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The Medical Maximizer-Minimizer Scale (MMS) captures the extent to which some individuals are more disposed to seek health care than others (Scherer et al, 2016). Recent findings of Scherer et al (2020) suggest that people more disposed to seeking health care ("Maximizers") may also be more likely to make low-benefit health care decisions. Low-benefit health care has negative consequences for individuals and for the efficacy of a health care system as a whole. The aims of this study are to explore whether: - the MMS predicts preference for low- or high-benefit care (replication of Scherer et al, 2020) - Protection Motivation Theory explains Minimizer and Maximizer preferences for health behaviour - intolerance of uncertainty adds further explanatory power in understanding MMS responses in a behavioural threat - manipulating the cost (risk) and threat (reassurance) appraisal changes people's preference for high- and low-benefit care. Effective interventions that encourage individuals who have a tendency to make low-benefit health care decisions to make better choices could be enormously beneficial to those individuals as well as enabling health resources to be used efficiently.

In the field of primary progressive aphasia (PPA), the most recent international consensus criteria of 2011 for diagnosis and variant classification have been shown not to capture accurately the whole range of PPA patients. Up to 30-40% of PPA patients appear not to satisfy the criteria of the three 'classical' PPA variants (non-fluent/agrammatic, logopenic, semantic) and are labelled either 'mixed PPA' or 'unclassifiable PPA'. Based on the PPA literature since 2011, this article discusses why patients might be under-diagnosed with respect to the three PPA variants, thus leading to the default concept of 'mixed/unclassifiable PPA' and, conversely, why the non-fluent/agrammatic variant appears to be over-diagnosed. It analyses and attempts to show how to resolve these issues, and it accordingly proposes clinical criteria, which are more inclusive to diminish the proportion of so-called mixed/unclassifiable PPA diagnoses and to reduce the proportion of questionable non-fluent/agrammatic diagnoses, which frequently correspond to progressive speech apraxia, rather than to aphasia.

Summary. Introduction. Despite the introduction of modern methods of diagnosis, tactics, and treatment of diseases of the abdominal organs, the risk of developing early postoperative complications remains high. The aim of this study is to clarify the causes of early postoperative complications and indications for their surgical treatment. Materials and methods. 3947 case histories of patients operated on for urgent indications were analyzed. In 73 cases, relaparotomies were performed in the early postoperative period (1.85 %). Results and discussion. The main nosologic unit, during the surgical treatment of which relaparotomies were performed, was acute appendicitis. Then there was a perforated pyloroduodenal ulcer and a strangulated hernia of various localization. The main indications for relaparotomy were progressive peritonitis, early adhesive intestinal obstruction, intra-abdominal abscesses, and infiltrates. In two cases, no pathology was detected during relaparotomy – there was an over diagnosis of postoperative peritonitis and anastomotic suture failure. Conclusion. 1. The main cause for relaparotomies in urgent surgery is the progression of preoperative peritonitis. 2. The second important cause is early postoperative adhesive intestinal obstruction. 3. Errors in intraoperative diagnostics, tactics, and techniques are the third leading cause of early relaparotomies.

Gonioscopy is the widely used technique of grading and evaluating the anterior chamber angle in current glaucoma evaluation practice. The grading of angle and open angle or narrow angle classification with gonioscopy is fairly accurate when done by an experienced ophthalmologist. In recent years, UBM and anterior segment OCT are advanced and in depth imaging tools for the anterior segment evaluation and accurate angle measurements. In our study, we have included 200 eyes for anterior chamber angle grading with gonioscopy and UBM and results are compared. Our study shows that some amount of estimation of angle depth by gonioscopy is overestimated in nearly closed and grade 1 angles. Estimation of grades 2 and 3 is nearly accurate with gonioscopy and comparable to UBM angle grading. Over diagnosis of occludable angles with gonioscopy which can be explained due to iris contour, inter-observer reliability or limitation to examine far periphery of the angle and this can be overcome by UBM examination. UBM provides accurate anterior chamber angle in degrees, peripheral iris configuration details and quantification of measurements is possible. Keywords: Gonioscopy, Ultrasound Biomicroscopy (UBM).

Over diagnosis of catheter-associated urinary tract infection (CAUTI) contributes to unnecessary and excessive antibiotic use, selection for resistant organisms, increased risk for Clostridiodes difficile infections, as well as a false elevation in CAUTI rates. Utilizing agile implementation to implement a urine culture algorithm achieved statistically significant reduction in CAUTI rates in a critical care unit resulting in sustainment and spread throughout the system.

Background: Thyroid cancer incidence has increased in many parts of the world since the 1980s, as has the prevalence of obesity. Evidence suggests that people with greater body size have higher thy...

Objective To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. Design and methods Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. Setting Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. Intervention GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. Main outcome measures Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. Results Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p

Background: Under-five and infant mortality constitutes a major health problem in India. To combat this high mortality, IMCI strategy aiming at holistic and integrated approach to child health and development was developed by WHO. Methods: This study is a comparative study conducted at Emergency and Outpatient Department of Pediatrics FHMC Tundla and SNMC Agra. Total of 200 young infants(0-2months) were taken. Detailed history and examination was done for all enrolled young infants according to IMNCI and for enrolled infants diagnosis and treatment was made in the Pediatric Department and was considered as Gold Standard. Results: Out of total 200 young infants, 117 were 0-7 days of age and rest 83 were 7- 59 days of age. Of these 109 infants were admitted, and 91 infants were sent home after initial management. There was no mismatch in diagnosis of 48% infants, while partial mismatch in 38.5% infants, over diagnosis in 10.5% and under diagnosis was present in 3% infants of 0-2 months of age. Conclusion: This study had good diagnostic agreement and only 3%of infants were underdiagnosed.

Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke’s Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice. RESUMO Os instrumentos de rastreio cognitivo (IRCs) para demência e comprometimento cognitivo leve são geralmente caracterizados em termos de medidas de discriminação, como sensibilidade, especificidade e razões de probabilidade, mas esses IRCs também têm limitações. Objetivo: Calcular várias medidas de limitação de testes para IRC comumente usados, a saber: taxa de classificação incorreta; relação entre dano líquido e benefício líquido; e probabilidade de diagnóstico ou diagnóstico incorreto. Métodos: Os dados de vários estudos de precisão de teste pragmático de IRC relatados anteriormente (MMSE, MoCA, MACE, 6CIT, AD8, TYM, Free-Cog) e realizados em uma única clínica foram reanalisados para calcular e comparar a taxa de classificação incorreta, o dano líquido para a relação de benefício líquido e a probabilidade de diagnóstico ou diagnóstico incorreto para cada teste. Resultados: Alguns IRC com sensibilidade muito alta, mas baixa especificidade para demência, tiveram desempenho ruim em medidas de limitação, com altas taxas de classificação incorreta, baixo prejuízo líquido para relações de benefício líquido e baixa probabilidade de diagnóstico ou diagnóstico incorreto; alguns tinham probabilidades de favorecer o diagnóstico incorreto ao invés do diagnóstico. Testes com melhor equilíbrio de sensibilidade e especificidade saíram-se melhor nas medidas de limitação. Conclusões: Ao decidir qual IRC administrar, as medidas de limitação, bem como as medidas de discriminação do teste, devem ser consideradas. A identificação de IRC com alta taxa de classificação incorreta, baixa relação de prejuízo e benefício e baixa probabilidade de diagnóstico ou diagnóstico incorreto pode ter implicações para seu uso na prática clínica.

Diagnosis of cow’s milk allergy (CMA) in infants is based on reproducible symptoms and absence of symptoms on elimination of cow’s milk protein.1,2 Previous research has raised concerns that CMA guidelines published by national or international organisations could be driving CMA overdiagnosis.1 Personal testimonies by mothers suggest that a diagnosis of suspected CMA may reduce breastfeeding confidence, especially when maternal dietary restrictions are advised,2 and the potential for this to lead to cessation of breastfeeding has been suggested by earlier comments by experts in the fields of breastfeeding and CMA.2,3 Dietary restrictions are not likely to be needed for most breastfed infants with CMA, since quantities of cow’s milk protein transferred to the infant via breastmilk are much smaller than thresholds of reactivity in children with CMA.

Purpose of review Advancements in breast screening technology have increased the sensitivity of screening and thereby increased the detection rates of nonlethal cancers. Thus, improvements in breast screening technology may contribute to 'over-diagnosis', which refers to detection of cancers that pose no threat to life and that, in the absence of screening, might never have been detected. The purpose of this review is to draw attention to risks of over-diagnosis and provide a rationale for evaluating screening clinical breast examination (CBE) as an alternative to modern technology-based (mammography) screening. Recent findings Novel screening technologies have been adopted largely on the basis of their abilities to increase tumor-detection rates. However, as breast cancer treatments have improved, the mortality benefits of screening have declined. Moreover, there is evidence suggesting that, in the modern era of effective adjuvant systemic therapies, the mortality benefit of screening CBE may now be comparable to that of modern screening mammography, but screening CBE carries less risk of over-diagnosis. Summary A randomized trial comparing modern mammography screening versus screening CBE is warranted. If confirmed that the mortality benefits of the two screening strategies are now comparable, then screening CBE might be considered a reasonable alternative to mammography screening.

Pulmonary embolism (PE) is an increasingly recognised condition which is associated with significant morbidity and mortality. Despite the better awareness of this serious condition, the diagnosis is still overlooked in many cases with sometimes fatal consequences. Under-diagnosis may be due to several reasons including reliance on non-specific 'classic' symptoms, belief that bedside measurements will likely be abnormal in the setting of acute PE, and confounding factors like co-existent cardiorespiratory diseases or being in an intensive care unit, where the diagnosis may not be considered. At the same time, incidental diagnosis of PE is occurring more often due to frequent use of imaging investigations alongside advancements in CT technology, and dilemma exists as to whether the chance finding of PE requires anticoagulation, especially when identified only at the subsegmental level. This article reviews these two issues of under-diagnosis and over-diagnosis of PE in the current era.

Rationale and objectives: Target recall rates are often used as a performance indicator in mammography screening programs with the intention of reducing false positive decisions, over diagnosis and anxiety for participants. However, the relationship between target recall rates and cancer detection is unclear, especially when readers are directed to adhere to a predetermined rate. The purpose of this study was to explore the effect of setting different recall rates on radiologist’s performance. Materials and Methods: Institutional ethics approval was granted and informed consent was obtained from each participating radiologist. Five experienced breast imaging radiologists read a single test set of 200 mammographic cases (20 abnormal and 180 normal). The radiologists were asked to identify each case that they required to be recalled in three different recall conditions; free recall, 15% and 10% and mark the location of any suspicious lesions. Results: Wide variability in recall rates was observed when reading at free recall, ranging from 18.5% to 34.0%. Readers demonstrated significantly reduced performance when reading at prescribed recall rates, with lower sensitivity (H=12.891, P=0.002), case location sensitivity (H=12.512, P=0.002) and ROC AUC (H=11.601, P=0.003) albeit with an increased specificity (H=12.704, P=0.002). However, no significant changes were evident in lesion location sensitivity (H=1.982, P=0.371) and JAFROC FOM (H=1.820, P=0.403). Conclusion: In this laboratory study, reducing the number of recalled cases to 10% significantly reduced radiologists’ performance with lower detection sensitivity, although a significant improvement in specificity was observed.

Background African American men (AAM) are under-represented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research.Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings. Conclusions Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research. Objectives Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study. Methods We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation.

Background: Central adjudication of stroke type is commonly implemented in large multicentre clinical trials. We investigated the effect of central adjudication of diagnosis of stroke type at trial entry in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods: ENOS recruited patients with acute ischaemic or haemorrhagic stroke, and diagnostic adjudication was carried out using cranial scans. For this study, diagnoses made by local site clinicians were compared with those by central, masked adjudicators using kappa statistics. The trial primary analysis and subgroup analysis by stroke type were re-analysed using stroke diagnosis made by local clinicians, and simulations were used to assess the impact of increased non-differential misclassification and subgroup effects. Results: Agreement on stroke type (Ischaemic, Intracerebral Haemorrhage, Unknown stroke type, No-stroke) was high (κ = 0.92). Adjudication of stroke type had no impact on the primary outcome or subgroup analysis by stroke type. With misclassification increased to 10 times the level observed in ENOS and a simulated subgroup effect present, adjudication would have affected trial conclusions. Conclusions: Stroke type at trial entry was diagnosed accurately by local clinicians in ENOS. Adjudication of stroke type by central adjudicators had no measurable effect on trial conclusions. Diagnostic adjudication may be important if diagnosis is complex and a treatment-diagnosis interaction is expected. Keywords: Adjudication, Diagnosis, Clinical trial, Stroke

The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast between categorical and dimensional models, with renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis.

Asthma is diagnosed on the basis of respiratory symptoms of wheeze, cough, chest tightness, and/or dyspnea together with physiologic evidence of variable expiratory airflow limitation. The prevalen...

The importance of quantitative literacy for creating and maintaining a democratic and just society is unequivocal, but undergraduate students often do not acquire these important skills. One barrier to teaching quantitative literacy skills is students’ anxiety. The empirical evidence of the extent of the problem, however, does not seem to match anecdotal accounts of instructors who may be “diagnosing” statistics anxiety as universal among students and across different sources of anxiety. The purpose of this study is to identify the specific aspects of statistics anxiety that present barriers to student success by employing the Statistics Anxiety Rating Scale (STARS) to analyze two-wave panel survey data from a sample of 113 undergraduates from eight sections of a Social Statistics course. This study also examines how gender shapes statistics anxiety/attitudes and whether changes over time in anxiety/attitudes are associated with academic performance. Results indicate that a majority of students report elevated levels of exam anxiety compared to the other types of anxiety/attitudes. Women report significantly more anxiety and more negative attitudes than men, but exam anxiety improves over the course of the semester significantly more so for women. Results also indicate that statistics anxiety/attitudes are largely unrelated to academic performance. Results are discussed in the context of their implications for directing attention to specific aspects of statistics anxiety on which to focus pedagogical efforts— to address statistics anxiety/attitudes if necessary, but also to avoid over-diagnosing by not assuming that it applies to all students or all aspects of statistics classes.

The Choosing Wisely initiative aims to reduce wasteful and harmful healthcare by encouraging clinicians and patients to discuss explicitly the healthcare that is really needed as well as that which is of low or no value. While low health literacy has been found to be associated with under-diagnosis and under-treatment, its potential role as a driver of over-diagnosis and overtreatment has received less attention. This article describes how low health literacy might lead to too much medicine. It then provides an overview of an evidence-based method of communication that might assist with identifying and addressing low health literacy in patients.

Though a decade of research led to the creation of disruptive mood dysregulation disorder (DMDD), it was not until the 2013 publication of the DSM-5 that DMDD became an official diagnosis. The conception of DMDD was largely due to increasing rates of paediatric bipolar disorder (PBD) diagnoses, which significantly impacted treatment for these youth. The core symptoms of DMDD include persistent irritability and recurrent outbursts; the absence of a previous diagnostic category for youth experiencing these symptoms may have led to the over diagnosis of PBD. Due to the chronicity of symptoms, these youth are impaired in multiple areas of functioning. This article will present background information about DMDD, discuss clinical assessment strategies including scales for measuring irritability and aggression, and review pharmacologic and psychosocial treatments for youth with DMDD and clinical phenotypes similar to DMDD.

PURPOSE: Shared patient-physician decision-making regarding treatment for prostate cancer detected by prostate-specific antigen screening involves a complex calculus weighing the risk of the cancer and patient life expectancy. We investigated quantifying these competing risks using the probability that the cancer was “overdiagnosed”—i.e., would not have been clinically diagnosed (diagnosed without screening) during the patient’s remaining lifetime. MATERIALS AND METHODS: Using an established model of prostate cancer screening and clinical diagnosis, we simulated screen-detected cases and determined whether modeled clinical diagnosis would occur before non-cancer death, which was based on comorbidity-adjusted population lifetables. Logistic regression models were fitted to the simulated data and used to estimate overdiagnosis probabilities given patient age, PSA level, Gleason sum, and comorbidity category. An online calculator was developed to communicate overdiagnosis estimates; face validity and ease of use was assessed by surveying 32 clinical experts. RESULTS: Estimated probabilities of overdiagnosis ranged 4%−78% across clinicopathologic variables and comorbidity status. Ignoring comorbidity, the estimated probability for a 70-year-old man with PSA 9.4 ng/mL and Gleason 6 is 34%; if he has severe comorbidities, the estimate increases to 51%, a personalization that may help inform the choice between active surveillance and definitive treatment. Based on responses from 20/32 experts, we modified the online calculator’s explanation of overdiagnosis and input method for comorbid conditions. CONCLUSIONS: The probability of overdiagnosis is strongly influenced by comorbidity status in addition to age. Personalized estimates incorporating comorbidity may contribute to shared decision-making between patients and providers regarding personalized treatment selection.

Purpose Pheochromocytomas (PCCs) exhibit malignant potential, but current histological modalities for the proper detection of aggressive behavior are debated. The two most widespread algorithms are the “Pheochromocytoma of the Adrenal Gland Scaled Score” (PASS) and the “Grading System for Adrenal Pheochromocytoma and Paraganglioma” (GAPP), both which mostly rely on histological parameters to identify PCC patients at risk of disseminated disease. Since the algorithms are derived from studies using predominantly sporadic PCCs, little is known whether the PASS or GAPP scores can predict malignant potential in hereditary cases. Methods PASS and GAPP were applied on 41 PCCs; 13 PCCs were diagnosed in ten multiple endocrine neoplasia type 2A (MEN 2A) patients carrying established germline RET proto-oncogene mutations, as well as 28 assumed sporadic PCCs. Results Six out of thirteen MEN 2A tumors (46%) exhibited PASS scores ≥ 4, indicative of a potential for aggressive behavior. In addition, 7/13 tumors (54%) exhibited GAPP scores ≥ 3, indicative of a “moderately differentiated type” with risk of future recurrence. All MEN 2A PCCs with an elevated PASS score also displayed an elevated GAPP score. In contrast, 4/28 (14%) sporadic PCCs demonstrated PASS scores ≥ 4, and 9/28 (32%) displayed GAPP scores ≥ 3. Follow-up found all cases in the study are free of metastatic or recurrent disease. Conclusions We conclude that the PASS and GAPP scoring systems might be suboptimal for determining true malignant potential in PCCs with constitutional RET mutations and advocate restrictive use of these scores in MEN 2A cases until the results are reproduced in larger numbers.

Introduction: The Widal test is widely used in hospitals in Bhutan for diagnosis of typhoid fever. The right test with high sensitivity and specificity supplements clinical judgement and contributes to correct diagnosis of disease. This study focuses on the contribution of the Widal test in the diagnosis of typhoid fever. Methods: Data was collected from records of patients who presented to Damphu hospital from March 2011 to June 2012 with clinical suspicion of typhoid fever. Blood samples were collected from patients and tested at Damphu Hospital, Tsirang and the Royal Centre for Disease Control, Thimphu. Seventy records were used for the study. Results: There was no growth of Salmonella typhi on blood cultures from patients who had tested positive in the Widal test. There were 20 (28.57%) samples which tested positive for scrub typhus; among these Widal test was positive in 10 (50%) samples. Thirty four out of 36 (94.44%) patients had duration of illness less than seven days and among them 26 (74.47%) had positive Widal test results. Conclusion: None of the samples that tested positive by Widal test gave a definite diagnosis of typhoid fever with blood culture. Clinical judgement may be more challenging because patients with other febrile illnesses like Scrub typhus also have positive Widal test result. We conclude that it is best not to rely on the Widal test alone for the diagnosis of typhoid fever and this test should be replaced by more accurate ones.

Background The paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart. Material and methods A sample of 1032 healthy children (505 boys, 527 girls; aged 5–11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted. Results Initially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p Conclusion Children’s foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.

Background Thyroid cancer is the most common malignant disease of the endocrine system. Previous studies indicate a rapid increase in the incidence of thyroid cancer in recent decades, and this increase has aroused the great public concern. The aim of this study was to analyze the trends in incidence, mortality and clinical-pathological patterns of thyroid cancer in Zhejiang province. Methods Population-based incidence and mortality rates of thyroid cancer were collected from eight cancer registries in Zhejiang from 2000 to 2012. The incidence and mortality rates were age-standardized to Segi’s world population. A Joinpoint model was used to examine secular trends in age-adjusted thyroid cancer rates with the Joinpoint Regression Program Version 4.0.0. Thyroid cancer patients were recruited from Zhejiang Cancer Hospital from 1972 to 2014. Patient demographics, tumor histology and tumor size were compared among the different periods of 1972–1985, 1986–1999 and 2000–2014. Results The age-standardized incidence rate of thyroid cancer in Zhejiang cancer registries was 2.75/105 in 2000, and increased to 19.42/105 in 2012. Additionally, we observed significantly increasing incidence rates with the Annual Percent Change (APC) of 22.86% (95%CI, 19.2%–26.7%). The age-standardized mortality of thyroid cancer in Zhejiang cancer registries was 0.23/105 in 2000 and 0.25/105 in 2012. No significant change in mortality rate was found. We observed a rapid increase in the proportions of papillary thyroid carcinoma (PTC) in 12,508 patients with thyroid carcinoma identified in the Zhejiang Cancer Hospital from 1972 to 2014 while the proportions of poorly differentiated thyroid cancer (PDTC), medullary thyroid carcinoma (MTC) and follicular thyroid carcinoma (FTC) decreased over the decades. In the PTC cases, the proportion of patients with maximum tumor diameter (MTD)

Objectives: To assess the changes in parameters of thyroid carcinoma, particularly papillary type, in the era of widespread use of sensitive diagnostic methods. We aim to investigate whether the increased frequency of thyroid cancer is true or resulted from over diagnosis. Methods: We conducted a retrospective study of 313 cases of thyroid carcinoma diagnosed at Jordan University Hospital and King Hussein Cancer Center from 2007-2015. Papillary carcinoma accounted for 290 (92.7%) of all cases. Cases were sub classified according to demographic features, histological type, size, stage, and other variables. For comparison of data, cases were subdivided into 2 study periods: Group I included patients diagnosed in the period 2007-2010, and Group II in the period 2011-2015. Results: The frequency of thyroid carcinoma has increased across the study period. Papillary carcinoma was the major type accounting for this increase. Papillary micro carcinomas ≤1cm accounted for 34.8% of cases of PTC. Most cases (52.4%) of papillary thyroid carcinoma (PTC) were localized stage tumors. Group II of the study witnessed a more than doubled number of cases of PTC compared to group I, with increased frequency of tumors of all sizes as well as tumors of both localized and regional stages. Conclusions: Our observed trend cannot be totally explained by over diagnosis and increased diagnostic scrutiny. This increase could be of true nature and cannot be explained by single cause. Saudi Med J 2018; Vol. 39 (2): 147-153 doi: 10.15537/smj.2018.2.21211 How to cite this article: Hajeer MH, Awad HA, Abdullah NI, Almuhaisen GH, Abudalu LE. The rising trend in papillary thyroid carcinoma. True increase or over diagnosis? Saudi Med J . 2018 Feb;39(2):147-153. doi: 10.15537/smj.2018.2.21211.

Historically, the field of mental health has been shrouded in controversy and conflict. The problems associated with diagnosing mental illnesses are still prevalent today, and this process becomes even more complicated when assessing children, who have yet to develop mature social skills and cognitive functioning. Attention deficit hyperactivity disorder (ADHD) is one of the mental health conditions that is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM). Overwhelming support from the primary literature suggests that the current procedures of diagnosing ADHD- which begin during childhood- allow for a high degree of subjectivity, inconsistency, and uncertainty. For these reasons, the issue of over-diagnosing ADHD in children has become more significant, and more plausible than ever before. By outlining the key factors that contribute to this problem, certain modifications can be made to improve the ADHD diagnostic procedures for future applications. These changes can increase the accuracy of mental health assessments, thus minimizing the number of false positive diagnoses of ADHD in children worldwide.

Background: White coat syndrome, masked hypertension, and poor technique may produce inaccurate offi ce-based blood pressure (BP) readings and lead to over diagnosis and over treatment with antihypertensive agents.

Purpose: to study the possibility of early clinical diagnosis of endocrine ophthalmopathy based on ocular symptoms of hyperthyroidism. Patients and methods: we analyzed the prevalence of ocular symptoms of hyperthyroidism in 139 patients (278 orbits) with newly diagnosed endocrine ophthalmopathy (group 1), developed on the background of diffuse toxic goiter. The comparison group consisted of 80 patients (160 orbits) with newly diagnosed diffuse toxic goiter with no radiographic evidence of endocrine ophthalmopathy (group 2). All patients were examined by an ophthalmologist and endocrinologist. We analyzed the prevalence of ocular symptoms of hyperthyroidism (symptom Dalrymple’, Mobius’, Zenger’, and combinations thereof), often encountered in diffuse toxic goiter, flowing with endocrine ophthalmopathy, and/or lack thereof - in the group of “thyrotoxic exophthalmos”. We took into account the frequency distribution of these clinical signs, and their combinations. We analyzed the clinical sensitivity and specificity of diagnosis based on the three most common symptoms, and their combinations, associated both with thyrotoxicosis and with endocrine ophthalmopathy. Results: Dalrymple’ symptom, is more common in thyrotoxic exophthalmos than with endocrine ophthalmopathy (compared to 100.0% versus 61.9 %, p

Objective To determine if the pernicious effects of over-diagnosis and over-treatment have been studied in the most common ocular diseases. Material and methods Bibliographic search conducted in PubMed. Results The search algorithm used retrieved 29 articles related with the topic. Most of them address the issue tangentially. Only 4 of them address the problem directly. One of them focuses on the problem of over-diagnosis and over-treatment in idiopathic intracranial hypertension. The remaining 3 focus on the problem of over-diagnosis and over-treatment in glaucoma. Conclusion The ophthalmology community has thought very little about the detrimental effects of over-diagnosis and over-treatment.