Miracle-dz/UniFAR-FTUs huggingface dataset:
Diagnostic accuracy of case-finding questions to identify perinatal depression

Background: Guidelines for perinatal mental health care recommend the use of two case-finding questions about depressed feelings and loss of interest in activities, despite the absence of validation studies in this context. We examined the diagnostic accuracy of these questions and of a third question about the need for help asked of women receiving perinatal care. Methods: We evaluated self-reported responses to two case-finding questions against an interviewer-assessed diagnostic standard (DSM-IV criteria for major depressive disorder) among 152 women receiving antenatal care at 26–28 weeks’ gestation and postnatal care at 5–13 weeks after delivery. Among women who answered “yes” to either question, we assessed the usefulness of asking a third question about the need for help. We calculated sensitivity, specificity and likelihood ratios for the two case-finding questions and for the added question about the need for help. Results: Antenatally, the two case-finding questions had a sensitivity of 100% (95% confidence interval [CI] 77%–100%), a specificity of 68% (95% CI 58%–76%), a positive likelihood ratio of 3.03 (95% CI 2.28–4.02) and a negative likelihood ratio of 0.041 (95% CI 0.003–0.63) in identifying perinatal depression. Postnatal results were similar. Among the women who screened positive antenatally, the additional question about the need for help had a sensitivity of 58% (95% CI 38%–76%), a specificity of 91% (95% CI 78%–97%), a positive likelihood ratio of 6.86 (95% CI 2.16–21.7) and a negative likelihood ratio of 0.45 (95% CI 0.25–0.80), with lower sensitivity and higher specificity postnatally. Interpretation: Negative responses to both of the case-finding questions showed acceptable accuracy for ruling out perinatal depression. For positive responses, the use of a third question about the need for help improved specificity and the ability to rule in depression.
The use of intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnancy in Ibadan, Nigeria: Implications for policy

Malaria in pregnancy (MIP) remains a major public health concern, inspite of the adoption of WHO recommended intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for its control in Nigeria. Using interviewer administered questionnaires, information on knowledge of the burden, consequences and the use of SP for malaria control in pregnancy was obtained from 800 mothers within 24 h after delivery at two health centres in Ibadan. Women who attended antenatal care (ANC) at the secondary facility were less likely to demonstrate poor knowledge of causes (OR = 0.18, 95% CI = 0.08, 0.38), consequences (OR = 0.37, 95% CI = 0.24, 0.55) and control strategies (OR = 0.32, 95% = 0.18, 0.59) compared with tertiary facility. Only 56.4% of all the mothers were aware of IPTp SP as government policy for prevention of MIP out of which 16.9% used IPTp SP in index pregnancy. Overall, only 18.4% of all mothers used IPTp SP. Being unaware of the existing government policy and educational attainment of ≤9 years independently predicted non-usage of IPTp SP. This study revealed that the uptake of IPTp SP in pregnancy is poor in spite of good knowledge of burden of malaria in pregnancy and underscores the need to scale up awareness campaign and monitor implementation at all levels of health care. Key words: Malaria in pregnancy, intermittent preventive treatment, sulphadoxine-pyrimethamine.
The Physical Health Check: A tool for mental health workers

Background: The physical health of people with mental illness is often poor. There is a need for mental health services to address the issue. Aims: The Physical Health Check (PHC) is a short tool designed to be used by mental health staff to assess physical health needs. It was developed by a multidisciplinary research group, with the intention that it should be quick and easy to use, and acceptable to service users. Results: When administered to 60 CMHT clients a high level of unmet physical needs were detected. These included the need for health promotion, as well as specific medical or other interventions. A comparison with routine practice in a neighbouring CMHT, suggests that use of the PHC significant improves the recording of physical health information. Conclusions: the PHC is a useful tool, designed to be used routinely by mental health staff to assess physical health needs. Declaration of interest: A small education grant from Eli Lilly was used to design and print copies of the PHC.
The living environments of community-dwelling older people who become frail: another look at the living standards of older New Zealanders survey.

Efforts to support older people who live in the community and who become frail will be enhanced by a better appreciation of the shared characteristics of this group. This paper reports indicative findings from a re-analysis of the Living Standards of Older New Zealanders survey (Fergusson et al. 2001) about the living conditions of this group in terms of their household arrangements, their income and standard of living, their housing situation, issues they face in terms of mobility and transport, and their social connectedness. Findings suggest a higher prevalence of frailty among older people with lower income levels and wealth, less secure housing, limitations to mobility, and with less frequent social contact. Disadvantage in these areas reduces the ability of the older person to adjust to their living environment, affecting the potential for recovery and the maintenance of wellbeing. Such disadvantage may well be amenable to social policy amelioration and is worthy of consideration by policy makers.
Two triterpene glycosides from the priority list Opinion of the Scientific Panel on Food Additives, Flavourings, Processing Aids and Materials in Contact with Food (AFC)

The Scientific Panel on Food Additives, Flavourings, Processing Aids and Materials in Contact with Food (the Panel) is asked to advise the Commission on the implications for human health of chemically defined flavouring substances used in or on foodstuffs in the Member States. In particular, the Scientific Panel is asked to evaluate 20 flavouring substances in the Flavouring Group Evaluation 17, Revision 1 (FGE.17Rev1), using the procedure as referred to in the Commission Regulation (EC) No 1565/2000. These 20 flavouring substances belong to chemical group 24 of Annex I of the Commission Regulation (EC) No 1565/2000.
Effects of Peer Counseling to Support Breastfeeding: Assessing the External Validity of a Randomized Field Experiment

In an effort to improve breastfeeding, the Oregon WIC Program tested whether a relatively low-cost telephone peer counseling initiative to support breastfeeding could increase the initiation and duration of exclusive breastfeeding among its participants. They conducted a large randomized field experiment (RFE) with over 1900 women from four WIC agencies in the state. In this study we use data from the RFE along with administrative data from the rest of the state to assess whether the results from the RFE can be extended to other agencies in the state. We find small or non-existent effects of peer counseling in the non-experimental settings, which suggest that the experimental estimates may reflect Hawthorne effects. We present evidence of selection into RFE in that exclusive breastfeeding among the controls is significantly greater than among women who were offered but declined to participate in the RFE as well as from women in the rest of the state who had no access to peer counseling. We conclude that despite the strong internal validity of the RFE, extending the program to other agencies in the state would have a limited impact at best on exclusive breastfeeding.
Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors

Background: Clinical trials are commonly done without blinded outcome assessors despite the risk of bias. We wanted to evaluate the effect of nonblinded outcome assessment on estimated effects in randomized clinical trials with outcomes that involved subjective measurement scales. Methods: We conducted a systematic review of randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome. We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press and Google Scholar for relevant studies. Two investigators agreed on the inclusion of trials and the outcome scale. For each trial, we calculated the difference in effect size (i.e., standardized mean difference between nonblinded and blinded assessments). A difference in effect size of less than 0 suggested that nonblinded assessors generated more optimistic estimates of effect. We pooled the differences in effect size using inverse variance random-effects meta-analysis and used metaregression to identify potential reasons for variation. Results: We included 24 trials in our review. The main meta-analysis included 16 trials (involving 2854 patients) with subjective outcomes. The estimated treatment effect was more beneficial when based on nonblinded assessors (pooled difference in effect size −0.23 [95% confidence interval (CI) −0.40 to −0.06]). In relative terms, nonblinded assessors exaggerated the pooled effect size by 68% (95% CI 14% to 230%). Heterogeneity was moderate (I2 = 46%, p = 0.02) and unexplained by metaregression. Interpretation: We provide empirical evidence for observer bias in randomized clinical trials with subjective measurement scale outcomes. A failure to blind assessors of outcomes in such trials results in a high risk of substantial bias.
Successful aging: Is there hope?

See related research article by Sabia and colleagues on page [1985][1] and at [www.cmaj. ca/lookup/doi/10.1503/cmaj.121080][2] The world’s population is aging rapidly, the consequences of which will be substantial. By 2031, more than 20% of Canadians will be senior citizens. [1][3],[2][4] This
Changes associated with a quota-based approach on a walking program for individuals with fibromyalgia.

STUDY DESIGN Single-subject, multiple-baseline design across 3 subjects. OBJECTIVE To investigate the use of a quota-based approach to prescribing a walking program for individuals with fibromyalgia (FM). BACKGROUND Exercise has been found to be beneficial for individuals with FM. What has not been determined is the best way to implement an exercise program that does not increase FM symptoms. METHODS AND MEASURES Three women with FM were randomly assigned a baseline period of 5, 6, or 7 weeks, which served as the control phase, followed by an intervention period consisting of an 8-week walking program. The walking program progression was prescribed using a quota-based approach. Weekly outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and SF-36v2 (acute). A 6-minute walk test was recorded twice: at the start of the baseline phase (after a trial phase) and at the end of the intervention phase. RESULTS Subjects 1 and 3 had a significant decrease in the symptoms associated with FM during the intervention phase (FIQ, P<.05), but no significant increase in self-efficacy (ASES). They increased their walking distances used for exercise by 640 and 480 m, respectively. Subject 2 had no significant improvements in her symptoms of FM. Despite a significant decrease in ASES (P<.05), walking distance used for exercise by subject 2 increased by 2080 m. Six-minute walk test distances increased 76, 32, and 106 m for subjects 1, 2, and 3, respectively. CONCLUSIONS Prescribing a walking program using a quota-based exercise prescription resulted in increasing the distance walked for 3 subjects. It also decreased symptoms associated with FM in 2 of the 3 subjects, but did not increase self-efficacy.
Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

Background: Canada has a growing multinational immigrant population. Many commonly used cognitive assessment tools have known cultural biases and are difficult to use in ethnically diverse patient populations. The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive assessment tool that was created for culturally and linguistically diverse populations. We performed a systematic review and meta-analysis to assess the psychometric characteristics of the RUDAS and to compare it with other available tools. Methods: We identified studies that assessed the psychometric properties of the RUDAS compared with a reference standard for diagnosing dementia or compared the RUDAS to other cognitive assessment tools. Two independent reviewers screened the abstracts and full-text articles and reviewed bibliographies for further references. We extracted data using standardized forms and assessed studies for risk of bias. Results: Our search resulted in 148 articles, from which 11 were included. The RUDAS was assessed in 1236 participants and was found to have a pooled sensitivity of 77.2% (95% confidence interval [CI] 67.4–84.5) and a pooled specificity of 85.9% (95% CI 74.8–92.6) yielding a positive likelihood ratio of 5.5 (95% CI 2.9–10.7) and a negative likelihood ratio of 0.27 (95% CI 0.17–0.40). A pooled estimate of the correlation between the RUDAS and the Mini-Mental State Examination (MMSE) was 0.77 (95% CI 0.72–0.81). Results of the RUDAS were less affected by language and education level than the MMSE. Interpretation: The RUDAS is a brief and freely available cognitive assessment tool with reasonable psychometric characteristics that may be particularly useful in patients with diverse backgrounds.
Special Considerations for the Supervision of Home-Based Counselors

Home-based counseling is often the most effective intervention for families that have a child at risk for removal from the home. Whereas the process of home-based counseling has received a fair amount of attention in the literature, there has been little attention paid to the supervision of the counselors who provide the services. This article presents some of the unique challenges inherent in providing home-based counseling and specific supervision considerations designed to support home-based counselors and the families they serve.
Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Background: Practice guidelines recommend that imaging to detect metastatic disease not be performed in the majority of patients with early-stage breast cancer who are asymptomatic. We aimed to determine whether practice patterns in Ontario conform with these recommendations. Methods: We used provincial registry data to identify a population-based cohort of Ontario women in whom early-stage, operable breast cancer was diagnosed between 2007 and 2012. We then determined whether imaging of the skeleton, thorax, and abdomen or pelvis had been performed within 3 months of tissue diagnosis. We calculated rates of confirmatory imaging of the same body site. Results: Of 26 547 patients with early-stage disease, 22 811 (85.9%) had at least one imaging test, and a total of 83 249 imaging tests were performed (mean of 3.7 imaging tests per patient imaged). Among patients with pathologic stage I and II disease, imaging was performed in 79.6% (10 921/13 724) and 92.7% (11 882/12 823) of cases, respectively. Of all imaging tests, 19 784 (23.8%) were classified as confirmatory investigations. Imaging was more likely for patients who were younger, had greater comorbidity, had tumours of higher grade or stage or had undergone preoperative breast ultrasonography, mastectomy or surgery in the community setting. Interpretation: Despite recommendations from multiple international guidelines, most Ontario women with early-stage breast cancer underwent imaging to detect distant metastases. Inappropriate imaging in asymptomatic patients with early-stage disease is costly and may lead to harm. The use of population datasets will allow investigators to evaluate whether or not strategies to implement practice guidelines lead to meaningful and sustained change in physician practice.
The effect of averaging multiple trials on measurement error during ultrasound imaging of transversus abdominis and lumbar multifidus muscles in individuals with low back pain.

STUDY DESIGN Clinical measurement, reliability study. OBJECTIVES To investigate the improvements in precision when averaging multiple measurements of percent change in muscle thickness of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles. BACKGROUND Although the reliability of TrA and LM muscle thickness measurements using rehabilitative ultrasound imaging (RUSI) is good, measurement error is often large relative to mean muscle thickness. Additionally, percent thickness change measures incorporate measurement error from both resting and contracted conditions. METHODS Thirty volunteers with nonspecific low back pain participated. Thickness measurements of the TrA and LM muscles were obtained using RUSI at rest and during standardized tasks. Percent thickness change was calculated with the formula thickness(contracted) - thickness(rest)/thickness(rest). Standard error of measurement (SEM) quantified precision when using 1 or a mean of 2 to 6 consecutive measurements. RESULTS Compared to when using a single measurement, SEM of both the TrA and LM decreased by nearly 25% when using a mean of 2 measures, and by 50% when using the mean of 3 measures. Little precision was gained by averaging more than 3 measurements. CONCLUSION When using RUSI to determine percent change in TrA and LM muscle thickness, intra examiner measurement precision appears to be optimized by using an average of 3 consecutive measurements.
Predicting low testosterone in aging men: a systematic review

Background: Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men. We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men. Methods: We searched the MEDLINE and Embase databases (January 1966 to July 2014) for studies that compared clinical features with a measurement of serum testosterone in men. Three of the authors independently reviewed articles for inclusion, assessed quality and extracted data. Results: Among 6053 articles identified, 40 met the inclusion criteria. The prevalence of low testosterone ranged between 2% and 77%. Threshold testosterone levels used for reference standards also varied substantially. The summary likelihood ratio associated with decreased libido was 1.6 (95% confidence interval [CI] 1.3–1.9), and the likelihood ratio for absence of this finding was 0.72 (95% CI 0.58–0.85). The likelihood ratio associated with the presence of erectile dysfunction was 1.5 (95% CI 1.3–1.8) and with absence of erectile dysfunction was 0.83 (95% CI 0.76–0.91). Of the multiple-item instruments, the ANDROTEST showed both the most favourable positive likelihood ratio (range 1.9–2.2) and the most favourable negative likelihood ratio (range 0.37–0.49). Interpretation: We found weak correlation between signs, symptoms and testosterone levels, uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition. It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men.
The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder.

SYNOPSIS This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder.
Comparative analysis of the structural properties of the collateral ligaments of the human knee.

STUDY DESIGN Controlled laboratory study. BACKGROUND Varus knee instability arising from lateral collateral ligament (LCL) injury increases stress on cruciate ligament grafts, potentially leading to failure of reconstructed ligaments. In contrast to the medial collateral ligament (MCL), little is known about the structural properties of the LCL. OBJECTIVES To compare the tensile properties of the LCL and MCL complex of the human knee joint. METHODS Ten fresh-frozen cadaveric knees (mean ± SD age, 81 ± 11 years), free of gross musculoskeletal pathology, were obtained. Following dissection, the length, width, and thickness of the ligaments were measured using calipers, and bone-ligament-bone preparations were mounted in a uniaxial load frame. After preconditioning, specimens were extended to failure at a rate of 500 mm/min (approximately 20%/s). Force and crosshead displacement were used to calculate structural properties, including stiffness, yield strength, ultimate tensile strength, and failure energy. RESULTS The fan-shaped MCL was significantly longer (60%; P<.001), wider (680%; P<.001), and thinner (19%; P = .009) than the cord-like LCL. The LCL failed at either the fibular attachment (n = 6) or midsubstance (n = 4), while failure of the MCL primarily occurred at the femoral attachment (n = 7). Although the ultimate tensile strength of the MCL (mean ± SD, 799 ± 209 N) was twice that of the LCL (392 ± 104 N; P<.001), there was no significant difference in stiffness of the ligaments (MCL, 63 ± 14 N/mm; LCL, 59 ± 12 N/mm). CONCLUSIONS Despite differences in geometry and strength, there was no significant difference in stiffness of the MCL and LCL when tested in vitro.