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Background Psychological distress is prevalent in patients with cancer, negatively affecting their treatment and quality of life. Clinical guidelines recommended screening all cancer patients routinely for psychological problems using simple measures such as the Distress Thermometer (DT) and Problem List (PL). This study is the first research in Vietnam to identify the optimal DT cutoff point to screen distress and the relationship with PL items among cancer patients. Methods 300 cancer patients were recruited from 10 departments at Vietnam National Cancer Hospital (K hospital) and completed the DT and PL. Participants also completed the Patient Health Questionnaire‐9 (PHQ‐9) and the Generalized Anxiety Disorder‐7 (GAD‐7) with standard cutoff scores for identifying significant depression and anxiety. Results Receiver operating characteristic (ROC) curve analyses showed that a DT cutoff score of 4 had an area under the ROC curve of 0.81 and 0.82 using the PHQ‐9 and GAD‐7 cutoff scores of 10 as the criterion, respectively. This indicated good overall accuracy. This cutoff also showed a sensitivity of 0.87 and 0.92 for PHQ‐9 and GAD‐7 total score defined cases, respectively. Both specificity values were 0.58. In terms of the PL, 164 distressed patients (54.7%) reported significantly more emotional problems, family issues, and practical and physical problem, implying various causes contribute to psychological distress among cancer patients. Conclusions The study showed that the DT with a cutoff of 4 accompanied with PL is a simple and effective instrument compared to previous, longer measures commonly used to detect psychosocial distress in Vietnamese cancer patients. This cutoff point also identified patients with problems contributing towards distress., The psychosocial aspects of cancer are usually underestimated and unrecognized. It is of necessity to use a short and simple screening measure for significant psychological problems of this vulnerable population. Our study is the first study in Vietnam to prove that the Distress Thermometer with the cutoff score of 4 accompanied with the Problem List is valid to Vietnamese people with cancer.

Background To enhance the convenience and reduce the cost of prostate cancer (PC) screening, a one-step prostate-specific antigen (PSA) test was evaluated in a large population. The PSA SPOT test kit enables rapid detection of human PSA in serum or plasma at or above a cutoff level of 4 ng/mL to aid in the diagnosis of PC. Methods PC screening using the PSA SPOT test was offered to male participants in educational public lectures that we conducted in various cities. Test results were reported to participants at the end of the lectures. Blood samples from 1429 men were evaluated. Two independent observers interpreted the tests at 15 and 30 min. The remaining serum samples were subsequently tested using a conventional quantitative assay. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the test were 79.9, 93.0, 65.4, 96.6, and 91.2%, respectively. The sensitivity and specificity of the test changed with variations in the reading time. Quantitative assessment of the intensity of the band was correlated with the PSA value. Conclusions PSA testing using this kit can be easily performed. The low cost and speed of the test make it a useful and convenient tool for primary PC screening.

BACKGROUND Carotid artery stenosis (CAS) is one of the major causes of stroke in coronary artery bypass grafting (CABG). AIMS The aim of this study was to determine which age groups require screening for CAS using carotid duplex ultrasound in asymptomatic patients undergoing CABG. METHODS We included 644 neurologically asymptomatic consecutive patients (mean [SD] age, 63.9 [8.8] years; men, 453 [70.3%]) who underwent elective isolated CABG between June 2015 and June 2020. Clinical, demographic, and radiological data as well as coronary angiography results were retrospectively reviewed. Patients were classified into 4 age groups: 40 to 50, 51 to 60, 61 to 70, and >70 years, as well as 3 groups depending on the CAS degree: 50% or less, 50% to 70%, and 70% or greater. Regression analysis was applied across the selected parameters to identify risk factors for significant CAS, and receiver operating characteristic analysis, to determine cutoff age and SYNTAX score of patients who had to be screened before CABG. RESULTS Overall, 8 (1.1%) patients included in the present study had stroke following CABG. Cutoff values of the SYNTAX score and CAS of 70% or greater were found to be 27 and 64 years, respectively. The sensitivity and specificity of the cutoff value were 98.4% to 98.3% and 74.3% to 55.1%, respectively. The area under the curve was 0.98 and 0.73, respectively. CONCLUSIONS Based on the receiver operating characteristic analysis, we recommended to perform screening for CAS in patients older than 64 years and with a SYNTAX score of 27 or higher, even if they are asymptomatic. WOS:000613427100005 2-s2.0-85100445536 PubMed: 33078919

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet. Temperature differentials in DFI patients (n = 52) were compared with a control group of similar diabetic patients (n = 45) without any foot wounds. Based on these findings, we drafted a receiver operating characteristic curve to determine an area-under-the-curve of 0.8455. This value suggests that the ThermoScale, as a diagnostic test, is reasonably accurate. A cutoff value of 2.15 °C temperature difference corresponded with a sensitivity of 88.9% and a specificity of 61.5%. As wearables, portable health electronics, and telemedicine become increasingly popular, we think that comparative temperature measurement technology is valuable in improving early diagnosis of DFIs.

Objective To define the development and validation of the Lebanese Insomnia Scale (LIS-18) to be used for the evaluation of insomnia in Lebanese adult patients. Methods A first cross-sectional study, conducted between August 2017 and April 2018, enrolled 789 participants (sample 1). A second sample was recruited in May 2018 to confirm the results obtained from the first sample. Results Five factors derived from the LIS-18 scale items with an Eigenvalue over 1, explaining a total of 59.64% of the variance (Cronbach’s alpha = 0.821). The first ROC curve, comparing participants with diagnosed insomnia to healthy individuals, showed that the optimal score was seen at a cutoff of 58.00, with a good sensitivity and specificity at this cutoff (93.3 and 88.4%, respectively). A second ROC curve, comparing participants taking drug medication for insomnia vs. those not taking drug, showed that the optimal score was seen at a cutoff of 52.50, with a good sensitivity and specificity at this cutoff (89.5 and 80.0%, respectively). A third ROC curve, comparing participants diagnosed by a physician or taking drug medication for insomnia and healthy control without insomnia drug, showed that the optimal score was seen at 51.50, with good sensitivity and specificity at this cutoff as well (90.0 and 78.10%, respectively). The positive predicted value (PPV) of the LIS-18 score in sample 2 was 93.3%, whereas the negative predicted value (NPV) was 88.4%. Conclusion The results demonstrate that the LIS-18 can be used in clinical practice and research to measure insomnia.

Objective The aims of this study were to compare body mass index (BMI) and triponderal mass index (TMI) as predictors of fat mass percentage (FM%) and to develop TMI cutoffs for screening high adiposity. Therefore, TMI- and BMI-based references against FM% criterion for indicating adiposity in Italian children and adolescents were compared. Methods This was a cross-sectional study conducted at the University of Rome Tor Vergata, Human Nutrition Unit, from 2008 to 2015. The sample included 485 children and adolescents from 8 to 17 y of age from central-southern Italy. Body weight (kg) and height (m) were assessed to calculate BMI and TMI. FM% was assessed by dual-energy x-ray absorptiometry. The prevalence of high adiposity was based on the 75th percentile of FM%, according to Ogden et al. curves. Statistical tests such as Mann–Whitney, Kruskal–Wallis, polynomial regression, receiver operating characteristics curve, and Cohen's κ, were performed using SPSS version 24 and MedCalc version 18. Results Prevalence of high adiposity according to FM% was 50.2% (95% confidence interval [CI], 43.2–57.2) in boys and 43.2% (95% CI, 37.3–49.2) in girls. TMI rather than BMI could better predict FM% for both sexes (boys R2 = 0.67 and girls R2 = 0.79 versus boys R2 = 0.44 and girls R2 = 0.74, respectively). TMI was found to present a significantly higher area under the curve than BMI for indicating high adiposity in children and adolescents. TMI sex- and age-specific cutoffs were responsible by better classification of adiposity, followed by the International Obesity Task Force, World Health Organization, and Cacciari reference curves. Conclusion TMI is a useful screening tool in pediatric clinical practice and epidemiologic studies concerning childhood obesity.

Objective: To study the value of α -fetoprotein (α -FP), β-human chorionic gonadotropin (β-HCG), inhibin A, and uncojugated estriol (UE3) at the second trimester for early screening of preeclampsia. Methods: This cohort study was performed on 1 713 consecutive pregnant women with gestational age from 15 to 18 weeks. We measured the serum levels of α -FP, β -HCG, inhibin A, and UE3 and they were followed-up for 48 h after delivery. Results: A total of 1 713 women were recruited and through the study 151 women (8.8%) were diagnosed with preeclampsia (n=123, 21.5% in the pregnant women with high risk, n=28, 2.5% in the pregnant women with low risk; P

RESUMEN El objetivo fue analizar la validez de la Escala de Depresión Posparto, forma abreviada (PDSS-SF) en la detección de los síntomas de depresión prenatal mediante el uso del cuestionario Patient Health Questionnaire-9 (PHQ-9) como gold standard. La muestra del presente estudio estuvo conformada por 449 gestantes reclutadas en el Hospital Clínico San Carlos de Madrid (España). Se utilizó un análisis de curva ROC. Los resultados indican que el área bajo la curva ROC para la depresión menor, moderada y severa fue .86, p < .001, .95, p < .001, y .99, p < .001, respectivamente. La sensibilidad y especificidad fueron .70 y .81 para la depresión menor con un punto de corte de 11, .85 y .88 para depresión moderada con un punto de corte de 14 y 1 y .99 con un punto de corte de 23 para depresión severa. Los resultados de PDSS-SF proporcionan una buena consistencia interna y muestran combinaciones satisfactorias de sensibilidad y especificidad. La PDSS-SF es una herramienta precisa para evaluar la depresión prenatal.

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Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22–0.24 lower compared to fully structured interviews and 0.06–0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82–0.92) and 0.86 (0.82–0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

Contains fulltext : 220797pub.pdf (Publisher’s version ) (Open Access) BACKGROUND & AIMS: We evaluated the incidence of interval cancers between the first and second rounds of colorectal cancer (CRC) screening with the FOB-Gold fecal immunochemical test (FIT), and the effects of different cutoff values and patient sex and age. METHODS: We collected data from participants in a population-based CRC screening program in the Netherlands who had a negative result from a first-round of FIT screening. We calculated the cumulative incidence of interval cancer after a negative result from a FIT and the sensitivity of the FIT for detection of CRC at a low (15 mug Hb/g feces) and high (47 mug Hb/g feces) cutoff value. RESULTS: Among the 485,112 participants with a negative result from a FIT, 544 interval cancers were detected; 126 were in the 111,800 participants with negative results from a FIT with the low cutoff value and 418 were in the 373,312 FIT participants with negative results from a FIT with the high cutoff value. The mean age of participants tested with the low cutoff value was 72.0 years and the mean age of participants tested the high cutoff value was 66.7 years. The age-adjusted 2-year cumulative incidence of interval cancer after a negative result from a FIT were 9.5 per 10,000 persons at the low cutoff value vs 13.8 per 10,000 persons at the high cutoff value (P < .005). The age-adjusted sensitivity of the FIT for CRC were 90.5% for the low cutoff value vs 82.9% for the high cutoff (P < .0001). The FIT identified men with CRC with 87.4% sensitivity and women with CRC with 82.6% sensitivity (P < .001). CONCLUSIONS: In an analysis of data from a FIT population-based screening program in the Netherlands, we found that incidence of interval CRC after a negative result from a FIT to be low. Although the sensitivity of detection of CRC decreased with a higher FIT cutoff value, it remained above 80%.

BackgroundItem 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Objectives The manual for the Japanese Stress Check Program recommends use of the Brief Job Stress Questionnaire (BJSQ) from among the program's instruments and proposes criteria for defining "high-stress" workers. This study aimed to examine how accurately the BJSQ identifies workers with or without potential psychological distress. Methods We used an online survey to administer the BJSQ with a psychological distress scale (K6) to randomly selected workers (n=1,650). We conducted receiver operating characteristics curve analyses to estimate the screening performance of the cutoff points that the Stress Check Program manual recommends for the BJSQ. Results Prevalence of workers with potential psychological distress defined as K6 score ≥13 was 13%. Prevalence of "high-risk" workers defined using criteria recommended by the program manual was 16.7% for the original version of the BJSQ. The estimated values were as follows: sensitivity, 60.5%; specificity, 88.9%; Youden index, 0.504; positive predictive value, 47.3%; negative predictive value, 93.8%; positive likelihood ratio, 6.0; and negative likelihood ratio, 0.4. Analyses based on the simplified BJSQ indicated lower sensitivity compared with the original version, although we expected roughly the same screening performance for the best scenario using the original version. Conclusions Our analyses in which psychological distress measured by K6 was set as the target condition indicate less than half of the identified "high-stress" workers warrant consideration for secondary screening for psychological distress.

The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3 +/- 6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specificity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62-0.65, 0.59-0.63 and 0.60-0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specificity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specificity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specificity, whereas sensitivity was higher for the GFI and TFI.

Background and Aim Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients; however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers that cannot afford it. Therefore, to decrease the economic and physical burden on patients, multiple noninvasive clinical, laboratory, and radiological parameters are evaluated as triage screening predictors of varices before patients' referral to endoscopy. In this respect, we tried to evaluate the validity of portal vein velocity (PVV) as a noninvasive screening tool of esophageal varices (EV). Methods One hundred thirty‐five cirrhotic patients were consecutively enrolled in this cross‐sectional study. All patients were evaluated independently and blindly by EGD as the gold standard and then by Doppler ultrasound on portal vein (PV). Results Univariate regression showed significant coefficients for PVV, platelet (PLT), albumin, bilirubin, international normalized ratio (INR), portal vein diameter, and ascites; however, multivariable regression showed significant coefficients only for PVV, PLT, and albumin; (P = 0.000, 0.000, and 0.006, respectively). Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, LR+, and LR− values were then calculated and validated using bootstrap analysis. PVV was more accurate than other evaluated parameters (AUROC: 0.927 and P = 0.000). The most accurate rule out cutoff value for PVV was ≥19 cm/s with the sensitivity of 97% and LR− of 0.05. Conclusion PVV may be useful as a noninvasive triage test for selection of the high‐risk cirrhotic patients who should be referred to and could benefit from EGD. We could highlight using PVV to rule out EV at a cutoff value ≥19 cm/s, reserving EGD only for patients with the PVV value, Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients, however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers with low economic conditions. Solving these obstacles, we tried to evaluate the validity of portal vein velocity as a non‐invasive triage screening tool of esophageal varices before patients' referral to endoscopy so as to decrease the economic and physical burden on patients. We found that portal vein velocity may be useful as a non‐invasive triage test for selection of the high risk cirrhotic patients who should be referred to and could benefit from EGD.

Background The Edinburgh Postnatal Depression Scale (EPDS) is widely used in many countries to screen women for depression in the perinatal period. However, across studies the psychometric properties and cutoff scores of the EPDS have varied considerably; potentially due to different depression criteria and diagnostic systems being used. Therefore, we validated the Danish EPDS against a depression diagnosis according to both DSM-5 and ICD-10. Furthermore, we examined whether the Danish EPDS is multidimensional, as it has previously been suggested. Methods Women (N = 324) were recruited after routine screenings with the EPDS between 2 and 10 months postpartum (T1). At a subsequent home visit (T2), the EPDS and the Structured Clinical Interview for DSM-5 were administered. Diagnostic interviews were audio recorded to enable subsequent coding for ICD-10 diagnoses and inter-rater reliability analysis. A two-phase stratified sampling strategy with three sampling categories (EPDS-score at T1) was used. Using the distribution of 4931 T1 EPDS-scores from the same population from which we sampled the participants, we used sampling weighing to reweight the sample. The calculation of weights was based upon the mother’s sampling category at T1 (i.e. the probability of being sampled) and the weights were applied when assessing the receiver operation characteristics (ROCs) of the EPDS. Sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve were computed from the reweighted data for all relevant cutoff values. CIs were computed by embedding the calculations in a weighted logistic regression. Exploratory factor analysis was done using oblique rotation. Parallel analysis was used to assess the number of factors. Results A score of 11 or more was found to be the optimal cutoff for depression according to both DSM-5 and ICD-10 criteria. Factor analysis suggested that the Danish EPDS consists of three factors, including an ‘anxiety factor’. Conclusions The Danish EPDS has reasonable sensitivity and specificity at a cutoff score of 11 or more. There are no notable differences with respect to using ICD-10 or DSM-5 criteria for depression in terms of optimal cutoff. The variation in cutoff scores is likely to be due to cultural variations in the expression of depressive symptoms. Electronic supplementary material The online version of this article (10.1186/s12888-018-1965-7) contains supplementary material, which is available to authorized users.

Background: We assessed whether the Eating Disorder Inventory (EDI) is suitable for screening binge eating disorder (BED) in young women. Method: Young women (N = 2825) from the 1975-79 birth cohorts of Finnish twins were assessed by questionnaires, including subscales of the EDI. For a subset of women (N = 548), we established DSM-5 diagnoses of BED; 16 women had lifetime BED. We compared screening properties of the EDI scales using receiver operating characteristic (ROC) analysis, determined optimal cutoff points, and calculated sensitivities and specificities. Results: The best screen for DSM-5 BED was the global score of three subscales (Bulimia, Drive for Thinness, Body Dissatisfaction) with an area under the curve (AUC) of 0.86. Its sensitivity was 87% and specificity 76% at cutoff >= 21. Three individual subscales had acceptable screening properties: Bulimia (AUC 0.83; sensitivity 80%, specificity 78% at cutoff >= 2), Drive For Thinness (AUC 0.82; sensitivity 87%, specificity 72% at cutoff >= 7), and Body Dissatisfaction (AUC 0.81; sensitivity 93%, specificity 60% at cutoff >= 8). Conclusion: The EDI performed well as a screening tool for BED in our community-based sample of young twin women. Future studies should assess its value in other populations and in clinical settings. (C) 2016 Elsevier Ltd. All rights reserved.

Background/Purpose The aim of our study is to develop a concise and effective dementia screening tool for use in primary care, wherein we selected five items from the Global Deterioration Scale (GDS) that were most predictive of dementia diagnosis. Methods Our study population comprised 191 patients older than 60 years who visited four university hospitals between 2008 and 2011 for impaired memory or medical care. Our 5-item screening tool is an abbreviated version of the GDS. We compared the assessment results obtained through our model with those obtained through the GDS in order to evaluate the accuracy of our tool in detecting dementia. Results The screening tool had a sensitivity of 91.2%, specificity of 75.0%, a cutoff value of 12.495, and an area under the curve of 0.911 (95% confidence interval, 0.862–0.948; p Conclusion We anticipate that our abridged GDS, composed of five items, will facilitate a rapid, yet effective assessment of patients in primary care centers. Its use will benefit both patients and medical professionals by minimizing the length of time required to conduct the assessment, and by allowing early diagnosis and care of patients. However, further research with a larger population is required to verify its efficacy.

The purpose of this study was to investigate whether the functional movement screen (FMS) could predict running injuries in competitive runners. Eighty-four competitive male runners (average age = 20.0 ± 1.1 years) participated. Each subject performed the FMS, which consisted of 7 movement tests (each score range: 0-3, total score range: 0-21), during the preseason. The incidence of running injuries (time lost because of injury ≤ 4 weeks) was investigated through a follow-up survey during the 6-month season. Mann-Whitney U-tests were used to investigate which movement tests were significantly associated with running injuries. The receiver-operator characteristic (ROC) analysis was used to determine the cutoff. The mean FMS composite score was 14.1 ± 2.3. The ROC analysis determined the cutoff at 14/15 (sensitivity = 0.73, specificity = 0.54), suggesting that the composite score had a low predictability for running injuries. However, the total scores (0-6) from the deep squat (DS) and active straight leg raise (ASLR) tests (DS and ASLR), which were significant with the U-test, had relatively high predictability at the cutoff of 3/4 (sensitivity = 0.73, specificity = 0.74). Furthermore, the multivariate logistic regression analysis revealed that the DS and ASLR scores of ≤3 significantly influenced the incidence of running injuries after adjusting for subjects' characteristics (odds ratio = 9.7, 95% confidence interval = 2.1-44.4). Thus, the current study identified the DS and ASLR score as a more effective method than the composite score to screen the risk of running injuries in competitive male runners.

This systematic review was conducted to assess the diagnostic accuracy of chronic kidney disease screening tests in the general population. MEDLINE, EMBASE, Web of Science, Scopus, The Cochrane Library and ProQuest databases were searched for English-language publications up to November 2016. Two reviewers independently screened studies and extracted study data in standardized tables. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of all available screening methods were identified through included studies. Ten out of 1349 screened records included for final analysis. Sensitivities of the dipstick test with a cutoff value of trace were ranged from 37.1% to 69.4% and specificities from 93.7% to 97.3% for the detection of ACR>30 mg/g. The diagnostic sensitivities of the UAC>10 mg/dL testing was shown to vary from 40% to 87%, and specificities ranged from 75% to 96%. While the sensitivities of ACR were fluctuating between 74% and 90%, likewise the specificities were between 77% and 88%. Sensitivities for C-G, Grubb and Larsson equations were 98.9%, 86.2%, and 70.1% respectively. In the meantime the study showed specificities of 84.8%, 84.2% and 90.5% respectively for these equations. Individual studies were highly heterogeneous in terms of target populations, type of screening tests, thresholds used to detect CKD and variations in design. Results pointed to the superiority of UAC and dipstick over the other tests in terms of all parameters involved. The diversity of methods and thresholds for detection of CKD, necessitate considering the cost parameter along with the effectiveness of tests to scale-up an efficient strategy. [GMJ.2020;9:e1573]

Prediction performance of a risk scoring system needs to be carefully assessed before its adoption in clinical practice. Clinical preventive care often uses risk scores to screen asymptomatic population. The primary clinical interest is to predict the risk of having an event by a pre-specified future time t(0). Accuracy measures such as positive predictive values have been recommended for evaluating the predictive performance. However, for commonly used continuous or ordinal risk score systems, these measures require a subjective cut-off threshold value that dichotomizes the risk scores. The need for a cut-off value created barriers for practitioners and researchers. In this paper, we propose a threshold-free summary index of positive predictive values that accommodates time-dependent event status and competing risks. We develop a nonparametric estimator and provide an inference procedure for comparing this summary measure between two risk scores for censored time to event data. We conduct a simulation study to examine the finite-sample performance of the proposed estimation and inference procedures. Lastly, we illustrate the use of this measure on a real data example, comparing two risk score systems for predicting heart failure in childhood cancer survivors.

International audience; BACKGROUND : The Montreal Cognitive Assessment (MoCA) score is a convenient and promising tool for estimating alcoholic patients' global cognitive functioning, a major challenge for all specialized alcohol treatment centers. However, whether or not the score should be corrected for education level and whether the proposed cutoff is relevant in patients with alcohol use disorders (AUD) should be determined.METHODS : We compared the MoCA scores in patients hospitalized for AUD with and without cognitive impairment assessed by a battery of neuropsychological (NP) tests. Sensitivity, specificity, and cutoff of the MoCA score were analyzed using receiver operating characteristic curve analysis.RESULTS : Thirty-one patients with and 25 without cognitive impairment were included in the study. There were 40 men and 16 women, with a mean age of 49.5 years. The mean uncorrected MoCA score was 23.1 ± 3.3 in those with and 27.0 ± 1.9 in those without cognitive impairment. NP tests were significantly correlated with the MoCA score. Uncorrected MoCA scores identified more than 80% of the patients with a cutoff score equal to 26, to obtain similar accuracy with the corrected score required using a cutoff score equal to 27.CONCLUSIONS : Our results confirm that the MoCA test is a convenient and reliable screening tool to measure cognition defects in alcoholic patients. As using the 1-point education adjustment increases the cutoff score by 1 point, it is suggested to use the noncorrected score and the usual cutoff, that is, 26. Being easy to administer and only moderately time-consuming, the MoCA score should be used extensively in addiction treatment centers.

Objectives: To provide insight into the trade-off between cost per case detected (CPCD) and the detection rate in questionnaire-based stepwise screening for impaired fasting glucose and undiagnosed type 2 diabetes.Study Design and Setting: We considered a stepwise screening in which individuals whose risk score exceeds a predetermined cutoff value arc invited for further blood glucose testing. Using individual patient data to determine questionnaire sensitivity and specificity and external sources to determine screening costs and patient response rates, we rolled back a decision tree to estimate the CPCD and the detection rate for all possible cutoffs on the questionnaire.Results: We found a U-shaped relation between CPCD and detection rate, with high costs per case detected at very low and very high detection rates. Changes in patient response rates had a large impact on both the detection rate and the CPCD, whereas screening costs and questionnaire accuracy mainly impacted the CPCD.Conclusion: Our applied method makes it possible to identify a range of efficient cutoffs where higher detection rates can be achieved at an additional cost per detected patient. This enables decision makers to choose an optimal cutoff based on their willingness to pay for additional detected patients. (C) 2015 Elsevier Inc. All rights reserved.

Background The Ages and Stages Questionnaire (ASQ-3) is frequently used for screening developmental delay in problem solving, communication, fine- and gross motor skills and personal-social behavior of infants, toddlers and preschool aged children. The adequacy of the ASQ-3 is evaluated for Dutch children by comparing results of the ASQ-3, completed by parents, to results of a standardized, professionally administered developmental assessment of cognition, fine- and gross motor skills and receptive and expressive communication for infants and toddlers: the Bayley-III-NL. Methods The ASQ-3 and Bayley-III-NL were administered to 1244 children aged 1 to 43months old. Two age cohorts were used: 1) the 2–16month age-versions; and 2) the 18–42month age-versions. Cutoff points for all ASQ-3 age-versions were calculated in three ways. Sensitivity and specificity of the ASQ-3 were evaluated with four methods, using different cutoff point combinations of 1 SD or 2 SD below the mean. Results Overall, sensitivity was between 7% and 77% and specificity between 53% and 99%. Sensitivity and specificity values were higher for the older age-cohort than for the younger age-cohort. For the older age-cohort, the best sensitivity (69%) and specificity (92%) was found, using 1 SD for the total ASQ-3 score and 2 SD for the Bayley-III-NL subtests as cutoff points. Conclusions For the oldest age-cohort, the ASQ-3 for now has the best potential as a screener for Dutch children. The ASQ-3 identifies most children without a developmental delay according to the Bayley-III-NL, but sensitivity needs improvement.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2018-08-06T12:50:49Z No. of bitstreams: 1 Maria B. Carmo et al. 2017.pdf: 499359 bytes, checksum: 207b7523bd33b6bdce73cedaa3b4faf1 (MD5) Made available in DSpace on 2018-08-06T12:50:49Z (GMT). No. of bitstreams: 1 Maria B. Carmo et al. 2017.pdf: 499359 bytes, checksum: 207b7523bd33b6bdce73cedaa3b4faf1 (MD5) Previous issue date: 2017 Objective: To analyze the prevalence of common mental disorders (CMD) assessed with the Self Reporting Questionnaire (SRQ-20), using the established cutoff point, and comparing it with the results of a joint correspondence factor analysis (CFA) and cluster analysis and of a latent class analysis (LCA). Methods: A cross-sectional study was carried out in an urban sample of 1,095 women aged 19 to 55 years. Joint CFA-cluster analysis and LCA were used. Results: We found a high prevalence of CMD, regardless of classification method (37.6% when using the cutoff point; 44.4% and 52% for LCA and joint CFA-cluster, respectively). The alternative analysis strategies describe the cases more efficiently when compared to the traditional cutoff method, especially regarding more severe symptoms. Both alternative strategies also provide a description of the SRQ-20 dimensions in their particularities, which may be useful for the planning and implementation of specific actions in a given population. Conclusion: The SRQ-20 cutoff point seems to nderestimate the magnitude of CMD among women. The alternative methods of analysis presented herein highlight the different possibilities of using this important instrument of screening for mental health. São Paulo

Objective We examined differences in distress levels and Distress Thermometer (DT) cutoff scores between different cancer types. The effect of socio-demographic and illness-related variables on distress was also examined.Methods One thousand three hundred fifty patients (response=51%) completed questions on socio-demographic and illness-related variables, the Dutch version of the DT and Problem List, and the Hospital Anxiety and Depression Scale. Receiver operating characteristics analyses were performed to determine cancer specific cutoff scores. Univariate and multivariate effects of socio-demographic and illness-related variables (including cancer type) on distress were examined.Results Prostate cancer patients reported significantly lower DT scores (M=2.5 +/- 2.5) and the cutoff score was lower (4) than in patients with most other cancer types (M varied between 3.4 and 5.1; cutoff5). Multivariate analyses (F=10.86, pConclusions Distress and cutoff score in prostate cancer patients were lower than in patients with other cancer types. Additionally, younger women and patients receiving treatment other than surgery only or wait and see' are at risk for higher distress. These results can help identify patients possibly in need of referral to professional psychosocial and/or allied health care. Copyright (c) 2012 John Wiley & Sons, Ltd.

Objective: To assess the discriminative capacity of the Kenny Music Performance Anxiety Inventory(K-MPAI), in its version adapted for Brazil, in a sample of 230 Brazilian adult musicians.Method: The Social Phobia Inventory (SPIN) was used to assess the presence of social anxietyindicators, adopting it as the gold standard. The Mann-Whitney U test and the receiver operatingcharacteristic (ROC) curve were used for statistical analysis, with p f 0.05 set as the significancelevel.Results: Subjects with social anxiety indicators exhibited higher mean total K-MPAI scores, as well ashigher individual scores on 62% of its items. The area under the ROC curve was 0.734 (p = 0.001),and considered appropriate. Within the possible cutoff scores presented, the score -15 had the bestbalance of sensitivity and specificity values. However, the score -7 had greater specificity andaccuracy.Conclusion: The K-MPAI showed appropriate discriminant validity, with a marked associationbetween music performance anxiety and social anxiety. The cutoff scores presented in the study haveboth clinical and research value, allowing screening for music performance anxiety and identificationof possible cases.Keywords: Anxiety; performance; music; scale; screening

Background/Purpose: A cutoff point in a test with sounded validity and professional preferences can help to make an accurate clinical decision. This study aimed to determine a cutoff point between two strategies for a developmental screening checklist (referred to as Taipei Ⅱ). Cutoff point A was set as one or more item failed and cutoff point B was set as two or more items failed or one or more marked item failed. Methods: This study was based on the total expected utilities of professional preferences and overall diagnostic indices. A self-administered questionnaire was developed to collect the estimated utility from professionals involved in early childhood interventions (n=81) regarding four screening outcomes (probabilities of true positive, false positive, true negative, or false negative) and costs. The total expected utilities were calculated from the probabilities of four screening outcomes and utility values. Results: The diagnostic odds ratio was higher for strategy B (695 and 209, respectively) than that of strategy A (184 and 150, respectively) when using the Taipei Ⅱ on children under 3 years of age and age 3 and over. Strategy B also had a higher median total expected utilities score than strategy A (0.78 vs. 0.72 for children＜3 and 0.76 vs. 0.67 for children≥3). Conclusion: If only one cutoff point can be chosen, the authors suggest that clinicians should choose cutoff point B when using the Taipei Ⅱ for screening. However, two cutoff points of Taipei Ⅱ, a combination of strategy A and B, can also be used clinically.

Immunochemical faecal occult blood tests have shown a greater sensitivity than guaiac test in colorectal cancer screening, but optimal number of samples and cutoff have still to be defined. The aim of this multicentric study was to evaluate the performance of immunochemical-based screening strategies according to different positivity thresholds (80, 100, 120 ng ml(-1)) and single vs double sampling (one, at least one, or both positive samples) using 1-day sample with cutoff at 100 ng ml(-1) as the reference strategy. A total of 20 596 subjects aged 50-69 years were enrolled from Italian population-based screening programmes. Positivity rate was 4.5% for reference strategy and 8.0 and 2.0% for the most sensitive and the most specific strategy, respectively. Cancer detection rate of reference strategy was 2.8 per thousand, and ranged between 2.1 and 3.4 per thousand in other strategies; reference strategy detected 15.6 per thousand advanced adenomas (range=10.0-22.5 per thousand). The number needed to scope to find a cancer or an advanced adenoma was lower than 2 (1.5-1.7) for the most specific strategies, whereas it was 2.4-2.7, according to different thresholds, for the most sensitive ones. Different strategies seem to have a greater impact on adenomas rather than on cancer detection rate. The study provides information when deciding screening protocols and to adapt them to local resources.

Introduction Fatigue is one of the most common symptoms in patients with advanced cancers. Despite its high prevalence, it is often unrecognized and undetected. This study assessed the feasibility and validity of a one-item fatigue scale (OIFS) in an outpatient oncology clinic. Methods Over a 3-month trial period, all patients in a thoracic oncology clinic were screened for fatigue with a one-item, 0 to 10 scale. Over a second trial period, an additional sample of 100 clinic patients completed validated measures of fatigue, including the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and Fatigue Symptom Inventory (FSI), in addition to the OIFS. Results During the initial trial period, more than 95% of patients (574 of 600) had a documented OIFS score on their first clinic visit. Data from the second cohort of patients revealed that the OIFS had good test-retest reliability ( r = 0.88) and was highly correlated with the FSI severity scale (0.87) and the FACIT-F (−0.75). Receiver operating characteristic analysis showed the OIFS had good discrimination compared with the FACIT-F (area under the curve=0.87). Sensitivity and specificity of several OIFS cutoff scores were compared, and scores between 3 and 5 were found to be optimal. Conclusions The use of a one-item scale to screen for fatigue is feasible in an ambulatory clinic setting. This scale had convergent validity with other measures of fatigue and was able to identify cases of fatigue that met criteria on the FACIT-F. These data support the recommendations in the National Comprehensive Cancer Network guidelines for cancer-related fatigue screening.

Background Major depressive disorder (MDD) may be present in 10%–20% of patients in medical settings. Routine depression screening is sometimes recommended to improve depression management. However, studies of the diagnostic accuracy of depression screening tools have typically used data-driven, exploratory methods to select optimal cutoffs. Often, these studies report results from a small range of cutoff points around whatever cutoff score is most accurate in that given study. When published data are combined in meta-analyses, estimates of accuracy for different cutoff points may be based on data from different studies, rather than data from all studies for each possible cutoff point. As a result, traditional meta-analyses may generate exaggerated estimates of accuracy. Individual patient data (IPD) meta-analyses can address this problem by synthesizing data from all studies for each cutoff score to obtain diagnostic accuracy estimates. The nine-item Patient Health Questionnaire-9 (PHQ-9) and the shorter PHQ-2 and PHQ-8 are commonly recommended for depression screening. Thus, the primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2 to detect MDD among adults across all potentially relevant cutoff scores. Secondary analyses involve assessing accuracy accounting for patient factors that may influence accuracy (age, sex, medical comorbidity). Methods/design Data sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. We will include studies that included a Diagnostic and Statistical Manual or International Classification of Diseases diagnosis of MDD based on a validated structured or semi-structured clinical interview administered within 2 weeks of the administration of the PHQ. Two reviewers will independently screen titles and abstracts, perform full article review, and extract study data. Disagreements will be resolved by consensus. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cutoff values. Discussion The proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2. Systematic review registration PROSPERO CRD42014010673

Overnight oximetry is widely used for screening for the sleep apnea hypopnea syndrome (SAHS). The degree of desaturation at an apnea event is known to be affected by the degree of obesity. We hypothesized that the diagnostic ability of oximetry for SAHS is affected by the degree of obesity. A total of 424 consecutive patients referred for possible SAHS were studied. The subjects were classified into three groups of normal-weight, overweight and obese based on the body mass index (BMI). The apnea-hypopnea index (> or = 15 h(-1)) by polysomnography was used as the diagnostic gold standard. Oximetry data were automatically analyzed to calculate the oxygen desaturation index (ODI2/3/4:at 2%/3%/4% threshold). The diagnostic abilities of the ODI were different in the three BMI-groups at a given cutoff value, e.g. the sensitivity/specificity of ODI4 (cutoff = 15) were 54%/100%, 83%/ 97%, and 98%/78% for the normal-weight, overweight and obese groups, respectively (P < 0.0001). The gender and the age had no significant effect on the ability. We demonstrated the diagnostic sensitivity and specificity of the ODI for SAHS depended on the BMI. Oximetry as a screening tool for SAHS may become more useful by selection of a cutoff value appropriate for the BMI of each subject.

Objetivo: avaliar o valor de parâmetros ultra-sonográficos para o diagnóstico da síndrome de Down fetal (T21), com a finalidade de permitir sua aplicação na prática clínica rotineira. Métodos: estudo do tipo coorte transversal prospectivo, utilizando múltiplos parâmetros ultra-sonográficos para predição da T21. Foram avaliados 1662 exames ultra-sonográficos no estudo de coorte e outros 289 exames como amostra diferencial para testar a curva de normalidade, de outubro de 1993 a novembro de 2000. A análise estatística se baseou no cálculo das variabilidades intra e interoperadores, na construção das curvas de normalidade dos parâmetros e provas de validação destas, nos cálculos de sensibilidade, especificidade, risco relativo, razão de probabilidade e dos valores preditivos pós-teste. Resultados: entre os 1662 casos do estudo, ocorreram 22 casos (1,32%) de fetos com T21. As curvas de normalidades foram construídas para os parâmetros espessura nucal, relação fêmur/pé e comprimento dos ossos próprios do nariz, sendo que a pelve renal obedeceu a distribuição semiquantitativa e o nível de corte estabelecido foi de 4,0 mm. Os valores de sensibilidade, especificidade, taxa de falso-positivos, risco relativo e razão de probabilidade para espessura da prega nucal acima do percentil 95 foram respectivamente 54,5%, 95,2%, 4,9%, 20,2 e 11. Para medida dos ossos próprios do nariz abaixo do percentil 5, os valores obtidos foram 59,0%, 90,1%, 9,0%, 13,4 e 6,5. Para a relação fêmur/pé abaixo do percentil 5, 45,5%, 84,4%, 15,6%, 3,7 e 2,6. Para a presença de bacinete >4,0 mm, 36,4%, 89,2%, 10,9%, 4,5 e 3,4. Para a ausência da falange média do quinto dedo, 22,7%, 98,1%, 1,9%, 13,2 e 11,9. Para a presença de anomalias estruturais, 31,8%, 98,7%, 1,3%, 27,2 e 24,8. A partir do cálculo da razão de probabilidade e da incidência de T21 nas diversas idades maternas, construiu-se tabela para risco pós-teste dos parâmetros ultra-sonográficos estudados. Conclusões: foram estabelecidas as curvas de normalidade e os índices para cálculo de risco populacional da síndrome de Down fetal utilizando diferentes idades maternas e os fatores multiplicadores por nós propostos. Não foi possível estabelecer curva de normalidade para o parâmetro medida da pelve renal, pois seus resultados tiveram comportamento semiquantitativo, tendo sido, portanto, analisados por faixa de normalidade. Purpose: to appraise the value of ultrasonographic parameters for the diagnosis of fetal Down syndrome (T21), in order to permit its use in routine clinical practice. Methods: this is a prospective cohort study using various ultrasonographic parameters for the prediction of T21. A total of 1662 scans were evaluated in the cohort study and 289 examinations were analyzed as a differential sample to test the normality curve from October 1993 to November 2000. The statistical analysis was based on the calculation of intra- and interobserver variations, the construction of normality curves for the studied parameters, as well as their validity tests, and the calculation of sensitivity, specificity, relative risk, likelyhood ratio and posttest predictive values. Results: among 1662 cases, 22 fetuses (1.32%) with T21 were identified. The normality curves were built for nucal fold thickness, femur/foot ratio and nasal bone length. Renal pelvis had a semiquantitative distribution and the proposed cutoff level was 4.0 mm. Sensitivity, specificity, false positive rate, relative risk and likelyhood ratio for nucal fold measurements above the 95th percentile were 54.5%, 95.2%, 4.9%, 20.2 and 11, respectively. For nasal bone measurements below the 5th percentile, 59.0%, 90.1%, 9.0%, 13.4 and 6.5. For femur/foot ratio below the 5th percentile, 45.5%, 84.4%, 15.6%, 3.7 and 2,6. For renal pelvis greater than 4.0 mm, 36.4%, 89.2%, 10.9%, 4.5 and 3.4. For absent fifth finger middle phalanx, 22.7%, 98.1%, 1.9%, 13.2 and 11.9. For the presence of major malformations, 31.8%, 98.7%, 1.3%, 27.2 and 24,8. After calculating the probability rates and the incidence of T21 in different maternal ages, a table for posttest risk using ultrasonographic parameters was set up. Conclusions: normality curves and indices for the assessment of risk for fetal Down syndrome on a population basis were established by the utilization of different maternal ages and by multiplying factors proposed by the authors. It was not possible to establish a normality curve for renal pelvis measurements, because of their semiquantitative distribution.

Background Skeletal muscle mass declines after the age of 50. Loss of skeletal muscle mass is associated with increased morbidity and mortality. Objective This study aims to identify predictors of low skeletal muscle mass in older adults toward development of a practical clinical assessment tool for use by clinicians to identify patients requiring dual-energy X-ray absorptiometry (DXA) screening for muscle mass. Methods Data were drawn from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2004. Appendicular skeletal mass (ASM) was calculated based on DXA scans. Skeletal muscle mass index (SMI) was defined as the ratio of ASM divided by height in square centimeters. Elderly participants were classified as having low muscle mass if the SMI was 1 standard deviation (SD) below the mean SMI of young adults (20–40 years old). Logistic regression was conducted separately in males and females age ≥65 years of age to examine the relationship between patients identified as having low muscle mass and health behavior characteristics, adjusting for comorbid conditions. The model was validated on a separate sample of 200 patients. Results Among the NHANES study population, 551 (39.7 %) males and 374 (27.5 %) females had a SMI below the 1 SD cutoff point. NHANES study subjects with a low SMI were older (mean age, 76.2 vs. 72.7 for male; 76.0 vs. 73.7 for female; and both p

Compared with the guaiac-based FOBT (G-FOBT), one of the main advantages of some immunochemical faecal occult blood tests (iFOBTs) is that they allow haemoglobin quantification (Itoh et al, 1996; Castiglione et al, 2002; Guittet et al, 2007). The semi-quantitative nature of these tests permits adjustment of the cutoff value for the detection of colorectal cancer (CRC) in an effort to optimise screening programmes for specific populations and health-care practices. Changing the cutoff value can have considerable implications on the performance of the test in a screening population. In general, lowering the cutoff value will increase sensitivity, but consequently decrease specificity and vice versa. An increase in sensitivity means an increase in the detection of patients with colorectal cancer or advanced adenomas, but the consequential decrease in specificity results in more persons without relevant lesions undergoing a colonoscopy (false positives). Some studies in screening populations have been published on changing the cutoff value of iFOBTs. However, in these studies only a few selected cutoff values are presented, and the complete range of possible cutoff values is not addressed (Castiglione et al, 2002; Guittet et al, 2007; Grazzini et al, 2009). Furthermore, colonoscopy data, verifying the presence or absence of pathology, are usually presented for test results equal to or above the threshold that is recommended by the manufacturer. The two most frequently presented quantitative iFOBTs, the OC-Sensor (Eiken Chemical) and the Magstream 1000 (Fujirebio Diagnostics, Tokyo, Japan), were developed in Japan, where incidence rates for CRC are lower than those in Europe (Minami et al, 2006). Therefore, the cutoff value with optimal overall performance may be different in Europe compared with Japan. In a recent study including 1000 symptomatic and other high-risk patients in Israel, cutoff values below the recommended threshold of 100 ng ml−1 were evaluated (Levi et al, 2007). The authors concluded that the optimal cutoff value might be as low as 75 ng ml−1; they also noted that the test performance in average-risk patients in a screening population is unknown. Our aim was to evaluate the performance and efficiency of a semi-quantitative iFOBT in an average-risk screening population.