1
|
Ambigapathy R, Ramachandram S, Rahim FF. Referral patterns and outcomes of children who failed Modified Checklist for Autism in Toddlers screening during routine health screening at maternal and child health clinics in the northeast district of Penang: A retrospective cohort study. Malays Fam Physician 2024; 19:9. [PMID: 38496769 PMCID: PMC10944646 DOI: 10.51866/oa.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Autism spectrum disorder (ASD) is a developmental disability that causes significant social, communication and behavioural challenges. The Modified Checklist for Autism in Toddlers (M-CHAT) is a parent-administered screening questionnaire for ASD used at 18 and 36 months of age. This study aimed to determine the outcomes of children who failed M-CHAT screening during routine health screening at maternal and child health clinics in northeast district, Penang and the prevalence of ASD among those with a final diagnosis. Methods This retrospective cohort study was conducted at 12 maternal and child health clinics. All children who failed M-CHAT screening at 18 and 36 months from January 2017 to December 2021 and received a final diagnosis before 31 March 2022 were recruited. All information required was recorded in a data collection form and analysed using SPSS. Multiple logistic regression was performed to assess the association between the factors and ASD status. Results Eighty-two children failed M-CHAT screening. Fifty children did not receive a final diagnosis. Among 32 children who received a final diagnosis, 25 were diagnosed with ASD (78.1%). Among the children who underwent M-CHAT screening, the odds of having ASD increased by a factor of 1.2 for every 1-unit increase in age at final diagnosis. Conclusion In northeast district, Penang, more than half of children who fail M-CHAT screening have no final diagnosis. The specificity of the M-CHAT is 78.1% among children with a final diagnosis of ASD. The age at final diagnosis is positively associated with the diagnosis of ASD.
Collapse
Affiliation(s)
- Ranjini Ambigapathy
- MBBS, M.MED (FAM MED), Klinik Kesihatan Sungai Dua (Timur Laut), Lot 2544, Mukim 13, Gelugor, Pulau Pinang, Malaysia.
| | - Sathyabama Ramachandram
- MBBS, MRCPCH, FRCPCH, Department of Paediatrics, Penang General Hospital, Jalan Residensi Georgetown Penang, Malaysia
| | - Fairuz Fadzilah Rahim
- BScBiomed, MScMedStats, Department of Public Health Medicine, RCSI & UCD Malaysia Campus 4, Sepoy Lines Road, George Town, Penang, Malaysia
| |
Collapse
|
2
|
Yun S, Park JE, Kim N, Park SY, Kim HS. Reducing false positives in deep learning-based brain metastasis detection by using both gradient-echo and spin-echo contrast-enhanced MRI: validation in a multi-center diagnostic cohort. Eur Radiol 2023:10.1007/s00330-023-10318-7. [PMID: 37891415 DOI: 10.1007/s00330-023-10318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To develop a deep learning (DL) for detection of brain metastasis (BM) that incorporates both gradient- and turbo spin-echo contrast-enhanced MRI (dual-enhanced DL) and evaluate it in a clinical cohort in comparison with human readers and DL using gradient-echo-based imaging only (GRE DL). MATERIALS AND METHODS DL detection was developed using data from 200 patients with BM (training set) and tested in 62 (internal) and 48 (external) consecutive patients who underwent stereotactic radiosurgery and diagnostic dual-enhanced imaging (dual-enhanced DL) and later guide GRE imaging (GRE DL). The detection sensitivity and positive predictive value (PPV) were compared between two DLs. Two neuroradiologists independently analyzed BM and reference standards for BM were separately drawn by another neuroradiologist. The relative differences (RDs) from the reference standard BM numbers were compared between the DLs and neuroradiologists. RESULTS Sensitivity was similar between GRE DL (93%, 95% confidence interval [CI]: 90-96%) and dual-enhanced DL (92% [89-94%]). The PPV of the dual-enhanced DL was higher (89% [86-92%], p < .001) than that of GRE DL (76%, [72-80%]). GRE DL significantly overestimated the number of metastases (false positives; RD: 0.05, 95% CI: 0.00-0.58) compared with neuroradiologists (RD: 0.00, 95% CI: - 0.28, 0.15, p < .001), whereas dual-enhanced DL (RD: 0.00, 95% CI: 0.00-0.15) did not show a statistically significant difference from neuroradiologists (RD: 0.00, 95% CI: - 0.20-0.10, p = .913). CONCLUSION The dual-enhanced DL showed improved detection of BM and reduced overestimation compared with GRE DL, achieving similar performance to neuroradiologists. CLINICAL RELEVANCE STATEMENT The use of deep learning-based brain metastasis detection with turbo spin-echo imaging reduces false positive detections, aiding in the guidance of stereotactic radiosurgery when gradient-echo imaging alone is employed. KEY POINTS •Deep learning for brain metastasis detection improved by using both gradient- and turbo spin-echo contrast-enhanced MRI (dual-enhanced deep learning). •Dual-enhanced deep learning increased true positive detections and reduced overestimation. •Dual-enhanced deep learning achieved similar performance to neuroradiologists for brain metastasis counts.
Collapse
Affiliation(s)
- Suyoung Yun
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-Ro 88, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | | | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-Ro 88, Songpa-Gu, Seoul, 05505, Republic of Korea
| |
Collapse
|
3
|
Frithioff-Bøjsøe C, Lund MAV, Lausten-Thomsen U, Fonvig CE, Lankjær IOJ, Hansen T, Hansen T, Baker JL, Holm JC. Early detection of childhood overweight and related complications in a Danish population-based cohort aged 2-8 years. Obes Res Clin Pract 2022; 16:228-234. [PMID: 35514021 DOI: 10.1016/j.orcp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Overweight in early childhood often tracks into adolescence and adulthood and early childhood is a critical period for developing sustained overweight. This study aims to investigate the early detection of childhood overweight (including obesity) and related cardiometabolic complications in a Danish population-based cohort of children aged 2.5-8 years in collaboration with primary care municipal dental clinics and public health nurses. METHODS In this prospective population-based cohort study, 335 pre-school children (age 2.5 and 5 years) were recruited from municipal dental clinics, and 657 school children (age 6-8 years) by public health nurses. A subgroup of 392 children (40%) participated in additional hospital-based examinations including blood pressure measurement and a blood sample. Children were re-examined approximately one year later. RESULTS The prevalence of overweight was 13.73% in pre-school children and 13.69% in school children at baseline. In the pre-school children, differences in cardiometabolic risk markers between children with and without overweight were minor, whereas in school children with overweight, cardiometabolic derangements were manifest including significantly higher levels of fasting glucose, insulin, homoeostasis model of assessment for insulin resistance, triglycerides, and alanine aminotransferase and lower levels of high-density lipoprotein cholesterol. During follow-up the prevalence of overweight did not change in pre-school children but increased to 17.0% in school children. CONCLUSIONS Existing contacts with the primary health care sector, including dental care, can successfully be used for detection of overweight. This study suggests that early detection should be initiated at pre-school ages since overweight-related complications are already established by school ages.
Collapse
Affiliation(s)
- Christine Frithioff-Bøjsøe
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.
| | - Morten Asp Vonsild Lund
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Lausten-Thomsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Cilius Esmann Fonvig
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics, Kolding Hospital a Part of Lillebælt Hospital, Kolding, Denmark
| | - Ida Olivia Juhl Lankjær
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Tina Hansen
- Department of Dental Care, Holbæk Municipality, Holbæk, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jennifer Lyn Baker
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
da Costa FA, Mala-Ladova K, Lee V, Tous S, Papastergiou J, Griffiths D, Chaumais MC, Hersberger KE, Viola R, Paulino E, Lobban T, Neubeck L, Freedman B, Antoniou S. Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study. J Thromb Thrombolysis 2021; 49:606-617. [PMID: 31782043 DOI: 10.1007/s11239-019-02000-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists' success; technology enhanced engagement amongst patients and increased pharmacists' confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF.
Collapse
Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal. .,Faculdade de Farmácia, The Research Institute for Medicines (iMED.ULisboa), Universidade de Lisboa, Lisbon, Portugal.
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovského, 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Vivian Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Salvador Tous
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Travessera de Gràcia, 56, 08006, Barcelona, Spain
| | - John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Dale Griffiths
- Westview Pharmacy, 5 Glendale Road, Glen Eden, Auckland, 0602, New Zealand
| | - Marie-Camille Chaumais
- Faculté de Pharmacie, Hôpital Antoine Béclère, Université Paris-Sud, 157, Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Pharmazentrum, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Reka Viola
- Faculty of Pharmacy, University of Szeged, Zrínyi u. 9, Szeged, 6720, Hungary
| | - Ema Paulino
- Farmácia Nuno Álvares, Avenida D. Nuno Álvares Pereira, 39-C, Almada, Portugal
| | - Trudie Lobban
- Atrial Fibrillation Association (AF Assoc)/ Arrhythmia Alliance (A-A), AF Association, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire, OX7 5SR, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthil Campus, Sighthill Court, Edinburgh, EH11 4BN, Scotland, UK
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney, John Hopkins Dr, Camperdown NSW, Sydney, 2006, Australia
| | - Sotiris Antoniou
- Barts Health NHS Trust, UCL Partners, 9 Prescot Street Aldgate, London, E1 8PR, UK
| |
Collapse
|
5
|
Abstract
There are many instruments for screening cognitive impairment. The common tools for screening cognitive impairment are categorized into 4 groups (very brief, brief, self-administered, and test batteries) in geriatrics. There are some tests used for specific tests of 6 cognitive domains (learning and memory, language, executive function, complex attention, and social cognition) by following the DSM-V criteria. Different settings, stages, conditions, and specific people need some specific tools for screening cognitive impairment. It must be noted that there is some harm in screening for cognitive impairment in geriatrics.
Collapse
Affiliation(s)
- Ziqi Wang
- Department of Neurology, Chengdu Fifth People's Hospital, No. 33 Mashi Street, Chengdu, Sichuan, China 611130
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China 610041.
| |
Collapse
|
6
|
Abstract
A low birth rate in addition to an increasing life expectancy within the context of an aging population characterize the current demographic situation in Germany. Cancer is primarily a disease of old age and the frequency increases with an expanding older population. In 2013, cancer was the second most common cause of death in Germany. With the aid of screening examinations cancer should be detected in the early stages so that suitable therapeutic measures can be initiated. In Germany, screening is currently offered for breast, cervical, colorectal, skin and prostate cancer and is covered by the statutory health insurance. Mammography screening is the only organized screening program in Germany. Eligible women are regularly invited to attend this program, which is not the case for the other types of cancer screening. In accordance with the Cancer Screening and Registry Act (KFRG) of 2013, colorectal and cervical cancer screening will also be implemented as organized screening programs in the future. As is the case in the mammography screening program, those eligible to participate will receive an invitation letter and the new programs are to be continually monitored, documented and evaluated.
Collapse
Affiliation(s)
- U Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Schlanstedt-Jahn
- Tumorepidemiologie, Universitäts KrebsCentrum, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S J Klug
- Tumorepidemiologie, Universitäts KrebsCentrum, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| |
Collapse
|
7
|
Kang JH, Hong SJ, Seo IA, Kwak MH, Cho SM, Kim DK, Choi SM, Lee DS. Early Detection of Kawasaki Disease in Infants. Korean Circ J 2015; 45:510-5. [PMID: 26617654 PMCID: PMC4661367 DOI: 10.4070/kcj.2015.45.6.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives This study aimed to investigate the clinical characteristics of infantile Kawasaki disease (KD), and to evaluate early diagnostic features of KD in febrile infants. Subjects and Methods We retrospectively reviewed the medical records of 64 KD patients from January 2010 to October 2014. There was an analysis of the clinical, laboratory data of the infants versus children groups. Furthermore, the clinical and laboratory data of infantile KD patients were compared with 16 infants who were admitted for other acute febrile diseases. Results A total of 64 patients with KD were identified; 20 (31.3%) were infants; 44 (68.8%) were >1 year old children. Incomplete KD was much more common in infants (n=13, 65.0%) than in children group (n=14, 31.8%) (p=0.013). The infants were characterized by significantly higher rates of inflammatory changes at the Bacille Calmett-Guérin (BCG) inoculation site (p<0.001), but lower rates of changes in the extremities (p=0.029) and cervical lymphadenopathy (p=0.006). The serum levels of platelet after 1 week (p=0.005), C-reactive protein (p=0.038), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0.026) were all significantly higher in the infants group. Comparing the infants with KD versus the other acute febrile diseases, there were significantly higher serum levels of erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.046) and NT-proBNP (p=0.001) for the infants with KD group. Conclusion BCGitis and higher levels of NT-proBNP can be helpful for early diagnosis of the incomplete KD in infants, and may be a good predictor of KD in acute febrile infants, when combined with other acute phase reactants.
Collapse
Affiliation(s)
- Ji Hae Kang
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Seung Ji Hong
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - In Ae Seo
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Min Ha Kwak
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Seung Man Cho
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Doo Kwon Kim
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Sung Min Choi
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Dong Seok Lee
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| |
Collapse
|
8
|
Abstract
General health checks are intended to identify risk factors or detect early signs of disease and to reduce mortality and morbidity from the disease by early interventions. Screening tests are not always beneficial; therefore, they have to be critically assessed with respect to the benefits and harms. Especially for general health checks there seems to be less awareness for potential harms than for other screening procedures because the diagnostic interventions are mostly less invasive and have low-risks of direct harms, such as ultrasonography or electrocardiography (ECG). Healthcare providers increasingly offer screening tests as individual out-of-pocket health services (Individuelle Gesundheits-Leistungen, IGeL) to patients without providing comprehensive information about the benefits and harms which would be necessary to enable informed decision-making. The article describes the current evidence and the methodological issues in the benefit assessment of general health checks in order to encourage a critical discussion on screening tests.
Collapse
|
9
|
Abstract
This article explains some important concepts of screening and early detection. It also discusses under which circumstances screening is useful, who can profit from screening and which persons may be at risk from screening procedures. Before the introduction of a screening program, empirical studies on the effectiveness are necessary to evaluate whether a screening program could be successful.
Collapse
|