Preliminary validity for the Big Five Inventory-2 in brazilian adults / Evidências preliminares de validade do Big Five Inventory-2 em adultos brasileiros / Evidencias preliminares de validez del Big Five Inventory-2 en adultos brasileños

The Big Five Inventory-2 (BFI-2) assesses personality through the big five factor model model (FFM). This study aimed to verify whether the internal structure of the BFI-2 is corroborated in a Brazilian sample. Participants were 908 cisgender adults, aged between 17 and 93 years, 532 of whom were women. Confirmatory factor analysis and Exploratory structural equation modeling were performed with the BFI-2. The 15 facets of personality resulted in adequate fit and reliability, mainly for the respondents under 60 years of age. We conclude that the BFI-2 presents evidence of preliminary validity based on its internal structure, although further validity studies are required with the instrument, to testify its psychometric quality. (AU)

O Big Five Inventory-2 (BFI-2) avalia a personalidade no modelo dos Cinco Grandes Fatores (CGF). O presente estudo objetivou verificar se a estrutura interna do BFI-2 é corroborada em uma amostra brasileira. Participaram 908 adultos cisgênero, com idades entre 17 e 93 anos, sendo 532 mulheres. Análise fatorial confirmatória e modelagem de equações estruturais exploratórias foram conduzidas no BFI-2. As 15 facetas de personalidade do BFI-2 resultaram em índices de ajuste adequados, principalmente para os respondentes com idade até 60 anos. Conclui-se que o BFI-2 apresenta evidência inicial de validade baseada em sua estrutura interna, apesar de que novos estudos de validade devem ser conduzidos com o instrumento, com o objetivo de atestar sua qualidade psicométrica. (AU)

El Big Five Inventory-2 (BFI-2) evalúa la personalidad según el modelo de los Cinco Grandes Factores (CGF). El presente estudio tuvo como objetivo verificar si la estructura interna del BFI-2 se corrobora en una muestra brasileña. Participaron 908 adultos cisgénero, de entre 17 y 93 años, de los cuales 532 eran mujeres. Se realizó un Análisis Factorial Confirmatorio y un Modelo de Ecuaciones Estructurales Exploratorio sobre el BFI-2. Las 15 facetas de personalidad del BFI-2 dieron lugar a índices de ajuste adecuados, especialmente para los encuestados de hasta 60 años. Se concluye que el BFI-2 presenta evidencias iniciales de validez basadas en su estructura interna, aunque se deben ejecutar más estudios de validez con el instrumento para atestiguar su calidad psicométrica. (AU)

Long-term trend of colorectal cancer survival rate in Qidong, 1972-2016 / 中华肿瘤杂志

Objective: The survival of colorectal cancer in Qidong City, Jiangsu Province from 1972 to 2016 was analyzed to provide a basis for the evaluation of prognosis and the formulation of prevention and control measures. Methods: Colorectal cancer data were obtained from the Qidong Cancer Registration and Reporting System, and the follow-up was up to December 31, 2021. The observed survival rate (OSR) and relative survival rate (RSR) were calculated by SURV 3.01 software, and the trend test was performed by Hakulinen's likelihood ratio test. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) of survival, and the ARIMA model was used to predict the trend of colorectal cancer survival. Results: There were 8 637 new cases of colorectal cancer in Qidong from 1972 to 2016. Dividing 1972-2016 into 9 periods at 5-year intervals, the 5-year OSR from 1972-1976 to 2012-2016 increased from 21.86% to 48.86%, and the 5-year RSR increased from 26.45% to 59.91%. The increasing trend of RSR was statistically significant (χ(2)=587.47, P<0.001). From 1972 to 2016, the survival rates of colorectal cancer in different sexes in Qidong were similar, and the 5-year RSR was 44.63% for men and 44.07% for women. Since the 1990s, the 5-year OSR and RSR for men have been lower than those for women. From 1972 to 2016, the 5-year RSR of colorectal cancer in Qidong was significantly improved in the 65-74 and ≥75-year-old groups, but the survival rate of the ≥75-year-old group was still the lowest (36.78%), followed by the 35-44-year-old group ( 43.04%). The time trend showed that the overall AAPC of colorectal cancer 5-year RSR in Qidong from 1972 to 2016 was 2.50% (t=16.45, P<0.001). The upward trend of different sexes was consistent, and the increase was greater in women (AAPC for males=2.18%, AAPC for females=2.54%, both P<0.05). The 5-year RSR of colorectal cancer in each age group showed an upward trend, and the AAPCs of the 35-44, 45-54, 55-64, 65-74, and ≥75-year-old groups were 1.54%, 1.83%, 2.00%, 3.51% and 4.35%, respectively (all P<0.05). The prediction results of colorectal cancer survival rate showed that the 5-year RSR of colorectal cancer in Qidong will increase to 71.62% by 2026. Conclusions: The overall survival rate of colorectal cancer patients in Qidong has been greatly improved, but there is still room for improvement. We should continue to pay attention to the early diagnosis and early treatment of colorectal cancer.

O Efeito Direto do Índice de Massa Corporal nos Resultados Cardiovasculares entre Participantes sem Obesidade Central pela Estimativa por Máxima Verossimilhança Direcionada / The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. Resultados: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. Conclusão: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886)

Background: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. Objective: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. Methods: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. Results: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. Conclusion: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886)

¿La detección de toxinas de Clostridioides difficile es necesaria cuando se detecta la enzima glutamato deshidrogenasa? / Is Clostridioides difficile toxins detection necessary when the glutamate dehydrogenase enzyme is detected?

Resumen Introducción: Clostridioides difficile causa diarrea y colitis pseudomembranosa. Su diagnóstico se realiza con la detección de glutamato-deshidrogenasa (GDH) o las toxinas A y B y se confirma con pruebas de amplificación de ácidos nucleicos. Objetivo: Definir si la determinación de GDH es redundante a la de las toxinas. Métodos: Estudio observacional retrospectivo de muestras fecales de pacientes con sospecha de infección por Clostridioides difficile. Las toxinas y GDH se determinaron mediante inmunocromatografía. Se realizó una simulación bayesiana con los cocientes de probabilidad; se consideró significativo un valor de p < 0.05. Resultados: Se analizaron 329 resultados de GDH y toxinas A y B. Se encontró una prevalencia de infección de Clostridioides difficile de 18.2 %. La sensibilidad y especificidad de la prueba de GDH fue de 0.90 y 0.89, respectivamente. El cociente de probabilidad positivo fue de 8.9 y el negativo, de 0.11. Conclusiones: Un resultado negativo de GDH disminuye considerablemente la probabilidad de infección, pero no la descarta. La detección de toxinas de Clostridioides difficile puede ser necesaria en instituciones donde la amplificación de ácidos nucleicos no es económica o accesible.

Abstract Introduction: Clostridioides difficile causes diarrhea and pseudomembranous colitis. Its diagnosis is made with glutamate dehydrogenase (GDH) or toxins A and B detection and is confirmed with nucleic acid amplification tests. Objective: To define if GDH determination is redundant to that of toxins. Methods: Retrospective, observational study in diarrheal stools of patients with suspected Clostridioides difficile infection. Toxins and GDH were determined by immunochromatography. Bayesian simulation was performed with likelihood ratios; a p-value < 0.05 was regarded as significant. Results: 329 GDH and toxin A and B results were analyzed. Clostridioides difficile infection prevalence was 18.2 %. Sensitivity and specificity of the GDH test were 0.90 and 0.89, respectively. Positive likelihood ratio was 8.9, and negative was 0.11. Conclusions: A negative GDH result considerably reduces the probability of infection but does not rule it out. Clostridioides difficile toxins detection may be necessary in institutions where nucleic acid amplification is not affordable or accessible.

Calculation of Likelihood Ratio for Identifying Half Sibling Relationship When Both Biological Mothers Participate / 法医学杂志

Objective To derive the formulae for likelihood ratio （LR） calculation of half sibling relationships when both mothers participate. Methods Based on the fact that both biological mothers participate in the identification of half sibling relationship between the two individuals, test hypothesis for the identification of half sibling relationship was established. Conditional probability ratios of genetic evidence under null hypothesis and alternative hypothesis conditions were simplified, and then applied to a real case of half sibling relationship identification. At the same time, the LR of half sibling relationships under the assumption that only a single biological mother or none of the biological mothers participate were respectively calculated. Results In the cases of identification of half sibling relationship from same fathers, with no biological father involved, after the same genetic indicator test analysis, when both biological mothers participate in the identification, the accumulated LR value was higher than that of accumulated LR with only a single biological mother or no parents participating. Conclusion When the autosome STR test is used for the identification and analysis of half sibling relationship between two individuals, the calculation of LR is more simple, intuitive and operable with both mothers participating. The biological mothers should participate in the test as much as possible, otherwise the number of STR loci would need to be increased for a more specific conclusion.

Recent advances in Bayesian inference of isolation-with-migration models

Isolation-with-migration (IM) models have become popular for explaining population divergence in the presence of migrations. Bayesian methods are commonly used to estimate IM models, but they are limited to small data analysis or simple model inference. Recently three methods, IMa3, MIST, and AIM, resolved these limitations. Here, we describe the major problems addressed by these three software and compare differences among their inference methods, despite their use of the same standard likelihood function.

Non-verbal nurse-parturient communication in labor in Portuguese-speaking countries / Comunicação não verbal enfermeiro-parturiente no trabalho de parto em países lusófonos / Comunicación no verbal entre enfermero y parturienta en trabajo de parto en países lusohablantes

Objective: to analyze nonverbal communication between nurse and parturient during the active phase of labor in two Portuguese-speaking countries. Method: a quantitative and analytical study, whose sample consisted of 709 interactions that used the nonverbal communication of nurses and parturients. The analyzed variables were: distance; posture; axis; contact; emblematic gestures; illustrator gestures and regulatory gestures. For the analysis of the data, the Chi-Square and Likelihood Ratio tests were used. Results: the intimate distance between nurse and parturient in both countries (p = 0.005) prevailed. In both, touch was the most commonly used form of contact (p <0.0001). In both countries, the parturient remained lying down (p <0.0001). In relation to the established contact (p <0.0001), the parturient did not use contact. The face-to-face axis predominated in the interactions in both countries between nurse-parturient (p <0.0001) and parturient-nurse (p <0.0001). Conclusion: similarities were observed in non-verbal communication between nurses and parturients in both countries. However, there are differences such as the established contact between Brazilian and Cape Verdean nurses to parturients.

Objetivo: analisar a comunicação não verbal entre enfermeiro e parturiente durante a fase ativa do trabalho de parto em dois países lusófonos. Método: estudo quantitativo analítico, cuja amostra foi composta por 709 interações que utilizaram a comunicação não verbal dos enfermeiros e parturientes. As variáveis analisadas foram: distância; postura; eixo; contato; gestos emblemáticos; gestos ilustradores e gestos reguladores. Para a análise dos dados, utilizaram-se os testes de Qui-Quadrado e Razão de Verossimilhança. Resultados: a distância íntima entre enfermeiro e parturiente nos dois países (p=0,005) prevaleceu. Em ambos, o toque foi a forma de contato (p<0,0001) mais usada. Nos dois países, as parturientes permaneceram deitadas (p<0,0001). Em relação ao contato estabelecido (p<0,0001), as parturientes não usaram contato. O eixo face a face predominou nas interações em ambos os países entre enfermeiro-parturiente (p<0,0001) e parturiente-enfermeiro (p<0,0001). Conclusão: perceberam-se semelhanças nos aspectos de comunicação não verbal entre enfermeiros e parturientes nos dois países. No entanto, observam-se diferenças como o contato estabelecido entre os enfermeiros brasileiros e cabo-verdianos à parturiente.

Objetivo: analizar comunicación no verbal entre enfermero y parturienta durante la fase activa del trabajo de parto en dos países lusohablantes. Método: estudio analítico cuantitativo, cuya muestra consistió en 709 interacciones que utilizaron la comunicación no verbal entre enfermeros y parturientas. Las variables analizadas fueron: distancia, postura, eje, contacto, gestos emblemáticos, gestos ilustradores y gestos reguladores. Para el análisis de los datos se utilizaron las pruebas de Chi-cuadrado y Razón de Verosimilitud. Resultados: la distancia íntima entre enfermero y parturienta en los dos países (p=0,005) prevaleció. En ambos, el toque fue la forma de contacto (p<0,0001) más usada. En los dos países las parturientas permanecieron acostadas (p<0,0001). En relación al contacto establecido (p<0,0001) las parturientas no usaron contacto. El eje cara a cara predominó en las interacciones en los dos países, entre enfermero-parturienta (p<0,0001) y parturienta-enfermero (p<0,0001). Conclusión: se percibió semejanzas en los aspectos de comunicación no verbal entre enfermeros y parturientas en los dos países. Sin embargo, se observan diferencias como es el caso del contacto establecido entre los enfermeros brasileños y los de Cabo Verde con la parturienta.

Fatores de risco de óbito neonatal em região do interior paulista, Brasil / Risk factors for neonatal death in an inland region in the State of São Paulo Brazil

Resumo O objetivo deste artigo é identificar os fatores de risco de óbito neonatal em região do interior paulista. Estudo de casos e controles. O grupo casos foi constituído por 162 crianças/óbitos neonatais ocorridos em 2009 na região do Departamento Regional de Saúde VI- Bauru/SP. Compuseram o grupo controle 324 crianças selecionadas do Sistema de Informações de Nascidos Vivos dentre aquelas com o mesmo ano de nascimento e município de residência. Para identificar os fatores associados ao óbito neonatal, realizou-se análise de regressão logística univariada e múltipla hierarquizada, estimando-se as razões de odds (e respectivos intervalos de confiança de 95%) brutas e ajustadas para potenciais fatores de confusão. Apresentaram maior chance de óbito os neonatos cujas mães tinham história de óbito infantil, realizaram até três consultas pré-natais e idade gestacional inferior a 28 semanas. A influência do peso ao nascer foi observada apenas entre crianças com peso inferior a 1500g. Este estudo identificou, de maneira independente, cinco fatores de risco para o óbito neonatal, com destaque para a história materna de óbito infantil anterior, fator ainda não valorizado em estudos prévios.

Abstract The main objective of this study was to identify risk factors for neonatal death in an inland region of the State of São Paulo. A case-control study was conducted using a case group of 162 child deaths that occurred in 2009 in the state's VI Regional Health Department - Bauru. The control group consisted of 324 children selected from the Live Births Information System database who shared the same birth date and city of residence. Univariate and hierarchical multiple logistic regression analyses were performed to identify the factors associated with neonatal death by calculating crude odds ratios adjusted for potential confounders and respective 95% confidence intervals. Results: The likelihood of neonatal death was greater among women who had had a history of infant death (OR = 24.97, CI = 12.20 to 51.10) and who had had only up to three antenatal appointments (OR = 11.40, CI = 5, 92 to 21.93), and among infants born at less than 28 weeks of gestation (OR = 168.00, CI = 49.63 to 568.66). The influence of birth weight was also observed among newborns weighing under 1,500g. Conclusions: This study identified five independent risk factors for neonatal death, the most notable of which is maternal history of neonatal death, which has not been properly acknowledged as a risk factor by previous studies.

Variables predictoras de la ideación suicida y sintomatología depresiva en adolescentes de Chiapas, México / Predictors of suicidal ideation and depressive symptoms among adolescents in Chiapas, Mexico

Resumen El objetivo del trabajo es evaluar la presencia de ideación suicida y sintomatología depresiva a partir de variables predictoras en adolescentes de Chiapas, México. El estudio es de tipo transversal, ex post-facto. Se aplicaron las escalas de Ideación Suicida, de Depresión del Centro de Estudios Epidemiológicos, Impulsividad y Autoestima, a una muestra no probabilística de 4,759 estudiantes de ambos sexos, con una edad promedio de 18.4 años. Los resultados indican que el puntaje de media para la ideación suicida (0.2), es inferior a lo reportado en otros estudios, mientras que para sintomatología depresiva, es similar. La prevalencia de ideación suicida es del 7.8%, por debajo de los índices señalados en el ámbito nacional e internacional. Los modelos de regresión logística multivariable para ideación suicida, confirman que la impulsividad y sintomatología depresiva, la hacen aumentar a casi el doble (OR= 1.907) y nueve veces (OR= 9.006) respectivamente. Es evidente la estrecha relación entre la ideación suicida y la sintomatología depresiva, señalándose la relevancia que esta tiene como predictora de su presencia en población adolescente.

Abstract The aim of this study was to assess the presence of suicidal ideation and depressive symptoms among adolescents in Chiapas, Mexico based on predictor variables. A cross-sectional study adopting an ex post facto design was conducted with a non-probability sample of 4,759 students of both sexes with an average age of 18.4 years and using the following tools: the Center for Epidemiologic Studies Depression Scale, Roberts' Suicidal Ideation Scale, the Impulsiveness Scale (IS), and the Rosenberg Self-Esteem Scale. The mean score obtained by the suicidal ideation scale was 0.2, which is lower than that reported by other studies, while the mean score for depressive symptoms was similar to those in the literature. The prevalence of suicidal ideation was 7.8%, which is lower than reported in national and international studies. Multivariable logistic regression showed that impulsiveness (OR = 1.907) and depressive symptoms (OR = 9.006) lead to a twofold and ninefold increase in the likelihood of suicidal ideation, respectively. The findings also showed a strong association between suicidal ideation and depressive symptoms, showing that the latter is a predictor of suicidal ideation among adolescents.

A Structural Equation Model on Korean Adolescents' Excessive Use of Smartphones

PURPOSE: Authors develop a unified structural model that defines multirelationships between systematic factors causing excessive use of smartphones and the corresponding results. METHODS: A survey was conducted with adolescents who live in Seoul, Pusan, Gangneung, Donghae, and Samcheok from February to March 2016. Authors used SPSS, version 22.0, and AMOS, version 22.0, to analyze the survey results at a .05 significance level. To investigate demographic characteristics of the participants and their variations, descriptive analysis was used. The maximum likelihood estimate method was adopted to verify the fitness of the hypothetical model and the hypotheses therein. Authors used χ² statistics, goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, normed fit index, incremental fit index, root mean square residual, and root mean square error of approximation to verify the fitness of our structural model. RESULTS: (1) The proposed structural model demonstrated a fine fitness level. (2) The proposed structural model could describe the excessive use of a smartphone with 88.6% accuracy. (3) The absence of the family function and relationship between friends, impulsiveness, and low self-esteem were confirmed as key factors that cause an excessive use of smartphones. (4) Furthermore, impulsiveness and low self-esteem are closely related to the absence of family functions and relations between friends by 68.3% and 54.4%, respectively. CONCLUSION: Authors suggest that nursing intervention programs from various angles are required to reduce adolescents' excessive use of smartphones. For example, family communication programs would be helpful for both parents and children. Consultant programs about relationships with friends would also be helpful.

An ensemble-based likelihood ratio approach for family-based genomic risk prediction / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#As one of the most popular designs used in genetic research, family-based design has been well recognized for its advantages, such as robustness against population stratification and admixture. With vast amounts of genetic data collected from family-based studies, there is a great interest in studying the role of genetic markers from the aspect of risk prediction. This study aims to develop a new statistical approach for family-based risk prediction analysis with an improved prediction accuracy compared with existing methods based on family history.@*METHODS@#In this study, we propose an ensemble-based likelihood ratio (ELR) approach, Fam-ELR, for family-based genomic risk prediction. Fam-ELR incorporates a clustered receiver operating characteristic (ROC) curve method to consider correlations among family samples, and uses a computationally efficient tree-assembling procedure for variable selection and model building.@*RESULTS@#Through simulations, Fam-ELR shows its robustness in various underlying disease models and pedigree structures, and attains better performance than two existing family-based risk prediction methods. In a real-data application to a family-based genome-wide dataset of conduct disorder, Fam-ELR demonstrates its ability to integrate potential risk predictors and interactions into the model for improved accuracy, especially on a genome-wide level.@*CONCLUSIONS@#By comparing existing approaches, such as genetic risk-score approach, Fam-ELR has the capacity of incorporating genetic variants with small or moderate marginal effects and their interactions into an improved risk prediction model. Therefore, it is a robust and useful approach for high-dimensional family-based risk prediction, especially on complex disease with unknown or less known disease etiology.

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

Interpretação da diretriz da Associação Nacional de Medicina do Trabalho (ANAMT) Epilepsia e Trabalho: rastreamento utilizando a razão de verossimilhança / Interpretation of National Association of Occupational Medicine (ANAMT) guideline Epilepsy and Work: screening using likelihood ratio

Contexto: O conhecimento e a utilização de metodologias de epidemiologia clínica no cenário atual da prática da medicina do trabalho pode ser um diferencial importante para o profissional que atua no setor. Frequentemente, o médico solicita testes ou encontra-se diante de resultados de exames, devendo decidir sobre a validade ou não de um diagnóstico realizado por colegas, muitas vezes, de outras especialidades. O eletroencefalograma (EEG) é um desses exemplos. A Associação Nacional de Medicina do Trabalho/Associação Médica Brasileira (ANAMT/AMB) publicou, em 2016, a diretriz "Epilepsia e Trabalho", visando orientar seus associados. Nessa diretriz não recomenda a utilização do eletroencefalograma no rastreamento da epilepsia. Objetivos: O presente artigo pretende discutir a utilização da razão de verossimilhança (RV) na avaliação clínica de exames médicos, notadamente no EEG, objetivando comparar os resultados obtidos com essa metodologia da medicina baseada em evidências. Métodos: Inicialmente, realizou-se uma busca bibliográfica em relação à RV na literatura clássica da medicina baseada em evidência. Posteriormente, fez-se a leitura da diretriz e das referências bibliográficas nela citadas, retirando os elementos importantes para o cálculo da RV. Após calcular a RV, realizou-se a comparação dos resultados. Resultados: Foram obtidas RV entre 2,36 e 43,5% dependendo da metodologia de realização do EEG (inicial ou sequencial). Conclusões: O EEG não mostrou ser importante no rastreamento da epilepsia, sempre tendo valor menor do que a percentagem de falso-positivos, mesmo nos casos em que se considera a especificidade de 98,0%, corroborando as recomendações da diretriz.

Background: Knowledge of and use of clinical epidemiology methods within the current scenario of occupational medicine practice might make a difference for the professionals who work in this field. Doctors frequently request or receive the results of tests and must decide on the validity or not of diagnoses made by colleagues, often from other specialties. Electroencephalography (EEG) is one example of this situation. In 2016 the National Association of Occupational Medicine/Brazilian Medical Association (ANAMT/ AMB) published the "Epilepsy and Work" guideline to orient its members, which does not recommend EEG for screening. Objectives: The present article discusses the use of likelihood ratio (LR) for clinical evaluation of medical tests, especially EEG, aiming at comparing the results obtained by means of this evidence-based medicine method. Methods: First a literature search on LR was conducted in the classical literature of evidence-based medicine. Next, the ANAMT/AMB guideline and its bibliographic references were analyzed, and relevant elements for the calculation of LR were extracted. LRs were calculated and the results were compared. Results: The LR values varied from 2.36 to 43.5% according to the EEG method used (initial or sequential). Conclusions: EEG proved not to be relevant for screening for epilepsy, with values systematically lower than the percentage of false-positive results, even in cases when 98.0% of specificity was considered, thus corroborating the recommendation made in ANAMT/AMB guideline.

Identifying a parsimonious model for predicting academic achievement in undergraduate medical education: a confirmatory factor analysis

Objectives: This study was conducted to adduce evidence of validity for admissions tests and processes and for identifying a parsimonious model that predicts students' academic achievement in Medical College

Methods: Psychometric study done on admission data and assessment scores for five years of medical studies at Aga Khan University Medical College, Pakistan using confirmatory factor analysis [CFA] and structured equation modeling [SEM]. Sample included 276 medical students admitted in 2003, 2004 and 2005

Results: The SEM supported the existence of covariance between verbal reasoning, science and clinical knowledge for predicting achievement in medical school employing Maximum Likelihood [ML] estimations [n=112]. Fit indices: X[2] [21] = 59.70, p =<.0001; CFK873; RMSEA= 0.129; SRMR = 0.093

Conclusions: This study shows that in addition to biology and chemistry which have been traditionally used as major criteria for admission to medical colleges in Pakistan; mathematics has proven to be a better predictor for higher achievements in medical college

Acompanhamento fonoaudiológico do aleitamento materno em recém-nascidos nas primeiras horas de vida / Speech-language therapy follow-up of breastfeeding in newborns in the first hours of life

RESUMO Introdução A fonoaudiologia tem assumido importante papel junto ao aleitamento materno. Objetivo Verificar a situação do aleitamento materno, considerando aspectos da díade mãe-recém-nascido, de acordo com tempo de vida do recém-nascido, mediante intervenção fonoaudiológica. Métodos Estudo realizado de maio de 2015 a setembro de 2016, com 166 díades mãe-recém-nascido, durante a situação do aleitamento materno, em uma maternidade pública de alto risco do estado de Sergipe. Foi utilizado protocolo específico, registrando-se aspectos anatômicos de bicos e mamas maternos, estado comportamental, padrão de pega e sucção dos recém-nascidos e postura das díades, para descrever a situação de aleitamento materno, nos três diferentes momentos: Momento 1 (linha de base); Momento 2 (intervenção fonoaudiológica); Momento 3 (acompanhamento). As análises foram descritas por meio de frequências simples e percentuais, utilizando o teste de Mantel-Haenzsel (M-H) e o teste da razão de verossimilhança (TRV), adotando nível de significância de 5%. Resultados Em relação ao efeito da intervenção fonoaudiológica, houve diferença significativa quanto aos parâmetros maternos, para situação das mamas (ingurgitamento). Nos parâmetros envolvendo os recém-nascidos, houve diferenças significativas, com melhora no padrão de pega, quanto aos seguintes aspectos: não abocanha somente o bico, abocanha parte da aréola, pega efetiva e consegue manter a pega. Quanto aos aspectos posturais da díade, houve diferenças significativas quanto à cabeça do recém-nascido elevada e alinhada e ao contato corporal ("barriga com barriga"). Conclusão A intervenção fonoaudiológica junto às díades mães-recém-nascidos, logo nas primeiras horas pós-parto, evidenciou melhora nos parâmetros considerados fundamentais para o sucesso da amamentação, vislumbrando uma prática de educação em saúde junto às puérperas.

ABSTRACT Introduction Speech therapy has assumed an important role with breastfeeding. Purpose To verify the breastfeeding situation, considering aspects of the mother-newborn dyad, according to newborn's lifetime through speech-language intervention. Methods Study conducted from May 2015 to September 2016, with 166 mother-newborn dyads during the breastfeeding situation, in a high-risk public maternity hospital in the state of Sergipe. A specific protocol was used registering anatomical aspects of nipples and breasts, newborn's behavioral status, newborn suckling and breast-latch pattern and dyads posture to describe the breastfeeding situation at different times: Moment 1 (Baseline); Moment 2 (Speech-Language Intervention); Moment 3 (Accompaniment). The results were described using simple and percentage frequencies, Mantel-Haenzsel Test (M-H) and the Likelihood Ratio Test (LRT), adopting significance level of 5%. Results Regarding the effect of the speech-language intervention, there was a significant difference in the maternal parameters for the breasts situation (regorgement); While in the parameters involving the newborns there were significant differences, with improvement in breast-latch patterns aspects such as: do not only pick up the beak, snatch part of the areola, breast-latcheffectively and manage to keep breast-latchpattern. Regarding the dyad postural aspects, there were significant differences regarding newborn's raised andaligned head and body contact (belly-to-belly). Conclusion Speech-language intervention with the mother-newborn dyads in the first hours after delivery showed an improvement in the parameters considered fundamental on a successful breastfeeding glimpsing a health education practice among the puerperal women.

Correlation Between Brain Activation Changes and Cognitive Improvement Following Cognitive Remediation Therapy in Schizophrenia: An Activation Likelihood Estimation Meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Several studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have indicated that cognitive remediation therapy (CRT) might improve cognitive function by changing brain activations in patients with schizophrenia. However, the results were not consistent in these changed brain areas in different studies. The present activation likelihood estimation (ALE) meta-analysis was conducted to investigate whether cognitive function change was accompanied by the brain activation changes, and where the main areas most related to these changes were in schizophrenia patients after CRT. Analyses of whole-brain studies and whole-brain + region of interest (ROI) studies were compared to explore the effect of the different methodologies on the results.</p><p><b>METHODS</b>A computerized systematic search was conducted to collect fMRI and PET studies on brain activation changes in schizophrenia patients from pre- to post-CRT. Nine studies using fMRI techniques were included in the meta-analysis. Ginger ALE 2.3.1 was used to perform meta-analysis across these imaging studies.</p><p><b>RESULTS</b>The main areas with increased brain activation were in frontal and parietal lobe, including left medial frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right postcentral gyrus, and inferior parietal lobule in patients after CRT, yet no decreased brain activation was found. Although similar increased activation brain areas were identified in ALE with or without ROI studies, analysis including ROI studies had a higher ALE value.</p><p><b>CONCLUSIONS</b>The current findings suggest that CRT might improve the cognition of schizophrenia patients by increasing activations of the frontal and parietal lobe. In addition, it might provide more evidence to confirm results by including ROI studies in ALE meta-analysis.</p>

Establishment of An Alloxan-induced Diabetes Model in Daphnia Pulex / 中国医学科学院学报

Objective To establish a Daphnia model of alloxan-induced diabetes. Methods Daphnia were exposed to three different concentrations of alloxan (3, 5, and 10 mmol/L) for 30 minutes. Blood glucose and survival rate were recorded for 72 hours after alloxan insult. Sequence analysis and phylogenetic inference for glucose transporters (GLUT) were clustered with the maximum-likelihood method. Using reverse transcription and quantitative polymerase chain reaction techniques, we investigated the transcriptional changes of GLUT at 12 hours after alloxan (5 mmol/L) exposure. Results Compared with control, 3 mmol/L, and 5 mmol/L as well as 10 mmol/L alloxan initially induced transient blood glucose decline by 15% for 2 hours and 12 hours respectively. In Daphnia with 5 and 10 mmol/L alloxan, their blood glucose was persistently raised by about 150% since after 24-hour insult. Survival rate of Daphnia exposure to alloxan with concentrations of 3, 5, and 10 mmol/L were 90%, 75%, and 25% respectively. We predicted seven GLUT genes in the Daphnia genome and successfully amplified them using real-time polymerase chain reaction. Two of seven GLUT transcripts were down-regulated in Daphnia with 5 mmol/L alloxan-induced diabetes. Conclusion Alloxan-induced diabetes model was successfully established in the Daphnia pulex, suggesting diabetes-relevant experiments can be conducted using Daphnia.

The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.

likelihood ratio and frequency of DQ2/DQ8 haplotypes in Iranian patients with celiac disease

Aim: The aim of this study was to evaluate the likelihood ratio and frequency of DQ2 and DQ8 in Iranian patients with celiac disease [CD]

Background: The HLA DQ2 and HLA DQ8 are the important mediators in the development of celiac disease. A few studies evaluated the frequency of HLA DQ2 and HLA DQ8 haplotypes among the Iranian population with low sample size

Patients and methods: In this cross-sectional study, to predict HLA-DQ2 and DQ8 haplotypes, 141[73 male, 78 female] confirmed CD patients compared to 151 healthy controls were enrolled into this study during 2013-2014. HLA DQ2/ DQ8 haplotypes was determined in cases and controls using PCR-SSP technique

Results: DQ2 and DQ8 were positive in 80% [n=111] and 49% [n= 69] of CD patients and 36% [n=61] and 13% [n=21] of control group respectively. Moreover, 32% [n=45] of CD patients and 5.3% [n=8] of the control group were carrier of both haplotypes. In the case group about one-third of patients [32.2%] were positive for carrying both DQ2 and DQ8 heterodimers while only 5.3% [n=8] of the control group were carrier. In addition, the positive likelihood ratio of DQ2 and DQ8 were 1.74 [CI: 1.4- 2.1], and 2.6 [CI: 1.8- 2.7], respectively

Conclusion: The result of this study showed that the frequency of DQ8 among our population is higher than those reported by European countries, but it is close to those founded in South America and Middle East. This result suggests that the higher prevalence of HLA DQ8 pattern in Iranian CD patients is similar to non-European patients