Optimal threshold for birth weight discordance: Does knowledge of chorionicity matter?

OBJECTIVE: To establish the optimal threshold of birth weight discordance (BWD) for prediction of stillbirth, perinatal mortality and morbidity in twins born in British Columbia with or without chorionicity information. STUDY DESIGN: This is a retrospective population-based cohort study of twins born in British Columbia from 2000 to 2010. Data from one hospital was used to adjust for chorionicity. Multivariate generalized estimating equation and receiver operating characteristic curve analyses were performed to evaluate the predictability of BWD in comparison with other fetal anthropometric measurements. Positive likelihood ratio is used to estimate test accuracy. Survival analysis was conducted to take gestational age and other confounders into account. RESULTS: We analyzed two cohorts, with (pairs=1493) and without (pairs=6328) chorionicity information, of which 1.5% experienced stillbirth, 2.9% suffered perinatal mortality and 22.6% identified with perinatal morbidities. BWD was a significant predictor of stillbirth. Standard receiver operating characteristic curve analysis and survival analysis suggested that BWD of ⩾30% is the optimal thresholds for stillbirth and perinatal mortality irrespective of chorionicity. However, the P-value for predictive accuracy of BWD was nonsignificant for perinatal morbidity, after adjusting for confounding variables engaging multivariate analysis. Sex discordance can be used as a proxy for chorionicity. CONCLUSION: BWD is a good predictor for stillbirth. A BWD cutoff limit of 30% and higher has optimal accuracy for detecting perinatal mortality.

[Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale]. / Adaptación al español y validez diagnósticade la Yale Global Tics Severity Scale.

AIM: The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global Tics Severity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument for quantifying the clinical evolution of patients with Tourette syndrome. PATIENTS AND METHODS: Analysis of the properties of the adapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis), internal consistency (Cronbach's alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change (Wilcoxon rank sum test). RESULTS: The factor analysis confirmed the existence of two dimensions on the scale, which account for 76.3% of the variability. The internal consistency, measured by Cronbach's alpha, was 0.997 for the motor tic dimension and 0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to or greater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the global scores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for the first interview (incorporation into the study group) and the second one (after 15 days' treatment). CONCLUSIONS: The Spanish version of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity and reliability is greater in the motor and phonic tic dimensions than in that of disability.

Adaptación al español y validez diagnóstica de la Yale Global Tics Severity Scale / Spanish adaptation and diagnostic validity of the yale global tics severity scale

El instrumento de medida habitualmente utilizado para valorar la gravedad clínica del síndrome deTourette es la Yale Global Tics Severity Scale (YGTSS), originariamente escrita en inglés, y no existe una versión validada enespañol que permita su aplicación directa a los pacientes hispanohablantes. Objetivo. Analizar las propiedades psicométricasde la versión de la YGTSS, traducida al español, y su sensibilidad para medir cambios, como instrumento para cuantificar laevolución en pacientes con síndrome de Tourette. Pacientes y métodos. El análisis versa sobre la validez del concepto (análisisfactorial de componentes principales), consistencia interna (alfa de Cronbach), fiabilidad intraobservadores (coeficientede correlación intraclase) y sensibilidad al cambio (test de rangos de Wilcoxon). Resultados. El análisis factorial confirmó laexistencia de dos dimensiones en la escala, que explican el 76,3% de la variabilidad. La consistencia interna fue de 0,997 parala dimensión tics motores, y de 0,996 para la dimensión tics fónicos. La fiabilidad intraobservadores fue igual o superior a0,95, tanto en los 10 ítems referidos a los tics (motores y fónicos) como en el ítem de discapacidad. En las puntuaciones globalesde tics motores, tics fónicos y discapacidad, hubo diferencias estadísticamente significativas entre la media de puntuaciónentre la primera entrevista (entrada en el estudio) y la segunda entrevista (a los 15 días de tratamiento). Conclusiones.La adaptación efectuada al español de la YGTSS cumple adecuadamente las tres propiedades psicométricas en nuestra poblaciónde estudio. La validez y fiabilidad es mayor en las dimensiones de tics motores y fónicos que en la discapacidad

The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global TicsSeverity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument forquantifying the clinical evolution of patients with Tourette syndrome. Patients and methods. Analysis of the properties of theadapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis),internal consistency (Cronbach’s alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change(Wilcoxon rank sum test). Results. The factor analysis confirmed the existence of two dimensions on the scale, which account for76.3% of the variability. The internal consistency, measured by Cronbach’s alpha, was 0.997 for the motor tic dimension and0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to orgreater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the globalscores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for thefirst interview (incorporation into the study group) and the second one (after 15 days’ treatment). Conclusions. The Spanishversion of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity andreliability is greater in the motor and phonic tic dimensions than in that of disability

Infección de HIV, hepatitis C y tuberculosis auto referida en una cárcel de Andalucía, 1999 / HIV, Hepatitis C and tuberculosis self reported infectionin an Andalusian prison, 1999

Objetivos: Conocer la incidencia de afectados por el virus de inmunodeficiencia humana, hepatitis C y tuberculosis enuna prisión andaluza, según autoinformes, analizar los posibles factores asociados y determinar el conocimiento de sus formasde transmisión.Métodos: Estudio transversal, llevado a cabo en una cárcel de Andalucía durante el año 1999. Se escogieron al azar del listadogeneral de internos 450 participantes, siendo que ninguno rechazó participar en el estudio. Los datos se recogieron apartir de un cuestionario sobre situación penitenciaria, salud, consumo de drogas y conocimiento sobre riesgo de infecciónde HIV, VHC y TBC.Resultados: La muestra se compone de 450 personas, en su mayoría hombres (90,4%), con una edad media de 32,19 años. El19,1% de los reclusos dijeron que eran seropositivos para HIV, el 2,7% que tenían tuberculosis y el 18,2% que tenían hepatitis C.Existe un mayor conocimiento sobre las forma de transmisión del HIV y menor sobre la tuberculosis. Los modelos de regresiónindican que quienes cumplen una condena mayor a cinco años y han estado más de una vez en prisión, consumían heroína en lacalle y han estado en tratamiento con metadona tienen una mayor probabilidad de declararse HIV o VHC positivos.Conclusiones: La prevalencia declarada de hepatitis C en los reclusos es muy inferior a la esperada. Las altas puntuacionesobtenidas en las escalas de conocimiento de transmisión de las afecciones por parte de quienes las padecen apoyan la utilizaciónde la estrategia de iguales para promoción de la salud en las prisiones (AU)

Objectives: To investigate the prevalence of HIV, hepatitis C and tuberculosis, by means of self reports amongst prisonersin an Andalusian prison, analyse possible associated factors, and to evaluate current knowledge about the transmissionof these diseases.Methods: Cross-sectional study, carried out in an Andalusian prison in 1999. Four hundred and fifty participants werechosen at random from the general inmate list. None of them refused to participate in the study. Data was collected using aquestionnaire about the prison situation, health, drug consumption, and risk behaviour awareness.Results: The sample consisted of 450 inmates, 90,4% male, with a mean age of 32.19 years old. In this sample, 19.1% ofthe inmates stated that they were HIV positive, 2.7% that they had tuberculosis and 18.2% hepatitis C. Participants showedmore awareness of HIV and less of tuberculosis risk behaviours. Participants undergoing a sentence of more than five years,with more than one entry in prison, with a history of heroin consumption in the street, and who had received methadonemaintenance treatment presented the highest probabilities of stating that they had hepatitis C and HIV respectively.Conclusions: Declared prevalence of hepatitis C in prisoners was lower than expected. The high scores obtained in thescales of awareness of HIV, hepatitis C and tuberculosis transmission risk behaviours by those who report these diseases supportthe use of peer intervention for health promotion in prisons (AU)

Los programas de tratamiento con metadona: situación real e ideal, definida por profesionales de Andalucía / The methadone maintenance programs: real and ideal situation, definition by Andalucia´s professionals

Objetivos. Se explora la situación actual de los programas de tratamiento con metadona (PTM) en Andalucía, definida por los profesionales implicados y cómo ellos valoran que dicho programa debiera ser en términos de excelencia. Para ello se ofrecen propuestas y medidas de mejora con las que acercar las situaciones descritas. Material y métodos. Reunión de expertos articulada con una variante del grupo nominal. Participaron 9 profesionales. Resultados. La situación ideal y en términos de excelencia de los PTM no concuerda en buena parte de sus cláusulas con la realidad actual de estas intervenciones. Los aspectos más destacados sobre cómo debieran ser los PTM son la dispensación, la agilidad y rapidez de los programas, junto a la existencia de una buena coordinación entre los recursos. La descripción y valoración de la situación actual de los PTM es menos favorable con rela ción a la situación ideal definida por los asistentes. Se recogen y puntúan propuestas y medidas de mejora con las que acercar ambas situaciones. Conclusiones. Aunque los PTM sean intervenciones de eficacia comprobada por la evidencia científica, son susceptibles de mejora. Para ello recoger la voz de los protagonistas directos en estas prácticas es importante para asegurar su continuidad y dotarlos de mayor calidad

Objectives. This study explores the methadone maintenance programs (MMPs) currently offered in Andalucia based on the opinions of providers involved, as well as their views on how these programs should be organised to achieve excelence. In order to advance towards this goal, proposals and measures for improvement are also provided. Material and methods. Experts' consensus meeting (9 providers) based on an adaptation of the nominal group technique. Results. there is a lack of concordance between the ideal situation of the MMPs in terms of excelence and the real situation of current service provision. The most relevant components of an ideal MMP were dispensing procedures, steadiness and rapidity in program provision, and good coordination across available resources. Description and assessment of the actual situation was less favourable when compared with the ideal situation as defined by participants. Proposals and measures for program improvement to approach both situations were also gathered. Conclusions. Although available scientific evidence has proved the efficiency of MMT programs, there is still room for improvement. Therefore, it is important to gather the views of the main actors in order to ensure the continuity of existing programs and to improve their quality

Infección de HIV, hepatitis C y tuberculosis auto referida en una cárcel de Andalucía, 1999 / HIV, Hepatitis C and tuberculosis self reported infection in an Andalusian prison, 1999

Objetivos: Conocer la incidencia de afectados por el virus de inmunodeficiencia humana, hepatitis C y tuberculosis en una prisión andaluza, según autoinformes, analizar los posibles factores asociados y determinar el conocimiento de sus formas de transmisión.Métodos: Estudio transversal, llevado a cabo en una cárcel de Andalucía durante el año 1999. Se escogieron al azar del listado general de internos 450 participantes, siendo que ninguno rechazó participar en el estudio. Los datos se recogieron a partir de un cuestionario sobre situación penitenciaria, salud, consumo de drogas y conocimiento sobre riesgo de infección de HIV, VHC y TBC.Resultados: La muestra se compone de 450 personas, en su mayoría hombres (90,4%), con una edad media de 32,19 años. El 19,1% de los reclusos dijeron que eran seropositivos para HIV, el 2,7% que tenían tuberculosis y el 18,2% que tenían hepatitis C. Existe un mayor conocimiento sobre las forma de transmisión del HIV y menor sobre la tuberculosis. Los modelos de regresiónindican que quienes cumplen una condena mayor a cinco años y han estado más de una vez en prisión, consumían heroína en la calle y han estado en tratamiento con metadona tienen una mayor probabilidad de declararse HIV o VHC positivos.Conclusiones: La prevalencia declarada de hepatitis C en los reclusos es muy inferior a la esperada. Las altas puntuaciones obtenidas en las escalas de conocimiento de transmisión de las afecciones por parte de quienes las padecen apoyan la utilización de la estrategia de iguales para promoción de la salud en las prisiones

Objectives: To investigate the prevalence of HIV, hepatitis C and tuberculosis, by means of self reports amongst prisoners in an Andalusian prison, analyse possible associated factors, and to evaluate current knowledge about the transmission of these diseases.Methods: Cross-sectional study, carried out in an Andalusian prison in 1999. Four hundred and fifty participants were chosen at random from the general inmate list. None of them refused to participate in the study. Data was collected using a questionnaire about the prison situation, health, drug consumption, and risk behaviour awareness.Results: The sample consisted of 450 inmates, 90,4% male, with a mean age of 32.19 years old. In this sample, 19.1% of the inmates stated that they were HIV positive, 2.7% that they had tuberculosis and 18.2% hepatitis C. Participants showed more awareness of HIV and less of tuberculosis risk behaviours. Participants undergoing a sentence of more than five years,with more than one entry in prison, with a history of heroin consumption in the street, and who had received methadone maintenance treatment presented the highest probabilities of stating that they had hepatitis C and HIV respectively.Conclusions: Declared prevalence of hepatitis C in prisoners was lower than expected. The high scores obtained in the scales of awareness of HIV, hepatitis C and tuberculosis transmission risk behaviours by those who report these diseases support the use of peer intervention for health promotion in prisons