FETAL ECHOCARDIOGRAPHY AS A ROUTINE ANTENATAL SCREENING TOOL FOR DETECTION OF FETAL CONGENITAL CARDIAC STRUCTURAL ANOMALIES.

Background: Fetal echocardiography plays a pivotal role in detecting congenital cardiac structural anomalies. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool needs to be dened. To evaluate the role of fetal echocardiography as a routine Objectives: antenatal screening tool for detection of congenital cardiac structural anomalies.To compare the prevalence of congenital cardiac structural anomalies by fetal echocardiography in antenatal women with low risk and high risk factors for cardiac structural anomalies. The study was carried out in the department of radiodiagnosis, SNMC, Agra. Materials and methods: 500 fetal hearts between 18-26 weeks gestation were evaluated through fetal echocardiography.They were categorised into two groups -low risk (Group I) and high risk (Group II) and scanned through four chamber , LVOT , RVOT and three vessel view. Result: The prevalence of fetal congenital cardiac structural anomalies in this study is 14/1000.Fetal echocardiography had a sensitivity of 85% & specicity of 99%. PPV is 85% and NPV is 99%. The incidence of congenital cardiac structural anomalies in high risk and low risk group was 12 % & 14.8 % per 1,000 respectively. based on these ndings it is highly Conclusion: suggestive that every pregnant woman should be subjected to a detailed fetal echocardiography. Fetal echocardiography should be included as a part of routine antenatal screening irrespective of risk factors for congenital cardiac structural anomalies.

A Strategy for Inpatient Evaluation and Improvement of the Quality of Our Palliative Care Team: Iterative Evaluations of Changes in a Palliative Screening Tool

To introduce early palliative care to patients, we have proactively used a palliative care screening tool to identify needs. We have emphasized not doing work in a routine manner, rather seeking to improve by continuous reevaluations. Because of a lack of feedback regarding changes in screening scores and actionable solutions derived from it, we executed a retrospective study about the effectiveness of our palliative care team and the identification of problems. All 91 cases studied meaningfully ameliorated their focused symptoms. However, we could not verify our team’s effectiveness because the backgrounds of patients who were eligible but not involved with our team differed significantly. The current study suggested that some patients missed opportunities to receive palliative care. We need to strengthen the system used with our patients as a safety-net so as not to overlook care opportunities by utilizing more effective screening methodology.

Modified pediatric nutrition screening tool to identify malnutrition and those at risk for malnutrition among patients aged 6 to 18 years old admitted at Philippine Children’s Medical Center

OBJECTIVE@#To determine the reliability and validity of the modified pediatric nutrition screening tool in identifying malnutrition and risk of malnutrition among admitted pediatric patients aged 6 to 18 years old.@*METHOD@#The Modified Pediatric Nutritional Screening Tool (PNST) was used to assess 130 admitted patients aged 6 to 18 years old. Evaluation of anthropometric measurements, body weight changes, clinical conditions and dietary intake were done within 48 hours of admission. Intraclass correlation coefficient was used to determine reliability of the tool among different raters while chi square test was used to determine correlation of the tool with the Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP).@*RESULT@#The comparison of the modified PNST measurements by two observers showed no significant difference with p value of 0.078. All PNST criteria except clinical condition were associated with risk of malnutrition based on STAMP. The overall modified PNST criteria is significantly associated with risk of malnutrition based on STAMP.@*CONCLUSION@#The modified PNST accurately identifies malnutrition and risk of malnutrition among admitted patients aged 6-18 years old. The criteria used in the modified PNST were strongly associated with risk for malnutrition measured using previously validated tools and demonstrates a good interobserver reliability. It is recommended to be used as routine screening in the hospital set- ting for early identification of malnutrition and risk for malnutrition.

Applicability of Modified Pediatric Nutritional Risk Screening Tool in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To explore the scheme of assigning rational scores to the Modified Pediatric Nutritional Risk Screening Tool for children with cerebral palsy(CP) at different Gross Motor Function Classification System(GMFCS) levels.Methods:The clinical data of 360 children with CP hospitalized in the Department of Children′s Rehabilitation, the Third Affiliated Hospital of Zhengzhou University from January to October 2019 were analyzed retrospectively.All the CP children at different GMFCS levels who met the inclusion criteria were subject to nutrition screening and assessment by using the Modified Pediatric Nutritional Risk Screening Tool and the Subjective Global Nutritional Assessment(SGNA) scale.The distribution of malnutrition rates assessed by the SGNA scale among the children at different GMFCS levels was examined.Data between groups were compared by the χ2 test.Children at different GMFCS levels were divided into different subgroups according to the statistical difference.Then, 0 or 1 score was assigned to the Modified Pediatric Nutritional Risk Screening Tool in different subgroups, and different combinations were formed.The nutritional risk screening results of different combinations were evaluated by using the SGNA scale assessment results as a reference. Results:In children with CP, the risk detection rate and incidence rate of malnutrition were 58.1%(209/360) and 36.9%(133/360), respectively.There was no significant difference in the incidence rate of malnutrition between GMFCS Ⅱ and GMFCS Ⅲ, as well as between GMFCS Ⅳ and GMFCS Ⅴ(all P>0.05). Therefore, children with CP were divided into 3 subgroups, namely, group Ⅰ, group Ⅱ to Ⅲ, and group Ⅳ to Ⅴ.Different CP disease scores were given to the Modified Pediatric Nutritional Risk Screening Tool in 3 subgroups, forming 3 different protocols[protocol 1 (0, 0, 1 point); protocol 2(0, 1, 1 point); current protocol (1, 1, 1 point)]. Taking the SGNA scale assessment results as a reference, the sensitivity of protocol 1, protocol 2 and current protocol were 85.7%, 92.5%, and 93.2% respectively.The specificity protocol 1, protocol 2 and current protocol were 81.1%, 78.0%, and 62.6%, respectively.And the Youden indexes of above three protocols were 0.668, 0.705, and 0.558, respectively.The Youden index of protocol 2 was relatively high. Conclusions:The Modified Pediatric Nutritional Risk Screening Tool can effectively identify the risk of malnutrition in children with CP.The scheme of assigning 0 points to children with GMFCS grade Ⅰ and 1 point to children with GMFCS grade Ⅱ to Ⅴ is more reasonable.

Usefulness of the STarT Back Screening Tool to Predict the Effect of Acupuncture Treatment: Evaluation of Its Risk Classification Focusing on the Changes in the Lumbar Pain Visual Analog Scale / 日本温泉気候物理医学会雑誌

  Background: The STarT (Subgrouping for Targeted Treatment) Back Screening Tool (SBST) is an established clinical evaluation tool that easily assesses the risk of chronic or refractory low back pain. This study aimed to examine the usefulness of acupuncture in patients with low back pain.  Methods: A total of 71 outpatients with low back pain who underwent acupuncture and moxibustion at the Center for Integrative Medicine, Tsukuba University of Technology, between 2019 and 2022 were included in this study, regardless of the specific medical condition causing the pain. Survey items included the SBST and lumbar pain intensity visual analog scale (VAS). Demographic factors and contents of acupuncture treatment were collected from the medical charts. The VAS score 4 weeks after the start of treatment was used as an index of clinical outcome and was analyzed using repeated measures analysis of variance (ANOVA) and hierarchical multiple regression analysis.  Results: Classification using the SBST at the first visit resulted in 36, 30, and 15 patients in the low-, medium-, and high-risk groups, respectively. Repeated-measures ANOVA showed statistically significant differences in the mean VAS values with respect to differences in time point (P < 0.01), group (P < 0.01), and interaction (P < 0.05). The VAS values after 4 weeks in the high-risk group were significantly higher than those in the other two groups (both P < 0.01). In the hierarchical multiple regression analysis, with VAS as the dependent variable, the relationship between SBST classification and VAS maintained a significant positive relationship in all models, including adjustments for interaction terms and patients’ background items. A simple slope analysis indicated that this relationship was more evident in patients with lower limb symptoms than in those without symptoms.  Conclusion: The SBST could be a simple and useful tool for predicting the clinical outcomes of acupuncture.

Cardiovascular physical examination as a screening tool for congenital heart disease in newborns at a teaching hospital in Ghana

Objectives: To determine the usefulness of cardiovascular physical examination (CPE) as a screening tool in a lowresource setting for detecting congenital heart disease (CHD) in newborns delivered at the Maternity Unit of Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Design: A hospital-based cross-sectional study with a comparison group component. Setting: Maternity Unit of the KBTH, Accra, Ghana. Participants: Over eight months, newborns aged 1-14 days delivered at ≥ 34 weeks' gestation at the Maternity Unit, KBTH, were recruited into the study. Intervention: Each newborn was examined using a set of CPE parameters for the presence of congenital heart disease. Those with suggestive features of CHD had a confirmatory echocardiogram test. Main Outcome Measure: Abnormal CPE features and their corresponding echocardiogram findings. Results: A total of 1607 were screened, with 52 newborns showing signs of CHD on CPE, of which 20 newborns were proven on echocardiogram to have congenital heart disease. Abnormal CPE parameter that was associated with CHD was murmur (P=0.001), dysmorphism (p=0.01), newborns with chest recessions (p=0.01) and lethargy (p=0.02). CPE's sensitivity, specificity, and positive and negative predictive values were 95%, 60.7%, 36.5% and 98,1%, respectively. The most common acyanotic CHD found was isolated atrial septal defect (ASD), followed by patent ductus arteriosus (PDA). The only cyanotic CHD found was a case of tricuspid atresia. Conclusion: Cardiovascular physical examination at birth is an effective and inexpensive screening tool for detecting CHD in newborns, which can easily be utilised in low-resource settings.

Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort

Abstract Objective: To verify the association between nutritional risk on admission and clinical outcomes of COVID-19 in hospitalized children and adolescents. Methods: Multicenter cohort study was conducted in two cities in the northeastern region of Brazil, with children under 18 years of age laboratory diagnosed with COVID-19. Sociodemographic data and nutritional risk screening by STRONGKids (low, medium and high risk) were collected remotely and in hospital records, respectively. The outcomes assessed were the need for ICU admission, length of stay (< 10 days or ≥ 10 days), critical cases, and death. Multivariable logistic regression models were used to evaluate the effects of high nutritional risk on COVID-19 clinical outcomes. Results: 103 individuals were evaluated, of these 35 (34.0%) had low risk, 44 (42.7%) medium risk, and 24 (23.3%) had high risk of malnutrition. In multivariate analysis, ICU bed admission (OR: 4.57; 95%CI, 1.39-4.97; p = 0.01), hospitalization longer than or equal to ten days (OR: 3.96; 95%CI, 1.22-2.83; p = 0.02) and critical cases (OR: 4.35; 95%CI, 1.08-7.55; p = 0.04) were associated with high nutritional risk. Death was not associated with high nutritional risk. Conclusions: Children and adolescents with high nutritional risk by STRONGkids at hospital admission were more likely to be admitted to the ICU, have hospitalization longer than or equal to ten days, and have critical cases when infected with SARS-CoV-2.

Assessment of appropriateness of prescribing among Indian geriatric outpatients using STOPP and START Criteria Version 2 at a tertiary care teaching hospital

Background: Inappropriate prescribing is more prevalent in geriatric patients. A popular tool for screening appropriateness of prescribing is the screening tool of older person’s prescriptions (STOPP) and screening tool to alert doctors to right treatment (START) criteria. In this study, our aim was to estimate the incidence of potentially inappropriate prescribing (PIP) utilizing these criteria among patients attending outpatient departments. In addition, we aimed to identify potential factors that are associated with PIP. Aims and Objectives: The objectives of the study are as follows: (1) To estimate incidence of potentially inappropriate medications (PIMs) using STOPP criteria; (2) To estimate incidence of potential prescribing omissions (PPOs) using START criteria; and (3) To identify potential factors that are associated with PIP. Materials and Methods: A prospective and cross-sectional study that was observational in nature was performed in patients with age 65 years and above. Prescriptions of these patients were analyzed by collecting relevant data that were subsequently entered in specially designed case record forms. The modified version 2.0 of STOPP/START criteria was utilized to assess PIP in the form of PIMs and PPOs. Data were entered in Microsoft Excel 2013 and analyzed. Categorical variables were described as frequency and percentage whereas continuous variables were described as mean with standard deviation. Results: Prescriptions of a total 306 patients were evaluated (mean age: 69.4, 60% male, average number of medications per prescription: 5.04 ± 2.44), PIMs were detected in 88 (28.75%) and PPOs in 30 (9.8%) patients. Ninety-six patients had either a PIM or a PPO. PIMs mainly involved were duplication of drug class (26.5%), use of first generation antihistaminic for >1 week (20.4%) and use of glimepiride (18.6%). Major PPOs identified were non-use of angiotensin converting enzyme inhibitors following acute myocardial infarction (26%), non-use of statin therapy (26%), and antiplatelet therapy (21.7%) in patients with diabetes mellitus along with cardiovascular risk factor. Polypharmacy (OR 6.011, P < 0.0001) and comorbidity (OR 3.097, P = 0.015) significantly increase the risk of PIM encounter. Conclusion: PIP in the form of PIMs and PPOs was prevalent in the studied patients. Polypharmacy and comorbidity were associated with an increased likelihood of PIM.

Validation of Hindi Translation of Survey of Well-Being of Young Children Tool in Indian Children

Objective: To validate the Hindi translation of Survey of well-being of young children (SWYC), a screening questionnaire to detect developmental delay and emotional-behavior problems by primary caregivers in Indian children. Methods: This cross-sectional observational study was done at the child development clinic of our private-sector tertiary care hospital. 180 children of either sex, 60 each in age group of 9, 18 and 24 months were enrolled in the study (30 high-risk and 30 low-risk in each group). Hindi translated version of SWYC age-specific questionnaire was administered to the parents, followed by a standardized development assessment by using the Bayley Scale of Infant and Toddler Development (BSID III). Results: SWYC Milestone score and Emotional/behavior scores showed a statistically significant correlation with BSID III (P<0.001). Milestone score’s overall sensitivity in detecting developmental delay was 94.4% and specificity was 93.4%. The sensitivity was best for the 24-month (100%) and specificity was best for 18-month questionnaire (96.7%). Behavioral score’s overall sensitivity was 68.4% and specificity 92.3%. The best sensitivity was for 18-month questionnaire (72%), and specificity for 24- month questionnaire (100%). SWYC had better sensitivity for detecting developmental delay in high-risk group (95.4%), and higher specificity in low risk group (95.5%). Conclusion: SWYC has strong test characteristics for detecting milestone delay and emotional/behavior problems in Indian children.

STRONGkids validation: tool accuracy / Validação do STRONGkids: acurácia do instrumento

Abstract Objective: Validate the accuracy of the Screening Tool for Risk on Nutritional status and Growth (STRONGkids) and estimate the prevalence of malnutrition and nutritional risk in hospitalized children. Methods: Cross-sectional study of a representative sample of children admitted to ten public pediatric emergency rooms. The sample was randomly estimated in stages, including children older than 30 days and younger than 10 years of age, of both sexes, excluding syndromic children and those in whom it was impossible to directly measure anthropometry. Weight, height, and arm circumference were measured, as well as the Z-scores of the anthropometric indices weight-for-age, height-for-age, weight-for-height, body mass index for age, and arm circumference for age, classified according to the reference curves of the World Health Organization. After the tool was applied, its accuracy tests were performed in comparison with the anthropometric data, with the evaluation of sensitivity, specificity, and positive and negative predictive values. Results: A total of 271 children were evaluated, 56.46% males and 41.70% younger than 2 years of age. The prevalence rates of malnutrition, nutritional risk assessed by anthropometric measurements, and nutritional risk assessed by the tool were 12.18%, 33.95%, and 78.60%, respectively. Accuracy showed sensitivity of 84.8%, specificity of 26.7%, positive predictive value of 49.8%, and negative predictive value of 67.2%, when the patients at nutritional risk were identified by anthropometry. Conclusion: Validation of the accuracy of STRONGkids was performed, showing high sensitivity, allowing the early identification of nutritional risk in similar populations.

Resumo Objetivo: Validar a acurácia do instrumento de triagem nutricional Screening Tool for Risk on Nutritional status and Growth (STRONGkids) e estimar as prevalências de desnutrição e risco nutricional em crianças hospitalizadas. Métodos: Estudo transversal, em amostra representativa de crianças admitidas em 10 prontos-socorros infantis públicos. A amostra foi estimada aleatoriamente, por etapas, foram incluídas crianças com idade superior a 30 dias e inferior a 10 anos, de ambos os sexos, e excluídas as sindrômicas e impossibilitadas de aferição direta da antropometria. Foram aferidos peso, estatura e circunferência do braço, calculados os Z-scores dos índices antropométricos peso para idade, estatura para idade, peso para estatura, índice de massa corporal para idade e circunferência do braço para idade, classificados de acordo com as curvas de referência da Organização Mundial da Saúde. Após a aplicação do instrumento foram realizados os testes de acurácia do instrumento em comparação a antropometria, foram avaliados sensibilidade, especificidade e valores preditivos positivo e negativo. Resultados: Foram avaliadas 271 crianças, 56,46% meninos e 41,70% menores de dois anos. As prevalências de desnutrição, risco nutricional pela antropometria e pelo instrumento foram de 12,18%, 33,95% e 78,60%, respectivamente. A acurácia mostrou 84,8% de sensibilidade, 26,7% de especificidade, 49,8% de valor preditivo positivo e 67,2%, negativo, quando identificados os pacientes em risco nutricional pela antropometria. Conclusão: A validação da acurácia do STRONGkids foi feita com verificação de alta sensibilidade, permitiu a identificação precoce de risco nutricional em populações semelhantes.

Treadmill test as a screening tool for detecting silent myocardial ischemia in type 2 diabetes patients: a case control study from Raipur, Chhattisgarh, India

Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.

Validation of track and act online developmental screening tool: a pilot study

Background: The global prevalence of developmental delay in children is reported as 1-3% according to WHO. Early diagnosis and intervention improve the quality of life in disabled children. There is need for screening tool. So, study was started to evaluate the ability of the online screening tool in detecting the developmental delay in the Indian children.Methods: After IRB approval, around 30 children after parental consent of either gender aged 4 months to 5 years attending the immunization outpatient department were involved in the study After a detailed history, children were screened with online screening tool 'Track and Act'. Due to the logistic reasons among them 30 were assessed in detail using Developmental Assessment Scale for Indian Infants (DASII) which is used as gold standard in this study.Results: Study showed high sensitivity and specificity for all the four domains of the tool. It showed sensitivity and specificity in physical of 83.3% and 91.6%, in language 66.6% and 87.5%, in cognitive 66.6% and 91.6% and in socio-emotional domain 83.3% and 91.6 % respectively.Conclusions: Track and Act screening tool has good test characteristics for detecting developmental delay among Indian children and it can be used for office practice for screening children.

A study of impact of stress: examinations on menstrual cycle among medical students

Background: Premenstrual Syndrome (PMS), a common problem among adolescent girls, is associated with various physical, mental and behavioral symptoms that lead to social and occupational impairment. Stress has also been hypothesized to be an important etiologic factor. Examination stress may also be responsible for affecting the premenstrual symptoms. The objectives of this study was to study the impact of exam stress on the menstrual cycle and the relationship of perceived stress with the severity of premenstrual symptoms. Methods: This was a cross-sectional observational study conducted among female medical students of final MBBS, who were candidate of upcoming exams. They were assessed on semi structured socio-demographic and menstrual history proforma, ACOG guidelines, DSM-5 criteria, Perceived Stress Scale (PSS) and Premenstrual Symptom Screening Tool (PSST).Results: As per ACOG guidelines, 66% participants had PMS and 6% participants had PMDD according to DSM-5 criteria. On PSST total 88% participants had premenstrual symptoms and out of them 58% had mild/no PMS while 30% had moderate to severe PMS. 5% participants also fulfilled criteria for PMDD on PSST. Stress was found to be mild in 26% and moderate in 74% participants on PSS. PMS was found in 93.75% participants who had painful menstruation (dysmenorrhea) and this association was statistically significant. Data wise 73.1% participants having mild stress had PMS, while 93.2% participants having moderate stress, had PMS and this association was found to be statistically significant.  Surprisingly not a single participant consulted to any health care provider for their menstruation related problems.Conclusions: Premenstrual Syndrome is common in adolescent girls and exam stress is an important etiological factor. PMS/PMDD was found significantly higher in participants who had dysmenorrhea and moderate stress. A positive and highly significant correlation was also found between the severity of stress and severity of premenstrual symptoms.

Face validity of the general development assessment test (EVADE) in children and adolescents aged 6-14 years / Validación de apariencia de la prueba general para la evaluación del desarrollo (EVADE) en niños, niñas y adolescentes entre los 6 y 14 años

Abstract Background: The general development assessment test (EVADE) for children and adolescents aged 6-14 years is the only national screening tool for development assessment of school-age children and adolescents. This article presents the results obtained after applying the face validity process to the test, the handbook, and the standardized materials. Methods: An exploratory, descriptive study was conducted with a quantitative-qualitative methodology. The EVADE test was applied to a sample of 730 children and adolescents between 6 and 14 years of age, for which the expert judgment technique was used. Data analysis was carried out through a psychometric analysis of the items and by the triangulation method. Results: From the 730 participants included, 44.5% were from rural areas (n = 325) and 55.4% from urban areas (n = 405), of which 51.7% (n = 378) of females and 48.2% (n = 352) of males were assessed by the test. The difficulty level and discriminative effectiveness quotient of the items were calculated, which, together with the experts' findings, resulted in 22-item modifications and the creation of four new items in the cognitive and language areas. The qualification by areas also changed, improving the handbook and creating new materials. Conclusions: This research provides a validated screening test for the child and adolescent population, which was included in the Costa Rican comprehensive childcare public policy. However, subsequent validation processes are recommended to improve specific areas, such as motor skills and social-affective development.

Resumen Introducción: La prueba general para la evaluación del desarrollo (EVADE) para niñas, niños y adolescentes entre 6 y 14 años es la única prueba a nivel nacional que valora el desarrollo en población escolar y adolescente. Este artículo presenta los resultados tras someter la prueba, el instructivo y los materiales estandarizados al proceso de validación de apariencia. Métodos: Se llevó a cabo un estudio descriptivo exploratorio, con metodología cuantitativa-cualitativa. La prueba EVADE se aplicó a una muestra de 730 niñas, niños y adolescentes entre 6 y 14 años; asimismo, se utilizó la técnica de juicio de expertos. El análisis de los datos se efectuó a través de un análisis psicométrico de los enunciados y triangulación. Resultados: De los 730 participantes, el 44.5% correspondió a zonas rurales (n = 325) y el 55.4% a zonas urbanas (n = 405). El 51.7% de ellos eran de sexo femenino (n = 378) y el 48.2%, de sexo masculino (n = 352). Se calculó el nivel de dificultad y el coeficiente de efectividad discriminativa para los enunciados. A la par de los hallazgos referidos por los expertos, resultó en la modificación de 22 enunciados, la creación de cuatro nuevos artículos en las áreas cognitiva y de lenguaje. También se cambió la calificación por áreas, se mejoró el instructivo y se crearon nuevos materiales. Conclusiones: La presente investigación aporta una prueba validada para la población infantil escolar y adolescente, que fue incluida en la política pública de atención integral de la población infantil costarricense. Se recomiendan procesos de validación subsecuentes con el fin de mejorar áreas específicas, como motricidad y socioafectiva.

A simple screening tool to identify women with previously undiagnosed prediabetes and diabetes mellitus in the community

Background:In the current context of rising prevalence of non-communicable diseases, simple low-cost screening tools are essential for identifying individuals who have glucose dysregulationat its early stages. Therefore, we developed and validated a screening tool for dysglycemia (defined as HbA1c≥5.7%) with the potential to identify undiagnosed prediabetes and as well as diabetes mellitus.Methods:A sample of 2800 women representative ofColombo Municipal Council area was screened using fasting blood glucose for dysglycemia. All (n=272) newly diagnosed dysglycemics and a further 345 normoglycemics were recruited following confirmation of glycemic status by HbA1c, to enable ROC analysis. Apretested questionnaire and the International physical activity questionnaire validated for Sri Lanka were used to generate variables for the risk score.Results:A risk score for dysglycemia with a sensitivity of 87% and specificity of 87% and AUC of 0.941 was developed with two common symptoms of dysglycaemia, history of recent increase in frequency of passing urine and recent reduction in vision, one common food related practice, inability to resist sugary food and one indicator of sedentary behavior, TV viewing time and a single anthropometric measurement, waist circumference.Conclusions: A tool to identify prediabetesis currently unavailable and this new tool fills this gap. Further, the tool is designed to include women with previously undiagnosed diabetes mellitus. Inclusion of lifestyle parameters having a known association with dysglycemia increased the strength of the tool. Early identification will ensure targeting of interventions at the point of maximum effect.

Foot length as a screening tool for identification of preterm babies: a cross sectional study

Background: India is one of the countries with the highest neonatal mortality, for which preterm birth is considered as major cause (43.7%). Therefore, early identification by a simple screening tool is important for prognostication and follow-up of new-born infants, especially preterm.Methods: Cross-sectional study was conducted on 300 live newborns at Saveetha Hospital in Kanchipuram. Anthropometric measures such as birth weight, crown-heel length, head circumference, foot length were taken within 3 days of life and gestational age assessment was done by new Ballard scoring after calculation by Naegles formula. Neonates were grouped into preterm, term and post-term and also small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA). Minimum to maximum range of variables in each gestational range was calculated. The sensitivity and specificity of each variable was found using receiver operating curve. Parameter having the highest sensitivity and good specificity was considered as potential screening tool to identify high risk babies. SPSS Software version 17 for windows was used.Results: The range of gestational age, length, foot length, birth weight and head circumference was 28-42 weeks, 35-53 cm, 5-8.8 cm, 0.8-4.7 kg and 22.8-54.3 cm respectively. Among all, maximum sensitivity at 37weeks gestational age was seen with foot length (80.57%) at a cut-off of 7.58 cm. A nomogram of foot length for each gestational age group (range of 2 weeks) was also derived.Conclusions: It can be concluded that foot length has the potential to be considered as a screening tool to identify preterm neonates especially at a concentrated community level and is particularly useful in resource constraint countries.

Study of fingerprints in children under 15 years of age with acute lymphoblastic leukaemia

Background: Acute Lymphoblastic leukaemia is a malignant condition resulting due to continuous clonally proliferation of progenitors of lymphoid cells. The objective is to identify the association between dermatoglyphics and acute lymphoblastic leukaemia and to assess the value of dermatoglyphics as a screening tool.Methods: A case-control study was conducted on a total of around 60 subjects below the age of 15, out of which 30 children were already diagnosed and suffering from Acute Lymphoblastic Leukaemia and the other 30 were age and sex matched controls. Fingerprints of 30 affected children were taken through an ink-pad method in both hands, analyzed and compared with controls. Information regarding any significant familial history was obtained.Results: The study suggested with an increased rate of incidence among children of age group 3-4 years and with a male preponderance (63.3%).The findings were found to be statistically significant with an association between whorls and loops among cases and controls with higher frequency of whorls in cases and loops in controls (p value < 0.05), whereas association between whorls, arches and loops, arches was not significant. In quantitative analysis, most of the cases (n=12, 39.6%) had a PII in the range of 16-20 whereas most of the controls (n=22, 72.6%) had it in the range of 11-15, with significant overlapping.Conclusions: The findings are suggestive of association of fingerprint pattern with the patients suffering from Acute Lymphoblastic Leukaemia and therefore they might help in early diagnosis of the condition in high risk children and thus can be helpful as a screening tool.

Validation of initial nutrition screening tool for hospitalized patients / 한국영양학회지

PURPOSE: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. METHODS: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. RESULTS: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n = 107) with CKUNRS and 44.6% (n = 306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8 ~ 99.5) and 33.3% (28.1 ~ 39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen's kappa coefficient was 0.34, indicating valid agreement between the two tools. CONCLUSION: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.

Construção de um instrumento de triagem do vocabulário para crianças entre 3 e 7 anos / Development of a vocabulary-screening tool for children 3 to 7-years of age

RESUMO Objetivo construir um instrumento de triagem do vocabulário para crianças entre 3 e 7 anos de idade. Métodos a etapa 1, de construção do instrumento, consistiu em revisão da literatura nacional e internacional, para verificar os instrumentos utilizados para triagem do vocabulário, por meio de pesquisa nas bases de dados SciELO, LILACS, ERIC e PubMed. Na etapa 2, denominada formulação de itens e manual de uso, foi elaborado um instrumento direcionado para o vocabulário, com a criação de um banco de dados de palavras para crianças de 3 a 7 anos, de acordo com 11 categorias semânticas, em habilidades expressivas e receptivas. Por fim, a etapa 3 consistiu na criação das fichas de aplicação do instrumento. Resultados na primeira etapa do estudo, foram identificados três instrumentos internacionais para triagem do vocabulário. Nenhum instrumento nacional foi encontrado. Quanto à segunda etapa, o banco de dados consistiu em um total de 210 palavras, dentre elas, substantivos, adjetivos e verbos. Na terceira etapa, foram criadas as imagens, manual e folhas de resposta. Conclusão verificou-se escassez de instrumentos de triagem do vocabulário na literatura internacional e nacional. Portanto, foi construído um instrumento de triagem do vocabulário infantil para crianças entre 3 e 7 anos de idade.

ABSTRACT Purpose To develop a vocabulary screening tool for children from 3 to 7 years of age. Methods Step one, development of the instrument, consisted of an integrative review of the National and International literature to verify instruments for vocabulary screening, and used the SciELO, LILACS, ERIC and PubMed databases. For step two, the items and user's manual were developed. A vocabulary-oriented instrument was developed: a database of words for children from 3 to 7 years old comprised 11 semantic categories and tapped expressive as well as receptive skills. The final step involved the creation of protocols for the instrument. Results In the first step of the study, three international vocabulary screening instruments were identified. No national instrument was found. For the second step, a set of a total of 210 words were selected, including nouns, adjectives and verbs. During the third and final step, images, manual and answer protocols were developed. Conclusion There was a scarcity of vocabulary screening instruments identified in international and national literature. Therefore, a vocabulary screening instrument for children between 3 and 7 years of age was developed.

Sensitivity & Specificity Of Screening Tools For Postpartum Depression: A Systematic Review

@#Postpartum depression is a depressive episode that can start at any point during the first year after childbirth. There are several tools that can be used for PPD screening. The need to define a predictive tool that is clinically useful and has acceptable sensitivity and sensitivity is important especially to be used in the primary care setting. This systematic review investigates the evidence of the sensitivity and specificity of screening tools used for PPD screening. The Standard for Reporting of Diagnostic Accuracies (STARD) guidelines were used to conduct the review as a basis for our methodology. PubMed, ScienceDirect and Springerlink databases between 2007 until 2017 were comprehensively searched EPDS and BDI instrument has sensitivity of more than 80% but findings for specificity was inconclusive. The heterogeneity across studies could be the result of methodological differences in validation of the instruments. In addition, these studies were conducted across continents and settings with different cultures, languages and resources. We have identified 5 different instruments used to screen for postpartum depression. The EPDS was the most validated instrument in the review and we found that EPDS and BDI have higher accuracy to screen postpartum depression because the sensitivity reported were more than 80%.