 0.05) scores; yet, it significantly predicted none of the them. Conclusions: Depressive symptoms may worsen patients' satisfaction for their interpersonal support. Marital status seems to foster sense of belonging and self-esteem. The paucity of significant associations between ISEL and clinical parameters may reflect the caregivers' continuous provision of support regardless of clinical status.

Research into the accuracy of self-reported measures used to quantify physical inactivity has been limited. The purposes of the current report were to examine the reliability of a survey question assessing time spent watching television and to describe associations between television watching and physical activity and health risk factors. Data from this cross-sectional investigation were obtained from a study designed to evaluate a physical activity module for potential use in the 2001 Behavioral Risk Factor Surveillance System. Participants were 93 men and women (aged 45.9 (15.4) years) who answered the question pertaining to television watching during an initial visit and three follow-up visits to the study center. Intra-class correlation coefficients (ICCs) between administrations of the survey question were used to assess test-retest reliability. Spearman rank order correlation coefficients were used to examine the associations of television viewing with physical activity and health risk factors. The test-retest reliability of the television-watching question suggested moderate agreement (ICCs of 0.42 and 0.55 over a 3-week and 1-week period, respectively). After adjustment for age and sex, reported television-watching hours were positively associated with BMI (P = 0.0002), percentage fat (P = 0.0001), and light-intensity physical activity (P = 0.006) and negatively associated with cardiorespiratory fitness (P = 0.004) and moderate-intensity and hard-intensity physical activity (P = 0.03 and P = 0.003, respectively). Increased time spent in sedentary behaviors has been identified as a major modifiable risk factor in the development of chronic diseases and conditions. The single-item survey question evaluated in this study was shown to be a reliable measure of television watching and was associated with physical activity and health risk factor outcomes.

Summary Objective Speech disorders could affect the intelligibility, but also social competence and emotional development of a cleft-palate child. In this study, we proposed to examine the phono-articulatory defects of a group of surgically treated cleft palate patients, relatively to the familial social background, and children ability of self-controlling during spontaneous language. Methods Sixty-eight children (22 males and 46 females) mean age 6.87 years, affected by a non-syndromic isolated cleft of the palate underwent to the same surgical protocol. Linguistic level was evaluated using the speech assessment protocol of Accordi and colleagues that focuses on intelligibility, nasality, nasal air escape, pharyngeal friction, and glottal stop. Each of these parameters is evaluated on a four-point scale, ranging from 0 to 3. Spearman rank order correlation was used to detect significant association between analyzed parameters; also the patient social background was considered for statistical analysis. Results The 5.88% of the sample had a negative result, with a severe to moderate degree of nasality and nasal air escape, presence of pharyngeal friction and glottal stop and, obviously a systematic compromising of the intelligibility. Also grimace was evident. The 38.23% of the sample showed an acceptable phonological outline; nasality and nasal air escape were mild, and the intelligibility resulted normal. Thirty-eight children (55.88%) showed a perfectly normal speech. Statistical analysis (Spearman rank order correlation) revealed a positive correlation between the severity of nasality and nasal air escape and the patient social contest of life (p ≤ 0.05); moreover, there was a positive correlation between nasality and nasal air escape with the final intelligibility (p ≤ 0.05), and between the intelligibility and the patient social contest of life. Conclusion Phonetic and phonological development in cleft child are not only due to the surgical strategies and the surgeon experience, but also influenced by the willingness to collaborate of the patient and especially of the parents, the timeliness of the logopaedic intervention, and by inborn capabilities of the child to control the emission of the air from nasal and oral cavities.

Background The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed for measuring end results of care in patients with knee or hip OA in Nigeria. The purpose of this study was to validate a Hausa translation of IKHOAM in order to promote its use among the Hausa populations of Nigeria and other West African countries. Methods Sixty-seven patients with knee OA, literate in Hausa and English, recruited consecutively from all government hospitals in Kano were assessed on both English and Hausa versions of IKHOAM. The order of assessment with the versions was randomized and separated by 24 hours. Participants also rated their pain intensity on the Visual Analogue Scale. Data was analyzed using the Spearman Rank Order correlation and Cronbach's alpha. Results The participants (17 males, 50 females) were aged 55.7 ± 13.4 years. Participants' scores on the Hausa version correlated significantly with the original version (r = 0.67, p = 0.000) and with pain intensity scores on the Visual Analogue Scale (r = -0.24, p = 0.005). The Cronbach's alpha for correlation on the different parts of the Hausa version ranged between 0.28 and 0.95. Conclusion The Hausa version of IKHOAM meets the criteria for validity and internal consistency and may be used in the Hausa speaking parts of Nigeria and other West African countries.

To prospectively evaluate diagnostic accuracy of 64-section computed tomography (CT) for evaluation of aortic regurgitation (AR), with transthoracic echocardiography (TTE) as reference.The institutional review board approved this study; written informed consent was obtained. Thirty patients (23 men, seven women; mean age, 56.6 years) with AR underwent TTE and retrospective electrocardiographically gated 64-section CT. CT data sets were reconstructed in 5% steps from 40% to 90% of R-R interval for analysis. Maximum regurgitant orifice area (ROA) in diastole was planimetrically measured with CT, and measurements were compared with semiquantitative classification with TTE (Spearman rank order correlation coefficients). Receiver operating characteristic (ROC) curves were calculated for differentiation between degrees of AR with ROA measurements. Dimensions of the aortic root and left ventricular parameters were compared (Pearson correlation analysis).A significant correlation was observed between CT planimetric size of ROA (mean, 62 mm2+/-63 [standard deviation]; range, 6-224 mm2) and TTE classification of mild, moderate, and severe AR (r=0.84, P.001). With ROC analysis, discrimination between degrees of AR with CT was highly accurate when cutoff ROAs (25 mm2 and 75 mm2) were used. A significant correlation was observed between methods in dimensions of aortic annulus (mean, 29.0 mm+/-4.6), sinus of Valsalva (mean, 38.3 mm+/-8.6), and ascending aorta (mean, 37.2 mm+/-8.0); mean values were 27.4 mm+/-4.9 (r=0.76, P.001), 37.7 mm+/-8.6 (r=0.94, P.001), and 38.2 mm+/-7.9 (r=0.96, P.001), respectively. Mean end-systolic volume (67 mL+/-38), end-diastolic volume (149 mL+/-48), and ejection fraction (57%+/-13) at CT correlated well with mean results at TTE (65 mL+/-36 [r=0.96, P.001], 140 mL+/-48 [r=0.91, P.001], 56%+/-13 [r=0.98, P.001], respectively).Results of assessment of AR with 64-section CT are similar to those with TTE.

Objective To assess reproducibility of a School-Based Nutrition Monitoring (SBNM) questionnaire for fourth-grade students. Design Test–retest. Setting Fourth-grade elementary school classrooms Participants Multiethnic fourth-grade students from 2 area school districts (N = 322). Main Outcome Measures Reproducibility coefficients with time intervals between questionnaire administrations of 2 hours for the yesterday food choice and physical activity questions or 2 weeks for the nutrition knowledge and attitude questions. Analysis Spearman rank order correlation, percent agreement, and Kappa statistic calculated for each individual questionnaire item. Results Of 43 questions that were included in the reproducibility analyses, test–retest kappa values were moderate to high (greater than 0.40) for more than 90% of the questions (39 questions). Spearman coefficients were greater than 0.70 for 24 questions, whereas percent agreement exceeded 75% for 28 questions. Conclusions and Implications The SBNM questionnaire showed good to excellent reproducibility for nutrition behavior questions, physical activity, weight behavior, and food selection skills overall. However, questions that assessed nutrition knowledge and attitudes were not as reproducible, probably resulting from learning effects over time. Results from the study indicate that this questionnaire can be easily administered in an elementary school classroom and can be used to measure nutrition behaviors among 9- to 10-year-old school children.

To determine whether differences in body mass index (BMI) and image section levels representing the proximal through the distal sections of the heart are associated with attenuation differences in images of calcium phantoms scanned during computed tomographic (CT) imaging of study subjects.Mean attenuation values for three calcium phantoms (each with a different calcium hydroxyapatite concentration), as measured at each of four different image section levels, were obtained for 691 participants in the Muscatine CT Vascular Calcium Study. The subjects were grouped according to sex-specific BMI quartiles, and the degree of attenuation in each phantom was investigated as a function of image section level and BMI quartile. Spearman rank order correlation coefficients and one-, two-, and three-factor repeated-measures analysis of variance were used to examine the association between section level and BMI and the mean phantom attenuations.Attenuation was, for the most part, significantly associated with both section level (P.005) and BMI quartile (P.0025-.05). The degree of attenuation tended to decrease in images obtained at the more distal cardiac levels and to increase with increasing BMI quartile.Differences in attenuation related to BMI and image section level appear to have a significant effect on current calcium scoring methods.

Objective To evaluate the reproducibility and validity of the School-Based Nutrition Monitoring (SBNM) secondary level student questionnaire. Design Reproducibility was evaluated using a test-retest study design by administering the questionnaire on the same day (morning and afternoon, n=254) and, when appropriate, 9 to 14 days apart (n=259). Validity was assessed by comparing foods selected on the questionnaire with foods reported from a single 24-hour recall covering the same referent period (yesterday) in 209 students. Subjects/setting Eighth grade students in middle schools from central Texas were used: male and female, approximately 75% white, for the reproducibility study, with 15% Hispanic, 6% African American; for the validation study, approximately 38% white, 41% Hispanic, and 17% African American. Statistical analysis Spearman rank order correlation, κ statistic, and percentage agreement were used for both reproducibility and the validation. Results For the reproducibility study, agreement for questions about food intake ″yesterday" were 70% to 98%, with κ statistics ranging from 0.54 to 0.93 and correlations between 0.66 and 0.97. Questions on recent physical activity had high agreement (66% to 89%) as did ″usual" physical activity items, weight loss, and food selection behaviors. Nutrition knowledge items showed relatively weaker reliability: agreements ranged from 47% to 92%, with κ statistics between 0.30 and 0.56. Attitude questions had weaker agreement (50% to 87%), κ statistics (0.27 to 0.52), and correlations (0.33 to 0.63). For the validation study, correlation coefficients ranged from 0.32 for breads to 0.68 for milk and beans. Percentage agreement ranged from 38% for breads to 89% for gravy. Applications/conclusions Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group. This questionnaire is a useful epidemiologic tool for surveillance, assessing broad intervention effects among groups or providing needs assessment data on selected nutrition and physical activity-related constructs. J Am Diet Assoc. 2003;103:186-194.

Objective: To investigate in a pilot study the use of extended walking times as an objective method of distinguishing differences in outcome in lower limb amputees. Setting: Sixteen lower limb amputees attending the prosthetic clinic. Method: Patients were asked to walk 100 m, turning every 20 m, using their usual walking aids and prostheses at their chosen walking speed. Demographic details and modified Stanmore/Harold Wood mobility grades, walking aids used and discomfort were recorded. Time to walk each 20 m up to 100 m was recorded. Statistical analysis was carried out using the Spearman rank order correlation coefficient. Results: There was a wide age range and differing causes of amputation. Five out of 16 subjects failed to complete 100 m and these had the slowest 20 and 40-m times. The mean time to walk 40 m was 41 seconds for those who were able to complete 100 m and 144 seconds for those who could not complete 100 m. All those with modified Stanmore/Harold Wood mobility grades less than four failed to complete 100 m. There was a high correlation between 20-, 40-, 60-, 80 and 100-m times and mobility grades, which was statistically significant, and between 20-, 40-, 60-, 80 and 100-m times. Conclusion: Forty-metre walking time can differentiate between those of mobility grades 4b–6 and those with lower mobility grades who are unable to walk significantly outside.

BACKGROUND Although patients' views on health care are perceived to be crucial, insight into the different constructs capturing these views remains limited. OBJECTIVE The aim of this study was to determine the relationship between patients' preferences and their evaluations of general practice care. METHODS Patients visiting five rural practices in The Netherlands were asked to complete a questionnaire measuring either their evaluations or their preferences on 44 aspects of general practice care. After at least 3 weeks, those patients who had answered the evaluation questionnaire received the questionnaire measuring their preferences, and vice versa. RESULTS A total of 449 patients answered both questionnaires (response 70%). The longer the period after the consultation, the lower was the mean percentage of all 44 aspects rated as 'good' in the evaluation questionnaire (P = 0.006) and the higher was the mean percentage of all 44 aspects rated as 'very important' in the preference questionnaire (P = 0.046). The Spearman rank order correlation between the ranking of patients' evaluations and patients' preferences was 0.34, a low although significant correlation (P = 0.024), i.e. the two rank orders do not resemble each other very much. CONCLUSIONS Patients clearly distinguished their preferences from their evaluations of general practice care. Aspects of general practice care, whether important or not, can be evaluated positively or negatively. Patients' preferences and patients' evaluations are, however, both influenced by the length of the time elapsed since the consultation.

Background A self-administered food frequency questionnaire was developed for the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Habitual consumption of 178 food items can be calculated from the questionnaire data. Methods Reproducibility and relative validity for food group intake were investigated in a population of 121 Dutch men and Women. The questionnaire was administered three times at 6-month intervals in order to determine the reproducibility. To assess the relative validity 12 monthly 24-hour recalls served as the reference method. Results Spearman rank order correlation coefficients between estimates of food group intake assessed by repeated questionnaires ranged from 0.45 to 0.92. For men, Spearman correlation coefficients between estimates of food group intake based on the questionnaire and those based on 24-hour recalls ranged from 0.21 for cooked vegetables to 0.78 for sugar and sweet products, with a range of 0.61. For women the median was 0.53, with a minimum of 0.31 for vegetables and a maximum of 0.87 for alcoholic beverages. The photographs in the questionnaire for the estimation of portion sizes contributed little to the relative validity of the ranking of subjects. However, on the group level most median food group estimates based on photographic portion sizes were closer to the median intakes as assessed by 24-hour recalls than those based on standard portion sizes. Conclusions The questionnaire seems adequate for ranking Dutch EPIC subjects according to intake of most food groups, although the relative validity for some food groups, such as vegetables and fish, remains of concern.

Background Olanzapine (OLZ) is one of the most prescribed atypical antipsychotic drugs but its use is associated with unfavorable metabolic abnormalities. N-desmethyl-olanzapine (DMO), one of the OLZ metabolites by CYP1A2, has been reported to have a normalizing action on metabolic abnormalities, but this remains unclear. Our aim was to explore the correlation between the concentrations of OLZ or DMO with various metabolic parameters in schizophrenic patients. Methods The chromatographic analysis was carried out with a solvent delivery system coupled to a Coulochem III coulometric detector to determine OLZ and DMO simultaneously in OLZ-treated patients. The correlation between the concentration of OLZ or DMO and the metabolic parameters was analyzed by the Spearman rank order correlation method (r s). Principal Findings The established analytical method met proper standards for accuracy and reliability and the lower limitation of quantification for each injection of DMO or OLZ was 0.02 ng. The method was successfully used for the analysis of samples from nonsmoking patients (n = 48) treated with OLZ in the dosage range of 5–20 mg per day. There was no correlation between OLZ concentrations and tested metabolic parameters. DMO concentrations were negatively correlated with glucose (r s = –0.45) and DMO concentrations normalized by doses were also negatively correlated with insulin levels (r s = –0.39); however, there was a marginally positive correlation between DMO and homocysteine levels (r s = +0.38). Conclusions The observed negative correlations between levels of DMO and glucose or insulin suggest a metabolic normalization role for DMO regardless of its positive correlation with a known cardiovascular risk factor, homocysteine. Additional studies of the mechanisms underlying DMO’s metabolic effects are warranted.

Culex pipiens/restuans mosquitoes are important vectors for a variety of arthropod borne viral infections. In this study, the associations between 20 years of mosquito capture data and the time lagged environmental quantities daytime length, temperature, precipitation, relative humidity and wind speed were used to generate a predictive model for the population dynamics of this vector species. Mosquito population in the study area was represented by averaged time series of mosquitos counts captured at 6 sites in Cook County (Illinois, USA). Cross-correlation maps (CCMs) were compiled to investigate the association between mosquito abundances and environmental quantities. The results obtained from the CCMs were incorporated into a Poisson regression to generate a predictive model. To optimize the predictive model the time lags obtained from the CCMs were adjusted using a genetic algorithm. CCMs for weekly data showed a highly positive correlation of mosquito abundances with daytime length 4 to 5 weeks prior to capture (quantified by a Spearman rank order correlation of r S = 0. 898) and with temperature during 2 weeks prior to capture (r S = 0. 870). Maximal negative correlations were found for wind speed averaged over 3 week prior to capture (r S = − 0. 621). Cx. pipiens/restuans population dynamics was predicted by integrating the CCM results in Poisson regression models. They were used to simulate the average seasonal cycle of the mosquito abundance. Verification with observations resulted in a correlation of r S = 0. 899 for daily and r S = 0. 917 for weekly data. Applying the optimized models to the entire 20-years time series also resulted in a suitable fit with r S = 0. 876 for daily and r S = 0. 899 for weekly data. The study demonstrates the application of interval lagged weather data to predict mosquito abundances with a feasible accuracy, especially when related to weekly Cx. pipiens/restuans populations.

In this study; the relationship of indicators of the local host response in gingival crevicular fluid (GCF) to the serum antibody titer to periodontal pathogens was examined. 15 patients with chronic adult periodontitis were studied. GCF was collected and analyzed for the total amount of IgG, IgM, the lysosomal enzyme B-glucuronidase (BG) and alpha-2-macroglobulin (alpha 2M). At the same examination, serum from these patients was collected, and enzyme-linked immunosorbent assays used to determine the serum IgG antibody titer to a panel of 17 periodontal pathogens (Actinobacillus actinomycetemcomitans (3 strains), Bacteroides gingivalis (4), Eikenella corrodens (2), Wolinella recta, Bacteroides intermedius (3), Fusobacterium nucleatum, and 3 Capnocytophaga species). Using Spearman rank order correlation analysis, correlation coefficients were calculated to relate the 4 indicators of host response in GCF to the serum IgG antibody titer to each of the 17 micro-organisms. The mean correlation between total IgG in GCF and the serum IgG antibody titer was positive (r = +0.30), and statistically significant correlations between total IgG in GCF and serum IgG antibody titer were observed for one strain of B. intermedius and C. ochracea. A weaker positive correlation was observed for IgM (r = 0.18). In contrast, the mean correlation between total BG in GCF and the serum antibody titer was negative (r = -0.34). Statistically significant negative correlations were observed for all 3 strains of A. actinomycetemcomitans, one strain of E. corrodens and W. recta. The mean correlation for alpha 2M was r = -0.06. These data suggest that elevated BG activity in GCF, believed to be a marker for lysosomal enzyme released from polymorphonuclear leukocytes in the crevicular environment, may be associated with a reduced serum IgG antibody response to suspected periodontal pathogens. Furthermore, these findings imply that the development of a serum IgG antibody response to suspected periodontal pathogens is consistent with a protective host response.

Recent publications have examined the extent of food frequency data needed to estimate nutrient intakes in epidemiological studies. The need for amount (usual portion size) data to supplement information on average frequency of intake has been questioned. In a case-control study of risk factors for lung cancer, we have collected data on frequency, amount and past pattern of intake for common or rich sources of vitamin A. These data have been combined with standard content information to calculate three different types of indices: one based on frequency alone, a quantitative index that included both frequency and amount, and a past-weighted index that combined the frequency, amount and data on relative consumption in the past. Odds ratios by tercile of carotene, retinol and total vitamin A intake varied little between the frequency index and the quantified and past-weighted indices. Higher intakes of carotene and total vitamin A were associated with a lower risk for lung cancer regardless of index type. This consistency of results is explained by a stability of relative intakes regardless of index type. Spearman rank order correlation coefficients between the frequency and quantitative indices exceeded 0.90 for total vitamin A, carotene, and retinol. This stability is attributable to parallel trends of increased frequency of consumption and portion size at higher levels of nutrient intake. Because similar trends were observed in five main food groups included in these analyses, these findings may be generalizable to other nutrients.

The present study was designed to determine which of three indices of sentence length most effectively predicted pre-schooler's correct sentence imitations : total number of words; number of content words only; or the density of content words within a sentence. Twenty-four pre-school children, mean age 3.11 years, were asked to imitate 32 sentences which varied in total number of words, number of content words, and lexical density. Analysis of the childrens' correct responses, using verbatim imitation criteria, revealed that the ordering of sentences obtained was one not predicted by any of the three length indices. Re-examination of the sentences suggested that the number of morphemes (the number of meaningful units), rather than the number of orthographically defined words, might be the appropriate counting index. A significant Spearman rank order correlation (r = + 0.67, 30 d.f., p

The aim of the present study was to evaluate and compare the upper-body aerobic fitness characteristics in 2 groups of competitive surfers with different performance levels. Thirteen male competitive surfers performed an incremental dry-land board paddling test to determine specific peak oxygen uptake (VO2peak), peak power output (Wpeak) and the exercise intensity (%VO2peak) that elicits a blood lactate concentration of 4 mmol x L(-1) (LT4). As a measure of surfing performance, surfers were ranked according to their competitive season performance (RANK) and divided into 2 groups based on their performance level; European top-level competitive surfers (ELS) (n = 7) and regional level competitive surfers (RLS) (n = 6). ELS reached significantly higher values than RLS for Wpeak (154.71 +/- 36.82 W vs. 117.70 +/- 27.14 W: P = 0.04) and LT4 (95.18 +/- 3.42 %VO2peak vs. 88.89 +/- 5.01 %VO2peak; P = 0.02) but not VO2peak (3.34 +/- 0.31 L x min(-1) vs. 3.40 +/- 0.37 L x min(-1); P = 0.77). Spearman-rank order correlation analysis revealed that RANK was inversely correlated with Wpeak (r = -0.65, P = 0.01) and LT4 (r = -0.58, P = 0.03). These findings identify that better surfers have higher upper body aerobic fitness scores.