A Debriefing Session with a Nutritionist Can Improve Dietary Assessment Using Food Diaries.

The objective of the current study was to evaluate the effect of a debriefing call on nutrient intake estimates using two 3-d food diaries among women participating in the Women's Health and Interview Study (WISH) Diet Validation Study. Subjects were 207 women with complete data and six 24-h recalls (24-HR) by telephone over 8 mo followed by two 3-d food diaries during the next 4 mo. Nutrient intake was assessed using the food diaries before and after a debriefing session by telephone. The purpose of the debriefing call was to obtain more detailed information on the types and amounts of fat in the diet. However, due to the ubiquitous nature of fat in the diet, the debriefing involved providing more specific detail on many aspects of the diet. There was a significant difference in macronutrient and micronutrient intake estimates after the debriefing. Estimates of protein, carbohydrate, and fiber intake were significantly higher and total fat, monounsaturated fat, saturated fat, vitamin A, vitamin C, -tocopherol, folic acid, and calcium intake were significantly lower after the debriefing (P <0.05). The limits of agreement between the food diaries before and after the debriefing were especially large for total fat intake, which could be under- or overestimated by 15 g/d. The debriefing call improved attenuation coefficients associated with measurement error for vitamin C, folic acid, iron, tocopherol, vitamin A, and calcium estimates. A hypothetical relative risk (RR) = 2.0 could be attenuated to 1.16 for folic acid intake assessed without a debriefing but to only 1.61 with a debriefing. Depending on the nutrients of interest, the inclusion of a debriefing can reduce the potential attenuation of RR in studies evaluating diet disease associations.

Isotopic assessment of sources and processes affecting sulfate and nitrate in surface water and groundwater of Luxembourg

Surface water and deep and shallow groundwater samples were taken from selected parts of the Grand-Duchy of Luxembourg to determine the isotopic composition of nitrate and sulfate, in order to identify sources and/or processes affecting these solutes. Deep groundwater had sulfate concentrations between 20 and 40 mg/L, d34Ssulfate values between -3.0 and -20.0‰, and d18Osulfate values between +1.5 and +5.0‰; nitrate was characterized by concentrations varying between

Validity of the Perceived Health Competence Scale in a UK primary care setting.

The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general healthrelated behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.

Changes in the attitudes of GPs to health screening of patients with learning disabilities

GP's appear reluctant to undertake health screening for people with learning disabilities. This article describes a specialist health screening service delivered mainly by community learning disability nurses to nearly 600 children and adults. Prior to the service being established, 141 GPs within a defined area were surveyed and 51% responded. Although a majority thought the service would be helpful, three-quarters felt it was better provided within the context of specialist services. After screening, 54% of the sample (318 persons) were referred to their GP for further assessment and treatment, nearly all for physoical health needs. A second study investigated the attitudes of 91 GPs who had patients refrrered. Those (45) who reported dealing with a referral were more favourably disposed to undertaking health screening within their practice, whereas those (23) who had been uninvolved continued to opt for specialist provision. Options for encouraging more GPs' to offer preventive health care to theisclient group are discussed, including medical training, extra consulting time and linking community learning disbaility nurses with GP practices.

Use of the Child Health Questionnaire in Children with Cerebral Palsy: A Systematic Review and Evaluation of the Psychometric Properties

Objective: To review the psychometric performance of the Child Health Questionnaire (CHQ) in samples ofchildren with cerebral palsy (CP).

Method: Four search terms were applied to five databases in a search forpapers published between 1993 and January 2007.

Results: A total of 13 papers were identified, providingdata on 1229 unique children aged 2–18 years old. Three studies reported on the reliability of the CHQ(internal consistency), whilst six studies provided evidence on various dimensions of validity (concurrent;discriminant and item discriminant validity).

Conclusions: This review identified a number ofpsychometric issues that need to be addressed. These include the assessment of additional types of reliability;an examination of the factor structure of the CHQ within the CP population; and the development ofnormative data using substantial representative samples, particularly in Europe. Until these issues areaddressed, researchers utilizing the CHQ in children with CP should be cautious about its interpretation.

An audit of assessment and reporting by Approved Social Workers (ASWs)

This paper examines the routine practice of Approved Social Workers (ASWs) in adult mental health services in Northern Ireland. It begins with a review of existing literature on the ASW role before describing how a retrospective audit, using a mixed methods approach, was used to collect data on eighty-four assessments carried out to determine whether compulsory admission to hospital was needed. Respondents were also asked to consider how such assessments might be affected by proposed changes to the law in this field. The key findings highlighted a number of areas of practice that may be improved. There were inconsistencies in how the assessments were recorded and an uneven distribution of workloads across ASWs. Some problems were identified with interagency working and, in a quarter of the assessments, the ASW reported having felt afraid or at risk. The authors make a number of recommendations, which include: the use of a standard reporting procedure; that organisations should consider how to deliver a more even distribution of ASW workload; that protocols should be developed that ensure that ASWs are not left alone in potentially risky situations; and that joint assessments with General Practitioners should be required, rather than just recommended.

Response shift in the assessment of quality of life among people attending cardiac rehabilitation

Objectives: To examine whether any response shift in quality of life assessment over the course of a cardiac rehabilitation programme could be explained by changes in individuals’ internal standards (recalibration), values (reprioritization) and/or conceptualization of quality of life and the extent to which any response shift could be explained by health locus of control, optimism and coping strategy. Design: Longitudinal survey design. Methods: The SEIQoL-DW was administered at the beginning and end of a cardiac rehabilitation programme. At the end of the programme, the SEIQoL-DW then-test was also administered to measure response shift. A total of 57 participants completed these measures and other measures to assess health locus of control, optimism and coping. Results: Response shift effects were observed in this population mainly due to recalibration. When response shift was incorporated into the analysis of QoL a larger treatment effect was observed. Active coping as a mechanism in the response shift model was found to have a significant positive correlation with response shift. Conclusion: This study showed that response shift occurs during cardiac rehabilitation. The occurrence of response shift in QoL ratings over time for this population could have implications for the estimation of the effectiveness of the intervention.

Assessment of the benefits of Discrete Conditional Survival Models in modelling ambulance response times

Many of the challenges faced in health care delivery can be informed through building models. In particular, Discrete Conditional Survival (DCS) models, recently under development, can provide policymakers with a flexible tool to assess time-to-event data. The DCS model is capable of modelling the survival curve based on various underlying distribution types and is capable of clustering or grouping observations (based on other covariate information) external to the distribution fits. The flexibility of the model comes through the choice of data mining techniques that are available in ascertaining the different subsets and also in the choice of distribution types available in modelling these informed subsets. This paper presents an illustrated example of the Discrete Conditional Survival model being deployed to represent ambulance response-times by a fully parameterised model. This model is contrasted against use of a parametric accelerated failure-time model, illustrating the strength and usefulness of Discrete Conditional Survival models.