Forest plot of the diagnostic odds ratio (dOR) of each index test in the reviewed studies.

<p>CI: confidence interval; (a), (b) and (c) indicate different subgroups of participants in that study, as defined by setting (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0154411#pone.0154411.t001" target="_blank">Table 1</a>).</p

The Accuracy of Diagnostic Methods for Diabetic Retinopathy: A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>The objective of this study was to evaluate the accuracy of the recommended glycemic measures for diagnosing diabetic retinopathy.</p><p>Methods</p><p>We systematically searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases from inception to July 2015 for observational studies comparing the diagnostic accuracy of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2h-PG). Random effects models for the diagnostic odds ratio (dOR) value computed by Moses’ constant for a linear model and 95% CIs were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the overall test performance.</p><p>Results</p><p>Eleven published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of retinopathy were 16.32 (95% CI 13.86–19.22) for HbA1c and 4.87 (95% CI 4.39–5.40) for FPG. The area under the HSROC was 0.837 (95% CI 0.781–0.892) for HbA1c and 0.735 (95% CI 0.657–0.813) for FPG. The 95% confidence region for the point that summarizes the overall test performance of the included studies occurs where the cut-offs ranged from 6.1% (43.2 mmol/mol) to 7.8% (61.7 mmol/mol) for HbA1c and from 7.8 to 9.3 mmol/L for FPG. In the four studies that provided information regarding 2h-PG, the pooled accuracy estimates for HbA1c were similar to those of 2h-PG; the overall performance for HbA1c was superior to that for FPG.</p><p>Conclusions</p><p>The three recommended tests for the diagnosis of type 2 diabetes in nonpregnant adults showed sufficient accuracy for their use in clinical settings, although the overall accuracy for the diagnosis of retinopathy was similar for HbA1c and 2h-PG, which were both more accurate than for FPG. Due to the variability and inconveniences of the glucose level-based methods, HbA1c appears to be the most appropriate method for the diagnosis diabetic retinopathy.</p></div

Literature search PRISMA consort diagram.

<p>Literature search PRISMA consort diagram.</p

Pooled accuracy parameters in the diagnosis of diabetic retinopathy, by index test.

<p>Values in parentheses are 95 per cent confidence intervals. FPG: fasting plasma glucose, PLR: positive likelihood ratio, NLR: negative likelihood ratio, dOR: diagnostic odds ratio, AUC: area under receiver operating characteristic curve.</p

Hierarchical summary receiver operating characteristic (HSROC) curves summarizing the ability of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) to identify diabetes retinopathy.

<p>Hierarchical summary receiver operating characteristic (HSROC) curves summarizing the ability of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) to identify diabetes retinopathy.</p

Characteristics of studies included in the meta-analysis.

<p>Sens: sensitivity; Spec: specificity; AUC, area under the curve; dOR, diagnostic odds ratio; FPG, fasting plasma glucose; 2h-PG, 2 hours plasma glucose.</p

Physical Activity and Bone Health in Schoolchildren: The Mediating Role of Fitness and Body Fat

<div><p>Background</p><p>The relationship between physical activity (PA) and bone health is well known, although the role of percent body fat (%BF) and fitness as confounders or mediators in this relationship remains uncertain.</p><p>Objective</p><p>To examine whether the association between PA and bone mineral content (BMC) is mediated by %BF and cardiorespiratory fitness (CRF).</p><p>Methods</p><p>In this cross sectional study, BMC, total %BF (by DXA), vigorous PA (VPA), CRF, age and height were measured in 132 schoolchildren (62 boys, aged 8–11 years). ANCOVA was used to test differences in BMC by %BF, CRF and VPA, controlling for different sets of confounders. Simple mediation analyses and serial multiple mediation analyses were fitted to examine whether the relationship between PA and BMC is mediated by %BF and fitness.</p><p>Results</p><p>Children with high %BF had higher total body BMC than their peers after controlling for all sets of confounders. Children with good CRF or VPA had significantly less total body BMC after controlling for age and sex but in children with good CRF this inverse relation disappeared after adjusting by %BF. %BF and CRF both act as a full mediator in the association between VPA and BMC, after inclusion of the potential confounders in the models.</p><p>Conclusion</p><p>Fitness and %BF seem to have a mediator role on the relationship between physical activity and bone mass.</p></div

ANCOVA models comparing means of total body bone mineral content (BMC) by total percent body fat (%BF), cardiorespiratory fitness (CRF) and vigorous physical activity (VPA) categories in children.

<p>Covariates for %BF: Model 1(age and sex); Model 2 (Model 1+ VPA); Model 3: (Model 2+CRF). Superscript letter indicates statistical significance (≤ 0.050) for post hoc hypothesis test determinates by using the Bonferroni correction for multiple comparisons:</p><p>^a High >Medium> Low;</p><p>^b High> Medium;</p><p>^c High> Low.</p><p>Covariates for CRF: Model 1(age and sex); Model 2 (Model 1+ VPA); Model 3: (Model 2+%BF) Superscript letter indicates statistical significance (≤ 0.050) for post hoc hypothesis test determinates by using the Bonferroni correction for multiple comparisons:</p><p>^a Poor> Satisfactory;</p><p>^b Poor> Good.</p><p>Covariates for VPA: Model 1(age and sex); Model 2 (Model 1+ CRF); Model 3: (Model 2+%BF). Superscript letter indicates statistical significance (≤ 0.050) for post hoc hypothesis test determinates by using the Bonferroni correction for multiple comparisons:</p><p>^a Poor> Good.</p><p>ANCOVA models comparing means of total body bone mineral content (BMC) by total percent body fat (%BF), cardiorespiratory fitness (CRF) and vigorous physical activity (VPA) categories in children.</p

ROC curve for determining PAD by oscillometric ABI compared with Doppler.

<p>Blue line: total sample, n = 180. Green line: calcified legs are excluded; oscillometric measurement errors are included, n = 167. Red line: oscillometric measurement errors and calcified legs are excluded, n = 151. The areas under the curve were 0.914, 0.958 and 0.944 respectively, showing the DeLong´s test no statistically significant differences between them.</p

Correlation and level of agreement in the pressures of arm, ankle and ABI for Doppler and oscillometer.

<p>Correlation and level of agreement in the pressures of arm, ankle and ABI for Doppler and oscillometer.</p