Current status of scoliosis school screening: targeted screening of underserved populations may be the solution

Classification and prediction of spinal disease based on the SMOTE-RFE-XGBoost model

Spinal diseases are killers that cause long-term disturbance to people with complex and diverse symptoms and may cause other conditions. At present, the diagnosis and treatment of the main diseases mainly depend on the professional level and clinical experience of doctors, which is a breakthrough problem in the field of medicine. This article proposes the SMOTE-RFE-XGBoost model, which takes the physical angle of human bone as the research index for feature selection and classification model construction to predict spinal diseases. The research process is as follows: two groups of people with normal and abnormal spine conditions are taken as the research objects of this article, and the synthetic minority oversampling technique (SMOTE) algorithm is used to address category imbalance. Three methods, least absolute shrinkage and selection operator (LASSO), tree-based feature selection, and recursive feature elimination (RFE), are used for feature selection. Logistic regression (LR), support vector machine (SVM), parsimonious Bayes, decision tree (DT), random forest (RF), gradient boosting tree (GBT), extreme gradient boosting (XGBoost), and ridge regression models are used to classify the samples, construct single classification models and combine classification models and rank the feature importance. According to the accuracy and mean square error (MSE) values, the SMOTE-RFE-XGBoost combined model has the best classification, with accuracy, MSE and F1 values of 97.56%, 0.1111 and 0.8696, respectively. The importance of four indicators, lumbar slippage, cervical tilt, pelvic radius and pelvic tilt, was higher.

Disparities in Pediatric Scoliosis: The Impact of Race and Insurance Type on Access to Nonoperative Treatment for Adolescent Idiopathic Scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) has evidence-based, nonoperative treatments proven to be effective with early diagnosis and prompt treatment. The purpose of this study was to identify potential disparities in access to nonoperative treatment for AIS. Specifically, we sought to determine the interaction of socioeconomic factors on a major curve magnitude and recommend treatment at the initial presentation.

METHODS

A retrospective review of AIS patients who underwent surgery at a single tertiary pediatric hospital between January 1, 2013 and December 31, 2018 was conducted. Patients were divided into 2 groups for comparison: patients with public insurance (PUB) and those with private insurance (PRV). Primary variables analyzed were patient race, Area Deprivation Index (ADI), major curve magnitude, and treatment recommendation at the initial presentation. Univariate and multivariate analyses were conducted to identify the predictors of the major curve magnitude at presentation.

RESULTS

A total of 341 patients met the inclusion criteria; PUB and PRV groups consisted of 182 (53.4%) and 159 (46.6%) children, respectively. Overall, the major curve magnitude at presentation was significantly higher in PUB compared with PRV patients (50.0° vs. 45.1°; P =0.004) and higher in Black patients compared to White patients (51.8 vs. 47.0, P =0.042). Surgery was recommended for 49.7% of the PUB group and 43.7% of the PRV group. A lesser number of PUB patients had curve magnitudes within the range of brace indications (≤40°) compared to PRV patients (22.5% vs. 35.2%, respectively; P =0.010). The odds of having an initial major curve magnitude <40 degrees were 67% lower among Black patients with public insurance compared to Black patients with private insurance (OR=0.33; 95% CI: 0.13-0.83; P =0.019).

CONCLUSION

This study demonstrated disparity in access to nonoperative treatment for pediatric scoliosis. Black patients with public insurance were the most at-risk to present with curve magnitudes exceeding brace indications. Future work focused on understanding the reasons for this significant disparity may help to promote more equitable access to effective nonoperative treatment for adolescent idiopathic scoliosis.

LEVEL OF EVIDENCE

III.

Spinal Deformities in the Adolescent Athlete

Idiopathic scoliosis will be noted in 2% to 3% of typically developing athletes. Sports physicals are an opportunity to screen for spinal deformity and to promote healthy involvement in activities. Bracing is effective at limiting further progression if a curve progresses beyond 20°. If spinal fusion is performed, most surgeons allow return to noncontact and contact sports by 6 to 12 months. There are many other conditions associated with scoliosis that require a more nuanced approach and assessment of the entire patient. Patients with Down syndrome should be examined for myelopathy before participation and a lateral radiograph obtained if concerned for instability.

Confirmatory Factor Structure and Predictive Validity of the Early Identification System-Student Report in a Community Sample of High School Students

The purpose of this paper is to confirm the factor structure, examine the invariance, and investigate the predictive validity using disciplinary data for 5262 high school students who completed the Early Identification System-Student Response (EIS-SR). The development and theory of the EIS-SR is discussed along with prior work. Building off of prior factor analytic work with a separate sample, it was hypothesized the items of the EIS-SR would coalesce into seven factors representing Externalizing Behavior, Internalizing Behavior, Peer Relationship Problems, School Disengagement, Emotional Dysregulation, Attention and Academic Issues, and Relational Aggression. Furthermore, it was hypothesized that EIS-SR scores would be invariant with regard to gender and grade level. Lastly, it was hypothesized that students with high EIS-SR subscale scores would be predictive of school discipline events. Our analyses indicated the EIS-SR did fit the previously observed factor structure with the items loading on seven distinct scales. Tests for measurement invariance indicated support that the EIS-SR measured the seven factors equally well regardless of both gender and grade level. Lastly, EIS-SR subscale scores predicted spring office disciplinary referrals, both in and out of school suspensions, and attendance.

Screening for scoliosis - New recommendations, old dilemmas, no straight solutions

This opinion review considers the prevailing question of whether to screen or not to screen for adolescent idiopathic scoliosis. New and improved standards of people-oriented care and person-centredness, as well as improved principles of preventive screening and guideline development, have been postulated and implemented in health care systems and cultures. Recommendations addressing screening for scoliosis differ substantially, in terms of their content, standards of development and screening principles. Some countries have discontinued issuing recommendations. In the last decade, a number of updated and new recommendations and statements have been released. Systematically developed guidelines and recommendations are confronted by consensus and opinion-based statements. The dilemmas and discrepancies prevail. The arguments concentrate on the issues of the need for early detection through screening in terms of the effectiveness of early treatment, on costs and cost-effectiveness issues, scientific and epidemiologic value of screenings, and the credibility of the sources of evidence. The problem matter is of global scale and applies to millions of people. It regards clinical and methodological dilemmas, but also the matter of vulnerable and fragile time of adolescence and, more generally, children's rights. The decisions need to integrate people's values and preferences - screening tests need to be acceptable to the population, and treatments need to be acceptable for patients. Therefore we present one more crucial, but underrepresented in the discussion, issue of understanding and implementation of the contemporary principles of person-centred care, standards of preventive screening, and guideline development, in the context of screening for scoliosis.