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Subjects with initially extreme observations upon remeasurement are found closer to the population mean. This tendency of observations toward the mean is called regression to the mean (RTM) and can make natural variation in repeated data look like real change. Studies, where subjects are selected on a baseline criterion, should be guarded against the RTM effect to avoid erroneous conclusions. In an intervention study, the difference between pre-post variables is the combined effect of intervention/treatment and RTM. Thus, accounting for RTM is essential to accurately estimate the intervention effect. Many real-life examples are better modeled by a bivariate binomial model with varying probability of success. In this article, a bivariate beta-binomial distribution is used that allows the probability of success to vary from subject to subject. Expressions for the total, RTM, and treatment effect are derived, and their behavior is demonstrated graphically. Maximum likelihood estimators of RTM are derived, and their statistical properties are studied via Monte Carlo simulation. The proposed techniques are employed to estimate the RTM effect by utilizing data related to the Countway WM-class circulation. [ABSTRACT FROM AUTHOR]

Abstract Background Although the metabolic equivalents (METs) system is a common procedure to quantify the intensity of physical activity in older adults, it remains unclear whether the conventional METs intensity thresholds (CTs) used for this purpose are appropriate in this population. Therefore, this study aimed (i) to derive overall and fitness-specific METs intensity thresholds in older adults ≥ 60 years old (OATs) expressed both in standard METs (VO2/3.5 mL O2·kg−1·min−1) and older adults METs60+ (VO2/2.7 mL O2·kg−1·min−1), and (ii) to compare them with the CTs. Methods A total of 93 subjects were assessed for cardiorespiratory fitness. Graded exercise test protocols using indirect calorimetry were performed to calculate individual VO2max and categorize subjects as "very poor/fair" or "good/superior" fitness. Overall and fitness-specific OATs expressed in standard METs (OATsstandard) and METs60+ (OATs60+) were derived based on the %VO2max and the ventilatory thresholds (VTs) physical intensity categories. Results Significantly higher VO2max, VO2 at VT1 and VO2 at VT2 (p

Background: Although the metabolic equivalents (METs) system is a common procedure to quantify the intensity of physical activity in older adults, it remains unclear whether the conventional METs intensity thresholds (CTs) used for this purpose are appropriate in this population. Therefore, this study aimed (i) to derive overall and fitness-specific METs intensity thresholds in older adults ≥ 60 years old (OATs) expressed both in standard METs (VO2/3.5 mL O2·kg−1·min−1) and older adults METs60+ (VO2/2.7 mL O2·kg−1·min−1), and (ii) to compare them with the CTs. Methods: A total of 93 subjects were assessed for cardiorespiratory fitness. Graded exercise test protocols using indirect calorimetry were performed to calculate individual VO2max and categorize subjects as "very poor/fair" or "good/superior" fitness. Overall and fitness-specific OATs expressed in standard METs (OATsstandard) and METs60+ (OATs60+) were derived based on the %VO2max and the ventilatory thresholds (VTs) physical intensity categories. Results: Significantly higher VO2max, VO2 at VT1 and VO2 at VT2 (p < 0.001) were obtained in the "good/superior" subgroup compared to the "very poor/fair" fitness subgroup. Accordingly, OATs were approximately 69% higher in individuals with a "good/superior" fitness compared to those with a "very poor/fair" fitness. Furthermore, this study showed that OATsstandard were approximately 21–24% lower than OATs60+, and 10–22% higher OATs were observed when following the VTs intensity categories (heavy-intensity physical activity [HPA] and severe-intensity physical activity [SPA]) compared to the %VO2max categories (moderate-intensity physical activity [MPA] and vigorous-intensity physical activity [VPA]). When compared with the CTs, similar or higher OATsstandard and OATs60+ for MPA, and HPA were obtained compared to the conventional MPA threshold (3.0 METs). Conversely, for VPA and SPA, lower, similar, or higher OATs were obtained depending on the METs derivation approach (OATsstandard or OATs60+) or the intensity categories (VO2max or VTs), compared to the conventional VPA threshold (6.0 METs). Conclusions: None of the derived OATs were concurrently similar to the CTs, suggesting that fitness-specific METs intensity thresholds adapted to the METs derivation approach should be used in older adults. Trial registration: FenotipAGING (Non-health-care intervention study), PRO-Training (NCT05619250). [ABSTRACT FROM AUTHOR]

Nomophobia is a situational phobia in which a person experiences fear of not being able to use the smartphone. The Nomophobia Questionnaire (NMP-Q) is the most widely used but it is not validated in the Spanish-speaking Latin American context. There are hardly any cross-cultural studies of nomophobia. The main objectives are to:1) adapt and validate the NMP-Q in a Mexican sample; 2) analyse gender, age and cross-cultural invariance; 3) examine the differences between countries. The Mexican sample consisted of 19,226 participants (63.1% girls), and the Spanish sample of 3897 (46% girls), aged between 14 and 19 years. The model of four-factors explained by a second-order factor fitted the data adequately. Satisfactory reliability indices were obtained, invariance by sex and age, and cross-cultural invariance. Higher scores were found in females, in adolescents aged 14–16 years, and in the Spaniards. The NMP-Q allows identifying problems of nomophobia in Mexicans and comparing them with Spaniards. [ABSTRACT FROM AUTHOR]

Background: Neck circumference (NC) is a novel anthropometric indicator to assess adiposity in the cervical region that is rarely used in Mexico. The greatest advantage of this evaluation is the saving of time, minimal use of instruments, and no prerequisites for patients. Objective: This study aimed to determine the effectiveness of NC as an indicator of obesity for Metabolic Syndrome (MetS) in comparison with BMI and Waist Circumference (WC), and to define NC cutoff levels based on parameters established by the International Diabetes Federation in a group of healthcare workers from a Public Health Hospital of the State of Morelos, Mexico. Methods: This was a no-randomized, cross-sectional-observational study. Instruments: Anthropometric evaluation and biochemical parameters: lipid profile, fasting glucose, and blood pressure. Statistical analysis: Descriptive, correlational, Poisson multiple regression adjusted by age/sex, and ROC curves using SPSS.23 program. Results: 200 healthcare workers were recruited (146 women and 54 men), age ẋ=42.87, σ=11.25 years. The prevalence of MetS was 38% (37% in women and 40.7% in men). BMI, WC, and NC were significantly correlated: BMI and WC (r=.924), BMI and NC (r=.814), and NC and WC (r=.810) (p=.01). Likewise, they were related to hyperglycemia, hypertriglyceridemia, hypertension, and decreased in HDL-cholesterol levels. The NC best cut-off points coupled with two or more components of MetS in women was ≥35.12 cm [AUC=0.765 (95% CI, 0.688-0.843)] and in men ≥41.25 cm [AUC=0.787 (95% CI, 0.688-0.906)]. Conclusion: NC proved to be a reliable indicator that can be quickly and inexpensively evaluated for the determination of obesity for the preliminary diagnosis of MetS. [ABSTRACT FROM AUTHOR]

Introduction: Sarcopenia is considered a muscular disease known in older adults, characterized by the reduction of muscle mass and physical performance. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) established criteria to define sarcopenia based on muscle mass, grip strength, and gait speed. Bioelectrical Impedance Analysis (BIA) has become popular for estimating body composition in various populations, particularly for assessing sarcopenia in geriatrics. Objective: To identify the cutoff points for Skeletal Muscle Mass Index (SMI) using BIA for the diagnosis of sarcopenia in men and women aged over 60 years within the period between January 1, 2010, and July 19, 2020. Methodology: A literature search was conducted in the databases of PubMed, Science Direct, Springer, EBSCO, Scopus, OVID, and WOS. Studies in English and Spanish reporting cutoff points for skeletal muscle mass evaluated by BIA for the diagnosis of sarcopenia in adults > 60 years of both sexes were included. Results: Only 14 studies met the inclusion criteria. The cutoff points for the decrease in muscle mass varied in each study from 7 kg/m² to ≤ 10.75 kg/m² in men and from <5.7 kg/m² to <7.4 kg/m² in women, adjusted for height. Conclusion: This systematic review enabled the recognition of distinct cutoff points for the diagnosis of sarcopenia in older adults worldwide. Furthermore, it demonstrated that the cutoff points for SMI vary from country to country. As a result, further studies encompassing diverse regions within each country are necessary to establish cutoff points that enhance the accurate diagnosis of sarcopenia in the elderly population. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is a condition characterized by disturbances in carbohydrate and lipid metabolism that precedes T2DM. The aim of the present study was to investigate the association between HDL and its subfraction profile and the progression of IR, as assessed by the Homeostatic Model Assessment for IR (HOMA-IR) index, and to define cut-off values to identify an increased risk of IR. Individuals with a HOMA-IR greater than 3.63 were considered to have IR. The HDL subfractions were separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) in three subclasses as large (HDL-L), intermediate (HDL-I) and small (HDL-S). Analyses were performed on samples from 240 individuals without IR and 137 with IR from the Hungarian general and Roma populations. The HDL-1 to -6 subfractions and the HDL-L and -I classes showed a significant negative association with the progression and existence of IR. Among them, HDL-2 (B = −40.37, p = 2.08 × 10−11) and HDL-L (B = −14.85, p = 9.52 × 10−10) showed the strongest correlation. The optimal threshold was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. Individuals with HDL-L levels below the reference value had a 5.1-fold higher risk of IR (p = 2.2 × 10−7), while those with HDL-2 levels had a 4.2-fold higher risk (p = 3.0 × 10−6). This study demonstrates that the HDL subfraction profile (especially the decrease in HDL-2 and -L) may be a useful marker for the early detection and intervention of atherogenic dyslipidemia in subjects with impaired glucose and insulin metabolism. [ABSTRACT FROM AUTHOR]

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Background: Currently, there are no cut‐off points for levels of empathy, making it difficult to assess the change experienced in its development or as a result of its intervention. It is an unsolved problem. Introduction: Empathy is a cognitive‐affective attribute that enables nursing staff to maintain a professional relationship that entails various benefits for the patient. Its strengthening and development during university education is desirable. Empathy studies in Latin American nursing students are based on the direct scores obtained on an empathy test, based on which the variable is described and groups are compared. Statistical comparisons are not enough to discriminate substantive changes since two statistical values can show differences without implying that the post‐intervention levels may correspond to a higher category in relation to those of pre‐intervention or that two compared groups are qualitatively different. The above applies to empathic behaviour and is valid for students and professionals of health. This study aimed to establish cut‐off points that allow defining ordinal categories in empathy. Methods: In this multicenter and cross‐sectional study, 3712 students from 11 Latin American nursing schools participated. The Jefferson Empathy Scale (JES) was applied; the psychometric properties were confirmed by Factor Analysis Confirmatory and Invariance. Results: The JSE empathy scale is a measure with adequate reliability and construct validity. Examined cut‐offs determined a structure of five empathy intervals that allowed them to be classified as empathy values in very high, high, medium, low and very low. Discussion: The sequence of statistical tests carried out allowed us to determine ranges of categorical values in the empathy levels of groups of students. However, the determined categories may constitute a specific characteristic of them. It is not possible to extrapolate these results to regions other than those of Latin America. Conclusion: The estimated rankings allow comparing levels of empathy between groups of nursing students and the real effect of empathic interventions. Implications for nursing: To contribute with strategies to evaluate changes in the empathic skills of nursing students, resulting in a well‐valued skill in health services. Implications for nursing policy: The cut‐off points define evaluative categories (very low, low, medium, high and very high) that allow objective classification of levels of empathy achieved after (for example) an empathic intervention. This allows assessment of substantive changes experienced by nursing students (and professionals). [ABSTRACT FROM AUTHOR]

Over the last 30 years deception researchers have changed their attention from observing nonverbal behaviour to analysing speech content. However, many practitioners we speak to are reluctant to make the change from nonverbal to verbal lie detection. In this article we present what practitioners believe is problematic about verbal lie detection: the interview style typically used is not suited for verbal lie detection; the most diagnostic verbal cue to deceit (total details) is not suited for lie detection purposes; practitioners are looking for signs of deception but verbal deception researchers are mainly examining cues that indicate truthfulness; cut-off points (decision rules to decide when someone is lying) do not exist; different verbal indicators are required for different types of lie; and verbal veracity indicators may be culturally defined. We discuss how researchers could address these problems. [ABSTRACT FROM AUTHOR]

Background: The European Working Group on Sarcopenia in the Elderly defined sarcopenia as a geriatric syndrome with a diagnostic criteria of low skeletal muscle mass (LMM). Various sarcopenia consensuses recommend as cut-offs for LMM, the use of below 2 SDs from the mean skeletal muscle mass index (SMI) of a young reference group. Given the contrast between reported cut-offs, the objective of this study was to establish cut-offs for LMM from older adults in Manizales and compare them with those published in the literature. Methods: This was a prospective, cross-sectional analytical study in 237 healthy elderly patients from the city of Manizales, Colombia. Anthropometric measurements of weight, height and body mass index were estimated. The SMI was estimated with the Xitron Technologies bioimpedance meter using the Janssen formula. For the comparison of SMI cut-offs, studies that evaluated this parameter with bioelectrical impedance analysis (BIA) were taken into account, in addition to being obtained from the −2 SD from the sex-specific mean of a young reference group. Results: The cut-off points for SMI were 8.0 kg/m 2 for men and 6.1 kg/m 2 for women. There was a statistically significant difference when evaluating LMM from the cut-offs of the present study and those reported in Spain, Turkey, and Finland. The cut-off points of SMI derived from this sample of Colombian men and women may be adequate for the diagnosis in the Colombian geriatric population. However, we did not find significant differences when comparing the cut-offs for SMI from a population of older adults and young adults from the same city. Conclusions: The cut-off points of SMI by BIA derived from a sample of Colombian men and women may be adequate for the diagnosis of LMM in the Colombian geriatric population or populations with similar characteristics to those of the sample evaluated here.

Abstract Background Neck circumference is one of the anthropometric parameters that is widely used in practical applications, clinical and epidemiological studies in children. It is aimed to determine the neck circumference cut-off points and to use them in the detection of overweight and obesity in children living in Northern Cyprus. Subjects This cross-sectional study was conducted between October 2019 and January 2020, and covered a sample of 692 children (367 girls and 325 boys) aged 6–10 years attending primary schools in the Northern Cyprus. Methods Body weight, height, neck circumference, waist circumference, subscapular and triceps skinfold tickness were measured. BF% was calculated with Slaughter equations. World Health Organization BMI cut-off points for age and gender percentiles were used to categorize obesity. BMI, WHtR, NC, body fat were calculated. The Pearson Correlation co-efficient between NC and the other anhtropometric measurements were calculated. Receiver operating characteristics analysis, sensitivity, specificity, PV + ve PV- was used to determine the optimal NC cut-off points for identifying children with overweight and obesity. Results NC was a statistically significant positive and strong relationship with body weight, BMI, waist circumference and hip circumference (p

This chapter presents a synopsis of African medicinal plants and their derived products with antimycobacterial properties. Several secondary plant metabolites are reported to have anti-tuberculosis activity comparable to existing anti-tuberculosis drugs. Using the data obtained from 77 active plant extracts and 75 active derived molecules towards Mycobacterium tuberculosis H37Rv, the rationale cut-off points for the classification of antimycobacterial agents from natural sources were established. (i) For botanicals: outstanding activity when MIC ≤ 6 µg/mL; excellent activity when 6 < MIC ≤ 16 µg/mL; very good activity when 16 < MIC ≤ 25 µg/mL; good activity when 25 < MIC ≤ 39 µg/mL, average activity when 39 < MIC ≤ 156 µg/mL, weak activity when 156 < MIC ≤ 2048 µg/mL, and not active MIC> 2048 µg/mL. (ii) For phytochemicals: outstanding activity when MIC ≤ 2.5 µg/mL, excellent activity when 2.5 < MIC ≤ 5R01;µg/mL, very good activity when 5512 µg/mL. Importantly, we have identified Artemisia abyssinica Schultz Bip. (Lamiaceae), Diospyros canaliculata De Wildeman (Ebenaceae), Diospyros crassiflora Hien (Ebenaceae), Croton macrostachyus Hochst. ex Del. (Lamiaceae), and Echinops giganteus A. Rich (Asteraceae) as the most active plants, and isobachalcone (1), diospyrone (2), laburnetin (3), 3,4'-di-O-methylellagic acid 3'-O-β-D-xylopyranoside (4), O1-demethyl-3',4'-deoxy-psorospermi-3',4' diol (5), plumbagin (6), crassiflorone (7), and bafoudiosbulbins C (8), as the most promising antimycobacterial phytochemicals. [ABSTRACT FROM AUTHOR]

Background: The European Working Group on Sarcopenia in the Elderly defined sarcopenia as a geriatric syndrome with a diagnostic criteria of low skeletal muscle mass (LMM). Various sarcopenia consensuses recommend as cut-offs for LMM, the use of below 2 SDs from the mean skeletal muscle mass index (SMI) of a young reference group. Given the contrast between reported cut-offs, the objective of this study was to establish cut-offs for LMM from older adults in Manizales and compare them with those published in the literature. Methods: This was a prospective, cross-sectional analytical study in 237 healthy elderly patients from the city of Manizales, Colombia. Anthropometric measurements of weight, height and body mass index were estimated. The SMI was estimated with the Xitron Technologies bioimpedance meter using the Janssen formula. For the comparison of SMI cut-offs, studies that evaluated this parameter with bioelectrical impedance analysis (BIA) were taken into account, in addition to being obtained from the −2 SD from the sex-specific mean of a young reference group. Results: The cut-off points for SMI were 8.0 kg/m2 for men and 6.1 kg/m2 for women. There was a statistically significant difference when evaluating LMM from the cut-offs of the present study and those reported in Spain, Turkey, and Finland. The cut-off points of SMI derived from this sample of Colombian men and women may be adequate for the diagnosis in the Colombian geriatric population. However, we did not find significant differences when comparing the cut-offs for SMI from a population of older adults and young adults from the same city. Conclusions: The cut-off points of SMI by BIA derived from a sample of Colombian men and women may be adequate for the diagnosis of LMM in the Colombian geriatric population or populations with similar characteristics to those of the sample evaluated here.

Background The European Working Group on Sarcopenia in Older People (EWGSOP) updated in 2018 the cut-off points for low grip strength to assess sarcopenia based on pooled data from 12 British studies. Objective Comparison of the EWGSOP2 cut-off points for low grip strength to those derived from a large German sample. Methods We assessed the grip strength distribution across age and derived low grip strength cut-off points for men and women (peak mean -2.5 × SD) based on 200,389 German National Cohort (NAKO) participants aged 19–75 years. In 1,012 Cooperative Health Research in the Region of Augsburg (KORA)-Age participants aged 65–93 years, we calculated the age-standardised prevalence of low grip strength and time-dependent sensitivity and specificity for all-cause mortality. Results Grip strength increased in the third and fourth decade of life and declined afterwards. Calculated cut-off points for low grip strength were 29 kg for men and 18 kg for women. In KORA-Age, the age-standardised prevalence of low grip strength was 1.5× higher for NAKO-derived (17.7%) compared to EWGSOP2 (11.7%) cut-off points. NAKO-derived cut-off points yielded a higher sensitivity and lower specificity for all-cause mortality. Conclusions Cut-off points for low grip strength from German population-based data were 2 kg higher than the EWGSOP2 cut-off points. Higher cut-off points increase the sensitivity, thereby suggesting an intervention for more patients at risk, while other individuals might receive additional diagnostics/treatment without the urgent need. Research on the effectiveness of intervention in patients with low grip strength defined by different cut-off points is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Fatty liver index (FLI) is the most recognized blood biomarker for diagnosis of hepatic steatosis (HS), but lacks the reliable specific cut-off points (COPs). Therefore, we aim to investigate the population-specific COPs of FLI based on the results of liver ultrasound transient elastography (LUTE) and conventional ultrasonography in the National Health and Nutrition Examination Survey (NHANES). Methods 5948 participants who underwent LUTE from the NHANES 2017–2018 and 14,797 participants who underwent conventional ultrasonography from the Third NHANES (NHANES III) were recruited. FLI was calculated by using body mass index (BMI), waist circumference (WC), triglyceride, and gamma-glutamyl transferase, and its optimal COPs in a specific population (stratified by sex, BMI, and WC) were obtained from receiver operator characteristics (ROC) curve with ultrasonic-diagnosed HS as the reference standard. Results Based on LUTE in NHANES 2017–2018, the prevalence of HS and metabolic dysfunction-associated fatty liver disease (MAFLD) were 58.7% and 56.2%, respectively, and the optimal COP of FLI for HS diagnosis in the overall population was 45.60, with an area under ROC curve (AUROC) of 0.833 (0.822–0.844). Based on conventional ultrasonography in NHANES III, the prevalence of HS and MAFLD were 34.4% and 27. 9%, respectively, and the optimal COP of FLI for HS was 59.5, with an AUROC of 0.681 (0.671–0.691). With the increase of BMI and WC, the COPs increased gradually with significant differences between different groups. Compared with conventional ultrasonography, the COPs of FLI based on LUTE were much more precise, with higher diagnostic ability. The population-specific COPs of FLI stratified by gender, WC, and BMI were tabulated. Conclusion In the United States, the incidences of HS and MAFLD were high, especially when assessed by LUTE. The FLI based on LUTE is well capable of predicting HS when stratified by gender, WC, and BMI.

Type 2 diabetes mellitus (T2DM) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is a condition characterized by disturbances in carbohydrate and lipid metabolism that precedes T2DM. The aim of the present study was to investigate the association between HDL and its subfraction profile and the progression of IR, as assessed by the Homeostatic Model Assessment for IR (HOMA-IR) index, and to define cut-off values to identify an increased risk of IR. Individuals with a HOMA-IR greater than 3.63 were considered to have IR. The HDL subfractions were separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) in three subclasses as large (HDL-L), intermediate (HDL-I) and small (HDL-S). Analyses were performed on samples from 240 individuals without IR and 137 with IR from the Hungarian general and Roma populations. The HDL-1 to -6 subfractions and the HDL-L and -I classes showed a significant negative association with the progression and existence of IR. Among them, HDL-2 (B = −40.37, p = 2.08 × 10−11) and HDL-L (B = −14.85, p = 9.52 × 10−10) showed the strongest correlation. The optimal threshold was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. Individuals with HDL-L levels below the reference value had a 5.1-fold higher risk of IR (p = 2.2 × 10−7), while those with HDL-2 levels had a 4.2-fold higher risk (p = 3.0 × 10−6). This study demonstrates that the HDL subfraction profile (especially the decrease in HDL-2 and -L) may be a useful marker for the early detection and intervention of atherogenic dyslipidemia in subjects with impaired glucose and insulin metabolism.

Abstract Background Increased waist circumference (WC) is one of the cardiovascular disease (CVD) risk factors used to predict cardiovascular events. Waist circumference cut-off values for predicting metabolic syndrome and other cardiovascular risks have been previously studied. Carotid intima-media thickness (CIMT) is one of the cardiovascular risk factor recently described and reported to be suitable as it is a direct measurement of vascular quality. Hence the aim of the present study was to determine the optimal WC cut-off point for the prediction of subclinical CVD. Methods The study was a cross-sectional study using quantitative methods, conducted among 1318 adults aged between 40 and 60 years old, residing in a rural Black population in Limpopo province. Carotid Intima-Media Thickness measurements were performed using a LOGIQ ultrasound system (GE Healthcare, CT, USA). Waist Circumference (WC) (cm) was measured to the nearest 0.1 cm. Bivariate correlation, logistic regression and receiver operating characteristic were analysed using the statistical package for social sciences version 26.0 software. Results Among the total population, 69% were women and 31% men with a mean age of 53 ± 7 years. Among women, WC at a cut-off value of 95 cm gave the highest sensitivity of 57%, the specificity of 55% and an area under the curve (AUC) of 0.588. In men, an optimum WC cut-off point of 82 cm yielded the highest sensitivity and specificity at 72% and 70% respectively, with an AUC of 0.767 p

Haoqiang Ji,1 Jia Xu,1 Ruiheng Wu,1 Xu Chen,1 Xintong Lv,2 Hongyu Liu,2 Yuxin Duan,1 Meng Sun,1 Yuanping Pan,1 Yunting Chen,1 Xiwei Lu,2 Ling Zhou1 1School of Public Health, Dalian Medical University, Dalian, 116044, People’s Republic of China; 2Office of Epidemic Surveillance, Dalian Tuberculosis Hospital, Dalian, Liaoning, People’s Republic of ChinaCorrespondence: Xiwei Lu; Ling Zhou 9 West Section, Lvshun South Road, Dalian, Liaoning Province, People’s Republic of ChinaTel +86 411 8611 0368Email yiluxiwei@126.com; zhouling0609@163.comPurpose: Despite increasing literature on the association between treatment delay and outcomes, cut-off point (1 month or median) selection in almost all studies for treatment delay is too subjective. This study explored more scientific cut-off points of treatment delay for poor treatment outcomes and death at the clinical level.Patients and Methods: A total of 18,100 newly confirmed pulmonary tuberculosis (TB) cases in Dalian, China were used in the final analysis. A 3-knotted restricted cubic spline (RCS) fitted for Cox proportional hazard regression models is used to analyse the effects of cut-off points of treatment delay on incident poor treatment outcomes. To explore the moderating effects of age, gender and diabetes, we added the interaction terms of these moderating variables and treatment delay to Cox proportional hazard regression models.Results: The median time of treatment initiation was 30 days (IQR: 14– 59 days). The risk of incident poor treatment outcomes increased when the time was greater than cut-off point 1 (53 days; adjusted HR: 1.26; 95% CI: 1.00– 1.60) of treatment delay, and the risk of incident death events increased when the time was greater than cut-off point 2 (103 days; adjusted HR: 1.56; 95% CI: 1.00– 2.44) of delay. In addition, treatment delay was associated with an increased risk of incident poor treatment outcomes and death, and older age, male sex, and diabetes may increase the risk of treatment delay for poor outcomes.Conclusion: This study is the first to identify scientific cut-off points of treatment delay for poor treatment outcomes and death, and this method of exploration should be popularized. In addition, the knowledge of tuberculosis must be spread to every adult. Moreover, the tuberculosis diagnosis level of community level health workers should be enhanced.Keywords: new pulmonary tuberculosis patients, poor treatment outcomes, treatment delay, cut-off points, restricted cubic spline

Background: Neck circumference is one of the anthropometric parameters that is widely used in practical applications, clinical and epidemiological studies in children. It is aimed to determine the neck circumference cut-off points and to use them in the detection of overweight and obesity in children living in Northern Cyprus.Subjects: This cross-sectional study was conducted between October 2019 and January 2020, and covered a sample of 692 children (367 girls and 325 boys) aged 6-10 years attending primary schools in the Northern Cyprus.Methods: Body weight, height, neck circumference, waist circumference, subscapular and triceps skinfold tickness were measured. BF% was calculated with Slaughter equations. World Health Organization BMI cut-off points for age and gender percentiles were used to categorize obesity. BMI, WHtR, NC, body fat were calculated. The Pearson Correlation co-efficient between NC and the other anhtropometric measurements were calculated. Receiver operating characteristics analysis, sensitivity, specificity, PV + ve PV- was used to determine the optimal NC cut-off points for identifying children with overweight and obesity.Results: NC was a statistically significant positive and strong relationship with body weight, BMI, waist circumference and hip circumference (p < 0,005). NC cut-off values to define overweight and obesity were calculated as 26,9 cm in girls (AUC: 0,851, 95% CI: 0,811-0,891, sensitivity 70,50%, specificity 84,65%) and 27,9 cm in boys (AUC: 0,847, 95% CI: 0,805-0,888, sensitivity 76,4%, specificity 79,3%). The ROC curves accurately define overweight and obesity of the whole cohort regardless of age for both sexes of children.Conclusions: The cut-off points for neck circumference were found to be 27,9 cm for boys and 26,9 cm for girls in determining overweight and obesity in children aged 6-10 years. The NC cut-off points obtained in this study can be used to define overweight and obesity in children in epidemiological studies. It is considered to shed light on studies that will examine the relationship between neck circumference and diseases with more people in future studies. [ABSTRACT FROM AUTHOR]

ObjectiveBody fat percentage (BF%) might be an alternative index of obesity which is the major risk factor for developing type 2 diabetes (T2D). We aim to longitudinally evaluated the relationship between BF% and risk of T2D.MethodsA sample of 5,595 adults aged 18–65 who participated in two waves of China Health and Nutrition Survey (CHNS 2015 and 2018) was analyzed. Two level mixed-effects modified Poisson regression with robust estimation of variance stratified by sex was used to evaluate the risk ratios (RRs) for T2D according to quintiles of BF%, and the curves of receiver operating characteristic (ROC) were plotted to identify the optimal total and trunk BF% cut-off points for predicting an increased T2D risk.ResultsIn males, compared with subjects in the first quintile of total BF%, those in the third (RR = 2.03, 95% CI 1.09–3.79), fourth (RR = 2.56, 95%CI 1.46–4.48), and fifth (RR = 2.16, 95%CI 1.22–3.82) quintile had higher risk of T2D after adjusting for all potential confounders (p-trend < 0.001). For females, the RR (95% CI) was 1.92 (1.14, 3.24) in the fifth quintile (p-trend = 0.014). Males and females with a trunk BF% >25.5 and 34.4% (≥ quintile 4), respectively, were at significantly increased risk of T2D (p-trend = 0.001). Besides, the optimal cut-off values of total and trunk BF% were 21.9 and 25.2% for males, and 36.7 and 30.3% for females, respectively.ConclusionsThe incident risk of T2D significantly increased over specific level of total and trunk BF% in both Chinese males and females, and the optimal BF% cut-off values were valuable for clinical application of BF% based on sex difference, which may be a cost-effective implementation for prevention and treatment of T2D in China.

The National Institute for Clinical Excellence (NICE) has just released its latest guidelines to assess and predict health risk, such as type 2 diabetes, hypertension or cardiovascular disease. Their latest advice is "Keep the size of your waist to less than half of your height". We believe this advice is flawed and will seriously and unfairly penalize shorter people and lull taller people into a false sense of security. In this short communication, we provide this evidence. We consider this a serious oversight by NICE and feel strongly that this evidence needs to be made available in the public domain. [ABSTRACT FROM AUTHOR]

In order to assess the accuracy and validity of proficiency diagnostic tests in Second Language (L2), specifically regarding the linguistic (orthographic, semantic, syntactic, lexical) and cognitive (verbal reasoning, lexical decision) components for the immigrant population in Portugal, a study of cut-off points of 6 tests was conducted. This study was motivated by the unknown tests and the gap concerning the testing and rating of individuals in L2 settings, different from English as L2. The objective was to validate and inform about new tests (and how to establish rating scores and understand the proficiency level of students) in Second Language Testing (for European Portuguese) especially concerning different psychometrics for specific skills (e.g., phonemic blending). In this way, we contribute to identify new procedures for schools and professionals about testing of cognitive functions in immigrant populations. First, we examined 108 non-native students attending Portuguese schools, aged 7–17 years, speakers of mother tongues other than Portuguese and residing in Portugal for a period not exceeding eight years. Then, series of univariate analyses, non-parametric tests and the calculation of percentiles enabled the subsequent classification of the subjects' proficiency levels: With or without proficiency. Several levels were identified. The sensitivity and specificity indexes were calculated using the Receiver Operating Characteristic (ROC) analysis to define the cut-off points for each test. The score calculation took into account the chronological age, age of immigration and gender variables. The evidence from this study suggests that all tasks are suitable to assess immigrant students. However with the ROC analysis, this assessment differs regarding degrees of proficiency between groups given the characteristics of the tasks and of the subjects. The importance of doing tests with discriminatory power of the subjects' performance to be able to intervene in the linguistic and cognitive areas with the greatest deficit is examined here. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the validity, reliability, and optimal cut-off points for the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), and Well-being Index (WHO-5) to screen mild depression among 400 Iranian students who completed these tools and Beck Depression Inventory (BDI-13). Further, a psychiatrist diagnosed the depression by using the "Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders." The validity and internal consistency of tools assessed and the accuracy were computed using the receiver operating characteristic (ROC) and area under the curve (AUC). The internal consistency values of PHQ-2, PHQ-9, and WHO-5 were.73,.88, and.94, respectively. The PHQ-2 (.53), PHQ-9 (.60), and WHO-5 (.54) were significantly associated with the BDI. The PHQ-2, PHQ-9, and WHO-5 had optimal cut-off points of 2, 5, and 9 with an AUC of.809,.851, and.823, respectively. Based on these findings, it is recommended to use the PHQ-9 for mild depression screening among medical university students in Iran because of its high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Bu araştırmada ilkokula devam eden çocukların, okuma, okuduğunu anlama ve yazma becerilerini ölçmek ve bu alanlarda güçlük yaşayıp yaşamadıklarını belirlemek amacıyla geliştirilmiş olan Okuma Yazma Değerlendirme Bataryasının (OYAB) geçerlik ve güvenirliğinin belirlenmesine yönelik analizlerinin yapılması ve kesme aralıkları ile değerlendirme ölçütlerinin belirlenmesi amaçlanmıştır. Araştırmanın katılımcıları ilkokul 1, 2, 3 ve 4. sınıflara devam eden 1177 çocuktan oluşmaktadır. Katılımcıların sosyoekonomik düzeyleri SED İndeksi Ebeveyn Bilgi Formuyla, okuma yazma becerileri ise OYAB ile değerlendirilmiştir. Analizlerde öncelikle OYAB’ın geçerlik ve güvenirliği incelenmiş, ardından performansı değerlendirmeye yönelik kesme aralıkları belirlenmiştir. Analizler sonucunda OYAB’ın kapsam geçerliğine sahip olduğu, üç faktörlü (okuma, okuduğunu anlama, yazma) bir yapısının olduğu ve bu yapının model uyum indekslerinin her bir sınıf düzeyi için yüksek düzeyde olduğu ve tüm sınıf düzeylerinde alt üst grupları ayırıcılığının yüksek olduğu bulunmuştur. Bataryanın güvenirlik analizlerinde iç tutarlılık katsayısının iyi düzeyde olduğu, test tekrar-test korelasyonları ile A ve B formlarının eş değerlik anlamında korelasyon katsayılarının da yüksek olduğu belirlenmiştir. Ek olarak, bataryanın tüm sınıf düzeylerinde performansa ilişkin “çok düşük, düşük, orta, yüksek, çok yüksek” şeklinde beş düzeyli bir değerlendirme yapılabilmesi için kesme noktaları ve aralıkları belirlenmiştir.

ObjectiveTo compare the predictive performance of five handgrip strengths for cardiovascular disease (CVD) risk factors.MethodsA total of 804 Chinese middle-aged community residents' health medical examinations were collected. The absolute handgrip strength was denoted as HGS. HGS/body weight (HGS/BW), HGS/body mass index (HGS/BMI), HGS/lean body mass (HGS/LBM), and HGS/muscle mass (HGS/MM) represented relative handgrip strength (RHGS). To assess predictive performance, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were constructed.ResultsHGS was not associated with most CVD risk biomarkers; however, RHGS showed a negative correlation trend after controlling for covariates (sex, age, smoking, and exercise). HGS/BMI and HGS/BW had better AUCs for predicting CVD risk factors than HGS/LBM or HGS/MM. HGS/BMI and HGS/BW can successfully predict all CVD risk factors in men with AUCs 0.55–0.65; similarly, women may effectively predict arteriosclerosis, hyperglycemia, hyperuricemia, and metabolic syndrome with AUCs 0.59–0.64, all p < 0.05. The optimal HGS/BW cut-off points for identifying different CVD risk factors were 0.59–0.61 in men and 0.41–0.45 in women, while the HGS/BMI were 1.75–1.79 in men and 1.11–1.15 in women.ConclusionsAlmost all CVD risk biomarkers and CVD risk factors were unrelated to HGS. There is, however, a significant inverse relationship between RHGS and CVD risk factors. HGS/BMI or HGS/BW should be recommended to be the best choice for predicting the risk of CVD risk factors in five expressions of handgrip strength. We also acquired the recommended optimal cut-off points of HGS/BMI and HGS/BW for predicting CVD risk factors.

The objective of this study was to compare moderate-to-vigorous physical activity (MVPA), minutes per week (min/wk), and fulfillment of the current recommendation (150 min/wk of MVPA) based on different cut-points in postmenopausal women. The sample was composed of 233 postmenopausal women aged 59.8 ± 6.7 years old. MVPA was measured using triaxial accelerometers. Accelerometers were initialized to collect in 60-s epochs. Participants were included if using at least 5 days. MVPA min/wk were obtained using Freedson, Troiano, Copeland, and Sasaki cut-points. Box-plot indicated large mean differences between almost all cut-points, except for Freedson and Troiano (9.3 [95% LoA: –5.6; 24.3] min/wk). The proportion of women who achieved 150 min/wk of MVPA was similar between Freedson and Troiano (31% vs. 30%). Sasaki and Copeland cut-points resulted in a greater proportion than other cut-points. We concluded that the cut-points analyzed generated different results in MVPA min/wk and low agreement when using current guidelines for MVPA pattern classification, except for the comparisons between Freedson and Troiano cut-points. [ABSTRACT FROM AUTHOR]

Background: The European Working Group on Sarcopenia in the Elderly defined sarcopenia as a geriatric syndrome with a diagnostic criteria of low skeletal muscle mass (LMM). Various sarcopenia consensuses recommend as cut-offs for LMM, the use of below 2 SDs from the mean skeletal muscle mass index (SMI) of a young reference group. Given the contrast between reported cut-offs, the objective of this study was to establish cut-offs for LMM from older adults in Manizales and compare them with those published in the literature. Methods: This was a prospective, cross-sectional analytical study in 237 healthy elderly patients from the city of Manizales, Colombia. Anthropometric measurements of weight, height and body mass index were estimated. The SMI was estimated with the Xitron Technologies bioimpedance meter using the Janssen formula. For the comparison of SMI cut-offs, studies that evaluated this parameter with bioelectrical impedance analysis (BIA) were taken into account, in addition to being obtained from the −2 SD from the sex-specific mean of a young reference group. Results: The cut-off points for SMI were 8.0 kg/m 2 for men and 6.1 kg/m 2 for women. There was a statistically significant difference when evaluating LMM from the cut-offs of the present study and those reported in Spain, Turkey, and Finland. The cut-off points of SMI derived from this sample of Colombian men and women may be adequate for the diagnosis in the Colombian geriatric population. However, we did not find significant differences when comparing the cut-offs for SMI from a population of older adults and young adults from the same city. Conclusions: The cut-off points of SMI by BIA derived from a sample of Colombian men and women may be adequate for the diagnosis of LMM in the Colombian geriatric population or populations with similar characteristics to those of the sample evaluated here.

Background: Fatty liver index (FLI) is the most recognized blood biomarker for diagnosis of hepatic steatosis (HS), but lacks the reliable specific cut-off points (COPs). Therefore, we aim to investigate the population-specific COPs of FLI based on the results of liver ultrasound transient elastography (LUTE) and conventional ultrasonography in the National Health and Nutrition Examination Survey (NHANES).Methods: 5948 participants who underwent LUTE from the NHANES 2017-2018 and 14,797 participants who underwent conventional ultrasonography from the Third NHANES (NHANES III) were recruited. FLI was calculated by using body mass index (BMI), waist circumference (WC), triglyceride, and gamma-glutamyl transferase, and its optimal COPs in a specific population (stratified by sex, BMI, and WC) were obtained from receiver operator characteristics (ROC) curve with ultrasonic-diagnosed HS as the reference standard.Results: Based on LUTE in NHANES 2017-2018, the prevalence of HS and metabolic dysfunction-associated fatty liver disease (MAFLD) were 58.7% and 56.2%, respectively, and the optimal COP of FLI for HS diagnosis in the overall population was 45.60, with an area under ROC curve (AUROC) of 0.833 (0.822-0.844). Based on conventional ultrasonography in NHANES III, the prevalence of HS and MAFLD were 34.4% and 27. 9%, respectively, and the optimal COP of FLI for HS was 59.5, with an AUROC of 0.681 (0.671-0.691). With the increase of BMI and WC, the COPs increased gradually with significant differences between different groups. Compared with conventional ultrasonography, the COPs of FLI based on LUTE were much more precise, with higher diagnostic ability. The population-specific COPs of FLI stratified by gender, WC, and BMI were tabulated.Conclusion: In the United States, the incidences of HS and MAFLD were high, especially when assessed by LUTE. The FLI based on LUTE is well capable of predicting HS when stratified by gender, WC, and BMI. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Increased waist circumference (WC) is one of the cardiovascular disease (CVD) risk factors used to predict cardiovascular events. Waist circumference cut-off values for predicting metabolic syndrome and other cardiovascular risks have been previously studied. Carotid intima-media thickness (CIMT) is one of the cardiovascular risk factor recently described and reported to be suitable as it is a direct measurement of vascular quality. Hence the aim of the present study was to determine the optimal WC cut-off point for the prediction of subclinical CVD.Methods: The study was a cross-sectional study using quantitative methods, conducted among 1318 adults aged between 40 and 60 years old, residing in a rural Black population in Limpopo province. Carotid Intima-Media Thickness measurements were performed using a LOGIQ ultrasound system (GE Healthcare, CT, USA). Waist Circumference (WC) (cm) was measured to the nearest 0.1 cm. Bivariate correlation, logistic regression and receiver operating characteristic were analysed using the statistical package for social sciences version 26.0 software.Results: Among the total population, 69% were women and 31% men with a mean age of 53 ± 7 years. Among women, WC at a cut-off value of 95 cm gave the highest sensitivity of 57%, the specificity of 55% and an area under the curve (AUC) of 0.588. In men, an optimum WC cut-off point of 82 cm yielded the highest sensitivity and specificity at 72% and 70% respectively, with an AUC of 0.767 p < 0.001.Conclusion: The traditional waist circumference cut-off points (94 cm for women and 80 cm for men) that are currently used for the diagnosis of metabolic syndrome might not be suitable in the prediction of an increased CIMT. [ABSTRACT FROM AUTHOR]

In the literature on global justice, there has been a lengthy debate about what the world's rich owe to the world's poor. Some have argued that rich individuals have positive duties of beneficence to help the poor, while others have argued that rich individuals only have negative duties not to harm them. A common objection to the former view is that once it is accepted that positive duties exist, fulfilling these duties will be overdemanding since rich individuals can almost always help a little more. Some have tried to overcome this overdemandingness objection by setting cut-off points for how demanding morality is. In this article, we aim to show that it is problematic to be committed to the following propositions: (1) Positive duties to aid exist; (2) The overdemandingness objection is a serious challenge for anyone who accepts that positive duties to aid exist; and (3) Setting cut-off points for how demanding morality is constitutes a plausible way to overcome the overdemandingness objection. Showing that a commitment to (1), (2) and (3) is problematic is of interest given that several influential theorists are committed to this set of views. This set of views is simply a bad theoretical cocktail. [ABSTRACT FROM AUTHOR]

Abstract Background The 12-item International Hip Outcome Tool (iHOT12) is a patient-reported outcome (PRO) designed to evaluate quality of life. We assessed the psychometric properties of the Greek version (iHOT12-Gr) in hip osteoarthritic patients. Methods Data from 124 patients aged > 50 years were used for factor analysis. Reliability evaluation included internal consistency, test-retest reliability, and interpretability. Content validity was examined by calculating the item-level content validity indices (I-CVI) and the scale-level content validity indices (S-CVI), using two methods: S-CVI Average (S-CVI/Ave), and the S-CVI Universal Agreement among experts (S-CVI/UA). Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek), Modified Harris Hip Score (MHHS-Gr), and the 30 s chair-to-stand, Timed Up & Go (TUG), and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using LEFS-Greek (cut-off = 53 points) as estimate variable. Responsiveness was examined pre and post total hip arthroplasty (4 and 8 weeks). Results Factor analysis revealed a two-factor model. Factor-1 (items 1–9) reflects “Symptoms and functionality”, while Factor-2 (items 10–12) reflects “Hip disorder-related concerns”. Reliability: Internal consistency and test-retest reliability of iHOT12-Gr-total were excellent: Cronbach’s alpha > 0.92 and ICC(95% CI) > 0.976(0.96–0.99)(p 0.8. Conclusion iHOT12-Gr showed excellent reliability properties. The content validity was excellent and significant weak-to-strong correlations were found regarding construct validity. The known-group validity was also significant, while the responsiveness was excellent. iHOT12-Gr could be a reliable and valid PRO for assessing quality of life in patients with hip osteoarthritis.

Being physically fit in younger years prevents several diseases in the presence as well as in the life course. Therefore, monitoring physical fitness and motor competence through motor testing is essential for determining developmental status and identifying health-related risks. The main objectives of this systematic review were (1) to identify currently available health-related criterion-referenced standards and cut-off points for physical fitness and motor competence test items, (2) to frame the methodological background on setting health-related criterion-referenced standards and (3) to give implications for a health-related evaluation system for physical fitness and motor competence tests. The electronic data base search (PubMed, Web of Science and SURF) yielded 2062 records in total and identified six empirical studies reporting cut-off points of motor test items for children (7–10 years), as well as 30 methodological papers discussing determination approaches to health-related criterion-referenced standards. Data collection, selection and analyses followed the PRISMA guidelines. Health-related motor test standards need to be gender- and age-specific but should refer to an absolute cut-off point rather than to relative performance in the reference group. Due to the lack of data on health-related criterion referenced standards, receiver-operating-characteristic (ROC) curves provide a tool for the determination of cut-off points and criterion referenced standards for physical fitness and motor competence tests. A standardized approach forms the fundamental base for a globally applicable evaluation of health-related fitness tests. [ABSTRACT FROM AUTHOR]

Background At a time when the world’s population is aging, one of the most important challenges for the healthcare field is to control the decline of the musculoskeletal system. This decline consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although there has been an increase in the number of publications on sarcopenia and its consequences, the reported prevalence varies widely, since these depend on the characteristics of the population studied, the definitions found in the literature and the cut-off points adopted. In this perspective, the heterogeneity in the classification and the different reference values has a critical impact on the epidemiology of sarcopenia, since neither the procedures, the components and the cut-off points are consistent. Objectives To develop cut-off points for the screening of sarcopenia in community-dwelling older people residents in the northeast of Brazil and compare the prevalences between the values defined by the consensus and the values of the population studied. Methods Community-dwelling older men and women living in three cities in the countryside of Rio Grande do Norte were evaluated. Cutoff points were defined for the variables used to screen for sarcopenia (handgrip strength, SMI, gait speed and SPPB) using the 20th percentile of their population distributions. Results The sample was composed of 1,290 older people (62.5% female and 37.5% male), with an average of 69.5 (± 6.05) years of age. Regarding the cutoff points, the handgrip values were defined as 25.3 kg and 16 kg for men and women, respectively. Considering the SMM adjusted according to their height, the values of 7.88 kg/m2 were adopted for men and 5.52 kg/m2 for women. When adjusting by BMI we obtained 0.73 kg/BMI for men and 0.41 kg/BMI for women. For gait speed it was defined 0.71 m/s for men and 0.63 m/s for women. In the case of SPPB, the result was the same for both genders (≤8). When applying the values found in the studied population, a variation in prevalence was observed for both men and women, depending on the cut-off points and consensus used. Conclusion The cutoff values found in our population were lower than those adopted by international consensus (EWGSOP2, IWGS and FNIH), except for HGS in woman and SMI/m2 for men. Therefore, using specific cutoff points for different populations can provide an accurate assessment of the presence of sarcopenia and better target health prevention strategies for the older people living in the community.

Background At a time when the world’s population is aging, one of the most important challenges for the healthcare field is to control the decline of the musculoskeletal system. This decline consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although there has been an increase in the number of publications on sarcopenia and its consequences, the reported prevalence varies widely, since these depend on the characteristics of the population studied, the definitions found in the literature and the cut-off points adopted. In this perspective, the heterogeneity in the classification and the different reference values has a critical impact on the epidemiology of sarcopenia, since neither the procedures, the components and the cut-off points are consistent. Objectives To develop cut-off points for the screening of sarcopenia in community-dwelling older people residents in the northeast of Brazil and compare the prevalences between the values defined by the consensus and the values of the population studied. Methods Community-dwelling older men and women living in three cities in the countryside of Rio Grande do Norte were evaluated. Cutoff points were defined for the variables used to screen for sarcopenia (handgrip strength, SMI, gait speed and SPPB) using the 20th percentile of their population distributions. Results The sample was composed of 1,290 older people (62.5% female and 37.5% male), with an average of 69.5 (± 6.05) years of age. Regarding the cutoff points, the handgrip values were defined as 25.3 kg and 16 kg for men and women, respectively. Considering the SMM adjusted according to their height, the values of 7.88 kg/m² were adopted for men and 5.52 kg/m2 for women. When adjusting by BMI we obtained 0.73 kg/BMI for men and 0.41 kg/BMI for women. For gait speed it was defined 0.71 m/s for men and 0.63 m/s for women. In the case of SPPB, the result was the same for both genders (≤8). When applying the values found in the studied population, a variation in prevalence was observed for both men and women, depending on the cut-off points and consensus used. Conclusion The cutoff values found in our population were lower than those adopted by international consensus (EWGSOP2, IWGS and FNIH), except for HGS in woman and SMI/m² for men. Therefore, using specific cutoff points for different populations can provide an accurate assessment of the presence of sarcopenia and better target health prevention strategies for the older people living in the community. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Mother Tongue Education / Ana Dili Egitim Dergisi is the property of Journal of Mother Tongue Education / Ana Dili Egitim Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Several epidemiological studies have suggested that optimal obesity and visceral adiposity indicators and their cut-off values to predict cardio-metabolic risks varied among different ethnic groups. However, few studies have investigated the associations of anthropometric indices with cardio-metabolic risks in Chinese Uyghur adults, and the results were inconsistent. Methods Between May and September 2016, a total of 4664 subjects aged ≥18 years old were recruited from Northwest China. Anthropometric indices and cardio-metabolic risk factors were measured by trained personnel. Partial correlation analyses and logistic regression analyses were used to evaluate the associations of anthropometric indices with cardio-metabolic risk factors. Receiver operating characteristic analysis was used to compare the abilities of different anthropometric indices to predict cardio-metabolic risk factors, and to determine the optimal cut-off values. Results The prevalence of metabolic syndrome was 39.41% in Uyghur adults from Xinjiang Uyghur Autonomous Region. Waist circumference (WC) performed better than other obesity indices in predicting the cardio-metabolic risk factors, and the optimal cut-off value of WC to diagnose metabolic syndrome risk factors was 86.50 cm for women and 90.50 cm for men. Conclusions Our study suggests that WC had the strongest predictive power for identifying cardio-metabolic risks in Xinjiang Uyghur adults. Further well-designed longitudinal studies are needed to confirm our findings.

This study aimed to compare the percentage attainment of fasting and non-fasting LDL-C and non-HDL-C target levels in coronary heart disease (CHD) patients receiving short-term statin therapy. This study enrolled 397 inpatients with CHD. Of these, 197 patients took statins for 0.05). Analysis of c-statistic showed that non-fasting cut-off points for LDL-C and non-HDL-C were 1.19 and 2.11 mmol/L, corresponding to their fasting goal levels of 1.4 and 2.2 mmol/L, respectively. When post-prandial LDL-C and non-HDL-C goal attainments were re-evaluated using non-fasting cut-off points, there were no significant differences in percentage attainment between fasting and non-fasting states. Non-HDL-C is more stable than LDL-C in assessing the percent attainment of non-fasting lipid for coronary heart disease patients. If we want to use LDL-C to assess the percent attainment of post-prandial blood lipids, we may need to determine a lower non-fasting cut-off point.

Background: One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. Results: Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/μL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. Conclusion: Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results. [ABSTRACT FROM AUTHOR]

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Objective To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. Methods Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'—which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. Results The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th–75th percentiles) were respectively 61.16 (41.16–77.00), 27.00 (19.00–32.00) and 19.0 (13.00–24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0–23 for remission, 24–40 for mild disease, 41–63 for moderate disease, 64–82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0–12 for remission, 13–20 for mild disease, 21–28 for moderate disease, 29–33 for severe disease and >33 for very severe disease; PDS: 0–5 for remission, 6–15 for mild disease, 16–20 for moderate disease, 21–25 for severe disease and >25 for very severe disease. Conclusions Disease severity cut-offs can represent an important improvement in interpreting FM. [ABSTRACT FROM AUTHOR]

Objective: Panel-based sequencing is widely used to measure tumor mutational burden (TMB) in clinical trials and is ready to enter routine diagnostics. However, cut-off points to distinguish “TMB-high” from “TMB-low” tumors are not consistent and the clinical implications of TMB in predicting responses to immune checkpoint blockade (ICB) in gastric cancer are not clearly defined. We aimed to assess whether TMB is associated with the response to immunotherapy and to examine its relation with other biomarkers of immunotherapy response in advanced gastric cancer.Design: In total, 63 patients with advanced gastric cancer treated with ICB were included in the study. Panel-based TMB in gastric tumor samples, treatment responses to ICB, clinicopathological data, and time to progression were retrospectively analyzed. Microsatellite instability (MSI) status, Epstein–Barr virus (EBV) positivity, and programmed death-ligand 1 (PD-L1) combined positive score (CPS) were also analyzed.Results: TMB ranged from 0 to 446 mutations/megabase (mt/mb) and was significantly associated with MSI (P < 0.001), PD-L1 CPS (P = 0.022), response to ICB (P = 0.04), chemotherapy (P = 0.02) and older patient age (≥65 years; P = 0.0014). The cut-off point of 14.31 mt/mb determined by log-rank statistics for progression-free survival divided the tumors into eight (12.7%) TMB-high and 55 (87.3%) TMB-low tumors. The median TMB of the chemo-refractory group was significantly higher (8.43 mt/mb) compared to that of chemo-naïve group (3.42 mt/mb) (P = 0.02). Patients with TMB-high tumors showed prolonged progression-free survival in univariate [HR, 0.32; 95% confidence interval (CI), 0.12–0.90] and multivariate (HR, 0.21; 95% CI, 0.07–0.69) analyses. In area under the receiver operating curve (AUC) analysis of TMB, PD-L1, EBV, MSI, and their combination, the AUC value was the highest for EBV (0.97), followed by MSI (0.96), PD-L1 (0.81), the combination (0.78), and TMB (0.56).Conclusion: In addition to EBV, MSI, and PD-L1 CPS, TMB could be used as a predictive biomarker in patients with advanced gastric cancer treated with ICB and may aid clinical decision making.

Background: The 12-item International Hip Outcome Tool (iHOT12) is a patient-reported outcome (PRO) designed to evaluate quality of life. We assessed the psychometric properties of the Greek version (iHOT12-Gr) in hip osteoarthritic patients. Methods: Data from 124 patients aged > 50 years were used for factor analysis. Reliability evaluation included internal consistency, test-retest reliability, and interpretability. Content validity was examined by calculating the item-level content validity indices (I-CVI) and the scale-level content validity indices (S-CVI), using two methods: S-CVI Average (S-CVI/Ave), and the S-CVI Universal Agreement among experts (S-CVI/UA). Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek), Modified Harris Hip Score (MHHS-Gr), and the 30 s chair-to-stand, Timed Up & Go (TUG), and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using LEFS-Greek (cut-off = 53 points) as estimate variable. Responsiveness was examined pre and post total hip arthroplasty (4 and 8 weeks). Results: Factor analysis revealed a two-factor model. Factor-1 (items 1–9) reflects "Symptoms and functionality", while Factor-2 (items 10–12) reflects "Hip disorder-related concerns". Reliability: Internal consistency and test-retest reliability of iHOT12-Gr-total were excellent: Cronbach's alpha > 0.92 and ICC(95% CI) > 0.976(0.96–0.99)(p < 0.001). Interpretability: There was no floor or ceiling effect; measurement error: 3.72 (Factor-1), 3.64 (Factor-2), and 3.22 (iHOT12-Gr-total); minimal detectable change: 10.3 (Factor-1), 10.1 (Factor-2), and 8.92 (iHOT12-Gr-total). Validity: Content validity: The I-CVI value of the 12 items ranged from 1.00 to 0.83, the S-CVI/Ave was 0.97 and the S-CVI/UA was 0.83. Construct validity: iHOT12-Gr correlated strongly with both LEFS-Greek and MHHS-Gr, and weakly but significantly with 30s chair-to-stand, TUG and 9S-A/D (p < 0.001). Known-groups validity showed that iHOT12-Gr well discriminated subgroups of patients (p < 0.001). ROC analysis cut-off points were 51.9 (Factor-1), 25 (Factor-2) and 45.2 (iHOT12-Gr-total) (p < 0.001). Responsiveness: Four and 8 weeks postoperatively, standardized response means of Factor-1, Factor-2, and iHOT12-Gr-total were > 0.8. Conclusion: iHOT12-Gr showed excellent reliability properties. The content validity was excellent and significant weak-to-strong correlations were found regarding construct validity. The known-group validity was also significant, while the responsiveness was excellent. iHOT12-Gr could be a reliable and valid PRO for assessing quality of life in patients with hip osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: Panel-based sequencing is widely used to measure tumor mutational burden (TMB) in clinical trials and is ready to enter routine diagnostics. However, cut-off points to distinguish "TMB-high" from "TMB-low" tumors are not consistent and the clinical implications of TMB in predicting responses to immune checkpoint blockade (ICB) in gastric cancer are not clearly defined. We aimed to assess whether TMB is associated with the response to immunotherapy and to examine its relation with other biomarkers of immunotherapy response in advanced gastric cancer. Design: In total, 63 patients with advanced gastric cancer treated with ICB were included in the study. Panel-based TMB in gastric tumor samples, treatment responses to ICB, clinicopathological data, and time to progression were retrospectively analyzed. Microsatellite instability (MSI) status, Epstein–Barr virus (EBV) positivity, and programmed death-ligand 1 (PD-L1) combined positive score (CPS) were also analyzed. Results: TMB ranged from 0 to 446 mutations/megabase (mt/mb) and was significantly associated with MSI (P < 0.001), PD-L1 CPS (P = 0.022), response to ICB (P = 0.04), chemotherapy (P = 0.02) and older patient age (≥65 years; P = 0.0014). The cut-off point of 14.31 mt/mb determined by log-rank statistics for progression-free survival divided the tumors into eight (12.7%) TMB-high and 55 (87.3%) TMB-low tumors. The median TMB of the chemo-refractory group was significantly higher (8.43 mt/mb) compared to that of chemo-naïve group (3.42 mt/mb) (P = 0.02). Patients with TMB-high tumors showed prolonged progression-free survival in univariate [HR, 0.32; 95% confidence interval (CI), 0.12–0.90] and multivariate (HR, 0.21; 95% CI, 0.07–0.69) analyses. In area under the receiver operating curve (AUC) analysis of TMB, PD-L1, EBV, MSI, and their combination, the AUC value was the highest for EBV (0.97), followed by MSI (0.96), PD-L1 (0.81), the combination (0.78), and TMB (0.56). Conclusion: In addition to EBV, MSI, and PD-L1 CPS, TMB could be used as a predictive biomarker in patients with advanced gastric cancer treated with ICB and may aid clinical decision making. [ABSTRACT FROM AUTHOR]

Being physically fit in younger years prevents several diseases in the presence as well as in the life course. Therefore, monitoring physical fitness and motor competence through motor testing is essential for determining developmental status and identifying health-related risks. The main objectives of this systematic review were (1) to identify currently available health-related criterion-referenced standards and cut-off points for physical fitness and motor competence test items, (2) to frame the methodological background on setting health-related criterion-referenced standards and (3) to give implications for a health-related evaluation system for physical fitness and motor competence tests. The electronic data base search (PubMed, Web of Science and SURF) yielded 2062 records in total and identified six empirical studies reporting cut-off points of motor test items for children (7–10 years), as well as 30 methodological papers discussing determination approaches to health-related criterion-referenced standards. Data collection, selection and analyses followed the PRISMA guidelines. Health-related motor test standards need to be gender- and age-specific but should refer to an absolute cut-off point rather than to relative performance in the reference group. Due to the lack of data on health-related criterion referenced standards, receiver-operating-characteristic (ROC) curves provide a tool for the determination of cut-off points and criterion referenced standards for physical fitness and motor competence tests. A standardized approach forms the fundamental base for a globally applicable evaluation of health-related fitness tests.

Visceral adipose tissue (VAT) has high metabolic activity and secretes a larger number of adipokines that are related to the inflammatory process. Quantifying VAT could estimate the risk of developing Metabolic Syndrome (MetS). This study was designed to determine the VAT cut-off points assessed by DXA associated with MetS in military men. In total, 270 (37.5 ± 6.9 years) military men from the Brazilian Army (BA) participated in the study. Anthropometric measurements, assessment of body composition by dual X-ray absorptiometry (DXA), hemodynamics and biochemical tests were performed. The Student’s t test, independent samples, Person’s correlation, ROC curve, Youden Index and positive (PPV) and negative predictive value (NPV) were used. The MetS prevalence was 27.4%, which means that 74 (38.0 ± 7.3 years) military men had at least three risk factors of MetS present. The cutoff point of VAT with the highest balance between sensitivity (77.0%) and specificity (69.9%) was 1025.0 cm3 (1086.0 g). An area on the ROC curve was 0.801 (p < 0.000), which was very good precision. VAT ≥ 1025.0 cm3 (1086.0 g) is associated with the risk factors of MetS and is, therefore, a predictor of the disease with good indicators of sensitivity and specificity and a robust indicator of MetS.