The accuracy of HADS and GHQ-12 in detecting psychiatric morbidity in breast cancer patients

Objective: Psychological problems should be identified in breast cancer patients proactively if doctors and nurses are to help them cope with the challenges imposed by their illness. Screening is one possible way to identify emotional problems proactively. Self-report questionnaires can be useful alternatives to carrying out psychiatric interviews during screening, because interviewing a large number of patients can be impractical due to limited resources. Two such measures are the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire-12 (GHQ-12). Method: The present study aimed to compare the performance of the GHQ-12, and the HADS Unitary Scale and its subscales to that of the Schedule for Affective Disorders and Schizophrenia (SADS) in identifying patients with affective disorders, including DSM major depression and generalized anxiety disorder. The sample consisted of 296 female breast cancer patients who underwent surgery for breast cancer a year previously. Results: A small number of patients (11%) were identified as having DSM major depression or generalized anxiety disorder based on SADS score. The findings indicate that the optimal thresholds in detecting generalized anxiety disorder and DSM major depression with the HADS anxiety and depression subscales were ≥ 8 and ≥ 7, with 93.3% and 77.3% sensitivity, respectively, and 77.9% and 87.1% specificity, respectively. They also had a 21% and 36% positive predictive value, respectively. Using the HADS Unitary Scale the optimal threshold for detecting affective disorders was ≥ 12, with 88.9% sensitivity, 80.7% specificity, and a 35% positive predictive value. In detecting affective disorders, the optimal threshold on the GHQ-12 was ≥ 2, with 77.8% sensitivity and 70.2% specificity. This scale also had a 24% positive predictive value. In detecting generalized anxiety disorder and DSM major depression, the optimal thresholds on the GHQ-12 were ≥ 2 and ≥ 4 with 73.3% and 77.3% sensitivity, respectively, and 67.5% and 82% specificity, respectively. The scale also had 12% and 29% positive predictive values, respectively. Conclusion: The HADS Unitary Scale and its subscales were effective in identifying affective disorders. They can be used as screening measures in breast cancer patients. The GHQ-12 was less accurate in detecting affective disorders than the HADS, but it can also be used as a screening instrument to detect affective disorders, generalized anxiety disorder, and DSM major depression.

Three decades of policy layering and politically sustainable reform in the European Union’s Agricultural Policy

The study of policy reform has tended to focus on single-stage reforms taking place over a relatively short period. Recent research has drawn attention to gradual policy changes unfolding over extended periods. One strategy of gradual change is layering, in which new policy dimensions are introduced by adding new policy instruments or by redesigning existing ones to address new concerns. The limited research on single-stage policy reforms highlights that these may not endure in the postenactment phase when circumstances change. We argue that gradual policy layering may create sustainability dynamics that can result in lasting reform trajectories. The European Union’s Common Agricultural Policy (CAP) has changed substantially over the last three decades in response to emerging policy concerns by adding new layers. This succession of reforms proved durable and resilient to reversal in the lead-up to the 2013 CAP reform when institutional and political circumstances changed.

Proposed feasibility oversight for pre-pack administration in England and Wales: window dressing or effective reform?

The 2014 Graham proposals aimed at reducing recidivism are unlikely to achieve the desired goals. It is argued that due consideration must be had for the future of the rescued entity. Further, both the viability review and the proposed capital structure of the rescued entity must be carefully assessed.

English language teaching and educational reform in Western China: a knowledge management perspective

This study examines the impact of a large-scale UK-based teacher development programme on innovation and change in English language education in Western China within a knowledge management (KM) framework. Questionnaire data were collected from 229 returnee teachers in 15 cohorts. Follow-up interviews and focus groups were conducted with former participants, middle and senior managers, and teachers who had not participated in the UK programme. The results showed evidence of knowledge creation and amplification at individual, group and inter-organizational levels. However, the present study also identified knowledge creation potential through the more effective organization of follow-up at the national level, particularly for the returnee teachers. It is argued that the KM framework might offer a promising alternative to existing models and metaphors of Continuing Professional Development (CPD).

Variation on the effects of the 2003 CAP reform and regional differences in the Italian olive oil sector

This paper analyses the impacts of the 2003 CAP reform on the production of Italian olive oil controlling for the regional differences in olive oil production as well as for the differences between years. Italian olive oil production time series data from the Farm Accountancy Data Network for the 2000-2010 period at regional level is used to examine the effect of the 2003 Fischler reform on the production of olive oil. Production costs and payments received by farmers to support their income are considered. The data were collected at micro level based on a sample of farms representative of the production systems in the country. In order to consider the differences in production among the regions, eight representative regions in terms of surveyed farms are considered: Liguria, Toscana, Umbria, Lazio, Campania, Calabria, Puglia and Sicilia. We found that the most important factors affecting the production of olive oil are the area under olive groves and labour productivity. Results also show no evidence that the level of payments have an impact to the level of production, however, the type of payments has. Future work should explore the impact of the 2003 reform into the technical and production efficiency of the Italian olive oil farmers. It would be interesting to link the measures introduced by the cross compliance and the management practices of the different farms to have a more complete picture of the various parameters influencing the production of olive oil.