Psychometric evaluation of the Chinese version of alcohol relapse risk scale (C-ARRS) in patients with alcohol use disorder.

Alcohol use disorder (AUD) is recognized as a chronic relapsing disorder. Alcohol Relapse Risk Scale (ARRS), a multidimensionally self-rating scale, was developed initially by the Japanese to assess the risk of alcohol reuse. The study aimed to validate the reliability and factor structure of the Chinese version of the ARRS (C-ARRS) for patients with AUD. A total of 218 patients diagnosed with AUD according to DSM-5 were recruited for self-administering C-ARRS. We assessed the internal consistency of C-ARRS using Cronbach's α coefficients and examined the factor structure through confirmatory factor analysis (CFA). Additionally, we investigated the concurrent validity by correlating C-ARRS with the Visual Analog Scale of Alcohol Craving (VAS), Penn Alcohol Craving Score (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. CFA demonstrated inadequate data fit for the original 32-item C-ARRS, prompting the development of a revised 27-item version consisting of 6 subscales with satisfactory model fit estimates. The 27-item C-ARRS exhibited favorable internal consistency, with Cronbach's α ranging from 0.611 to 0.798, along with adequate factor loadings. The 27-item C-ARRS scores displayed significant correlations with the scores of VAS, PACS, BDI and BAI (p < .001). Our results indicated favorable reliability and factor structure of the 27-item C-ARRS. The significant correlation between the 27-item C-ARRS and clinical measures (such as depression, anxiety, and craving) demonstrates satisfactory concurrent validity. These observations collectively support the feasibility of using 27-item C-ARRS to assess the risk of alcohol relapse in patients with AUD.

Identifying risk for status epilepticus with the ADAN scale: a prospective multicenter validation study. / Escala ADAN para la identificación del estado epiléptico: estudio de validación prospectivo y multicéntrico.

OBJECTIVES: Status epilepticus (SE) is a serious event associated with high mortality. This study aims to validate the recently developed ADAN (Abnormal speech, ocular Deviation, Automatisms, and Number of motor epileptic seizures) scale for detecting high risk for SE. MATERIAL AND METHODS: Prospective, multicenter, observational study in adults with suspected epileptic seizures. Consecutive recruitment took place over a 27-month period in 4 hospital emergency departments (EDs). The main endpoint was the proportion of patients with criteria for SE based on the collection and analysis of clinical characteristics and the ADAN scale criteria on arrival at the ED. RESULTS: Of the 527 patients recruited, 203 (38.5%) fulfilled the criteria that predicted SE. Multiple regression analysis demonstrated that the 4 ADAN criteria were the only variables independently associated with a final diagnosis of SE (P .001). The predictive power of the scale was 90.9% (95% CI, 88.4%-93.4%) for a final SE diagnosis. We established 3 risk groups based on ADAN scores: low (score, 0-1: 8.7%), moderate (2, 46.6%), and high (> 2, 92.6%). A cut point of more than 1 had a sensitivity of 88.2% for predicting SE, specificity of 77.8%, positive predictive value of 71.3%, and negative predictive value of 91.3%. CONCLUSION: The ADAN scale is a prospectively validated, simple clinical tool for identifying patients in the ED who are at high risk for SE.

OBJETIVO: El estado epiléptico (EE) es una enfermedad grave con elevada mortalidad. Este estudio tiene como objetivo validar la escala ADAN, propuesta recientemente para identificar pacientes con alto riesgo de desarrollar un EE. METODO: Se realizó un estudio prospectivo, multicéntrico y observacional que incluyó a pacientes adultos con sospecha de crisis epilépticas. Se llevó a cabo un reclutamiento consecutivo durante 27 meses en los servicios de urgencias (SU) de cuatro hospitales. La variable principal fue la proporción de pacientes que cumplían criterios para EE. Se han recopilado y analizado las características clínicas y la puntuación en la escala ADAN a su llegada al SU. RESULTADOS: Se reclutaron 527 pacientes, de los cuales 203 (38,5%) cumplieron criterios de EE. En el análisis de regresión múltiple, se demostró que el habla anormal, la desviación ocular, los automatismos y el número de crisis epilépticas motoras fueron las únicas variables independientemente asociadas con un diagnóstico final de EE (p 0,001). La capacidad predictiva de la escala fue del 90,9% (intervalo de confianza del 95%, 88,4-93,4) para identificar el EE como diagnóstico final. Se establecieron tres grupos de riesgo: bajo (0 1 puntos: 8,7%), moderado (2: 46,6%) y alto (> 2: 92,6%). Una puntuación de corte > 1 punto proporcionó una sensibilidad del 88,2%, especificidad del 77,8%, valor predictivo positivo del 71,3% y valor predictivo negativo del 91,3% para predecir el EE. CONCLUSIONES: La escala ADAN es una herramienta clínica simple y validada de manera prospectiva para identificar, en los SU, a los pacientes con elevado riesgo de EE.

Las herramientas predictivas de riesgo, una alternativa diagnóstica en la retención de caninos maxilares

Se describen, en la literatura médica, predictores radiográficos que constituyen herramientas diagnósticas útiles para la retención de los caninos maxilares. Sin embargo, en la especialidad de ortodoncia las investigaciones sobre las herramientas predictivas de riesgo son escasas. Por ello se decide realizar una revisión bibliográfica con el objetivo de recopilar información acerca de la utilidad de las herramientas predictivas de riesgo en el diagnóstico de la retención de los caninos maxilares. Se realizó una búsqueda de información de artículos en idioma español e inglés, utilizándose las bases de datos SciELO, PubMed, Cochrane y Scopus. Para lograr un tratamiento óptimo de la anomalía debe priorizarse un buen diagnóstico, basado en métodos clínicos y radiográficos, pero se hace notoria la ausencia de herramientas que identifiquen individuos con alto riesgo en la comunidad. Los modelos o escalas de riesgo pueden ser útiles en este aspecto, para detectar precozmente el trastorno eruptivo y priorizar así intervenciones preventivas, que eviten el uso excesivo de medios auxiliares de diagnóstico y la sobrecarga de los sistemas de salud. Las herramientas predictivas de riesgo constituyen una alternativa para la clasificación adecuada de la población con alto riesgo de retención de caninos maxilares. Un instrumento de tal magnitud es de gran utilidad tanto en los servicios de Estomatología General como en los de Ortodoncia.

Radiographic predictors that are useful diagnostic tools for the retention of maxillary canines are described in the literature. However, in the specialty of orthodontics, research on risk predictive tools is scarce. Therefore, it was decided to carry out a bibliographic review with the objective of collecting information about the usefulness of risk predictive tools in the diagnosis of retention of maxillary canines. A search for information on articles in Spanish and English was carried out, using the SciELO, PubMed, Cochrane and Scopus databases. To achieve optimal treatment of the anomaly, a good diagnosis should be prioritized, based on clinical and radiographic methods, but the absence of tools that identify individuals at high risk in the community is notorious. Models or risk scales can be useful in this aspect, to detect the eruptive disorder early and thus prioritize preventive interventions that avoid the excessive use of diagnostic aids and the overload of health systems. Predictive risk tools are an alternative for the adequate classification of the population with high risk of retention of maxillary canines. An instrument of this magnitude is very useful both in General Dentistry and Orthodontics services.

Impact of preeclampsia and parity on sex-based discrepancies in subclinical carotid atherosclerosis in type 1 diabetes.

CONTEXT: The excess risk of fatal and non-fatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes (T1D). OBJECTIVE: To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale. DESIGN: Cross-sectional study. SETTING: Single tertiary hospital. PATIENTS: 728 T1D (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor. INTERVENTION: Standardized carotid ultrasonography. MAIN OUTCOME MEASURES: Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk). RESULTS: Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio [OR]: 0.48, 95% confidence interval [0.28-0.82]; adjusted OR: 0.51 [0.33-0.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve (AUC) of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: 0.7886, nulliparous women: 0.9026, women without preeclampsia: 0.8230, preeclampsia group: 0.7841; p between groups=0.042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the AUC. CONCLUSIONS: The risk for carotid plaque in women compared to men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.

Time point and scale measurement of carbon sink trading market risk based on catastrophe entropy and potential function.

According to the principle of total entropy change of dissipative structure, the carbon trading market is defined as a nonlinear complex system that follows the law of entropy increase in this paper. Based on the potential function of sudden change theory, this paper studies the risk point and scale of the carbon trading market. The results show that (1) the theory of dissipative structure and catastrophe theory can be used as the theoretical basis of carbon financial market risk research, and its core technology can be used to measure and predict risks. (2) The risk mutation point measurement model based on the total entropy change principle and potential function technology effectively detected 16 major risk mutation points in the financial crisis, the European debt crisis, and the European new energy efficiency plan. The empirical test shows that the model has a good ability to capture abrupt changes and prediction accuracy. The fitting effect is very good. (3) The risk index value of the risk abrupt point can be calculated effectively by the risk scale measurement technique based on information entropy and the potential function surface equation. Furthermore, we judge the degree and grade of risk. From 2008 to 2021, amongst the 16 risk mutation points in the EU carbon trading market, there are three extremely high risk mutation points, seven high-risk mutation points, two medium-risk mutation points, two low-risk mutation points, and two very low risk mutation points. High risk or above grade accounted for 62.5%. Empirical analysis supports this conclusion.

Diseño y validación de una escala de riesgo de parto pretérmino con enfoque periodontal / Design and validation of a preterm birth risk scale with a periodontal approach i: en

Introducción: La escala de riesgo diseñada para estimar la probabilidad de parto pretérmino con enfoque periodontal debe ser validada antes de su implementación en la práctica clínica. Objetivo: Diseñar y validar una escala de riesgo de parto pretérmino con enfoque periodontal. Métodos: Se realizó un estudio analítico, de casos y controles, de 1152 puérperas ingresadas en los hospitales maternos de la provincia de Santiago de Cuba en el período 2011-2022, para lo cual fueron seleccionadas 2 muestras: una de construcción del modelo (n=750) y otra de validación de la escala (n=402). Se determinaron los posibles predictores a través del análisis univariado y el cálculo del odds ratio, con un nivel de significación de p≤0,05; asimismo, se elaboró un modelo de regresión logística binaria multivariada y se obtuvo la escala de riesgo que fue validada por diferentes métodos. Resultados: La escala se obtuvo con 7 predictores y 2 estratos de riesgo. Esta alcanzó buena discriminación (80 %), así como buen nivel de ajuste y validez de constructo (p=0,72). Igualmente, aseguró una predicción correcta de más de 50 % de los partos pretérmino, valores de sensibilidad y especificidad aceptables (79,20 y 70,20 %, respectivamente), así como validez de contenido, validez interna y confiabilidad adecuadas. Conclusiones: La escala de riesgo para estratificar el riesgo de parto pretérmino incluye predictores de gravedad de la enfermedad periodontal, con buenos parámetros de validación para ser usada en la toma de decisiones para prevenir este tipo de parto.

Introduction: The risk scale designed to estimate the probability of preterm birth with periodontal approach should be validated before its implementation in the clinical practice. Objective: To design and validate a risk scale of preterm birth with periodontal approach. Methods: A cases and controls analytic study of 1152 newly-delivered women admitted to maternal hospitals in Santiago de Cuba province was carried out in the period 2011 - 2022, and 2 samples were selected: one of pattern construction (n=750) and another of scale validation(n=402). The possible predictors were determined through the single varied analysis and odds ratio calculation, with a significance level of p≤0.05; also, a multivariate binary logistical regression model was elaborated and the risk scale was obtained, which was validated by different methods. Results: The scale was obtained with 7 predictors and 2 risk stratum. It reached a good discrimination (80%), as well as a good adjustment level and construction validity (p=0.72). Likewise, it assured a correct prediction of more than 50% of preterm births, acceptable sensibility and specificity values (79.20 and 70.20%, respectively), as well as adequate content validity, internal validity and reliability. Conclusions: The risk scale to stratify the risk of preterm birth includes predictors of periodontal disease severity, with good validation parameters to be used in the decisions making to prevent this type of childbirth.

Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy.

OBJECTIVE: Degenerative cervical myelopathy (DCM) is routinely treated with surgical decompression, but disparate postoperative outcomes are frequently observed, ranging from complete neurological recovery to persistent decline. Although numerous clinical and radiological factors have been independently associated with failure to improve, the relative impact of these proposed risk factors remains obscure. In this study, the authors assess the combined role of clinical and radiographic parameters in contributing to failure to attain neurological improvement after surgery. METHODS: A consecutive series of patients who underwent surgery for DCM between July 2013 and August 2018 at a single institution was identified from a prospectively maintained database. Retrospective chart review was undertaken to record perioperative clinical and radiographic parameters. Failure to improve on the last follow-up evaluation after surgery, defined as a change in modified Japanese Orthopaedic Association (mJOA) score less than 2, was the primary outcome in univariate and multivariate analyses. RESULTS: The authors included 183 patients in the final cohort. In total, 109 (59.6%) patients improved (i.e., responders with ΔmJOA score ≥ 2) after surgery and 74 (40.4%) were nonresponders with ΔmJOA score < 2. Baseline demographic variables and comorbidity rates were similar, whereas baseline Nurick score was the only clinical variable that differed between responders and nonresponders (2.7 vs 3.0, p = 0.02). In contrast, several preoperative radiographic variables differed between the groups, including presence and degree of cervical kyphosis, number of levels with bidirectional cord compression, presence and number of levels with T2-weighted signal change, intramedullary lesion (IML) length, Torg ratio, and both narrowest spinal canal and cord diameter. On multivariate analysis, preoperative degree of kyphosis at C2-7 (OR 1.19, p = 0.004), number of levels with bidirectional compression (OR 1.83, p = 0.003), and IML length (OR 1.14, p < 0.001) demonstrated the highest predictive power for nonresponse (area under the receiver operating characteristic curve 0.818). A risk factor point system that predicted failure of improvement was derived by incorporating these 3 variables. CONCLUSIONS: When a large spectrum of both clinical and radiographic variables is considered, the degree of cervical kyphosis, number of levels with bidirectional compression, and IML length are the most predictive of nonresponse after surgery for DCM. Assessment of these radiographic factors can help guide surgical decision-making and more appropriately stratify patients in clinical trials.

The relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk.

Introduction: The perceived COVID-19 risk may lead to the use of various complementary and alternative medicine (CAM) modalities to reduce the potential risks of this disease. This study was conducted to investigate the relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk. Methods: The study was conducted in Turkey between November 2021 and March 2022 and 1003 individuals voluntarily participated. The Personal Information Form, Attitude Towards Holistic Complementary and Alternative Medicine Scale (HCAMS), and Perceived COVID-19 Risk Scale (PCRS) were used for data collection. To evaluate the data descriptive statistics, Pearson's correlation, and Cronbach's alpha reliability analysis were used. Results: In the study, 54.2% of the individuals were found to use CAM during the pandemic, and 56.2% believed that CAM practices were useful in preventing or recovering from COVID-19. It was revealed that 53.8% of the individuals drank herbal tea, 55.2% used religious and spiritual healing to manage, 6.6% used massage, and 10.1% applied aromatherapy. The mean total score of the HCAMS was 28.29 ± 4.99, and the mean total score of the perceived COVID-19 risk scale was 27.78 ± 6.35. A statistically significant positive correlation was identified between the CAM subscale and the emotional risk subscale (p < 0.05). Conclusion: Individuals had a positive attitude towards using CAM during the pandemic period, the risk perception of COVID-19 was high and CAM methods were widely used.The literature should be supported by increasing the current and scientific studies in which CAM methods are questioned and their benefits are investigated during epidemic periods.

ERICVA Risk Scale simplified as a predictor of amputation in critical limb ischemia.

OBJECTIVE: Demonstrate that simplified ERICVA (Valladolid Critical Limb Ischaemia Risk Scale) is useful in predicting amputation in chronic limb-threatening ischemia (CLI) after one year of revascularization. METHODS: A retrospective cohort study was performed. We analyzed the medical records of 93 patients over the age of 35 with the diagnosis of CLI who were treated in the Department of Internal Medicine, Orthopedics or in the Cardiovascular Surgery Unit of the Víctor Lazarte Echegaray Hospital and the High Complexity Virgen de La Puerta Hospital during the period 2015-2018. The simplified ERICVA score was determined in patients before surgical and endovascular revascularization. We included 31 patients who scored 2 or more points in the exposed group and 62 patients who scored less than 2 points in the group not exposed to amputation risk. The collected data was analyzed with the statistical program SPSS where the Relative Risk and significance was obtained with Pearson's Chi-square. The multivariate analysis was also carried out in order to obtain the adjusted relative risk. RESULTS: It was identified that the simplified ERICVA score greater than or equal to 2 points was more frequent in those who underwent amputation (90.3%) compared to patients who did not undergo amputation (4.8%), increasing the risk of amputation in those patients with CLI who underwent revascularization (RR: 18.67, P<0.001). It was also possible to identify that within the group of patients that showed a high risk of amputation according to the ERICVA scale, they had a higher risk of major amputation (RR: 9.32, P<0.001) as opposed to the risk of minor amputation (RR: 1, 89, P=0.193). Among the items of the simplified ERICVA scale, the preoperative neutrophil-lymphocyte ratio and hematocrit were significantly higher in the group of amputated patients (P<0.001). In addition, it was possible to identify that the score greater than or equal to 2 was independently associated with the risk of amputation in patients revascularized with CLI (RR: 13.5, P<0.001). CONCLUSION: In our patient population, the simplified ERICVA scale is useful in predicting major and minor amputation in critical limb ischemia after revascularization. The present data showed that the patients who had a simplified ERICVA score greater than or equal to 2 had a higher risk of major amputation compared to the risk of minor amputation. However, it is important to highlight that the impact on the prediction of minor amputation is greater because in some circumstances major amputation can appear as a complication of CLI.

Fall risks and the related factors for the homebound older people with dementia: Evidence from East China.

Purpose: Falls are a major public health problem, especially for older people. This research aimed to provide a direct illustration of fall risks among the homebound older people with dementia in China, and to identify the risk factors associated with it. Methods: In 2020, a questionnaire-based field survey was used to assess 1,042 people aged over 60 years in Ningbo, Eastern China. The Morse Fall Risk Scale's result was employed as the dependent variable, while the basic health problems, living environment difficulties, social support problems, and behavioral awareness issues were utilized as the independent variables; subsequently, chi-squared tests and four multivariate ordinarily ordered logistic regression models were performed. Results: Overall, nine hundred and thirty-one older people with dementia were included in this study (the effective rate was 89.34%), with the majority of them having severe dementia (27.9%). Furthermore, 16.2% had fallen in the past 3 months, and 16.8% were at a high risk of falling. The risk factors for the older people's cognitive function included 80-90 years old, vascular dementia, marital status, and history of falls (P < 0.05); the kinds of chronic diseases, the activities of daily living, living environment, caregiver burden, caregiver knowledge, the Cohen Mansfield Agitation Inventory results, and the Clinical Dementia Rating were the protective factors for the risk of falls in them (P < 0.05). Conclusion: The risk of falling of the Chinese homebound older people with dementia was high. Their caregivers, such as relatives, need to pay attention to these risk factors and perform appropriate measures to prevent falls.

Reliability and Validity of the Composite Activity-Related Fall Risk Scale.

Introduction: The newly developed Composite Activity-related Risk of Falls Scale (CARFS) is designed to measure composite activity-related risk of falls (CARF) in relation to the activity-specific fear of falling and physical behavior. This study tested the reliability and validity of the CARFS in older people with various health statuses and persons with stroke or spinal cord injury. Methods: Participants included 70 older adults, 38 persons with stroke, and 18 with spinal cord injury. They were first surveyed using a combined questionnaire including the CARFS and activity-specific balance confidence (ABC) scale in addition to items asking for personal and disease-related information, fall history, walking independence levels for examining internal consistency, ceiling and floor effects, and convergent validity in each participant group. One week after the initial survey, 33 older participants were reexamined using the CARFS to analyze test-retest reliability, where a minimal detectable change was found. Significance was set at α = 0.05 for all analyses. Results: The CARFS showed excellent test-retest reliability in the dimensions of fear of falling, physical behavior, and CARF [ICC (3,1) = 0.972, 0.994, and 0.994, respectively for their overall score], with a minimal detectable change of 3.944 in the older population. The internal consistency of CARFS items was excellent in the older participants, good in participants with stroke or spinal cord injury (Cronbach's alpha = 0.945, 0.843, 0.831 in each participant group, respectively). No ceiling and floor effects were demonstrated in the wide range of people. For the convergent validity, overall CARF score was significantly correlated with the average ABC score in each participant group (rho = -0.824, -0.761, and -0.601, respectively; p < 0.01), and was significantly correlated with walking independence levels in each participant group (rho = -0.636, -0.423, and -0.522, respectively; p < 0.01). It showed weak correlation with the number of previous falls only in participants with stroke (rho = 0.291, p = 0.076). Conclusion: The CARFS is a reliable and valid tool for measuring fall risk in older people and persons with stroke or spinal cord injury.

Impact of SARS-CoV-2 Pandemic on Psychosocial Burden and Job Satisfaction of Long-Term Care Nurses in Poland.

Psychosocial consequences of the coronavirus pandemic are severe for health care workers due to their higher levels of exposure. Nurses often experience tremendous psychological pressure as a result of their workload in a high-risk environment. The purpose of this study was to determine the impact of the SARS-CoV-2 pandemic on the psychosocial burden and job satisfaction of nurses employed in long-term care. One hundred thirty-eight nurses employed in long-term care participated in the study. The respondents were 96.4% female and 3.6% male. The mean age of the respondents was 53.99 (standard deviation-4.01). The study was conducted between February and June 2021. The research tool was a standardized psychosocial risk scale questionnaire, which is a scientifically validated diagnostic tool with high reliability and accuracy coefficients. The primary tests used during the statistical analyses were non-parametric Mann-Whitney U (for two samples) and Kruskal-Wallis (for more than two samples) tests for assessing differences. During these analyses, in addition to standard statistical significance, appropriate p-values were calculated using the Monte Carlo method. Correlations between ordinal or quantitative variables were made using Spearman's rho coefficient. The results obtained allow us to conclude that the respondents rated the characteristics present in the workplace that constitute psychosocial risks at an average level. Emotional commitment and continuance-type commitment to the respondents' job position were also at a medium level. Respondents' self-rated ability to work for nurses employed in long-term care during the SARS-CoV-2 pandemic and commitment to patient care was high at 4.0 and 4.18, with a maximum of 5 points.

A predictive model to quantify joint torques and support reaction forces when using a smartphone while standing with support.

The present study had a dual objective: (1) to present and validate a predictive model of standing posture in the sagittal plane, joint torques and support forces for a smartphone user built from biomechanical principles; (2) propose risk scales for joint torques and reaction forces based on simulations in order to use them into the musculoskeletal disorders prevention. Comparison of the modelled data with experimental measurements (400 tested postures with sample size verification) for calling and texting tasks highlights the model's ability to correctly estimate posture and reaction forces on the ground. The model was able to provide estimates of the range of variation of each parameter for a wide range of environmental conditions as a function of the user body mass index (setting between 12.5 and 50). Joint torques risk scales have been constructed, especially for shoulder and elbow, to characterise the risks incurred by the users. Practitioner summary: The proposed model enables the postures, joint torques and reaction forces to be estimated from subject's body mass index and environmental configuration without resorting to experimentation, which is relevant in industry. This approach allows the proposition of new scales based on joint torques to reinforce the recommendations for MSDs prevention. Abbreviations: BMI: body mass index; LUBA: postural loading on the upper body assessment; MSDs: musculoskeletal disorders; RULA: rapid upper limb assessment; WHO: World Health Organization.

Baseline parameters and the prediction of treatment failure in patients with intravenous drug use-associated spinal epidural abscesses.

OBJECTIVE: Despite the increasing incidence of spinal epidural abscess (SEA), the baseline parameters potentially predictive of treatment failure remain poorly characterized. In this study, the authors identify the relevant baseline parameters that predict multimodal treatment failure in patients with either intravenous drug use (IVDU)-associated SEA or non-IVDU-associated SEA. METHODS: The authors reviewed the electronic medical records of a large institutional series of consecutive patients with diagnosed SEA between January 2011 and December 2017 to characterize epidemiological trends as well as the complement of baseline measures that are predictive of failure after multimodal treatment in patients with and without concomitant IVDU. The independent impact of clinical and imaging factors in detecting treatment failure was assessed by performing stepwise binary logistic regression analysis. RESULTS: A total of 324 consecutive patients with diagnosed SEA were identified. Overall, 226 patients (69.8%) had SEA related to other causes and 98 (30.2%) had a history of recent IVDU. While non-IVDU SEA admission rates remained constant, year-over-year admissions of patients with IVDU SEA nearly tripled. At baseline, patients with IVDU SEA were distinct in many respects including younger age, greater unemployment and disability, less frequent diabetes mellitus (DM), and more frequent methicillin-resistant Staphylococcus aureus infection. However, differences in length of stay, loss to follow-up, and treatment failure did not reach statistical significance between the groups. The authors constructed independent multivariate logistic regression models for treatment failure based on identified parameters in the two cohorts. For the non-IVDU cohort, the authors identified four variables as independent factors: DM, hepatitis B/C, osteomyelitis, and compression deformity severity. In contrast, for patients with IVDU, the authors identified three variables: albumin, endocarditis, and endplate destruction. Receiver operating characteristic and area under the curve (AUC) analyses were undertaken for the multivariate models predicting the likelihood of treatment failure in the two cohorts (AUC = 0.88 and 0.89, respectively), demonstrating that the derived models could adequately predict the risk of multimodal treatment failure. Treatment failure risk factor point scales were derived for the identified variables separately for both cohorts. CONCLUSIONS: Patients with IVDU SEA represent a unique population with a distinct set of baseline parameters that predict treatment failure. Identification of relevant prognosticating factors will allow for the design of tailored treatment and follow-up regimens.

CARDIOTOXICITY RISK PREDICTION IN BREAST CANCER PATIENTS. / PROGNOZUVANNIa RYZYKU KARDIOTOKSYChNOSTI U KhVORYKh NA RAK GRUDNOÏ ZALOZY.

Breast cancer patients receive combined antitumor treatment (surgery, chemotherapy, targeted drugs and radia-tion), so they are considered to be the patients with potentially high risk of cardiotoxicity (CT). Risk stratificationof cardiovascular complications before the beginning and during the cancer treatment is an important issue. OBJECTIVE: to develop a CT risk model score taking into account cardiological, oncological and individual risks. MATERIAL AND METHODS: The study included 52 breast cancer patients with retrospective analysis of their medicalhistory, risk factors, and echocardiographic parameters before the onset and in 12 months follow up. Based on theanalysis of the data, a CT risk model score was developed and recommended. The patients were divided into groupsaccording to the score: Group 1 - low risk of CT development - score < 4 points, Group 2 - moderate risk - 5-7points, Group 3 - high risk > 8 points. According to the scale, BC patients with a total of > 8 points are consideredto be at high risk for CT complications. Radiation therapy and anthracyclines, as well as associated cardiovasculardiseases were the most important risk factors of CT. RESULTS: Based on the study of retrospective analysis of risk factors, data of heart function monitoring during follow-up,the risk model score of cardiotoxicity has been developed for the BC patients' stratification. According to the proposedscore risk model, BC patients with a total score of > 8 points considered to have high risk of cardiotoxic complications. CONCLUSIONS: Using of the proposed risk model score with calculation of CT risk factors both before the beginningand during cancer therapy is important, because it allows predicting the risk of CT development - to identify high-risk patients, accordingly, to develop an individualized plan for cardiac function monitoring and to start timely cardioprotective therapy.

Portuguese Version of COVID-19 Perceived Risk Scale and COVID-19 Phobia Scale: Psychometric Properties.

The COVID-19 pandemic scenario has a psychological impact on individuals and society. A higher level of perceived risk concerning COVID-19 has been found when compared to other potential health threats. A misperception of risk in contrast with the real risk may lead people to develop disruptive cognitive, affective, or behavioral responses to the COVID-19 pandemic, namely, coronaphobia. Validated instruments are needed to evaluate such responses. This work aims to validate the COVID-19 Perceived Risk Scale (C19PRS) and the COVID-19 Phobia Scale (C19PS) in the Portuguese population. The two scales were translated from English to Portuguese using the back-translation technique. The cultural adaptation was framed in the context of establishing the validity and reliability of the instruments. In two studies, C19PRS and C19PS were validated for the adult Portuguese population (N = 1122; women = 725 (64.6%); mean age of 31.91 years old) through exploratory factorial analysis, followed by a confirmatory factorial analysis. Convergent validity was calculated by composite reliability (CR) and average variance extracted (AVE) values. Discriminant validity was assessed by square roots of the AVE values and their comparison with the C19PRS and C19PS dimensions' cross-correlations. Both C19PRS and C19PS present a good adjustment model and solid reliability and validity and have significant correlations with fear of COVID-19 and COVID-19 anxiety scales.

Complicaciones a corto y medio plazo en pacientes con fibrilación auricular que acuden a urgencias: diseño y validación interna de la escala CoSTuM / Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale

Objetivo. Diseñar y validar una escala clínica para predecir el riesgo de sufrir eventos adversos a los 90 días del alta de urgencias en pacientes con fibrilación auricular (FA).Método. Estudio observacional, prospectivo que incluyó pacientes con FA que acudieron a urgencias. Durante el seguimiento, se registró la incidencia de cualquier evento adverso. Se llevó a cabo un análisis de regresión logística multivariante para investigar las variables independientemente asociadas con eventos adversos. El 66% de los pacientes (seleccionados al azar) conformaron la cohorte de derivación y los restantes la cohorte de validación interna.Resultados. Se incluyeron 645 pacientes (50,2% mujeres, mediana de edad de 76 años, RIC 67-81) y 165 (25,6%) presentaron al menos un evento adverso (114 en la cohorte de derivación y 51 en la de validación interna). La edad $ 70 años, enfermedad vascular, insuficiencia cardiaca, enfermedad pulmonar obstructiva crónica (EPOC), enfermedad renal, obesidad, síntomas mal controlados (EHRA III-IV), uso de oxigenoterapia, digoxina y otros antiarrítmicos en urgencias y el mal control de la frecuencia cardiaca se asociaron independientemente con el riesgo de eventos adversos. Con estas variables se diseñó la escala CoSTuM (COmorbilidades, Sintomatología, Tratamiento en Urgencias y Mal control de la frecuencia cardiaca), que mostró una óptima capacidad predictiva tanto en la cohorte de derivación (estadístico c: 0,901, IC 95% 0,869-0,928; p < 0,001) como en la de validación (estadístico c: 0,850, IC 95% 0,796-0,894; p < 0,001).Conclusiones. En pacientes con FA atendidos en urgencias, la escala CoSTuM demostró tener una buena capacidad de predicción de eventos adversos a los 90 días tras el alta. (AU)

Objective. To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF).Methods. Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model.Results. We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67–81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III–IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869–0.928; P < .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796–0.894; P < .001).Conclusion. The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF. (AU)

Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale. / Complicaciones a corto y medio plazo en pacientes con fibrilación auricular que acuden a urgencias: diseño y validación interna de la escala CoSTuM.

OBJECTIVES: To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF). MATERIAL AND METHODS: Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model. RESULTS: We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67-81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III-IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869-0.928; P .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796-0.894; P .001). CONCLUSION: The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF.

OBJETIVO: Diseñar y validar una escala clínica para predecir el riesgo de sufrir eventos adversos a los 90 días del alta de urgencias en pacientes con fibrilación auricular (FA). METODO: Estudio observacional, prospectivo que incluyó pacientes con FA que acudieron a urgencias. Durante el seguimiento, se registró la incidencia de cualquier evento adverso. Se llevó a cabo un análisis de regresión logística multivariante para investigar las variables independientemente asociadas con eventos adversos. El 66% de los pacientes (seleccionados al azar) conformaron la cohorte de derivación y los restantes la cohorte de validación interna. RESULTADOS: Se incluyeron 645 pacientes (50,2% mujeres, mediana de edad de 76 años, RIC 67-81) y 165 (25,6%) presentaron al menos un evento adverso (114 en la cohorte de derivación y 51 en la de validación interna). La edad 70 años, enfermedad vascular, insuficiencia cardiaca, enfermedad pulmonar obstructiva crónica (EPOC), enfermedad renal, obesidad, síntomas mal controlados (EHRA III-IV), uso de oxigenoterapia, digoxina y otros antiarrítmicos en urgencias y el mal control de la frecuencia cardiaca se asociaron independientemente con el riesgo de eventos adversos. Con estas variables se diseñó la escala CoSTuM (COmorbilidades, Sintomatología, Tratamiento en Urgencias y Mal control de la frecuencia cardiaca), que mostró una óptima capacidad predictiva tanto en la cohorte de derivación (estadístico c: 0,901, IC 95% 0,869-0,928; p 0,001) como en la de validación (estadístico c: 0,850, IC 95% 0,796-0,894; p 0,001). CONCLUSIONES: En pacientes con FA atendidos en urgencias, la escala CoSTuM demostró tener una buena capacidad de predicción de eventos adversos a los 90 días tras el alta.

The Risk of Type 2 Diabetes Mellitus in a Russian Population Cohort According to Data from the HAPIEE Project.

The aim of this study is to investigate the 14-year risk of type 2 diabetes mellitus (T2DM) and develop a risk score for T2DM in the Siberian cohort. A random population sample (males/females, 45-69 years old) was examined at baseline in 2003-2005 (Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE) project, n = 9360, Novosibirsk) and re-examined in 2006-2008 and 2015-2017. After excluding those with baseline T2DM, the final analysis included 7739 participants. The risk of incident T2DM during a 14-year follow-up was analysed using Cox regression. In age-adjusted models, male and female hazard ratios (HR) of incident T2DM were 5.02 (95% CI 3.62; 6.96) and 5.13 (95% CI 3.56; 7.37) for BMI ≥ 25 kg/m2; 4.38 (3.37; 5.69) and 4.70 (0.27; 6.75) for abdominal obesity (AO); 3.31 (2.65; 4.14) and 3.61 (3.06; 4.27) for fasting hyperglycaemia (FHG); 2.34 (1.58; 3.49) and 3.27 (2.50; 4.26) for high triglyceride (TG); 2.25 (1.74; 2.91) and 2.82 (2.27; 3.49) for hypertension (HT); and 1.57 (1.14; 2.16) and 1.69 (1.38; 2.07) for family history of diabetes mellitus (DM). In addition, secondary education, low physical activity (PA), and history of cardiovascular disease (CVD) were also significantly associated with T2DM in females. A simple T2DM risk calculator was generated based on non-laboratory parameters. A scale with the best quality included waist circumference >95 cm, HT history, and family history of T2DM (area under the curve (AUC) = 0.71). The proposed 10-year risk score of T2DM represents a simple, non-invasive, and reliable tool for identifying individuals at a high risk of future T2DM.

Association between anticholinergic burden and hospital readmission in older patients: a prospective analysis.

OBJECTIVE: Despite known adverse effects of anticholinergic (AC) medication, little work has been devoted to the impact of high anticholinergic burden on the rate of hospital readmission. The purpose of this study was to analyze prospectively the link between high AC burden and the rate of all-cause thirty-day hospital readmission in older people. STUDY DESIGN: This was a prospective non-interventional study conducted from January to August 2019 in one acute-care geriatric ward. All hospital stays of patients aged at least 75 years who were discharged to their home were included in the analysis. AC burden was determined from discharge prescriptions using the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS), and defined as high if ≥3. RESULTS: The analysis concerned 350 hospital stays. Median patient age was 88 years (interquartile interval 84-91). In a multivariate analysis, the risk of hospital readmission within 30 days was not increased for patients with high AC burden (ADS≥3): odds ratio 1.16 [95% confidence interval 0.56-2.37], compared to a patient whose anticholinergic burden was not high. CONCLUSION: Unlike retrospective studies on this issue, the findings of our prospective analysis do not support a higher risk of hospital admission within 30 days for older people with high AC burden as assessed from their discharge prescriptions.