The optimal endometrial thickness threshold for prediction of endometrial cancer in postmenopausal women without bleeding remains uncertain-Systematic review and meta-analysis.

The incidental finding of endometrial thickness (ET) >4 mm in the absence of postmenopausal bleeding (PMB) is a common cause of referring women to secondary care. However, there is lack of consensus amongst gynecologists as regards the management. It is estimated that up to 15 % of endometrial cancers occur in women without PMB. The aim this study was to determine the optimal ET threshold, on trans-vaginal ultrasound scan, that discriminates normal endometrium from endometrial hyperplasia and cancer in this cohort. On using a thorough search strategy, a total 16 studies including 4088 women were deemed eligible. However, the data were not amenable to meta-analysis. There were wide variations in the thresholds reported with potential bias given the retrospective nature of the majority of the studies. Despite contacting authors, we could not obtain the primary data to generate a Receiver Operating Characteristic (ROC) Curve. No linear or curvilinear association was found between ET thresholds and the percentage of women diagnosed with endometrial hyperplasia and cancer using either Pearson's correlation, linear or curvilinear regression, or a simple visual scan/scatter diagram. The result of this study reveals the lack of evidence to inform clinical practice in this area, and there is a need for a well-designed multi-center prospective study.

Exploring cardiovascular health in children: the influence of Hemoglobin-to-Platelet ratio in contrasting rural and urban communities.

Understanding the associations and possible mechanisms between Cardiorespiratory Fitness (CRF) and residential location is an important focus of public health research. This is a cross-sectional study carried out with 2250 students (6-17 years), from southern Brazil. In addition to age, sex, and body size measurements, we also recorded hemoglobin and platelet count measurements using venous blood samples (10 ml). The CRF was measured using the 6-minute run/walk test, with predictors explored via allometry. Results identified a novel and independent association between the hemoglobin-to-platelet count ratio and children's CRF, after controlling for confounders. We also provide evidence of a possible mechanism for this association, having identified reduced measures of hemoglobin and increased platelet counts observed in children living in urban (vs rural) areas. These results suggest the need for more effective public health practices and policies addressing the built enviroment´s health effects in Brazil and potentially other congested ciries.

Oral ethanol prescribing for alcohol withdrawal syndrome: initial findings and future directions following implementation within a United Kingdom National Health Service setting.

INTRODUCTION: Prescribing of ethanol may be an alternative to benzodiazepines for managing alcohol withdrawal syndrome. We present our experience of oral ethanol prescribing within an acute United Kingdom National Health Service setting. METHODS: A retrospective review of patients presenting with alcohol withdrawal who were managed with oral ethanol or benzodiazepines was performed from data collected across two acute care settings. Ethanol prescribing inclusion: high risk of delirium tremens, or a history of harmful alcohol consumption (typically ≥30 units/day; in which 1 unit = 8 grams of alcohol; one standard United States drink = 14 grams of alcohol) or known to have a history of severe alcohol withdrawal, alcohol-related seizures or delirium tremens. Inverse propensity score weighting was used to partially account for variance between the two patient populations. RESULTS: Fifty (82 per cent male; average age 50.9 years) and 93 (84 per cent male; average age 46.5 years) patients in receipt of benzodiazepines or ethanol, respectively, were included. The likelihood of hospital admission was significantly reduced when individuals were managed with ethanol (odds ratio 0.206 (95 per cent confidence interval; 0.066-0.641), Wald chi-square P = 0.006). In those not admitted, the treatment type had no significant impact on length of stay or the number of occasions a pharmacological agent was required. In those admitted, treatment had no significant effect on length of stay. DISCUSSION: We offer preliminary evidence to support a role of oral ethanol in the management of patients with alcohol withdrawal. We have implemented a robust and translatable guideline. Despite limitations in the data set the impact of ethanol in reducing the likelihood of admission remained significant. CONCLUSIONS: In individuals at significant risk of severe alcohol withdrawal, prescribing ethanol as part of a comprehensive care plan, may reduce unplanned admissions. The preliminary findings presented here warrant further assessment through prospective studies.

Growth charts of Brazilian youngs: 20-years data of 95,000 children and adolescents from "Projeto Esporte Brasil".

This article aims to present growth curves for height, weight, and BMI of 95,000 Brazilian youths aged 6 to 17 years, including the five regions of the country, the Amazon region, and indigenous populations, and compare them with the World Health Organization (WHO) growth references. The final sample consisted of 52,729 boys and 42,731 girls from the "Projeto Esporte Brasil" database. Body mass and height information were used to derive the curves. The generalized additive model for location, scale, and shape was employed. In this study, we present smoothed weight-for-age, height-for-age, and BMI-for-age curves for boys and girls. Differences were observed between the results of the Brazilian curves and the WHO growth references. The developed curves will be valuable for professionals in medicine, public health, nutrition, physical education, and other related fields, regarding the assessment of physical growth in Brazilian children and adolescents and monitoring the nutritional status of this population. Additionally, these curves will facilitate the identification of individuals or subgroups at risk of diseases and delayed growth, with a greater focus on specific country-related factors.

Validity, reliability and responsiveness of a goniometer watch to measure pure forearm rotation.

Introduction: Innovative instruments have been designed to assess forearm rotation, an anatomically challenging motion to measure. This study assessed the concurrent validity, interrater reliability and responsiveness of a novel goniometer watch (GoWatch) to measure pure forearm rotation. The modified finger goniometer (MFG) was the criterion reference. Methods: Forty participants with restricted forearm rotation were recruited. Two raters measured supination and pronation using the GoWatch and MFG before and after a hand therapy session. Repeated-measures ANOVA assessed for systematic bias with an apriori residual error of 5° deemed as acceptable. Secondary analysis used intraclass coefficients (ICCs) to categorise interrater reliability. Responsiveness of the GoWatch was calculated using Cohen's d. Results: The GoWatch demonstrated acceptable agreement with the MFG with a mean difference for supination 1.19° and pronation 0.20°. Interrater reliability was also within acceptable limits with a mean difference GoWatch supination 4.43° and pronation 2.23°. Interrater reliability for GoWatch supination and pronation were categorized as excellent (ICC = 0.94) and good (ICC = 0.85) respectively. Systematic bias was observed in the instrument by rater interaction with rater two consistently underestimating GoWatch measures (p<.05). GoWatch supination showed small to medium responsiveness (Rater 1: d = 0.14; Rater 2: d = 0.29) and pronation very small to medium responsiveness (Rater 1: d = 0.29; Rater 2: d = 0.05). Conclusion: The GoWatch is a viable and user-friendly alternative to measure forearm rotation with demonstrable validity, interrater reliability and responsiveness. Further research is required to ensure systematic bias is not endemic when used across multiple raters.

Short-Term High-Intensity Rowing Ergometry Training Improves Rowing Performance Equally in Healthy Weight and Obese Adolescents.

PURPOSE: Childhood obesity is a major health concern and physical activity is commonly proposed as an intervention strategy to combat the increasing prevalence of overweight and obesity in young people. The aim of this study was to examine the effect of high-intensity, supervised, rowing ergometer training on maximal and submaximal rowing performance in healthy weight and centrally obese adolescents (12-13 yr). METHODS: Participants were randomized to either 6 wk of supervised rowing ergometry, comprising of 2 sessions per week with each session comprising of 2 × 3-min bouts of high-intensity rowing ergometry ( n = 57), or a control group who continued with their habitual activities ( n = 45). At baseline and follow-up, rowing performance was assessed via a submaximal test and a 3-min maximal test. RESULTS: Six weeks of rowing ergometer training significantly improved maximal exercise performance; total distance rowed in a 3-min maximal effort improved by 19.7 m (2.7%) (time × group, P = 0.018) and produced a significant reduction in perceived effort in response to a set submaximal load (60 W) (time × group, P = 0.040). At baseline total distance rowed during the 3-min maximal test was significantly affected by body mass (main effect of body mass, P = 0.002), whereby a higher body mass was associated with enhanced rowing performance. However, the pattern of change over time was not different between healthy weight and centrally obese adolescents (time × group × waist centile, P = 0.577). CONCLUSIONS: A 6-wk high-intensity rowing ergometry training intervention improved maximal rowing performance. This improvement was similar in healthy weight versus overweight and obese adolescents; yet overall overweight and obese adolescents had superior rowing performance compared to their healthy weight counterparts, suggesting that rowing may be an attractive exercise modality for interventions in overweight and obese young people.

Growth charts of Brazilian youngs: 20-years data of 95,000 children and adolescents from "Projeto Esporte Brasil" / Curvas de crescimento de jovens brasileiros: dados de 20 anos com 95.000 crianças e adolescentes do "Projeto Esporte Brasil"

Abstract This article aims to present growth curves for height, weight, and BMI of 95,000 Brazilian youths aged 6 to 17 years, including the five regions of the country, the Amazon region, and indigenous populations, and compare them with the World Health Organization (WHO) growth references. The final sample consisted of 52,729 boys and 42,731 girls from the "Projeto Esporte Brasil" database. Body mass and height information were used to derive the curves. The generalized additive model for location, scale, and shape was employed. In this study, we present smoothed weight-for-age, height-for-age, and BMI-for-age curves for boys and girls. Differences were observed between the results of the Brazilian curves and the WHO growth references. The developed curves will be valuable for professionals in medicine, public health, nutrition, physical education, and other related fields, regarding the assessment of physical growth in Brazilian children and adolescents and monitoring the nutritional status of this population. Additionally, these curves will facilitate the identification of individuals or subgroups at risk of diseases and delayed growth, with a greater focus on specific country-related factors.

Resumo O objetivo do artigo é apresentar curvas de crescimento de altura, peso e IMC de 95.000 jovens brasileiros com idades entre 6 e 17 anos, incluindo as cinco regiões do país, a região da Amazônia e os povos indígenas, e comparar com as referências de crescimento da Organização Mundial da Saúde (OMS). A amostra final foi composta por 52.729 meninos e 42.731 meninas provenientes do banco de dados do "Projeto Esporte Brasil". As informações de massa corporal e estatura foram utilizadas para derivar as curvas. O modelo aditivo generalizado para localização, escala e forma foi usado. neste estudo, apresentamos as curvas suavizadas de peso-idade, altura-idade e IMC-idade para meninos e meninas. Foram observadas diferenças entre os resultados das curvas brasileiras e as referências de crescimento da OMS. As curvas desenvolvidas serão úteis para profissionais da medicina, saúde pública, nutrição, educação física, entre outros, no que diz respeito a avaliação do crescimento físico de crianças e adolescentes brasileiros e para monitorar o estado nutricional desta população. Além disso, essas curvas permitirão a detecção de indivíduos ou subgrupos em risco de doenças e crescimento retardado, com um foco maior em fatores específicos do país.

Identification of key somatic features that are common and the ones that differ between swim strokes through allometric modeling.

Introduction: The aim of this study was to explore which key somatic features are common to four swim strokes and medley, and specifically to identify which characteristics benefit only specific strokes. Methods: The sample was composed of 130 swimmers (95 males aged 19.5 ± 2.9 years and 35 females aged 18.4 ± 2.8 years). A set of anthropometric variables was used to predict swimming speed in the four swimming strokes and medley. Results: A multiplicative model with allometric body size components was used to identify the demographic and anthropometric predictors of swimming speed. Trunk height and waist circumference were the only variables significantly different among swimming strokes (p < 0.05). Associations between swimming speed and arm length were similar in breaststroke and medley, and in freestyle, backstroke and butterfly (R2 = 60.9%). The model retained as swimming speed predictors the age2, upper body circumference, hand breadth, waist circumference, and subscapular skinfold thickness (these last two had negative associations). Conclusion: All these predictors were common to all four swim strokes and medley. Arm length was also retained as a significant predictor, but this one varied significantly between the four different swim strokes and medley. These findings highlight the importance of having a "V-shape" trunk, longer upper limbs, and large hands as predictors of swimming performance.