How Do We Define Congenital Heart Defects for Scientific Studies?

Estimates of the prevalence of congenital heart defects (CHD) have been published over many years and from many regions. As they are based on different definitions of which cases to include in the CHD prevalence, published prevalence estimates vary substantially. With the increasing use of echocardiography in neonatal intensive care, a patent ductus arteriosus (PDA) or flow over the atrial septum will often be visible. These findings may be coded as CHD at discharge and in this way falsely increase the CHD prevalence in the population. There are several purposes for which population‐based data on CHD may be used: etiology, planning of treatment, or obtain information on outcome, including mortality. For etiology studies, it is important to include terminations of pregnancy as well as all births with CHD. For mortality studies in live births, inclusion of preterm born infants with PDA will increase overall mortality of CHD. The Danish Register of Congenital Heart Disease is based on hospital discharge diagnoses and diagnoses from outpatient visits. To increase the validity of these data, extensive data cleaning has been carried out based on record review and knowledge on the discharge coding practice. We include PDA and atrial septal defects as CHD cases if these defects are still open 2 months after birth. International consensus on how to define CHD would improve the validity and comparability of epidemiological studies on CHD.     

不同诊断标准下腹膜透析患者代谢综合征与大动脉僵硬度的关系

目的 对腹膜透析患者在不同诊断标准下诊断的代谢综合征与大动脉僵硬度的关系进行研究,从而确定一个最适合腹膜透析患者的标准,同时对影响大动脉僵硬度的因素进行分析.方法 选取稳定透析的持续不卧床腹膜透析患者155例,测量颈股动脉脉搏波速度作为大动脉僵硬度的评价指标,用WHO 1999、IDF 2007和ATPⅢ2001三个标准分别诊断代谢综合征,比较不同标准下代谢综合征组与非代谢综合征组脉搏波速度有无差别,并对脉搏波速度的相关因素进行分析.结果 用WHO 1999、IDF 2007和ATPⅢ2001标准诊断的合并代谢综合征的持续不卧床腹膜透析患者均比无代谢综合征患者有较高的脉搏波速度(P<0.05).脉搏波速度与持续不卧床腹膜透析患者的年龄、腰围、收缩压及血糖呈正相关(P<0.05或P<0.01),与血高密度脂蛋白胆固醇呈负相关(P<0.05),它们都是脉搏波速度的独立影响因素.结论 无论用WHO 1999、IDF 2007和ATPⅢ2001中任何一个代谢综合征标准,合并代谢综合征的持续不卧床腹膜透析患者大动脉僵硬度均较非代谢综合征患者增加.年龄和代谢综合征中多数因子均是脉搏波速度的独立影响因素.经多方考虑,我们推荐在持续不卧床腹膜透析患者用ATPⅢ标准诊断代谢综合征.     

Defining hard-to-reach populations for vaccination

Extending the benefits of vaccination to everyone who is eligible requires an understanding of which populations current vaccination efforts have struggled to reach. A clear definition of “hard-to-reach” populations – also known as high-risk or marginalized populations, or reaching the last mile – is essential for estimating the size of target groups, sharing lessons learned based on consistent definitions, and allocating resources appropriately. A literature review was conducted to determine what formal definitions of hard-to-reach populations exist and how they are being used, and to propose definitions to consider for future use. Overall, we found that (1) there is a need to distinguish populations that are hard to reach versus hard to vaccinate, and (2) the existing literature poorly defined these populations and clear criteria or thresholds for classifying them were missing. Based on this review, we propose that hard-to-reach populations be defined as those facing supply-side barriers to vaccination due to geography by distance or terrain, transient or nomadic movement, healthcare provider discrimination, lack of healthcare provider recommendations, inadequate vaccination systems, war and conflict, home births or other home-bound mobility limitations, or legal restrictions. Although multiple mechanisms may apply to the same population, supply-side barriers should be distinguished from demand-side barriers. Hard-to-vaccinate populations are defined as those who are reachable but difficult to vaccinate due to distrust, religious beliefs, lack of awareness of vaccine benefits and recommendations, poverty or low socioeconomic status, lack of time to access available vaccination services, or gender-based discrimination. Further work is needed to better define hard-to-reach populations and delineate them from populations that may be hard to vaccinate due to complex refusal reasons, improve measurement of the size and importance of their impact, and examine interventions related to overcoming barriers for each mechanism. This will enable policy makers, governments, donors, and the vaccine community to better plan interventions and allocate necessary resources to remove existing barriers to vaccination.     

Fracture-related infection: A consensus on definition from an international expert group

Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition.The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI.Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria.In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.     

Definition and treatment of microcarcinoma of the cervix uteri

Patients with tumors without vessel invasion have a better prognosis than patients with tumors of the same size with vessel invasion. The depth of stromal infiltration should be measured from the epithelial surface. In patients with an infiltration less than 1 mm, conization will be sufficient treatment, but hysterectomy is necessary when the disease is more advanced. When the tumor has infiltrated into vessels, additional treatment including pelvic lymphadenectomy or external irradiation should be performed.     

病例定义改变对流感监测系统的影响

目的评价新修订的流感样病例定义在流感监测中的适用性和灵敏性，为科学制定流感样病例定义提供参考依据。方法通过对深圳市四区2005～2007年流感样病例暴发疫情中的流感样病例个案进行回顾性分析，重点比较各种流感样症状的频率、病例定义的范围和疫情规模，使用SPSS（11．0）和EPIINFO进行统计分析。结果深圳市流感样病例暴发疫情资料真实可靠，1529例（83．6％）符合流感样病例定义，68例（3．7％）未符合流感样病例定义，未有详细流行病学调查个案232例（12．7％）。流感样病例症状前3位顺位分别为咳嗽（70．2％），头痛（46．6％）、咽痛（41．9％）。新修订的流感样病例定义与原病例定义对流感样病例的一致率为83．4％，增加“头痛”（OR=0．37，adjOR=0．29～0．48）或“流涕”（OR=0．48，adjOR=0．38～0．60）症状，能有效扩大流感样病例定义的涵盖范围。另新修订的流感样病例定义，0-4人组段的疫情规模起数明显上升（Χ^2=10．6，P〈0．01），整体上降低了流感样病例暴发疫情规模的判断。结论我国新修订的流感样病例定义清晰明确，易于操作，但涵盖范围缩小，降低对流感样病例暴发疫情规模的判断。在新修订的病例定义基础上增加“头痛”或“流涕”一项或两项症状，均能较大程度扩大病例定义的适用范围，提高代表性和灵敏性。     

Definitions of healthy eating in Spain as compared to other European Member States

Study objective: To assess what healthy eating means for the European population and whether this concept differs between Spain and other European Countries. Design: A Pan-European survey was developed between October 1995 and February 1996 by the Institute of European Food Studies (Dublin). Each subject was asked to describe in his or her own words what he/she understood by healthy eating. Comparisons were made among four groups of European countries (Northern, Central, Spain, and other Mediterranean countries). Setting: The survey included participants from the 15 member states of the European Union, selecting quota-controlled samples to make them nationally representative. Subjects: The questionnaire was completed by 14,331 persons, approximately 1000 from each country. Results: The responses were grouped into 89 broad categories of similar answers concerning nutritional value and afterwards these responses were collapsed to simplify the presentation. The definition of healthy eating such as more fiber and less fat was more prevalent in other States, members of the European Union than in Mediterranean Countries, although the definition of balanced diet was more frequently mentioned in Spain than in the rest of the European Union. Conclusions: Our results show that the concept of balance and variety is more prevalent in Spaniards than in other traditional Mediterranean countries. Differences in the definitions of healthy eating among European countries could be explained, at least partially by differences in consumption patterns and in the nutrition education.     

The insular region: Part of the prefrontal cortex?

Prefrontal and insular regions in different mammalian species are described on the basis of Brodmann's cytoarchitectonic findings. It is shown that the prefrontal cortex, defined cytoarchitectonically, and defined as the projection area of the mediodorsal thalamic nucleus, is often a considerably discordant area. An inverse relationship is assumed between the extent of insular cortex, which on the basis of mediodorsal thalamic afferents has to be termed prefrontal, and frontal cortex, which on the basis of the existence of a granular cell layer four has to be termed prefrontal. It is hypothesized that, because of a lower concordance of additional criteria, on which cortex may be termed prefrontal, and because of evidence, which makes the role of the mediodorsal nucleus for a definition of the prefrontal cortex questionable, nonprimates in comparison to primates in general will possess only “weaker copies” of the primate prefrontal cortex. Tentative support for this view is indicated.     

Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)

The International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) have come to consensus definitions for the terms epileptic seizure and epilepsy. An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.     

Evaluation of point-of-care test systems using the new definition of myocardial infarction

OBJECTIVES: To examine the proportion of patients admitted to CCU because of chest pain with a negative quantitative troponin t-test (Cardiac reader; Roche), who despite the negative test, would fulfil the new myocardial infarction criteria. A second aim was to evaluate the clinical utility of troponin I. DESIGN AND METHODS: Troponin T (Cardiac reader; Roche) was measured 12 h after the last chest pain episode. If Troponin T was negative the subjects were included in the study. All included subjects were also examined with troponin I (Stratus CS; Dade Behring) and troponin T at the central laboratory (Elecsys 2010) at the same time. 187 patients were included. CKMB was also measured 6 h after the last chest pain (Stratus CS; Dade Behring). RESULTS: Fifteen patients (8.0%) fulfilled the criteria of myocardial infarction, despite a negative Troponin T (Cardiac reader; Roche). CKMB measures did not add useful diagnostic information. The sensitivity and specificity were 100% and 95.3%, respectively for troponin I, when 0.2 microg/L was used as cut off level for myocardial infarction. CONCLUSION: In this low risk group, eight percent of the patients with a negative Troponin T (Cardiac reader; Roche) fulfilled the new criteria of myocardial infarction. Troponin I (Stratus CS; Dade Behring) appeared to be a reliable method in this group.