Cross-Cultural Translation and Adaptation to Brazilian Portuguese of the Paediatric Pain Profile in Children With Severe Cerebral Palsy

ContextPain is a prevalent symptom in children with severe cerebral palsy (CSCP), mainly as a result of the progression of muscle contractures, bone deformities, gastroesophageal reflux, and recurrent infections. Considering the lack of verbal communication in this population, both pain diagnosis and assessment of the analgesic treatment are often neglected. Although the Paediatric Pain Profile (PPP), an instrument with 20 items, is used to assess behavior indicative of pain in CSCP, it is not validated in Brazil.ObjectivesTo translate, adapt, and evaluate the psychometric properties of the PPP to Brazilian Portuguese.MethodsThe study was carried out at a philanthropic institution for CSCP and a university hospital. The sample of CSCP unable to communicate through speech or any device, their respective parents or primary caregivers, and health professionals were included. First, the instrument was translated and then back translated, and its clarity was evaluated by parents, primary caregivers, and professionals. The psychometric properties of the final version were evaluated for internal consistency (Cronbach's α) and stability (test-retest).ResultsForty-five children with a mean (SD) chronological age of 16 (8.69) years, 26 of whom were male, were included in the study. A total of 150 applications of PPP were carried out: 30 to assess clarity and 120 to assess the psychometric properties. Each item of the translated version showed a median between 3.00 and 4.00, considered to be clear and very clear, respectively. The internal consistency of the items was α = 0.864, with no significant difference between test and retest (P = 0.271).ConclusionThe adapted version of the PPP in Brazilian Portuguese demonstrated good internal consistency (similar to the original instrument) and stability over time, decisive for the next step of clinical validation for CSCP.     

Translation of the short version of the Smartphone Addiction Scale into Brazilian Portuguese: cross-cultural adaptation and testing of measurement properties

BackgroundSmartphone use has been constantly increasing. Smartphone addiction can lead to changes in the emotional state and musculoskeletal system of users. To identify smartphone addicts, the Smartphone Addiction Scale-Short Version was developed; however, this scale has not been translated into Brazilian Portuguese and tested for its measurement properties.ObjectiveTo translate and cross-culturally adapt the Smartphone Addiction Scale-Short Version into Brazilian Portuguese; to assess the internal consistency, reliability and construct validity of the scale among university students.MethodsThe cross-cultural adaptation was performed following the guidelines for cross-cultural adaptation of self-report measures, and data were collected via online surveys administered to 59 university students over 18 years of age for test–retest. To test the measurement properties of the final version of the Smartphone Addiction Scale-Short Version, a convenience sample including 130 university students was used.ResultsThe Smartphone Addiction Scale-Short Version showed good reliability for test–retest scores (ICC_3,1 = 0.82; 95% CI = 0.70–0.89) and good internal consistency considering all 10 items (Cronbach's alpha = 0.95). The construct validity was calculated comparing the Smartphone Addiction Scale-Short Version score to data from a questionnaire prepared by the authors of this study, including frequency per day (r = 0.35; p < 0.001), leisure time on the smartphone (r = 0.33; p < 0.001), and time working on the smartphone (r = 0.18; p = 0.04) that were significantly positively associated with higher Smartphone Addiction Scale-Short Version scores. The results show a high prevalence of smartphone addiction among university students (33.1%).ConclusionIt can be concluded that the Brazilian Portuguese version of the Smartphone Addiction Scale-Short Version is a reliable and valid tool for screening smartphone addiction in university students.     

Newborn screening for hepatorenal tyrosinemia-I by tandem mass spectrometry using pooled samples: A four-year summary by the New England newborn screening program

ObjectiveThe objective of this study is to develop an isotope dilution liquid chromatography tandem mass spectrometry assay to screen for hepatorenal tyrosinemia (HT) from newborn filter paper samples using pooled extracts to increase high throughput screening.Design and methodsSuccinylacetone (SUAC), the marker for HT, was extracted from dried blood spots with the formation of the hydrazone derivative of SUAC; up to eight sample extracts were pooled and the SUAC-derivative was analyzed by mass spectrometry methods with an injection-to-injection time of one minute. If any pooled sample extract screened positive, then the samples comprising the pooled sample were assayed individually.ResultsTwo newborn infants were identified with high levels of SUAC (7 & 23 μM) and later confirmed to have HT. Three older children whose initial filter paper samples were taken at 195 days to 614 days of age with elevated SUAC (range 4.9–5 μM) were identified; one of the three had clinical signs of HT and was placed on treatment (diagnosis of the other two are unavailable).ConclusionMS/MS analysis of pooled dried blood sample extracts permits sensitive, reduced instrumental analytical time and increase high throughput screening for HT.     

Validación de la escala CUIDAR-MaPre: una herramienta para medir la competencia de las madres en el cuidado de sus hijos prematuros

ObjectiveTo determine the validity and reliability of the CUIDAR instrument in mothers of premature infants.MethodCross-sectional validation study. The study was conducted in two stages. First stage: literature review, semantic adequacy, and judgement with 7 experts to establish content validity. In the second stage, the psychometric properties of the instrument were evaluated by exploratory factor analysis after its application to 207 mothers of premature infants.ResultsIn the expert's judgment, the content validity index was higher than 0.8, which indicated adequate representativeness of the items. Agreement between judges was moderate with a Fleiss Kappa of 0.51. The exploratory factor analysis established the adequacy of the sample with a Kaiser-Mayer-Olkin statistic of 0.859 and Bartlett's test of sphericity 2953.9 (p = .000). After considering various scenarios, a 7-dimensional, 33-item model explained 57.9% of the variance, with an overall Cronbach's alpha of 0.852 and adequate goodness-of-fit indices. The goodness-of-fit tests allowed us to establish through statistical significance χ² = 0.01, CFI = 0.92, BIC =  > 10 and RMSEA = 0.05 indicating that the model has a good fit.ConclusionsA new model was identified based on the items and dimensions of the CUIDAR instrument, which allows us to assess the competence of mothers to care for their premature children in a valid and reliable way.     

Increased MMA concentration and body mass index are associated with spontaneous abortion in Brazilian women: A pilot study

BackgroundThe pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age, body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin B6) and vitamin-dependent metabolites were analyzed.MethodsStudy population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP.ResultsEighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th–75th percentile] = 274 [149–425] nmol/l) relative to Group 1 (138 [98–185]) (P < 0.01). No differences between the groups were observed for serum cobalamin, serum or red cell folate, and serum total homocysteine or allele frequencies for 8 polymorphisms. In a conditional logistic regression analysis including age, gestational age, serum creatinine, MMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI] = 3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI] = 5.49 [1.29, 23.39] per quartile) and gestational age (OR [95% CI] = 0.10 [0.01, 0.77] per increase of interval in gestational age).ConclusionsIncreased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women.     

Free thyroxine and thyroid-stimulating hormone reference intervals in very low birth weight infants at 3–6 weeks of life with the Beckman Coulter Unicel DxI 800

ObjectivesTo establish reference intervals for thyroid stimulating hormone (TSH) and free thyroxine (FT4) at 3–6 weeks of age in very low birth weight (VLBW) infants with the Beckman Coulter Unicel DxI 800 by gender, birth weight (BW) and gestational age (GA) subgroups.Design and methodsA 4 year retrospective cohort of 308 VLBW infants (GA = 27.9 weeks, BW = 992.3 g) was studied. All blood samples for TSH and FT4 were analyzed using the modified fTSH2 (TSH) and two-step competitive enzyme immunoassay (FT4). Reference intervals were evaluated according to the most recent Clinical and Laboratory Standards Institute (CLSI) guidelines.ResultsThe study provides non-parametric 95% reference intervals with associated 90% confidence intervals for FT4 and TSH derived from 308 infants screened at a median of 31 days. The reference intervals for this population are TSH = 1.14–11.04 mIU/L and FT4 = 10.9–21.4 pmol/L. TSH statistically differed according to birth weight (< 1000 g vs 1000–1499 g) while FT4 differed according to gender and gestational age at time of testing (< 32 weeks vs ≥ 32 weeks); however, these differences were not clinically significant and a single reference interval for each analyte is reported.ConclusionThe results of this study highlight the importance and complexity of establishing appropriate reference intervals for thyroid function testing for the preterm population.     

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

ContextNurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting.ObjectivesTo examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge.Design and settingCross sectional analysis combining nurse survey data with infant discharge data.ParticipantsA national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997).MethodsSequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support).ResultsThe majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001).ConclusionsNeonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.     

Resultados maternos y perinatales en gestantes nulíparas con preeclampsia de aparición tardía: estudio comparativo frente a gestantes sin preeclampsia

ObjectiveTo assess obstetrical outcomes in a sample of nulliparous gestations with preeclampsia, as compared to gestations without preeclampsia, attended in the Enrique C. Sotomayor Hospital of Guayaquil, Ecuador.MethodThis was a comparative study of maternal and perinatal outcome data of gestations with late onset preeclampsia (n = 150; gestational age = 36.7 ± 3.3 weeks) with that of normal gestations (n = 150; gestational age 38.7 ± 1.7 weeks).ResultsAlmost three-quarters (73.3%) of preeclampsia cases were defined as severe. Compared to normal gestations, preeclampsia cases had higher anthropometric indices (neck and mid-arm circumference) and had more oligohydramnios, cesarean sections, transfusions, distressed fetuses, and adverse perinatal outcomes such as, lower Apgar scores at birth, and more preterm births, lower birth weight and small for gestational age infants.ConclusionGestations with preeclampsia had a negative impact on maternal and perinatal outcomes compared to gestations without preeclampsia.     

Satisfaction levels with physical therapy in hospitalized patients

BackgroundPatient's satisfaction level is considered an indicator that interferes with interventions effectiveness. There is evidence from other health professionals that patients with higher satisfaction level recover faster. However, benefits toward physical therapy intervention is poorly known.ObjectiveTo measure the inpatient satisfaction level receiving physical therapy care and to evaluate which aspects of these treatments are flawed.MethodsPatients admitted to hospital were evaluated using MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) that scores from 1 to 5 (higher values indicate higher satisfaction) for each item. Patients clinical and demographic characteristics and the Global Perceived Effect (GPE) were also collected. Exploratory factor analysis was conducted.Results200 patients were evaluated (50.9 ± 18.81 years, 58% male). Most of MRPS items were above 4. The highest scoring item (4.75) was physical therapist's respect to the patient. The lowest scoring item (1.82) was in relation to physical therapy guidelines at hospital discharge. Mean MRPS total score and GPE were 46.09 ± 4.93 and 2.18 ± 1.18, respectively.ConclusionThe majority of patients are satisfied and showed improvement after physical therapy treatment. There is the need for advances and intervention in relation to physical therapy guidelines at hospital discharge. MRPS instrument proved to be appropriate to measure inpatient's satisfaction level with physical therapy care.     

Non-nutritive sucking,oral breast milk,and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective,randomized controlled trial

BackgroundPreterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous.AimsWe compared the effects of combined sucking+ breast milk, sucking + breast milk + tucking, and routine care on preterm infant pain during and after heel-stick procedures.DesignA prospective, randomized controlled trial.SettingsLevel III neonatal intensive care unit and a neonatal unit at a medical center in Taipei.Participants/subjectsPreterm infants (N = 109, gestational age 29–37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking + breast milk + tucking.MethodsPain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10 min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4–8).ResultsFor infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2–8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values < 0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2–8 (all p-values < 0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care.ConclusionThe combined use of sucking + breast milk +tucking and sucking + breast milk effectively reduced preterm infants’ mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants’ procedural pain.     

NASCAR pit-stop model improves delivery room and admission efficiency and outcomes for infants <27 weeks’ gestation

AimTo evaluate a new process based on teamwork in a manner similar to the race car pit stop on organization and efficiency during the “Golden Hours” for extremely preterm infants.MethodsA team designed an improved process focused on checklists, preparation, assigning roles, and best practices, for the care of infants <27 weeks’ gestation in the delivery room (DR) through admission to the neonatal intensive care unit (NICU). Clinical outcomes 2 years before and after implementation were analyzed. A survey was administered to NICU staff prior to and 14 months after implementation. The survey assessed organization and efficiency in the DR and during the admission process of the target population.ResultsThere were 62 inborn infants prior to and 90 infants after implementation with overall survival of 90.3% and 86.6%, respectively (p = 0.61). Infants were more stable on admission with a mean arterial blood pressure equal to or greater than their gestational age in the post intervention group compared to the pre-cohort (76% vs 57%, p = 0.02) and discharged home at a lower mean postmenstrual age (39.0 ± 2.2 vs 40.1 ± 3.5 weeks, p = 0.04) The survey demonstrated improvement in assessment of roles being clearly defined in the DR and in the organization and the efficiency both in the DR and during the NICU admission (p < 0.05).ConclusionsA systematic approach to the care of the <27 weeks’ gestation neonate increased staff perception of improved organization and efficiency in the DR through admission processes and improved outcomes.     

Reference range of thyroid function (FT3, FT4 and TSH) among Indian adults

ObjectivesTo generate thyroid hormone reference norms using electro-chemiluminescence technique.Design and methodsCross sectional study on apparently normal 4349 Delhi adults (18–86 years). Predetermined exclusion criteria (goiter, hypoechogenicity or nodularity on ultrasound, elevated anti-thyroid peroxidase antibody, hypo or hyperthyroidism and family history of thyroid dysfunction) excluded 2433 subjects leaving 1916 (916 males and 1000 females) as the reference population.ResultsMean age and BMI of the reference population were 41.2 ± 18.1 years and 24.5 ± 4.4 kg/m² respectively. Median urinary iodine excretion was 233.6 μg/L (79–458;3rd–97th centile). The population was categorized into various age groups (18–30, 31–40, 41–50, 51–60, 61–70 and ≥ 70 years). Overall FT3 and FT4 values in the reference population irrespective of age, ranged from 2.4–8.8 (mean 4.6 ± 0.9) pmol/L and 10.1–24.8 (mean 15.40 ± 2.0) pmol/L, respectively. Mean TSH value in the reference population was 2.2 ± 0.9 mIU/L which was significantly lower than that of total population (3.8 ± 6.1; p < 0.001).ConclusionFT3 values were observed to be significantly higher in men than women (p = 0.001). The centiles (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) of FT3, FT4 and TSH were derived for reference purposes in Indian adults. This community based study in Indian adults has established mean reference intervals for FT3, FT4 and TSH for different age groups for both sexes separately using strict exclusion criteria. These can be used as reference norms for Indian adults.     

The assessment of disability in children and adolescents with headache: Adopting PedMIDAS in an epidemiological study

ObjectiveThe study aimed at the assessment of disability in children with headache (n = 1585, 11–14 yrs) from a randomly drawn population based sample. We explored the suitability of the PedMIDAS in epidemiological research by various indicators of response quality. Furthermore, predictors of disability were examined, as well as its association with measures of health care behaviour.MethodsThe PedMIDAS measures functional interference in different domains of life by asking the children for the number of days that their headache partially or totally interfered with their activities.ResultsThe examination of response behaviour revealed a marked attrition of responses (missing, invalid) in two items. As a consequence, the total score for disability could not be obtained for about 25% of the children. Analysis of homogeneity of the PedMIDAS items revealed low item/total correlations in two items. The grading of disability resulted in 81.2% of all children with headache showing no or low disability. Only 1.4% was “severely” disabled. Disability was predicted by frequency, type and intensity of headache. From all psychological variables only dysfunctional stress coping was significantly associated with disability. Disability itself was significantly associated with medical consultation.ConclusionsSuitability of the PedMIDAS for epidemiological research was supported, however with a caveat and recommendations for item revision. Severe disability due to headache was rare in the studied unselected sample when defined by behavioural interference. It is suggested to explore the construct of disability by a multi-method approach, including further instruments assessing headache related distress, (respectively) quality of life.     

Monitoring salivary testosterone and cortisol concentrations across an international sports competition: Data comparison using two enzyme immunoassays and two sample preparations

ObjectivesSalivary testosterone (T) and cortisol (C) concentrations were monitored across a sports competition. Data were compared using two enzyme-immunoassay (EIA) methods and two sample preparations to determine their influence on hormone concentrations.Design and methodsA group of male athletes (n = 19) provided a saliva sample the morning before and one day after (24 h post) an international rugby union match. Following an extraction procedure, the samples were analysed for T and C concentrations using a commercial kit (CM^E) and an in-house method (IH^E). Raw samples (no extraction procedure) were also tested using the commercial kit (CM^R).ResultsThere were no significant changes in T and C levels from pre to post competition with each EIA method and sample preparation, but significant differences in T (IH^E > CM^E > CM^R) and C (CM^R > IH^E and CM^E) concentrations were seen when both samples were pooled. Bland–Altman analyses confirmed the presence of fixed and proportional bias. Strong and significant correlations were demonstrated between the IH^E and CM^E measures of salivary T (r = 0.93–0.97) and C (r = 0.95–0.97). The T and C values from the raw and extracted samples were also strongly correlated (r = 0.93–0.96).ConclusionsThe measurement of salivary T and C concentrations across an international sports event was influenced by different EIA methods and sample preparations, but all measures were strongly correlated with some bias. Both T and C were unresponsive to the sports event, but within the group results large individual variation was seen.     

A clinical prediction tool for hospital mortality in critically ill elderly patients

BackgroundVery elderly (80 years of age and above) critically ill patients admitted to medical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and living in a dependent state should they survive.ObjectiveThe objective was to develop a clinical prediction tool for hospital mortality to improve future end-of-life decision making for very elderly patients who are admitted to Canadian ICUs.DesignThis was a prospective, multicenter cohort study.SettingData from 1033 very elderly medical patients admitted to 22 Canadian academic and nonacademic ICUs were analyzed.InterventionsA univariate analysis of selected predictors to ascertain prognostic power was performed, followed by multivariable logistic regression to derive the final prediction tool.Main resultsWe included 1033 elderly patients in the analyses. Mean age was 84.6 ± 3.5 years, 55% were male, mean Acute Physiology and Chronic Health Evaluation II score was 23.1 ± 7.9, Sequential Organ Failure Assessment score was 5.3 ± 3.4, median ICU length of stay was 4.1 (interquartile range, 6.2) days, median hospital length of stay was 16.2 (interquartile range, 25.0) days, and ICU mortality and all-cause hospital mortality were 27% and 41%, respectively. Important predictors of hospital mortality at the time of ICU admission include age (85-90 years of age had an odds ratio of hospital mortality of 1.63 [1.04-2.56]; > 90 years of age had an odds ratio of hospital mortality of 2.64 [1.27-5.48]), serum creatinine (120-300 had an odds ratio of hospital mortality of 1.57 [1.01-2.44]; > 300 had an odds ratio of hospital mortality of 5.29 [2.43-11.51]), Glasgow Coma Scale (13-14 had an odds ratio of hospital mortality of 2.09 [1.09-3.98]; 8-12 had an odds ratio of hospital mortality of 2.31 [1.34-3.97]; 4-7 had an odds ratio of hospital mortality of 5.75 [3.02-10.95]; 3 had an odds ratio of hospital mortality of 8.97 [3.70-21.74]), and serum pH (< 7.15 had an odds ratio of hospital mortality of 2.44 [1.07-5.60]).ConclusionWe identified high-risk characteristics for hospital mortality in the elderly population and developed a Risk Scale that may be used to inform discussions regarding goals of care in the future. Further study is warranted to validate the Risk Scale in other settings and evaluate its impact on clinical decision making.     

Association of sociodemographic factors and prostate-specific antigen (PSA) testing

ObjectivesThere are conflicting recommendations regarding the use of prostate specific antigen (PSA) as a screening test. Integral to this debate is an understanding of who is currently being tested. The purpose of this study was to provide a detailed account of PSA testing practices in a major Canadian city (Calgary, Alberta) and to identify variables that may affect access to the PSA test.Design and methodsPSA test counts were retrieved from Calgary Laboratory Services' Laboratory Information System from January 1, 2011 to December 31, 2011. A total of 75,914 individual PSA tests were included in our analysis. The frequency of PSA testing was plotted onto a dissemination area map of Calgary using ArcGIS software. Associations with sociodemographic variables were tested using Poisson regression.ResultsThe median PSA value was 0.93 μg/L and the median age at collection was 58 years. Forty-three percent of men aged 60–69 received a PSA test. Visible minority status ‘Black’ (P = 0.0002) and Métis status (P = 0.0075) were associated with lower PSA testing frequencies, while median household income (P = < 0.0001) and university education (P = < 0.0001) were associated with higher PSA testing frequencies.ConclusionThere are areas in Calgary which are significantly over or under tested relative to the mean. The amount of PSA testing in men < 50 years of age is increasing, which is contrary to PSA testing guidelines.     

Direct determination of tin in whole blood and urine by GF AAS

ObjectiveThe aim of this work was to develop a procedure for the determination of tin in whole blood and urine by GF AAS with a minimum sample pre-treatment, using Pd/Mg as chemical modifier.Design and methodsThe analyses of tin were conducted using an atomic absorption spectrometer with Zeeman background correction. The laboratory staff volunteered blood and urine samples for the experimental studies and application of the methodology.ResultsSamples were just diluted with 0.2% v/v Triton X-100, and pyrolysis and atomization temperatures of 1300 and 2200 °C were used. External calibration was performed with matrix matched calibration solutions. Limits of detection of 2.7 and 0.8 μg L^? 1 were reached for blood and urine, respectively. The method was applied to the determination of Sn in blood and urine of eleven subjects not occupationally exposed, working in a laboratory of toxicology in a large Brazilian city, and the results ranged from 7.4 to 11.2 μg L^? 1 and ≤ 0.8 to 2.2 μg L^? 1, for blood and urine, respectively. Accuracy was assessed by analysis of standard reference materials for tin in blood (Contox I, lot TM144-1097, Kaulson Laboratories, USA) and urine (Seronorm, lot 0511545, Sero AS, Norway).ConclusionsResults showed good agreement between experimental and reference values according to the Student's t test at 95% of confidence.     

Reliability of two functional clinical tests to evaluate trunk and lumbopelvic neuromuscular control and proprioception in a healthy population

ObjectivesThe need to accurately assess trunk and lumbopelvic proprioception and neuromuscular control is widely accepted. However, based on current literature, there is a lack of reliable clinical tests to evaluate these aspects in clinical practice. The objective of this study is to investigate intra- and inter-tester reliability of the lateral step down test and the lumbopelvic position–reposition test in a healthy population.MethodsProtocol and scoring methods were developed for the lateral step down test and lumbopelvic position–reposition test, used to assess trunk and lumbopelvic neuromuscular control and proprioception respectively. Each test was performed once by thirty participants and video analysis for test scoring was performed. Three items on the lateral step down test were scored to evaluate neuromuscular control and, four items on the lumbopelvic position–reposition test were scored to evaluate proprioception. Aggregate scores for each test were calculated based on the separate item scores. Intraclass correlation coefficients and linear weighted kappa coefficients were determined for intra- and inter-tester reliability.ResultsBased on the aggregate score, excellent intra- and inter-tester reliability (ICC (2,1) = 0.73–0.88) was found for both tests. Moderate/almost perfect intra-and inter-tester agreement (K = 0.62–0.91) was found for the separate items of the lateral step down test and fair/substantial agreement (K = 0.25–0.76) for the items of the lumbopelvic position–reposition test.ConclusionCurrent testing protocol and scoring method for the lateral step down test is reliable. Adjustments for the scoring method of the lumbopelvic position–reposition test are warranted to improve reliability.