This study assessed the impact of body mass index (BMI) and socioeconomic status (SES) on the Zurich Neuromotor Assessment, second version (ZNA-2), a battery of tests of motor development in typically developing children between 3 and 18 years of age. BMI measurements and international socio-economic index data were taken from the normative sample of the ZNA-2 for 321 children (158 boys, 163 girls) with a median age of 9.3 years. The age- and gender-adjusted motor performance of these children was quantified and grouped into five components: fine, pure, and gross motor tasks, static balance, and contralateral associated movements. A total score was also calculated. The associations of BMI and SES with the motor scores contribute to less than 5.1% of the total variance.Conclusion: The ZNA-2 for motor development is suitable for measuring motor abilities’ development as it is largely independent of the BMI of the child and the SES of the family. What is Known:• Typical motor development, as measured with the Zurich Neuromotor Assessment, second edition (ZNA-2), is strongly dependent on age and gender.• The ZNA-2 focusses on motor performance, motor quality and simple motor skills. What is New:• Higher socio-economic status (SES) is associated with slightly better motor performance as measured by the ZNA-2 total score.• In the ZNA-2 less than 5.1% of the variability in motor performance is attributable to the combined effect of body mass index and SES.

Key Points: When assessing urine output, consideration of an average or persistent value below a threshold has important diagnostic and prognostic implications Seventy-three percent (95% confidence interval, 72.3 to 73.7) of patients had oliguria by the average method versus 54.3% (53.5 to 55.1) by the persistent method. Background: Oliguria is defined as a urine output (UO) of <0.5 ml/kg per hour over 6 hours. There is no consensus as per whether an average or persistent value should be considered. Methods: We analyzed all adults admitted to a tertiary intensive care unit between 2010 and 2020, except those on chronic dialysis or who declined consent. We extracted hourly UO and, across 6-hour sliding time windows, assessed for the presence of oliguria according to the average (mean UO below threshold) and persistent (all measurements below a threshold) methods. For both methods, we compared oliguria's incidence and association with 90-day mortality and acute kidney disease at hospital discharge. Results: Among 15,253 patients, the average method identified oliguria more often than the persistent method (73% [95% confidence interval, 72.3 to 73.7] versus 54.3% [53.5 to 55.1]). It displayed a higher sensitivity for the prediction of 90-day mortality (85% [83.6 to 86.4] versus 70.3% [68.5 to 72]) and acute kidney disease at hospital discharge (85.6% [84.2 to 87] versus 71.8% [70 to 73.6]). However, its specificity was lower for both outcomes (29.8% [28.9 to 30.6] versus 49.4% [48.5 to 50.3] and 29.8% [29 to 30.7] versus 49.8% [48.9 to 50.7]). After adjusting for illness severity, comorbidities, age, admission year, weight, sex, and AKI on admission, the absolute difference in mortality attributable to oliguria at the population level was similar with both methods (5%). Similar results were obtained when analyses were restricted to patients without AKI on admission, with documented body weight, with presence of indwelling catheter throughout stay, and who did not receive KRT or diuretics. Conclusions: The assessment method of oliguria has major diagnostic and prognostic implications. Its definition should be standardized.

Background: Incidence of and mortality from colorectal cancer (CRC) can be effectively reduced by screening with the fecal immunochemical test (FIT) or colonoscopy. Individual risk to develop CRC within 15 years varies from 15% among people aged 50 to 75 years. Communicating personalized CRC risk and appropriate screening recommendations could improve the risk-benefit balance of screening test allocations and optimize the use of limited colonoscopy resources. However, significant uncertainty exists regarding the feasibility and efficacy of risk-based screening. Objective: We aim to study the effect of communicating individual CRC risk and a risk-based recommendation of the FIT or colonoscopy on participants’ choice of screening test. We will also assess the feasibility of a larger clinical trial designed to evaluate the impact of personalized screening on clinical outcomes. Methods: We will perform a pilot randomized controlled trial among 880 residents aged 50 to 69 years eligible to participate in the organized screening program of the Vaud canton, Switzerland. Participants will be recruited by mail by the Vaud CRC screening program. Primary and secondary outcomes will be self-assessed through questionnaires. The risk score will be calculated using the open-source QCancer calculator that was validated in the United Kingdom. Participants will be stratified into 3 groups—low (<3%), moderate (3% to <6%), and high (≥6%) risk—according to their 15-year CRC risk and randomized within each risk stratum. The intervention group participants will receive a newly designed brochure with their personalized risk and screening recommendations. The control group will receive the usual brochure of the Vaud CRC screening program. Our primary outcome, measured using a self-administered questionnaire, is appropriate screening uptake 6 months after the intervention. Screening will be defined as appropriate if participants at high risk undertake colonoscopy and participants at low risk undertake the FIT. We will also measure the acceptability of the risk score and screening recommendations and the psychological factors influencing screening behavior. We will also assess the feasibility of a full-scale randomized controlled trial. Results: We expect that a total sample of 880 individuals will allow us to detect a difference of 10% (α=5%) between groups. The main outcome will be analyzed using a 2-tailed chi-squared test. We expect that appropriate screening uptake will be higher in the intervention group. No difference in overall screening uptake is expected. Conclusions: We will test the impact of personalized risk information and screening recommendations on participants’ choice of screening test in an organized screening program. This study should advance our understanding of the feasibility of large-scale risk-based CRC screening. Our results may provide insights into the optimization of CRC screening by offering screening options with a better risk-benefit balance and optimizing the use of resources. Trial Registration: ClinicalTrials.gov NCT05357508; https://www.clinicaltrials.gov/study/NCT05357508 International Registered Report Identifier (IRRID): DERR1-10.2196/46865

Background: Orthopedic surgeons often use the intra-articular white blood counts (WBCs) and the percentage of polymorphonuclear cells (PMN) in the diagnosis of an acute swollen and painful knee joint in children. Today, there is no established threshold for the synovial WBC, and their differentiation, as indicative of native joint knee bacterial arthritis. We determine the sensitivity and specificity of synovial WBCs and PMN percentages in the prediction of a community-acquired, acute bacterial native joint septic arthritis (SA) in the pediatric population. Methods: A retrospective study on healthy children 0–16 years of age who underwent knee joint aspiration for a community-acquired, acute irritable knee effusion in our tertiary-care children’s hospital between May 2009 and April 2019 was conducted. We divided the study population into two groups according to the detection of bacterial arthritis in the synovial fluid (bacterial arthritis versus its absence) and compared the intra-articular leukocyte and C-reactive protein (CRP) levels. Results: Overall, we found a statistically significant difference regarding the total CRP (p = 0.017), leukocyte or PMN counts (p ≤ 0.001 in favor of a bacterial arthritis). In contrast, the percentage of the neutrophils was not determinant for the later confirmation of bacterial pathogens, and we were unable to establish diagnostically determining minimal thresholds of the intra-articular CRP and leukocyte levels. Conclusions: This pilot study suggests that either the leukocyte or PMN counts may be associated with a bacterial origin of knee arthritis in children. We plan a larger prospective interventional study in the future to confirm these findings including the investigation of other joint aspirate biomarkers.

INTRODUCTION: Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk may optimize benefit with lower risks, individual burden, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on risk-appropriate screening uptake in an organized screening setting. METHODS: Randomized controlled trial among residents aged 50–69 years not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and screening recommendation. The control group received a usual brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, and colonoscopy if ≥6%) at 6 months. A secondary outcome was overall screening uptake. RESULTS: Of 5,396 invitations, 1,059 people responded (19%) of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% [SD = 0.5], age 52.2 years [SD = 2.2], 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95% confidence interval 6%–22%). Overall screening uptake was 50% in the intervention group and 49% in the control group (absolute difference 1%, 95% confidence interval −7% to 10%). DISCUSSION: In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk and resource allocation.