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.

Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials

Background Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. Methods We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Results Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. Conclusions There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations’ funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning. Keywords: Adaptive designs; flexible designs; barriers; surveys; confirmatory trials; Phase 3; clinical trials; early stopping; interim analyses

A low mortality, high morbidity reduced intensity status epilepticus (RISE) model of epilepsy and epileptogenesis in the rat

Animal models of acquired epilepsies aim to provide researchers with tools for use in understanding the processes underlying the acquisition, development and establishment of the disorder. Typically, following a systemic or local insult, vulnerable brain regions undergo a process leading to the development, over time, of spontaneous recurrent seizures. Many such models make use of a period of intense seizure activity or status epilepticus, and this may be associated with high mortality and/or global damage to large areas of the brain. These undesirable elements have driven improvements in the design of chronic epilepsy models, for example the lithium-pilocarpine epileptogenesis model. Here, we present an optimised model of chronic epilepsy that reduces mortality to 1% whilst retaining features of high epileptogenicity and development of spontaneous seizures. Using local field potential recordings from hippocampus in vitro as a probe, we show that the model does not result in significant loss of neuronal network function in area CA3 and, instead, subtle alterations in network dynamics appear during a process of epileptogenesis, which eventually leads to a chronic seizure state. The model’s features of very low mortality and high morbidity in the absence of global neuronal damage offer the chance to explore the processes underlying epileptogenesis in detail, in a population of animals not defined by their resistance to seizures, whilst acknowledging and being driven by the 3Rs (Replacement, Refinement and Reduction of animal use in scientific procedures) principles.

Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Risk factors for dengue virus infection in rural Amazonia: Population-based cross-sectional surveys

A comparison of dengue virus (DENV) antibody levels in paired serum samples collected from predominantly DENV-naive residents in an agricultural settlement in Brazilian Amazonia (baseline seroprevalence, 18.3%) showed a seroconversion rate of 3.67 episodes/100 person-years at risk during 12 months of follow-up. Multivariate analysis identified male sex, poverty, and migration from extra-Amazonian states as significant predictors of baseline DENY seropositivity, whereas male sex, a history of clinical diagnosis of dengue fever, and travel to an urban area predicted subsequent seroconversion. The laboratory surveillance of acute febrile illnesses implemented at the study site and in a nearby town between 2004 and 2006 confirmed 11. DENV infections among 102 episodes studied with DENV IgM detection, reverse transcriptase-polymerise chain reaction, and virus isolation; DENV-3 was isolated. Because DENV exposure is associated with migration or travel, personal protection measures when visiting high-risk urban areas may reduce the incidence of DENV infection in this rural population.

Age-Dependent Acquisition of Protective Immunity to Malaria in Riverine Populations of the Amazon Basin of Brazil

Five community-based cross-sectional surveys of malaria morbidity and associated risk factors in remote riverine populations in northwestern Brazil showed average parasite rates of 4.2% (thick-smear microscopy) and 14.4% (polymerase chain reaction [PCR]) in the overall population, with a spleen rate of 13.9% among children 2-9 years of age. Plasmodium vivax was 2.8 times more prevalent than P. falciparum, with rare instances of P. malariae and mixed-species infections confirmed by PCR; 9.6% of asymptomatic subjects had parasitemias detected by PCR. Low-grade parasitemia detected by PCR only was a risk factor for anemia, after controlling for age and other covariates. Although clinical and subclinical infections occurred in all age groups, the risk of infection and disease decreased significantly with increasing age, after adjustment for several covariates in multilevel logistic regression models. These findings suggest that the continuous exposure to hypo- or mesoendemic malaria may induce significant anti-parasite and anti-disease immunity in native Amazonians.

The signature of dark energy perturbations in galaxy cluster surveys

Models of dynamical dark energy unavoidably possess fluctuations in the energy density and pressure of that new component. In this paper we estimate the impact of dark energy fluctuations on the number of galaxy clusters in the Universe using a generalization of the spherical collapse model and the Press-Schechter formalism. The observations we consider are several hypothetical Sunyaev-Zel`dovich and weak lensing (shear maps) cluster surveys, with limiting masses similar to ongoing (SPT, DES) as well as future (LSST, Euclid) surveys. Our statistical analysis is performed in a 7-dimensional cosmological parameter space using the Fisher matrix method. We find that, in some scenarios, the impact of these fluctuations is large enough that their effect could already be detected by existing instruments such as the South Pole Telescope, when priors from other standard cosmological probes are included. We also show how dark energy fluctuations can be a nuisance for constraining cosmological parameters with cluster counts, and point to a degeneracy between the parameter that describes dark energy pressure on small scales (the effective sound speed) and the parameters describing its equation of state.

Changes in attitudes to mothers working: evidence from Australian surveys

The aim of this article is to contribute to the development of our  understanding of two aspects of attitude change in Australia. First, both cohort and individual explanations for attitude change are tested empirically. Second, empirical evidence is provided about the nature and scope of change in gender role attitudes amongst males and females, and of different birth cohorts in Australia, as reported in two survey periods: 1994 and 2002. In particular, the question of whether there is empirical evidence of cohort differences in attitudes to gender roles in Australia is investigated. TheThe aim of this article is to contribute to the development of our understanding of two aspects of attitude change in Australia. First, both cohort and individual explanations for attitude change are tested empirically. Second, empirical evidence is provided about the nature and scope of change in gender role attitudes amongst males and females, and of different birth cohorts in Australia, as reported in two survey periods: 1994 and 2002. In particular, the question of whether there is empirical evidence of cohort differences in attitudes to gender roles in Australia is investigated. The findings show that birth cohorts display progressively more modern attitudes, but people tend not to change their attitudes as they get older. In addition, men and women have different attitudes to gender roles, with men displaying more traditional beliefs than women. Having more than one child makes women less inclined to express the belief that women should work.

Managing contactability in telephone surveys

The Australian market research industry relies on telephone interviewing as one of its major data collection methods. Through Its LIST initiative, the industry has committed to best practice In research methods in order to address various concerns, especially the decline in response rates for telephone interviews. Response rates are determined by the co-operation of eligible respondents and their degree of contactabllity. The reported study is concerned with the way the industry attempts to manage contactabiIity. A study of fieldwork managers responSible for over 75% of all phone interviews in Australia revealed a limited use of contact enhancing strategies such as longer fieldwork periods and more callbacks. Commercial imperatives for timely surveys and a lack of end-user concern for response rate issues, along with cost issues, were believed to be responsible.

An analysis of CSI/FBI and AusCERT surveys

The paper responds to the release of both the AusCERT and CSI/FBI computer crime and security surveys with a comparison of the results between the two countries' respondents. Overall both surveys show the trend that most organisations employ security technologies but half of them still experience incidents which compromise their security. These incidents have significant quantifiable losses but despite these organisations are still loathed to report to law enforcement agencies for various reasons. These include the impression that law enforcement agencies are not interested, and the negative publicity such incidents can cause in their aftermath.

The effect of attitudes and experience on respondent answers to demographic questions in on-line surveys

Survey response rates and response quality are declining in most markets, threatening the viability of many established research techniques. One attempt to combat this has been to make survey completion more convenient for respondents, with on-line surveys being an example of this. This paper looks at respondent attitudes to demographic questions in on-line surveys – questions that are crucial for many analysis practices and yet often have the highest non-completion rates. The exploratory survey conducted here (n=198) examined attitudes towards surveys and empirically examined the reasons behind non-completion and intentions to give misleading information. The results suggest that general attitudes towards providing demographic data in on-line surveys are related to the likely response behaviour, and the more uncomfortable someone claims to be with providing this data, the more likely they will be to either omit a response or exit the survey altogether. Past experience with on-line surveys increases the chances of respondents answering completely and accurately and in most cases, significantly reduces the likelihood of exiting the survey completely if asked these questions. Finally, there is some evidence that providing broad categorical response options is preferred to more specific categories or open text boxes, and this may represent the best technique for improving response rates and quality.

Response rates in telephone surveys: managing contactability

Telephone interviewing is the major data collection method for the market research industry. Although social trends such as mobile phones and call screening make it harder to contact people, better technology and contact regimes can assist companies to ameliorate the situation. A study of fieldwork managers responsible for over 75% of all phone interviews in Australia revealed limited use of contact enhancing strategies such as longer survey periods and more callbacks. Commercial imperatives for timely surveys and a lack of end-user concern for response rate issues, along with costs concerns, were believed to be responsible.

Reaching the invisible : overcoming sampling barriers in GLB research via web surveys

Sampling is fundamental to the credibility of any empirical investigation, and this is no different for the area of Gay, Lesbian and Bisexual (GLB) research. In fact, it would not be an overstatement to say that publication of GLB research into high quality and mainstream journals has been limited in part because of sampling issues. The purpose of this paper is to raise awareness of the unique sampling problems posed by GLB resaerch and to offer solutions to these through the use of web surveys and recruitment strategies. In particular, we provide data which show that, contrary to voiced concerns, when employed with a rigorous recruitment strategy, web surveys increase rather than reduce sampling coverage. Further, we provide evidence that the web survey technique can yield data of comparable quality to that obtained with a hard-copy survey. The paper concludes with strategies researchers can adopt to overcome barriers in obtaining a diverse GLB sample.