Abstract Background Fathers are increasingly involved in infant care, and depression in postnatal fathers as well as mothers may have negative effects on child development and behaviour. The EPDS has ...been validated to identify depression in new mothers, but few validation studies have involved fathers and there is doubt as to whether the EPDS measures the same constructs in men as in women. Subjects and methods A population-based sample of 1014 couples were sent the EPDS and the HAD-A subscale 3 months postnatally. All high-scoring fathers and a random sample of fathers scoring low were invited for a diagnostic interview to assess the presence of any depression or anxiety disorder. A factor analysis of the EPDS data was conducted for mothers and fathers. Findings A factor analysis of the EPDS data revealed a different factor structure for fathers, implying that the scale picks up more worry, anxiety and unhappiness than depression. The EPDS yields high sensitivity and specificity, but low positive predictive value when screening for probable major depression at the optimal cut-off score of 12 or more. The accuracy of the EPDS, however, is modest for minor depression, and low for anxiety disorders. Neither the EPDS-3A score nor the HAD-A subscale reached acceptable validity in this study. Conclusions The EPDS seems to pick up more distress than pure depression in new fathers. It is a valid instrument for screening for probable major depression, but it is questionable if it should be used to screen for minor depression. Neither the EPDS nor the HAD-A subscale can be recommended for screening for anxiety in postnatal fathers. Limitations Confidence intervals around the estimates are wide and the interviewed fathers were selected preferentially.
Diagnosing narcolepsy without cataplexy is often a challenge as the symptoms are nonspecific, current diagnostic tests are limited, and there are no useful biomarkers. In this report, we review the ...clinical and physiological aspects of narcolepsy without cataplexy, the limitations of available diagnostic procedures, and the differential diagnoses, and we propose an approach for more accurate diagnosis of narcolepsy without cataplexy.
A group of clinician-scientists experienced in narcolepsy reviewed the literature and convened to discuss current diagnostic tools, and to map out directions for research that should lead to a better understanding and more accurate diagnosis of narcolepsy without cataplexy.
To aid in the identification of narcolepsy without cataplexy, we review key indicators of narcolepsy and present a diagnostic algorithm. A detailed clinical history is mainly helpful to rule out other possible causes of chronic sleepiness. The multiple sleep latency test remains the most important measure, and prior sleep deprivation, shift work, or circadian disorders should be excluded by actigraphy or sleep logs. A short REM sleep latency (≤ 15 minutes) on polysomnography can aid in the diagnosis of narcolepsy without cataplexy, although sensitivity is low. Finally, measurement of hypocretin levels can helpful, as levels are low to intermediate in 10% to 30% of narcolepsy without cataplexy patients.
Summary
Little attention has been paid to the long‐term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general ...health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow‐up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence.
With increasing life expectancy and improved preventive measures, teeth are retained longer, leading to a rise in prevalence of root caries lesions (RCL). However, little is known about how dentists ...manage this condition. The present survey aimed to evaluate the knowledge of Swiss dentists on decision making and management of RCL.
The survey evaluated dentists' knowledge, clinical routines, and demographics concerning RCL. Dentists were contacted via email and local newsletters, and 383 dentists from 25 (out of 26) cantons responded. Mann-Whitney U test, χ2 test, intraclass correlation coefficients, Spearman correlation and Chi Square were used.
The dentists had a mean(SD) working experience of 22.5(12) years. Most dentists correctly classified an inactive (67%) and an active (81%)RCL. Although the inactive lesion did not call for restorative treatments, 61% of the dentist declared they would restore it. From the active lesion,83% would restore it. The invasive treatments leaned toward complete caries excavation with composite resin as preferred restorative material. There were significant correlations between material choice and expected success rates. Among the non-invasive options, oral hygiene instructions and (highly-)fluoridated toothpaste were favored. Most dentists declared having a recall system for such patients, with biannual follow-ups preferred. The dentists’ place of education significantly influenced restorative decisions (p < 0.001), while participants’ age (≥60years) impacted activity status (p = 0.048) and restorative decisions (p = 0.02).
Material preferences for non-invasive or invasive management varied greatly and there were minimal differences in the management of inactive or an active RCL. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones.
Despite diverse material preferences for (non-)invasive treatments, a strong positive correlation existed between the chosen restorative material and its expected 2-year success rate. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. The outcome emphasis the need to align guideline recommendations with their application in private dental practices.
A dyslexia diagnosis in Denmark can have significant consequences for individuals, as support is not available to others with reading difficulties. Currently, the diagnosis is given solely on the ...basis of an electronically administered test consisting of two tasks assessing grapheme-phoneme correspondences. To examine whether the Danish diagnostic test is sufficient to identify university students with dyslexia, we compared the performance of 239 Danish university students who reported literacy difficulties and were tested for dyslexia with the Danish diagnostic test on three word-level tests (low-frequency word reading, high-frequency word reading and spelling to dictation) with the performance of separate control groups for each test: 220, 212 and 218 students, respectively. The results showed that 61% of students labelled “not dyslexic” by the Danish diagnostic test performed significantly worse than controls on at least two out of three word-level tests. In terms of self-report of literacy difficulties, students labelled “not dyslexic” by the diagnostic test were indistinguishable from those labelled “dyslexic.” These findings suggest that the current method of diagnosing dyslexia in Denmark is too narrow and that adding a few simple tests of word reading and spelling would minimize the risk of overlooking students in need of literacy support.
Pediatric Failure To Thrive (FTT), commonly presented in young infants, is often not diagnosed on time or missed. Lack of timely infants’ diagnosis can adversely affect their growth and development. ...We have developed and successfully tested FTTell—a model‐based system for diagnosing FTT during common pediatric follow up. FTTell is an executable model‐based diagnostic tool for diagnosing FTT. We use Object‐Process Methodology extended with Methodical Approach to Executable Integrative Modeling, enabling qualitative considerations and quantitative parameters of the problem to be modeled jointly, enabling FTT diagnosis. The validity of FTTell is demonstrated on data collected from 100 infants. For each child, FTTell calculates a score indicating FTT presence and severity. We compared the systems’ outcomes to a pediatric gastroenterologist expert severity assessment. Of the 100 infants, the system initially yielded 82% validity. Reassessment improved it to 87% validity. Pediatricians may miss infants with FTT, especially in borderline cases. FTTell can effectively serve as a FTT diagnosis tool, boosting pediatricians’ correct diagnosis and proper investigation. Our cloud‐based system can be continuously updated with the latest research findings. FTTell can diagnose FTT and its severity in infants with 87% accuracy. Pediatricians can use this model‐based standardized approach to improve their FTT diagnosis and provide appropriate timely intervention when needed. Model‐based diagnosis is a novel application of conceptual models, and OPM ISO 19450 is especially fit for this purpose. The model‐based diagnosis approach can be extended beyond medicine to diagnosing problems with engineered, technological, and socio‐technical systems.
•Novel ZIF decorated HA nanocontainer with stimulus responsiveness were developed.•Encapsulation of Phen in nanocontainer can be easily achieved by one-step method.•Localized corrosion can be timely ...and precisely located and reported.•Coating exhibits barrier, corrosion self-diagnosing and self-repairing traits.
Polymeric coatings with long life, strong environmental adaptability and high durability are of great significance for practical applications. This work presents a facial strategy to construct a smart nanocomposite coating with excellent shielding, corrosion self-diagnosing and self-repairing functions by integrating nanocontainers into epoxy resin. The nanocontainers were synthesized through decorating the hydroxyapatite sheets with zeolitic imidazolate frameworks (HA-ZIF), which were employed to encapsulate corrosion probe (Phenanthroline, Phen). With the occurrence of localized corrosion, Phen molecules could be timely released and reacted with the metal ions to form conspicuous red color at damaged sites, achieving real time corrosion diagnosing function. Given the stimulus responsive property of ZIF, the corrosion propagating process can be significantly inhibited by the released benzimidazole. As contrast of the traditional nanocontainers applied in anticorrosion coating, the inhibitors were used directly to synthesis the HA-ZIF nanocontainer rather than subsequent loading, which greatly improved inhibitors content in nanocontainers. Moreover, the impermeability of composite coating has been remarkably enhanced by the presence of HA sheets, ensuring the long-term protective performance. Importantly, the integrating multi functions in one coating is realized in the ingeniously designed nanocontainers. It is envisioned that the facial and feasible strategy provides insights in improving the longevity, functionality and reliability of protective coatings.
Objective: To address the increasing demand for assessments of Adult Attention Deficit Hyperactivity Disorder (ADHD), the primary author developed a protocol for Counseling and Psychological Services ...(CAPS) at Stanford University's Vaden Student Health Center to improve the efficiency of such evaluations. Participants: As part of quality assurance, we reviewed the charts of Stanford students who sought assessment for ADHD before the protocol was implemented (September 2011-June 2013) and after the protocol was established (October 2013-August 2014). An IRB exemption was obtained. Methods: The protocol includes questionnaires that solicit detailed clinical information from a variety of sources prior to the student's initial visit. Results: A peer chart review of 35 randomly selected charts showed that students completing the protocol are receiving a more thorough assessment. Conclusion: The new Stanford ADHD protocol, designed to improve clinic efficiency, also increases the availability of relevant clinical information.
Cytomegalovirus (CMV) viral load detected by real-time polymerase chain reaction (PCR) in plasma or stool may facilitate detection of CMV colitis.
This prospective study enrolled 117 patients with ...clinically suspected CMV colitis. Patients presenting with gastrointestinal symptoms and having increased risk of CMV infection were eligible. All participants underwent colonoscopy with tissue biopsy. Five patients underwent colonoscopy twice because of clinical recurrence, resulting in a total of 122 colonoscopies. Stool CMV-PCR and plasma CMV-PCR were performed within 7 days before/after colonoscopy. Twenty asymptomatic volunteers also underwent the same protocol.
Twenty-seven (23.1%) of 122 colonoscopies yielded positive for CMV colitis. The sensitivity and specificity was 70.4% and 91.6% for stool CMV-PCR and 66.7% and 94.7% for plasma CMV-PCR, respectively. The sensitivity of either positive plasma or positive stool CMV-PCR was 81.5%, which is significantly higher than that of plasma CMV-PCR alone ( P = 0.045). However, positive results from both tests yielded a specificity of 95.8%, which is significantly higher than that of stool CMV-PCR alone ( P = 0.045). There was a good and significant correlation between stool CMV-PCR and plasma CMV-PCR ( r = 0.71, P < 0.01), and both tests significantly correlated with the cytomegalic cell count ( r = 0.62, P < 0.01 for stool and r = 0.64, P < 0.01 for plasma). There were no positive stool or plasma CMV-PCR assays among volunteers.
The results of this study strongly suggest that the combination of stool CMV-PCR and plasma CMV-PCR can be used to confidently rule in (both positive) or rule out (both negative) a diagnosis of CMV colitis.
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