Alzheimer`s disease diagnosis disclosure in Brazil: a survey of specialized physicians` current practice and attitudes

Background: There is little, though growing, interest in the research area of attitudes held among physicians towards disclosing the diagnosis of dementia and Alzheimer`s disease (AD), or the current practice on AD disclosure. This study aimed to investigate the practice and attitudes of specialized physicians towards AD diagnosis disclosure in Brazil. Methods: A questionnaire was devised to survey the current practice and attitudes regarding diagnosis disclosure of AD in Brazil and sent to specialized physicians (170 geriatricians, 300 neurologists and 500 psychiatrists) by electronic mail. Results: From 970 potential respondents, 181 physicians who usually attend AD patients returned the questionnaire. There were no significant differences between the three specialties regarding the frequency with which they informed patients of their AD diagnosis (p = 0.17). The results revealed that only 44.8% of the physicians would regularly inform the patient of the diagnosis, although 85.6% of these use clear terminology. Despite their usual practice, 76.8% would want to know their diagnosis if they themselves were affected by AD. Conclusions: Disclosure of AD diagnosis is not common among specialized physicians in Brazil and different factors are involved. In the clinical context, discussion on advantages of diagnosis disclosure can be useful for improving the care of AD patients and their families.

Genetic and environmental contributions to educational attainment in Australia

The genetic and environmental contributions to educational attainment in Australia are examined using a multiple regression model drawn from the medical research literature. Data from a large sample of Australian twins are analysed. The findings indicate that at least as much as 50 percent and perhaps as much as 65 percent of the variance in educational attainments can be attributed to genetic endowments. It is suggested that only around 25 percent of the variance in educational attainments may be due to environmental factors, though this contribution is shown to be around 40 percent when adjustments for measurement error and assortative mating are made. The high fraction of the observed variation in educational attainments due to genetic differences is consistent with results reported by Heath et al. (Heath, A.C., Berg, K., Eaves, L.J., Solaas, M.H., Corey, L.A., Sundet, J., Magnus, P., Nance, W.E., 1985. Education policy and the heritability of educational attainment. Nature 314(6013), 734-736.), Tambs et al. (Tambs, K., Sundet, J.M., Magnus, P., Berg, K., 1989. Genetic and environmental contributions to the covariance between occupational status, educational attainment and IQ: a study of twins. Behavior Genetics 19(2), 209-222.), Vogler and Fulker (Vogler, G.P., Fulker, D.W., 1983. Familial resemblance for educational attainment. Behavior Generics 13(4), 341-354.) and Behrman and Taubman (Behrman, J., Taubman, P., 1989. Is schooling mostly in the genes? Nature-nurture decomposition using data on relatives. Journal of Political Economy 97(6), 1425-1446.), suggesting that the finding is robust. (C) 2001 Elsevier Science Ltd. All rights reserved.

Health services research using linked records: who consents and what is the gain?

Objective: To assess consent to record linkage, describe the characteristics of consenters and compare self-report versus Medicare records of general practitioner use. Method. Almost 40,000 women in the Australian Longitudinal Study on Women's Health were sent a request by mail for permission to link their Medicare records and survey data. Results: 19,700 women consented: 37% of young (18-23 years), 59% of mid-age (4550 years) and 53% of older women (70-75 years). Consenters tended to have higher levels of education and, among the older cohort, were in better health than nonconsenters. Women tended to under-report the number of visits to general practitioners. Conclusions: Record linkage of survey and Medicare data on a large scale is feasible. The linked data provide information on health and socio-economic status which are valuable for understanding health service utilisation. Implications: Linked records provide a powerful tool for health care research, particularly in longitudinal studies.