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3.
Swiss Med Wkly ; 151: w20471, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33580705

RESUMO

OBJECTIVES: To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). DESIGN: Cross-sectional study with a representative sample (development) and a case-control sample (validation). SETTING: The two largest Swiss prisons. PARTICIPANTS: (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). MAIN OUTCOME MEASURES: The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. RESULTS: Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). CONCLUSIONS: The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.


Assuntos
/etiologia , Técnicas de Apoio para a Decisão , Programas de Rastreamento/normas , Prisioneiros/estatística & dados numéricos , Medição de Risco/normas , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Prisões , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Suíça
4.
J Public Health Manag Pract ; 27(3): 229-232, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33394643

RESUMO

Reopening in-person education in public schools during the coronavirus 2019 (COVID-19) pandemic requires careful risk-benefit analysis, with no current established metrics. Equity concerns in urban public schools such as decreased enrollment among largely Black and Latinx prekindergarten and special needs public school students already disproportionately impacted by the pandemic itself have added urgency to Chicago Department of Public Health's analysis of COVID-19 transmission. Close tracking within a large school system revealed a lower attack rate for students and staff participating in in-person learning than for the community overall. By combining local data from a large urban private school system with national and international data on maintaining in-person learning during COVID-19 surges, Chicago believes in-person public education poses a low risk of transmission when the operational burden imposed by the second wave has subsided.


Assuntos
/transmissão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Educação/normas , Guias como Assunto , Instituições Acadêmicas/estatística & dados numéricos , Instituições Acadêmicas/normas , Estudantes/estatística & dados numéricos , Adolescente , Chicago/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Masculino , Pandemias , Medição de Risco/métodos , Medição de Risco/normas
5.
Trials ; 22(1): 90, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494785

RESUMO

BACKGROUND: New considerations during the ethical review processes may emerge from innovative, yet unfamiliar operational methods enabled in pragmatic randomized controlled trials (RCT), potentially making institutional review board (IRB) evaluation more complex. In this manuscript, key components of the pragmatic "Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE)" randomized trial that required a reappraisal of the IRB submission, review, and approval processes are discussed. MAIN TEXT: ADAPTABLE is a pragmatic, multicenter, open-label RCT evaluating the comparative effectiveness of two doses of aspirin widely used for secondary prevention (81 mg and 325 mg) in 15,000 patients with an established history of atherosclerotic cardiovascular disease. The electronic informed consent form is completed online by the participants at the time of enrollment, and endpoint ascertainment is conducted through queries of electronic health records. IRB challenges encountered regarding centralized IRB evaluation, electronic informed consent, patient engagement, and risk determination in ADAPTABLE are described in this manuscript. The experience of ADAPTABLE encapsulates how pragmatic protocol components intended to facilitate the study conduct have been tempered by unexpected, yet justified concerns raised by local IRBs. How the lessons learned can be applied to future similar pragmatic trials is delineated. CONCLUSION: Development of engaging communication channels between IRB and study personnel in pragmatic randomized trials as early as at the time of protocol design allows to reduce issues with IRB approval. Integrations of the lessons learned in ADAPTABLE regarding the IRB process for centralized IRBs, informed consent, patient engagement, and risk determination can be emulated and will be instrumental in future pragmatic studies.


Assuntos
Aspirina/administração & dosagem , Aterosclerose/prevenção & controle , Comitês de Ética em Pesquisa/normas , Projetos de Pesquisa/normas , Prevenção Secundária/métodos , Adulto , Aspirina/efeitos adversos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Consentimento Livre e Esclarecido/normas , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/ética , Estudos Multicêntricos como Assunto/normas , Participação do Paciente , Ensaios Clínicos Pragmáticos como Assunto/ética , Ensaios Clínicos Pragmáticos como Assunto/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Medição de Risco/normas , Resultado do Tratamento
6.
J Urol ; 205(1): 241-247, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716742

RESUMO

PURPOSE: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. MATERIALS AND METHODS: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. RESULTS: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6±0.6 and 2.2±0.8, respectively. Median MeNTS scores were 52 (46.5, 57.5), 50 (44.5, 54.5) and 48 (43.5, 54) for individual surgeon based surgical prioritization priority 1, 2 and 3 cases (p=0.129), and 55 (51.5, 57), 47.5 (42, 56) and 49 (44, 54) for consensus/expert opinion based surgical prioritization priority scores 1, 2, and 3 (p=0.002). There was none to slight agreement between consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores (Kappa 0.131, p=0.002). CONCLUSIONS: Questionnaire based, expert opinion based and individual surgeon based approaches to case prioritization result in significantly different case prioritization. Questionnaire based surgical prioritization did not meaningfully stratify urological cases, and consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization frequently disagreed. The strengths and weaknesses of each of these systems should be considered in future disaster planning scenarios.


Assuntos
/prevenção & controle , Procedimentos Cirúrgicos Eletivos/normas , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Adulto , Idoso , /transmissão , Tomada de Decisão Clínica , Controle de Doenças Transmissíveis/normas , Consenso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Tempo , Triagem/normas , Estados Unidos/epidemiologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-33321736

RESUMO

Environmental and community context earliest in the life course have a profound effect on life-long health outcomes. Yet, standard needs assessments for maternal and child health (MCH) programs often overlook the full range of influences affecting health in-utero and early childhood. To address this, we developed a methodology for assessing community risk in MCH based on six domains integrating 66 indicators across community, environment, socioeconomic indicators, and MCH outcomes. We pilot this methodology in Pennsylvania, and share examples of how local governments, planners, and public health officials across the geographic spectrum can integrate this data into community planning for improved maternal and child health.


Assuntos
Ambiente Construído , Saúde da Criança , Planejamento em Saúde , Saúde Materna , Saúde Pública , Medição de Risco , Meio Social , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Planejamento em Saúde/métodos , Humanos , Saúde Materna/estatística & dados numéricos , Pennsylvania , Saúde Pública/estatística & dados numéricos , Medição de Risco/normas
8.
J Med Internet Res ; 22(11): e24018, 2020 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-33027032

RESUMO

BACKGROUND: COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. OBJECTIVE: The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. METHODS: We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19-positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. RESULTS: Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. CONCLUSIONS: We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Aprendizado de Máquina/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Lesão Renal Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Prognóstico , Curva ROC , Medição de Risco/métodos , Medição de Risco/normas , Adulto Jovem
11.
BMJ ; 371: m3731, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082154

RESUMO

OBJECTIVE: To derive and validate a risk prediction algorithm to estimate hospital admission and mortality outcomes from coronavirus disease 2019 (covid-19) in adults. DESIGN: Population based cohort study. SETTING AND PARTICIPANTS: QResearch database, comprising 1205 general practices in England with linkage to covid-19 test results, Hospital Episode Statistics, and death registry data. 6.08 million adults aged 19-100 years were included in the derivation dataset and 2.17 million in the validation dataset. The derivation and first validation cohort period was 24 January 2020 to 30 April 2020. The second temporal validation cohort covered the period 1 May 2020 to 30 June 2020. MAIN OUTCOME MEASURES: The primary outcome was time to death from covid-19, defined as death due to confirmed or suspected covid-19 as per the death certification or death occurring in a person with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the period 24 January to 30 April 2020. The secondary outcome was time to hospital admission with confirmed SARS-CoV-2 infection. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance, including measures of discrimination and calibration, was evaluated in each validation time period. RESULTS: 4384 deaths from covid-19 occurred in the derivation cohort during follow-up and 1722 in the first validation cohort period and 621 in the second validation cohort period. The final risk algorithms included age, ethnicity, deprivation, body mass index, and a range of comorbidities. The algorithm had good calibration in the first validation cohort. For deaths from covid-19 in men, it explained 73.1% (95% confidence interval 71.9% to 74.3%) of the variation in time to death (R2); the D statistic was 3.37 (95% confidence interval 3.27 to 3.47), and Harrell's C was 0.928 (0.919 to 0.938). Similar results were obtained for women, for both outcomes, and in both time periods. In the top 5% of patients with the highest predicted risks of death, the sensitivity for identifying deaths within 97 days was 75.7%. People in the top 20% of predicted risk of death accounted for 94% of all deaths from covid-19. CONCLUSION: The QCOVID population based risk algorithm performed well, showing very high levels of discrimination for deaths and hospital admissions due to covid-19. The absolute risks presented, however, will change over time in line with the prevailing SARS-C0V-2 infection rate and the extent of social distancing measures in place, so they should be interpreted with caution. The model can be recalibrated for different time periods, however, and has the potential to be dynamically updated as the pandemic evolves.


Assuntos
Algoritmos , Regras de Decisão Clínica , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Mortalidade , Pandemias , Pneumonia Viral , Medição de Risco , Adulto , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Estudos de Coortes , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Bases de Dados Factuais/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Medição de Risco/normas
12.
Intern Emerg Med ; 15(8): 1409-1414, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32930963

RESUMO

The epidemic phase of Coronavirus disease 2019 (COVID-19) made the Worldwide health system struggle against a severe interstitial pneumonia requiring high-intensity care settings for respiratory failure. A rationalisation of resources and a specific treatment path were necessary. The study suggests a predictive model drawing on clinical data gathered by 119 consecutive patients with laboratory-confirmed COVID-19 admitted in Busto Arsizio hospital. We derived a score that identifies the risk of clinical evolution and in-hospital mortality clustering patients into four groups. The study outcomes have been compared across the derivation and validation samples. The prediction rule is based on eight simple patient characteristics that were independently associated with study outcomes. It is able to stratify COVID-19 patients into four severity classes, with in-hospital mortality rates of 0% in group 1, 6-12.5% in group 2, 7-20% in group 3 and 60-86% in group 4 across the derivation and validation sample. The prediction model derived in this study identifies COVID-19 patients with low risk of in-hospital mortality and ICU admission. The prediction model that the study presents identifies COVID-19 patients with low risk of in-hospital mortality and admission to ICU. Moreover, it establishes an intermediate portion of patients that should be treated accurately in order to avoid an unfavourable clinical evolution. A further validation of the model is important before its implementation as a decision-making tool to guide the initial management of patients.


Assuntos
Regras de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Medição de Risco/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Reprodutibilidade dos Testes , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Índice de Gravidade de Doença
13.
Health Qual Life Outcomes ; 18(1): 276, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787865

RESUMO

BACKGROUND: Personality traits are related with risk of hazardous alcohol use and alcohol dependence. The Substance Use Risk Profile Scale (SURPS) measures personality traits associated with addictive substance abuse. We examined psychometric properties of the SURPS in Lithuanian population. MATERIALS AND METHODS: Two hundred forty-seven participants (mean age 37.22 ± 0.78 years), were recruited from the local community and from an inpatient addiction treatment centre. Internal consistency, stability, factor structure, content validity, and external validity of the SURPS were examined. Hazardous alcohol use was evaluated by Alcohol Use Disorder Identification Test (AUDIT). Alcohol dependence diagnosis was established by International Classification of Diseases - 10 (ICD - 10). We also performed gender analyses for associations of personality traits with alcohol dependence and hazardous use of alcohol. RESULTS: The SURPS scale demonstrated appropriate internal validity, good temporal stability, and adequate criterion validity and construct validity. The SURPS scores of hopelessness, anxiety sensitivity and impulsivity were higher in the alcohol dependence group than in the control group for both males and females. Impulsivity and sensation seeking were associated with hazardous alcohol use and these associations were more prevalent in females. CONCLUSIONS: Lithuanian translation of the SURPS scale was appropriate. The SURPS demonstrated good sensitivity for discriminating on alcohol dependence and was more sensitive for discriminating on hazardous alcohol use for females.


Assuntos
Alcoolismo/diagnóstico , Medição de Risco/normas , Adulto , Alcoolismo/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Lituânia , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores Sexuais , Inquéritos e Questionários , Traduções , Adulto Jovem
14.
PLoS One ; 15(7): e0235969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645097

RESUMO

Decisions surrounding the presence of infectious diseases are typically made in the face of considerable uncertainty. However, the development of models to guide these decisions has been substantially constrained by computational difficulty. This paper focuses on the case of finding the optimal level of surveillance against a highly infectious animal disease where time, space and randomness are fully considered. We apply the Sample Average Approximation approach to solve our problem, and to control model dimension, we propose the use of an infection tree model, in combination with sensible 'tree-pruning' and parallel processing techniques. Our proposed model and techniques are generally applicable to a number of disease types, but we demonstrate the approach by solving for optimal surveillance levels against foot-and-mouth disease using bulk milk testing as an active surveillance protocol, during an epidemic, among 42,279 farms, fully characterised by their location, livestock type and size, in the state of Victoria, Australia.


Assuntos
Surtos de Doenças/veterinária , Vírus da Febre Aftosa/patogenicidade , Febre Aftosa/diagnóstico , Febre Aftosa/prevenção & controle , Gado/virologia , Modelos Teóricos , Vigilância da População/métodos , Medição de Risco/normas , Animais , Austrália/epidemiologia , Febre Aftosa/epidemiologia , Febre Aftosa/transmissão
17.
Mutat Res ; 853: 503171, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32522346

RESUMO

The tests used and the general principles behind test strategies are now often over 30 years old. It may be time by now, given that our knowledge of genetic toxicology has improved and that we also technically are better able to investigate DNA damage making use of modern molecular biological techniques, to start thinking on a new test strategy. In the present paper, it is discussed that the time is there to consider a new approach for genotoxicity assessment of substances. A fit for all test strategy was discussed making use of the most recent technological methods and techniques. It was also indicated that in silico tools should be more accepted by regulatory institutes/bodies as supporting information to better conclude which tests should be required for each separate substance to demonstrate its genotoxic potency. Next to that there should be a good rationale for performing in vivo studies. Finally, the need for germ cell genotoxicity testing, essential when classification and labeling of substances is mandatory, was discussed. It was suggested to change the GHS for genotoxicity classification and labelling from in vivo tests in germ cells into in vivo tests in somatic cells. Quantitative genotoxicology was also discussed. It appeared that we are currently at a transition, where the science developing to justify carrying out human health risk assessments based on genetic toxicology data sets supported by mechanistic data and exposure data. However, implementation will take time, and acceptance will be supported through the development of numerous case studies. Major remaining questions are: is genetic damage a relevant endpoint in itself, or should the risk assessment be carried out on the apical endpoint of cancer and which genotoxic endpoint should be used to derive the point of departure (PoD) for the human exposure limit?


Assuntos
Testes de Mutagenicidade/métodos , Testes de Mutagenicidade/normas , Animais , Dano ao DNA/efeitos dos fármacos , Células Germinativas/efeitos dos fármacos , Humanos , Indústrias/métodos , Indústrias/normas , Mutagênicos/toxicidade , Neoplasias/induzido quimicamente , Medição de Risco/métodos , Medição de Risco/normas
18.
Vaccine ; 38(34): 5556-5561, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571717

RESUMO

Nucleic acid (DNA and RNA) vaccines are among the most advanced vaccines for COVID-19 under development. The Brighton Collaboration Viral Vector Vaccines Safety Working Group (V3SWG) has prepared a standardized template to describe the key considerations for the benefit-risk assessment of nucleic acid vaccines. This will facilitate the assessment by key stakeholders of potential safety issues and understanding of overall benefit-risk. The structured assessment provided by the template can also help improve communication and public acceptance of licensed nucleic acid vaccines.


Assuntos
Medição de Risco/métodos , Vacinas de DNA/efeitos adversos , Vacinas de DNA/normas , Vacinas Virais/genética , Vacinas Virais/normas , Infecções por Coronavirus/genética , Infecções por Coronavirus/prevenção & controle , Humanos , Opinião Pública , Medição de Risco/normas , Vacinas de DNA/genética , Vacinas Virais/efeitos adversos
19.
Rev Bras Epidemiol ; 23: e200060, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555929

RESUMO

INTRODUCTION: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. METHODOLOGY: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen's kappa coefficient and the intraclass correlation coefficient (ICC). RESULTS: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen's kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). CONCLUSION: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Medição de Risco/normas , Inquéritos e Questionários/normas , Traduções , Adulto , Idoso , Brasil , Comparação Transcultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores de Risco , Tradução
20.
J Clin Nurs ; 29(17-18): 3482-3493, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32564439

RESUMO

AIMS AND OBJECTIVES: The main purpose of this study was to identify the best fall-risk assessment tool, among the Morse Fall Scale, the Johns Hopkins fall-risk Assessment Tool and the Hendrich II fall-risk Model, for a tertiary teaching hospital. The study also analysed fall-risk factors in the hospital, focusing on the items of each fall assessment tool. METHODS: Data on falls were obtained from the patient safety reports and electronic nursing records of a tertiary teaching hospital. A retrospective study was conducted to compare the sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, Youden index and accuracy of the Morse Fall Scale, the Johns Hopkins fall-risk Assessment Tool and the Hendrich II fall-risk Model. This study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology guideline for reporting case-control studies. RESULTS: By analysing the association between falls and the items included in the three tools, we identified significant fall-risk factors such as gait, dizziness or vertigo, changes in mental status, impulsivity, history of falling, elimination disorder, drugs affecting falls, and depression. CONCLUSIONS: The Hendrich II fall-risk Model had the best predictive performance for falls of the three tools, considering the highest in the area under the curve and the Youden index that comprehensively analysed sensitivity and specificity, while the Johns Hopkins fall-risk Assessment Tool had the highest accuracy. The most significant fall-risk predictors are gait, dizziness or vertigo, change in mental state, and history of falling. RELEVANCE TO CLINICAL PRACTICE: To improve the fall assessment performance of the Morse Fall Scale at the study hospital, we propose that it be supplemented with four most significant fall-risk predictors identified in this study.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Medição de Risco/normas , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
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