Risk factors for prediabetes in community-dwelling adults: A generalized estimating equation logistic regression approach with natural language processing insights.

The global prevalence of prediabetes is expected to reach 8.3% (587 million people) by 2045, with 70% of people with prediabetes developing diabetes during their lifetimes. We aimed to classify community-dwelling adults with a high risk for prediabetes based on prediabetes-related symptoms and to identify their characteristics, which might be factors associated with prediabetes. We analyzed homecare nursing records (n = 26,840) of 1628 patients aged over 20 years. Using a natural language processing algorithm, we classified each nursing episode as either low-risk or high-risk for prediabetes based on the detected number and category of prediabetes-symptom words. To identify differences between the risk groups, we employed t-tests, chi-square tests, and data visualization. Risk factors for prediabetes were identified using multiple logistic regression models with generalized estimating equations. A total of 3270 episodes (12.18%) were classified as potentially high-risk for prediabetes. There were significant differences in the personal, social, and clinical factors between groups. Results revealed that female sex, age, cancer coverage as part of homecare insurance coverage, and family caregivers were significantly associated with an increased risk of prediabetes. Although prediabetes is not a life-threatening disease, uncontrolled blood glucose can cause unfavorable outcomes for other major diseases. Thus, medical professionals should consider the associated symptoms and risk factors of prediabetes. Moreover, the proposed algorithm may support the detection of individuals at a high risk for prediabetes. Implementing this approach could facilitate proactive monitoring and early intervention, leading to reduced healthcare expenses and better health outcomes for community-dwelling adults.

Interventions Addressing Symptoms in Older Adults with Multimorbidity: An Umbrella Review.

This umbrella review was to synthesize the summarized evidence-based research regarding interventions addressing symptoms in older populations with multimorbidity. Three databases including PsycINFO, MEDLINE, and CINAHL were searched systematically. The JBI Methodology for Umbrella Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to report this review. Six reviews published between 2016 and 2010 were included for analysis. Interventions were mixed and included components on health-related behaviors, body systems or functions, activities and participation domains, and the environment. Outcomes concerning physiological/clinical functioning were most reported. The evidence regarding the symptoms-related interventions was mixed, but all showed promising outcomes compared with usual care or not. To sum up, this umbrella review reveals the lack of strong empirical evidence for the effectiveness of intervention addressing symptoms in older adults with multimorbidity. It highlights the need to evaluate the established approach of interventions further to support this population.

Capacities and needs of health care facilities for schistosomiasis diagnosis and management in elimination settings.

BACKGROUND: Schistosomiasis is a debilitating neglected tropical disease endemic in sub-Saharan Africa. The role of health facilities in the prevention, diagnosis, control, and elimination of schistosomiasis is poorly documented. In a setting targeted for schistosomiasis elimination in Zanzibar, we assessed the prevalence of Schistosoma haematobium among patients seeking care in a health facility and investigated schistosomiasis-related knowledge of staff, and health facilities' capacities and needs for schistosomiasis diagnosis and management. METHODS: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management. RESULTS: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities. CONCLUSIONS: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases.

Knowledge levels of stroke among hypertensive and diabetic patients in a tertiary hospital.

BACKGROUND: Strokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels. OBJECTIVES: This study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC). METHODS: This was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded. RESULTS: The majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had "poor total knowledge" of stroke factors. Half of the participants (50.5 %) had "poor knowledge" about stroke risk factors, though the most commonly identified risk factor was "hypertension". Additionally, the findings showed that 46.4 % of participants had "poor knowledge" of stroke warning signs and symptoms, with the most commonly identified warning sign being "difficulty in speaking." Nearly half of participants (46.4 %) had "good knowledge" of stroke prevention methods; however, "regular exercise" was the most commonly identified prevention method. CONCLUSION: Although the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media.

Non-alcoholic Wernicke's Encephalopathy Masquerading As CNS Relapse of Acute Myeloid Leukemia.

While Wernicke's encephalopathy (WE) is mostly caused by thiamine deficiency secondary to chronic alcohol use, other conditions that may affect one's nutritional status, such as bariatric surgery, hyperemesis gravidarum, chronic gastrointestinal disease, HIV/AIDS, and certain malignancies, may also lead to this outcome. We are discussing one such case, WE, in a young man with acute myeloid leukemia (AML) who underwent chemotherapy. The patient presented with blurred vision, paresthesia, weakness, and vomiting. Although he denied alcohol abuse, his symptoms, physical exam findings, and MRI results were consistent with WE. Treatment with thiamine resulted in a significant improvement in his visual disturbances and mental status. The authors highlight the importance of recognizing WE in non-alcoholic patients, particularly those undergoing prolonged hospitalization and chemotherapy, as nutritional deficiencies can develop. They recommend thiamine supplementation for patients receiving chemotherapy and those with poor oral intake. The case underscores the need for high clinical suspicion and early intervention in atypical cases of WE.

Pain, symptoms and therapy satisfaction in adult oncologic patients at admission to palliative care: An Italian prospective, multicenter, observational study.

BACKGROUND: Pain in cancer patients is a complex clinical problem. Pain is systematically assessed and treated during palliative care, but little is known about how it is addressed before starting palliative care. AIM: This study primarily analyzed pain, symptoms, ongoing therapy at patients' admittance to the palliative care unit, and the relationships between pain and tumor, comorbidities, performance status and quality of life (QoL). Notably, patient satisfaction with the received antalgic therapy was assessed. METHODS: A multicentric, prospective, observational study was conducted in seven Italian palliative centers. The population consisted of adult cancer patients admitted to specialist palliative care units in hospice and home care. RESULTS: The sample consisted of 476 patients. Ninety-three patients reported moderate pain of 4.0 and worst pain of 5.9 at the initial medical examination. The pain was high, and QoL was lower in breakthrough pain. The pain was lower in older subjects when it was discontinuous and when it was also treated with corticosteroids. A total of 61% of the patients were unsatisfied with the prescribed pain therapy. CONCLUSIONS: Before the beginning of palliative care, physicians do not manage pain adequately. We support the idea that palliative care is not only intended for the last days of life but must be started early and simultaneously with oncological treatments. All that, in our opinion, is often ignored, and we hope that our study could have a positive influence and that the study results stimulate further research in this area with in-depth studies.

Self-Perceived Vocal Symptoms and Discomfort in Amateur Church Singers.

PURPOSE: To analyze self-perceived vocal symptoms and discomfort in amateur church singers and compare them between genders and church types. METHODS: It was a quantitative cross-sectional study involving 99 amateur church singers aged between 18 and 59years. Data collection was carried out through the completion of a sociodemographic questionnaire, the Voice Symptom Scale (VoiSS), and the Vocal Tract Discomfort Scale (VTDS). The Mann-Whitney test was used for comparisons, and Spearman's correlation test was used for analyzing correlations between scale scores. The adopted significance level was 5% (P < 0.05). RESULTS: There was a prevalence of females (71.7%), amateur singers from Protestant churches (73.7%), with a mean age of 27.5years. The average VoiSS total score was 22.6 points, the "limitation" domain was 12.3, the "emotional" domain was 2.55, and the "physical" domain was 7.7. The most self-perceived sensations in the VTDS were "dryness," "sore throat," and "itchiness" with mild to moderate intensity. There was a statistically significant difference between genders (P < 0.05) and a positive correlation from weak (r = 0.212) to strong magnitude (r = 0.660) between vocal symptoms and vocal tract discomfort. There was no statistically significant difference between types of churches. CONCLUSION: Amateur singers self-report high levels of vocal symptoms, which impact limitation, emotional, and physical domains. Furthermore, they experience vocal tract discomfort sensations, with dryness being the most frequently reported, followed by sore throat and itching. No significant differences were found between the scale scores and church types. However, females reported a greater frequency and intensity of vocal tract discomfort sensations. The greater the self-reported vocal symptoms in this population, the higher their self-reported frequency and intensity of vocal tract discomfort sensations. These findings underscore the importance of addressing vocal health issues in amateur singers to enhance their overall well-being.

Trajectories of patient-reported outcomes after oesophageal cancer surgery - A population-based study.

BACKGROUND: This study aimed to investigate the trajectories of patient-reported outcomes for individuals who have undergone surgery for oesophageal cancer over a five-year post-surgical period, and to identify modifiable factors that contribute to a decline in quality of life. METHODS: Patients who underwent resection in Sweden between 2013 and 2020 were included. Data were collected at one-year post-surgery and at regular pre-determined intervals during the five-year post-surgical period. Latent class analysis and logistic regression models were used to identify symptom trajectories and determine their association with lifestyle factors, respectively. RESULTS: This study included 408 patients, and the majority experienced consistent symptom burdens during the five-year post-surgery period. Current smokers had a higher risk of belonging to the severe dysphagia, severe eating restriction, and severe reflux trajectory. Physically active patients were less likely to belong to the severe dysphagia, severe eating restriction, and severe pain and discomfort trajectory. Patients with a stable weight were less likely to belong to the severe eating restriction and to the recovering body image trajectory. CONCLUSIONS: Patients who are smokers, have a low level of physical activity, and experience weight loss need further attention and individual support to mitigate long-term symptom burden.

Conventional clinical signs and symptoms are poor predictors of postoperative cerebrospinal fluid leak: A single-centre cohort perspective.

BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks. METHODS: Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression. RESULTS: Seventy-nine patients (57.7%) had high-flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV [95% CI] = 7.6% [4.8%, 11.9%]), followed by severe headache (n = 47, 34.3%; 6.3% [3.1%, 12.5%]), dizziness (n = 43, 31.4%; 2.3% [0.4%, 12.1%]), salty or metallic taste (n = 20, 14.6%; 9.9% [3.3%, 25.8%]), and throat drainage (n = 10, 7.3%; 9.9% [1.7%, 41.4%]). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV [95% CI] = 4.1% [2.0%, 8.1%]). On univariate regression, no sign or symptom, including rhinorrhea (OR [95% CI] = 7.00 [0.76-64.44]), throat drainage (3.42 [0.35-33.86]), salty/metallic taste (4.22 [0.66-27.04]), severe headache (3.00 [0.48-18.62]), dizziness (0.54 [0.06-4.94]), fever (3.16 [0.50-19.99]), and nausea/vomiting (1.33 [0.22-8.21]), associated with postoperative CSF leak. CONCLUSIONS: A range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response.

A cross-sectional study of Hispanic and Latina/o/x/e individuals' acute coronary syndrome symptom knowledge, attitudes, and beliefs.

BACKGROUND: Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. OBJECTIVES: To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. METHODS: This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. RESULTS: The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. CONCLUSIONS: Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population.

Comparative Performance of COVID-19 Test Methods in Healthcare Workers during the Omicron Wave.

The COVID-19 pandemic presents unique requirements for accessible, reliable testing, and many testing platforms and sampling techniques have been developed over the course of the pandemic. Not all test methods have been systematically compared to each other or a common gold standard, and the performance of tests developed in the early epidemic have not been consistently re-evaluated in the context of new variants. We conducted a repeated measures study with adult healthcare workers presenting for SARS-CoV-2 testing. Participants were tested using seven testing modalities. Test sensitivity was compared using any positive PCR test as the gold standard. A total of 325 individuals participated in the study. PCR tests were the most sensitive (saliva PCR 0.957 ± 0.048, nasopharyngeal PCR 0.877 ± 0.075, oropharyngeal PCR 0.849 ± 0.082). Standard nasal rapid antigen tests were less sensitive but roughly equivalent (BinaxNOW 0.613 ± 0.110, iHealth 0.627 ± 0.109). Oropharyngeal rapid antigen tests were the least sensitive (BinaxNOW 0.400 ± 0.111, iHealth brands 0.311 ± 0.105). PCR remains the most sensitive testing modality for the diagnosis of COVID-19 and saliva PCR is significantly more sensitive than oropharyngeal PCR and equivalent to nasopharyngeal PCR. Nasal AgRDTs are less sensitive than PCR but have benefits in convenience and accessibility. Saliva-based PCR testing is a viable alternative to traditional swab-based PCR testing for the diagnosis of COVID-19.

Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment.

BACKGROUND: Early users found Engagement and Visualization to Improve Symptoms in Oncology Care (ENVISION), a web-based application designed to improve home management of hospice patients' symptoms and support patients' and family caregivers' well-being, to be generally useful and easy to use. However, they also raised concerns about potential challenges users with limited technological proficiency might experience. OBJECTIVE: We sought to concurrently accomplish two interrelated study aims: (1) to develop a conceptual framework of digital inclusivity for health information systems and (2) to apply the framework in evaluating the digital inclusivity of the ENVISION application. METHODS: We engaged ENVISION users (N=34) in a qualitative study in which data were collected via direct observation, think-aloud techniques, and responses to open-ended queries. Data were analyzed via theory elaboration and basic qualitative description. RESULTS: Accessibility, relevance, and impact were identified as 3 essential considerations in evaluating a health system's digital inclusivity. Study findings generally supported ENVISION's digital inclusivity, particularly concerning its perceived relevance to the work of family caregivers and hospice clinicians and its potentially positive impact on symptom management and quality of life. Limitations to ENVISION's digital inclusivity centered around issues of accessibility, particularly operability among individuals with limited technological knowledge and skills. CONCLUSIONS: The Accessibility, Relevance, and Impact conceptual framework of digital inclusivity for health information systems can help identify opportunities to strengthen the digital inclusivity of tools, such as ENVISION, intended for use by a broad and diverse range of users.

Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín.

OBJECTIVE: To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN: Prospective cohort study between June 2019 and March 2020. SETTING: Hospital Universitario San Vicente Fundación, Colombia. PATIENTS: Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS: From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS: Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

History of smallpox vaccination and marked clinical expression of mpox among cases notified in France from May to July 2022.

OBJECTIVES: The aim was to estimate the effect of reported history of smallpox vaccination prior to 1980 on clinical expression of mpox. METHODS: We included all confirmed mpox cases identified by the national mpox surveillance system in France between May and July 2022. Cases tested positive for monkeypox virus or orthopoxviruses by PCR. Cases were interviewed by phone using a questionnaire documenting demographics, symptoms and exposures. To estimate the effect of smallpox vaccination on the presence of marked mpox symptoms (association of fever, lymphadenopathy and extensive mucocutaneous lesions), we estimated prevalence ratios (PRs) and 95% CIs using Poisson regression models with robust standard errors. RESULTS: There were 1888 confirmed mpox cases with date of symptom onset between 7 May and 31 July 2022. Overall, 7% (93/1394) presented marked mpox symptoms. Among patients who provided information about their vaccination status, 14% (207/1469) reported smallpox vaccination prior to 1980. The proportion of cases with marked symptoms was 2% (3/170) among those reporting smallpox vaccination prior to 1980 and 8% (76/974) among those who reported no vaccination. The proportion of marked symptoms was four times lower among cases reporting previous smallpox vaccination than in cases reporting no vaccination (PR, 0.24; 95% CI: 0.08-0.76). There was no evidence of an effect of smallpox vaccination on development of complications (PR, 0.65; 95% CI: 0.35-1.22) or hospitalization due to mpox (PR, 0.64; 95% CI: 0.23-1.80). DISCUSSION: Our results suggest that smallpox vaccination during childhood attenuated the clinical expression of monkeypox virus infection, but there was no evidence of an effect on complications or hospitalization.

Neurological aspects of HTLV-1 infection: symptoms in apparently asymptomatic carriers.

Human T-lymphotropic virus type 1 (HTLV-1) is classically associated with the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although the mechanisms of this neurological disorder remain unclear. In addition, some patients who develop "minor" neurological signs that do not meet diagnostic criteria for HAM/TSP are classified as asymptomatic carriers. This study aims to demonstrate the neurological symptoms of Brazilian patients living with HTLV-1 classified as not-HAM.TSP. This observational study evaluated patients treated in an HTLV reference center in Bahia, Brazil, between February 2022 and July 2023. The data were obtained through the analysis of medical records and neurological consultation. Those individuals classified as HAM/ TSP were excluded from this study. 74 patients were submitted to a careful neurological evaluation: 23 HAM/TSP, 22 were classified with intermediate syndrome (IS), and 29 were oligosymptomatic. Self-reported symptoms were significantly more common in the IS group, including urinary symptoms such as nocturia, urgency, incontinence, dysuria, weakness, paresthesia, lumbar pain, xerostomia, and xerophthalmia. Physical examination findings consistent with reduced vibratory and tactile sensitivity were more common in the IS group (p = 0.017 and p = 0.013). Alterations in the V and VIII cranial nerves were present in both groups. HTLV-1 can lead to the development of important neurological signs and symptoms in apparently asymptomatic individuals. This data highlights the need for more research into the neurological aspects of HTLV-1 infection and emphasizes the importance of early diagnosis, treatment, and support for individuals living with this virus.

Head-and-neck Cancer in the Emergency Department: A Contemporary Review of Common Presentations and Management.

Head-and-neck cancer (HNC) can present with life.threatening symptoms in the emergency department. Patients can sometimes be misdiagnosed with pulmonary disease due to similar signs and symptoms, ultimately leading to delayed diagnosis and potentially devastating consequences. Reasons for this include lack of awareness of patient risk factors and knowledge of the myriad of presenting complaints in the disease process among physicians working in primary care and in the emergency department. This article explores the contemporary risk factors and common presenting symptoms and discusses initial management for a patient with potential head-and-neck malignancy. Emergency presentations of HNC are wide ranging and can overlap with common respiratory pathologies. Clinician awareness of this can assist the team in deciding what appropriate examination and investigations are required to reduce the risk of delaying diagnosis and further treatment.

Vocal Tract Discomfort Scale-Brazil (VTDS-BR): Validation Based on Internal Consistency, Reliability, and Accuracy.

OBJECTIVE: To validate the Vocal Tract Discomfort Scale for the Brazilian Portuguese (VTDS-BR), based on internal consistency, reliability, and accuracy. METHODS: The participants were 431 adults of both sexes, divided in two groups: dysphonia (DG) and vocally healthy (VHG). We built a digital database with personal, professional information and the item-by-item VTDS-BR responses of the participants. We applied Cronbach's alpha, exploratory factor analysis; confirmatory factor analysis; Item Response Theory (IRT) using the Samejima model; and ROC (Receiver Operating Characteristic) curve analysis to obtain the VTDS-BR cut-off point. RESULTS: The VTDS-BR has an eight-item structure and two factors: vocal hyperfunction without phonotraumatic injury and with phonotraumatic injury. Each item is evaluated based on two facets related to frequency and intensity, with a Likert scale response key. There are four possible answers: never, sometimes, often, and always for frequency and none, mild, moderate, and intense for intensity. We applied an IRT model, which allowed the identification of which items are more related to dysphonia, based on higher values in the parameters discrimination (a) and difficulty (b), which contributed to the calculation of each participant's aptitude for the development of voice problems, by means of a score. The cut-off value was determined using the ROC curve, in which values greater than - 1.432 indicate a higher probability of voice alterations. CONCLUSION: VTDS-BR went through the stages of validation of internal consistency, reliability, and accuracy. It presents an 8-item, two-factor, and two-facet structure to assess frequency and intensity of vocal tract discomfort symptoms. VTDS-BR is suitable for clinical use or in screening activities, as it is quick to apply and its interpretation is indicative of people with and without phonotraumatic injury.

Accelerated decline in motor suppression in patients with cerebrovascular disorders: A kinetic analysis using the square-tracing task.

BACKGROUND: Patients with cerebrovascular disorders (CVDs) tend to exhibit impulsive behaviour without controlling their movements, leading to difficulty in performing activities of daily living and an increased risk of accidents. This hastiness, termed 'pacing impairment', has been studied but is not fully understood. OBJECTIVE: To experimentally examine the kinetic features of pacing impairment by focusing on changes in speed and investigating neuropsychological substrates. METHODS: We instructed 53 inpatients with CVDs, 20 orthopaedic inpatients, and 20 healthy participants to trace a 200 mm-sided square as slowly as possible for 120 seconds. We measured the tracing length and mean acceleration and examined the relationship between these measurements, neuropsychological symptoms, and lesion sites. RESULTS: Gradual acceleration in drawing, i.e., decline in motor suppression, was observed more frequently in the CVD group than in the control groups. Excessive acceleration was associated with unilateral spatial neglect, frontal lobe signs, and attention disorders but not with motor impersistence. Additionally, the incidence of excessive acceleration did not differ between left and right hemisphere lesion subgroups and was not associated with any specific lesion site. CONCLUSION: Pacing impairment can manifest as general or holistic deficits in attentional function widely distributed throughout the cerebral hemispheres.

Clusterization of Behavioral and Psychological Symptoms of Dementia as Assessed by Neuropsychiatric Inventory: A Case Against the Use of Principal Component Analysis.

Background: The term Behavioral and Psychological Symptoms of Dementia (BPSD) covers a group of phenomenologically and medically distinct symptoms that rarely occur in isolation. Their therapy represents a major unmet medical need across dementias of different types, including Alzheimer's disease. Understanding of the symptom occurrence and their clusterization can inform clinical drug development and use of existing and future BPSD treatments. Objective: The primary aim of the present study was to investigate the ability of a commonly used principal component analysis to identify BPSD patterns as assessed by Neuropsychiatric Inventory (NPI). Methods: NPI scores from the Aging, Demographics, and Memory Study (ADAMS) were used to characterize reported occurrence of individual symptoms and their combinations. Based on this information, we have designed and conducted a simulation experiment to compare Principal Component analysis (PCA) and zero-inflated PCA (ZI PCA) by their ability to reveal true symptom associations. Results: Exploratory analysis of the ADAMS database revealed overlapping multivariate distributions of NPI symptom scores. Simulation experiments have indicated that PCA and ZI PCA cannot handle data with multiple overlapping patterns. Although the principal component analysis approach is commonly applied to NPI scores, it is at risk to reveal BPSD clusters that are a statistical phenomenon rather than symptom associations occurring in clinical practice. Conclusions: We recommend the thorough characterization of multivariate distributions before subjecting any dataset to Principal Component Analysis.

Using the NEWS2 and ABCDE assessment to identify early signs of clinical deterioration.

Nurses may encounter deteriorating patients in their clinical practice, so they require an understanding of the early physiological signs of deterioration and a structured approach to patient assessment. This enables appropriate management and a timely response to the most life-threatening issues identified, such as a compromised airway. This article describes how nurses can use early warning scores and a structured patient assessment, using the ABCDE (airway, breathing, circulation, disability, exposure) framework, to identify early signs of deterioration and facilitate the timely escalation of patient care where necessary.