Comparability of skin screening histories obtained by telephone interviews and mailed questionnaires: A randomized crossover study

The comparability of information collected through telephone interviews and information collected through mailed questionnaires has not been well studied. As part of the first phase of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors compared histories of skin examination reported in telephone interviews and self-administered mailed questionnaires. A total of 1,270 subjects each completed a telephone interview and a mailed questionnaire 1 month apart in 1999; 564 subjects received the interview first, and 706 received the mailed questionnaire first. Agreement between the two methods was 91.2% and 88.6% for whole-body skin examination by a physician in the last 12 months and the last 3 years, respectively, and 81.9% for whole-body skin self-examination in the last 12 months. Agreement was lower for any skin self-examination. Agreement between the two methods was similar regardless of whether the interview or the questionnaire was administered first. Missing data were less frequent for interviews (0.5%) than for mailed questionnaires (3.8%). Costs were estimated at A$9.55 (US$6.21) per completed interview and A$3.01 (US$1.96) per questionnaire. The similarity of results obtained using telephone interviews and mailed questionnaires, coupled with the substantially higher cost of telephone interviews, suggests that self-administered mailed questionnaires are an appropriate method of assessing this health behavior.

The experience of insomnia among older women

Study Objectives: To measure sleeping difficulty and sleep quality among older women, explore experience and attitudes towards sleep, and test for negative association between difficulty sleeping and health-related quality of life. Design: Four-year longitudinal study. Setting: Women were participants in the Australian Longitudinal Study on Women's Health. Participants: Women were sampled according to use of sleeping medication and classified into 4 groups: sleeping badly and using sleeping medications; not sleeping badly, but using sleeping medications; sleeping badly, not using sleeping medications; not sleeping badly, not using sleeping medications. Interventions: None. Measurements and Results: Sleeping difficulty and sleeping-medication use were measured at Survey 1, Survey 2 (3 years later), and Survey 3 (4 years later). Survey 3 included: Nottingham Health Profile Sleep Subscale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Geriatric Depression Scale, Duke Social Support Index, Medical Outcomes Study Short-Form 36-item Health Survey, and a 21-item life events scale. Survey 3 was returned by 1011 women (84%). Sleeping problems were negatively associated with SF-36 subscale scores. Most associations remained significant after comorbid conditions, Geriatric Depression Scale, life events scores, and medication use were added to models. Most women with sleeping problems (72%) sought help from a doctor, and 54% used prescribed sleeping medications in the past month. Conclusions: Sleeping difficulty is a serious symptom for older women and is associated with poorer quality of life. Some of this effect can be explained by comorbidities, depression scores, life events, and use of sleeping medications.

Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias

The measurement of lifetime prevalence of depression in cross-sectional surveys is biased by recall problems. We estimated it indirectly for two countries using modelling, and quantified the underestimation in the empirical estimate for one. A microsimulation model was used to generate population-based epidemiological measures of depression. We fitted the model to 1-and 12-month prevalence data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) and the Australian Adult Mental Health and Wellbeing Survey. The lowest proportion of cases ever having an episode in their life is 30% of men and 40% of women, for both countries. This corresponds to a lifetime prevalence of 20 and 30%, respectively, in a cross-sectional setting (aged 15-65). The NEMESIS data were 38% lower than these estimates. We conclude that modelling enabled us to estimate lifetime prevalence of depression indirectly. This method is useful in the absence of direct measurement, but also showed that direct estimates are underestimated by recall bias and by the cross-sectional setting.

Psychosocial and non-psychosocial risk factors for the new diagnosis of diabetes in elderly women

Objectives: Determine psychosocial variables associated with the new diagnosis of diabetes in elderly women. Examine whether variables remained significant predictors after controlling for non-psychosocial risk factors and the frequency of doctor visits. Research design and methods: A longitudinal cohort study was conducted using data from 10 300 women who completed a survey in 1996 and 1999. The women were aged between 70 and 74 years of age in 1996. The were asked to provide self-reports on a number of psychosocial and non-psychosocial variables in 1996 and on whether they had been diagnosed for the first time with diabetes in the 3-year period. The relationships between the potential risk factors and new diagnosis of diabetes were examined using binary logistic regression analysis. Results: Univariate results showed that not having a current partner, having low social support and having a mental health index score in the clinical range were all associated with higher risks of being diagnosed with diabetes for the first time. However the multivariate results showed that only a mental health index score in the clinical range and not having a current partner provided unique prediction of being newly diagnosed with diabetes. Of the non-psychosocial variables measured, only having a high BMI and hypertension were associated with increased risks of new diagnosis, while there was also evidence of a U shaped relationship between alcohol consumption and new diagnosis. Even after adjusting for frequency of doctor visits and non-psychosocial risk factors, a mental health index in the clinical range proved to still be a significant risk factor. Conclusions: A score on the mental health index that is within the clinical range is an independent risk factor for the new diagnosis of diabetes in elderly women. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

Measurement properties of the CHAMPS physical activity questionnaire in a sample of older Australians

Background: The effective evaluation of physical activity interventions for older adults requires measurement instruments with acceptable psychometric properties that are sufficiently sensitive to detect changes in this population. Aim: To assess the measurement properties (reliability and validity) of the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in a sample of older Australians. Methods: CHAMPS data were collected from 167 older adults (mean age 79.1 S.D. 6.3 years) and validated with tests of physical ability and the SF-12 measures of physical and mental health. Responses from a sub-sample of 43 older adults were used to assess 1-week test-retest reliability. Results: Approximately 25% of participants needed assistance to complete the CHAMPS questionnaire. There were low but significant correlations between the CHAMPS scores and the physical performance measures (rho=0.14-0.32) and the physical health scale of the SF-12 (rho=0.12-0.24). Reliability coefficients were highest for moderate-intensity (ICC=0.81-0.88) and lowest for vigorous-intensity physical activity (ICC=0.34-0.45). Agreement between test-retest estimates of sufficient physical activity for health benefits (>= 150 min and >= 5 sessions per week) was high (percent agreement = 88% and Cohen's kappa = 0.68). Conclusion: These findings suggest that the CHAMPS questionnaire has acceptable measurement properties, and is therefore suitable for use among older Australian adults, as long as adequate assistance is provided during administration. (c) 2006 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Weight gained in two years by a population of mid-aged women: how much is too much?

Objective: To establish the prevalence of weight change in mid-aged women over a 2-year period, and to assess the relationship between weight change and physical and mental well-being (SF36) in order to begin debate about the need for quantified standards of weight gain. Design: Prospective study of weight change and well-being over a 2-year period among mid-aged women participating in a large national survey. Subjects: Seven thousand two hundred and seventy women without surgical menopause aged between 45 and 50 years (termed mid-aged), enrolled in the Australian Longitudinal Study on Women's Health. Measurements: Weight change (self-reported weight at two time points) and physical and mental well-being (SF-36) explored using linear regression, while adjusting for potential confounders. Results: Only half the women maintained their weight within 2.25 kg, and one-third gained more than this amount in a 2-year period. While weight gain (>= 2.25 kg) was negatively associated with physical well-being, both weight loss and weight gain were associated with poorer mental well-being. Conclusion: This is the first prospective study using a large, population-based cohort to demonstrate that small changes in weight are associated with changes in well-being in mid-aged Australian women. It provides further evidence of the need for public health messages to specify the actual amount that constitutes weight gain, but further research is needed to establish these standards for the entire population.

'Occasional' and 'social' smokers: Potential target groups for smoking cessation campaigns?

Objective: To describe the characteristics [of self-described 'occasional' and 'social' Australian smokers. Design: Analysis of a national cross-sectional survey of smoking patterns, conducted in Australia in 2004. Setting and participants: Australian adults in 2004 who responded to a survey question about self-described smoking status. Main outcome measures: Demographic characteristics, patterns of alcohol and tobacco use, smoking cessation attempts in the past year, and interest in cessation. Results: Smokers who described themselves as 'occasional' and 'social' smokers comprised 29% of all smokers. A significant proportion of occasional and social smokers had been daily smokers, but the majority either believed that they had 'already quit' or had no intention of quitting smoking. Conclusions: Self-ascribed occasional and social smokers potentially represent an important target group for cessation. These types of smokers may be more resistant to public health messages regarding cessation because they do not view their smoking behaviour as presenting a high risk.

The psychometric properties of a psychosis screen in a correctional setting

Many people who go to gaol are mentally ill. Remandees, prisoner receptions or people in jails have a substantially higher rate of severe mental disorder than other prisoners and the general population. There are no completely satisfactory ways to screen for psychosis and few existing screening questionnaires are available for use in correctional establishments. The Screening Instrument for Psychosis (PS) was developed in the context of the Australian Mental Health Survey: Study of Low Prevalence Disorders. It can help indicate whether a person should be referred to mental health professional for a diagnostic evaluation and possible treatment and/or diversion. We trialled the PS in a high security remand and reception centre. Measures of validity and reliability are reported. (c) 2006 Published by Elsevier Inc.

A PRESENÇA DE DEPRESSÃO EM PACIENTES DURANTE O PERÍODO DE REABILITAÇÃO FÍSICA E O IMPACTO NA QUALIDADE DE VIDA DOS MESMOS

A depressão é um termo que descreve uma série de comportamentos complexos e tem sido empregada para designar tanto um estado afetivo normal, quanto um sintoma, uma síndrome e uma ou várias doenças. É caracterizada por um conjunto de sintomas relacionados a uma dada situação, ou ainda pelo aparecimento destes, de forma repetida e/ou sem nenhuma causa aparente. Os principais sintomas para o diagnóstico da depressão são alteração do apetite, agitação ou retardo psicomotor, diminuição da energia ou cansaço excessivo, sensação de culpa, dificuldade de concentração e pensamentos recorrentes de morte ou suicídio. A qualidade de vida está relacionada ao completo bem-estar físico, psíquico e social do indivíduo. Este estudo tem como objetivo investigar a presença de depressão em pacientes portadores de doenças reumatológicas e neurológicas, que estão em tratamento fisioterapêutico na Clínica Escola de Fisioterapia da Universidade Metodista de São Paulo e analisar o impacto da depressão sobre a qualidade de vida dos mesmos. Foram selecionados indivíduos nos setores de neurologia e reumatologia, em atendimento no período de junho a agosto de 2003, os quais responderam a dois questionários, Inventário de Beck para investigar a presença de depressão e, o SF-36 para avaliar a qualidade de vida. Os resultados obtidos foram analisados pelo teste T-Student, de correlação de Pearson, análise de Cluster, e Lambda de Wilks. Os dados foram analisados no programa STATISTICA, foi adotado um nível de significância de 5% (p≤ 0,05). Concluiu-se que durante o período de reabilitação física dos indivíduos participantes deste estudo, um número significativo de pacientes apresentou depressão em diferentes níveis, com provável incidência no grupo reumatológico e este mesmo grupo, apresentou qualidade de vida inferior a dos indivíduos do grupo neurológico avaliados neste estudo

OPINIÃO DE CRIANÇAS SOBRE O LAR DE LONGA PERMANÊNCIA PARA IDOSOS: MUDANÇAS POR CONTATO LÚDICO

Esta pesquisa verifica a opinião da criança por meio do desenho sobre o Lar de Longa Permanência para Idosos, antes e depois de contato lúdico com idosos institucionalizados. Para melhor caracterizar a população idosa, traça seu perfil neuropsicológico. Desenvolve-se junto a 21 idosos institucionalizados e 61 crianças com idades entre 7 e 12 anos, do Ensino Fundamental público. Inicia-se por verificar a opinião destas crianças sobre Asilo, por meio de desenho. Em seguida, realiza intervenção lúdica com crianças e idosos, de 10 encontros com brincadeiras simbólicas e jogos de regras. A seguir, reavalia a opinião das crianças e faz avaliação neuropsicológica dos idosos, por meio de Mini-Exame do Estado Mental, da Escala de Depressão Geriátrica, do Short-Form Health Survey (SF-36) e do Índice de Katz. Para verificar a opinião das crianças expressa por meio do desenho, utiliza de um título em aberto “Asilo é...”, a ser completado. Eles são analisados com subsídios do teste projetivo House-Tree-Person (HTP). Os resultados demonstram que houve, de uma aplicação para outra, alteração na opinião de 67% das crianças, que manifestaram opinião mais positiva relativa a perceber os idosos mais interativos e o Asilo mais humanizado, por meio de desenhos mais coloridas, de casas com portas e janelas, de pessoas sorrindo e em movimento e de mensagens afetuosas. Como aspectos negativos, encontram-se maior número de grades e de pessoas desenhadas sem face, o que pode representar a percepção da criança da dificuldade de contato do idoso com o mundo externo. Na análise estatística, encontrou-se média geral de 0,34 e desvio padrão de 0,16, no primeiro desenho e, no segundo, média de 0,42 e desvio padrão de 0,19, com médias obtidas numa escala de 0 a 1, em que se considera positivo o valor próximo a 1. Na avaliação neuropsicológica dos idosos, no MEEM, 50% demonstram preservação cognitiva. Os demais instrumentos indicam que a maior parte deles não apresenta sintomas depressivos, emite opinião positiva com relação à própria saúde, participa das atividades lúdicas e é dependente. Este estudo ressalta contudo que as características da instituição pesquisada, juntamente com a realização de atividades lúdicas, podem ter favorecido a opinião das crianças após seu contato com o Asilo. O estudo indica a necessidade de novas pesquisas sobre interação criança-idoso institucionalizado

Quality of life instruments in studies of menorrhagia: a systematic review

BACKGROUND: The use of quality of life (QoL) instruments in menorrhagia research is increasing but there is concern that not enough emphasis is placed on patient-focus in these measurements, i.e. on issues which are of importance to patients and reflect their experiences and concerns (clinical face validity). The objective was to assess the quality of QoL instruments in studies of menorrhagia. STUDY DESIGN: A systematic review of published research. Papers were identified through MEDLINE (1966-April 2000), EMBASE (1980-April 2000), Science Citation Index (1981-April 2000), Social Science Citation Index (1981-April 2000), CINAHL (1982-1999) and PsychLIT (1966-1999), and by manual searching of bibliographies of known primary and review articles. Studies were selected if they assessed women with menorrhagia for life quality, either developing QoL instruments or applying them as an outcome measure. Selected studies were assessed for quality of their QoL instruments, using a 17 items checklist including 10 items for clinical face validity (issues of relevance to patients' expectations and concerns) and 7 items for measurement properties (such as reliability, responsiveness, etc.). RESULTS: A total of 19 articles, 8 on instrument development and 11 on application, were included in the review. The generic Short Form 36 Health Survey Questionnaire (SF36) was used in 12/19 (63%) studies. Only two studies developed new specific QoL instruments for menorrhagia but they complied with 7/17 (41%) and 10/17 (59%) of the quality criteria. Quality assessment showed that only 7/19 (37%) studies complied with more than half the criteria for face validity whereas 17/19 (90%) studies complied with more than half of the criteria for measurement properties (P = 0.0001). CONCLUSION: Among existing QoL instruments, there is good compliance with the quality criteria for measurement properties but not with those for clinical face validity. There is a need to develop methodologically sound disease specific QoL instruments in menorrhagia focussing both on face validity and measurement properties.

Quality of life instruments in studies of menorrhagia: a systematic review

BACKGROUND: The use of quality of life (QoL) instruments in menorrhagia research is increasing but there is concern that not enough emphasis is placed on patient-focus in these measurements, i.e. on issues which are of importance to patients and reflect their experiences and concerns (clinical face validity). The objective was to assess the quality of QoL instruments in studies of menorrhagia. STUDY DESIGN: A systematic review of published research. Papers were identified through MEDLINE (1966-April 2000), EMBASE (1980-April 2000), Science Citation Index (1981-April 2000), Social Science Citation Index (1981-April 2000), CINAHL (1982-1999) and PsychLIT (1966-1999), and by manual searching of bibliographies of known primary and review articles. Studies were selected if they assessed women with menorrhagia for life quality, either developing QoL instruments or applying them as an outcome measure. Selected studies were assessed for quality of their QoL instruments, using a 17 items checklist including 10 items for clinical face validity (issues of relevance to patients' expectations and concerns) and 7 items for measurement properties (such as reliability, responsiveness, etc.). RESULTS: A total of 19 articles, 8 on instrument development and 11 on application, were included in the review. The generic Short Form 36 Health Survey Questionnaire (SF36) was used in 12/19 (63%) studies. Only two studies developed new specific QoL instruments for menorrhagia but they complied with 7/17 (41%) and 10/17 (59%) of the quality criteria. Quality assessment showed that only 7/19 (37%) studies complied with more than half the criteria for face validity whereas 17/19 (90%) studies complied with more than half of the criteria for measurement properties (P = 0.0001). CONCLUSION: Among existing QoL instruments, there is good compliance with the quality criteria for measurement properties but not with those for clinical face validity. There is a need to develop methodologically sound disease specific QoL instruments in menorrhagia focussing both on face validity and measurement properties.