Inter-observer reliability using the General Movement Assessment is influenced by rater experience.

OBJECTIVE: To describe the inter-observer reliability of the General Movement Assessment (GMA) among a sample of infants at high-risk of cerebral palsy (CP) among raters with various levels of experience. METHODS: Video assessments of 150 high-risk infants at 10-15 weeks corrected age were rated by three Prechtl GMA-certified observers with varied experience using the assessment. Videos were scored based on temporal organization of fidgety movements (FMs), presence of abnormal FMs, or absence of FMs. Inter-observer agreements were analyzed with Gwet's AC1 statistic. RESULTS: We found fair to moderate agreement when subcategories of normal FMs (continuous and intermittent) were included (AC1 = 0.32-0.57) and moderate to near perfect agreement when normal categories of FMs were combined (AC1 = 0.60-0.95). Reliability was higher among observers with more experience using the GMA (AC1 = 0.57-0.98) than the observer with less experience (AC1 = 0.32-0.61). CONCLUSIONS: Caution may be warranted when the GMA is used to differentiate "continuous and intermittent" FMs temporal organization. The GMA is highly reliable among experienced raters when comparing normal FMs to other FMs categorizations.

Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes.

BACKGROUND AND AIMS: Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. MATERIAL AND METHODS: T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. RESULTS: We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]). CONCLUSION: Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.

Resistant hypertension: do all definitions describe the same patients?

Resistant hypertension (RH) is defined as blood pressure (BP) that remains ⩾140 and/or 90 mm Hg despite therapy with ⩾3 full-dose antihypertensive drugs (classical definition=CD). A definition proposed subsequently (new definition=ND) includes patients requiring ⩾4 drugs irrespective of BP values. We aimed to evaluate whether both definitions characterize the same kind of patients.One hundred and twenty-four consecutively attended patients with RH were classified into two groups according to their BP control: 66 patients had non-controlled BP (all those who met the CD criteria plus a few patients who met the ND criteria); 58 patients had controlled BP (all with RH according to the ND). Clinical, laboratory and office BP data were recorded. RH patients with non-controlled BP were more frequently diabetic (72% vs 49%), and had higher plasmatic glucose (149 vs 130 mg dl(-1)), cholesterol (179 vs 164 mg dl(-1)), low-density lipoprotein (LDL)-cholesterol (107 vs 95 mg dl(-1)) and triglyceride (169 vs 137 mg dl(-1)) levels; P<0.05 for all comparisons. In multivariate logistic regression analysis, the variables that independently associated with non-controlled BP were diabetes (P=0.001) and higher LDL-cholesterol (P=0.007).We conclude that, although both cohorts of patients are phenotypically quite similar, uncontrolled RH patients have higher prevalence of diabetes mellitus and higher LDL-cholesterol levels than controlled RH patients.

Characteristics of female psychiatrists.

OBJECTIVE: This study assessed within-gender differences between psychiatrists and other physicians by using data taken from a large national sample of U.S. female physicians. METHOD: The authors used data from the Women Physicians' Health Study, a large, national questionnaire-based survey conducted in 1993-1994, to compare characteristics of female psychiatrists (N=570) with those of other female physicians (N=3,875). RESULTS: Psychiatrists were older, in poorer health, less likely to be married, more likely to be current or ex-smokers, and more likely to be politically liberal than were the other female physicians. Psychiatrists were somewhat (although not necessarily significantly) more likely than the other female physicians to report having had personal or family histories of various psychiatric disorders. Psychiatrists were more likely to have a solo practice and less likely to be in a group practice. They worked fewer hours than the other female physicians but reported comparable hourly incomes. Psychiatrists did not differ from the other female physicians in perceived work amount, work stress, work control, or career satisfaction. Their satisfaction with their specialty was, however, greater than that of the other female physicians. For nearly all of the 14 preventive health care counseling practices examined, the amount of preventive counseling psychiatrists reported performing, the clinical relevance they ascribed to those practices, their self-confidence in performing the practices, and the amount of training they reported receiving in preventive counseling practices was significantly lower than that of primary care practitioners and lower than or comparable to that of other specialists. CONCLUSIONS: Female psychiatrists significantly differ from other female physicians with regard to a number of personal and professional dimensions.

Methylphenidate effects on symptoms of attention deficit disorder in adults.

The objectives of this study were (1) to determine whether attention deficit disorder (ADD) is a specific diagnostic entity in adulthood; (2) to evaluate, using a double-blind crossover design, the efficacy of methylphenidate hydrochloride in adults with evidence of residual ADD with hyperactivity (ADD-H) (N = 26); and (3) to evaluate the specificity of drug response by also administering methylphenidate to patients with similar adult symptoms but no childhood history of ADD-H (N = 35). Results indicated success in differentiating relatively distinct groups. However, no overall benefit from methylphenidate was evident, regardless of childhood history of ADD-H. Approximately 25% of the sample appeared clinically to benefit from methylphenidate, but no clear-cut predictors of drug response were identified; history of drug abuse (polydrug) appeared to be the best predictor. Even among the responders, benefit was generally not as marked nor as clinically valuable as in childhood ADD-H.