Do hand-held calorimeters provide reliable and accurate estimates of resting metabolic rate?

This paper provides an overview of a new technique for indirect calorimetry and the assessment of resting metabolic rate. Information from the research literature includes findings on the reliability and validity of a new hand-held indirect calorimeter as well as use in clinical and field settings. Research findings to date are of mixed results. The MedGem instrument has provided more consistent results when compared to the Douglas bag method of measuring metabolic rate. The BodyGem instrument has been shown to be less accurate when compared to standard metabolic carts. Furthermore, when the Body Gem has been used with clinical patients or with under nourished individuals the results have not been acceptable. Overall, there is not a large enough body of evidence to definitively support the use of these hand-held devices for assessment of metabolic rate in a wide variety of clinical or research environments.     

Do the media provide transparent health information? A cross-cultural comparison of public information about the HPV vaccine

The media is a powerful tool for informing the public about health treatments. In particular, the Internet has gained importance as a widely valued source for health information for parents and adolescents. Nonetheless, traditional sources, such as newspapers, continue to report on health innovations. But do websites and newspaper reports provide balanced information? We performed a systematic media analysis to evaluate and compare media coverage of the human papillomavirus (HPV) vaccine on websites and in newspapers in Germany and Spain. We assessed to what extent the media provide complete (pros and cons), transparent (absolute instead of relative numbers), and correct information about the epidemiology and etiology of cervical cancer as well as the effectiveness and costs of the HPV vaccine. As a basis for comparison, a facts box containing current scientific evidence about cervical cancer and the HPV vaccine was developed. The media analysis included 61 websites and 141 newspaper articles in Germany, and 41 websites and 293 newspaper articles in Spain. Results show that 57% of German websites and 43% of German newspaper reports communicated correct estimates of epidemiological data, whereas in Spain 39% of the websites and 20% of the newspaper did so. While two thirds of Spanish websites explicitly mentioned causes of cervical cancer as well as spontaneous recovery, German websites communicated etiological information less frequently. Findings reveal that correct estimates about the vaccine's effectiveness were mentioned in 10% of German websites and 6% of German newspaper reports; none of the Spanish newspaper reports and 2% of Spanish websites reported effectiveness correctly. Only German websites (13%) explicitly referred to scientific uncertainty regarding the vaccine's evaluation. We conclude that the media lack balanced reporting on the dimensions completeness, transparency, and correctness. We propose standards for more balanced reporting on websites and in newspapers.     

Female mortality in the Municipality of São Paulo: quality of medical death certificates

OBJECTIVE: To evaluate the quality of the medical certification of deaths of 10-49 year-old women, resident in the Southern region of the city of S. Paulo METHODS: The Puffer methodology was utilized to investigate the causes of death of all 10-49 year-old women, resident in the region, and deceased in the year 1989 (664 deaths in the total). The main causes of death in the original death certificates and the "new" causes of death arisen from the research were compared. The sensitivity and the kappa index were calculated. RESULTS: In some chapters of the International Classification of Diseases and Causes of Death, 9th Revision (CID-9), a high sensitivity was found: "Diseases of the Circulatory System" (91.9%), "Neoplasms" (89.7%) and "External Causes" (84.1 %). In some others, a very low sensitivity was found. The chapter "Mental Illnesses", with a 34.3 percent sensitivity only, must be mentioned. From 11 deaths originally classified in this chapter, 32 cases were found. In most of these "new" cases, the main cause of death was found to be alcoholism. The chapter "Complications of Pregnancy, Delivery and the Puerperium", also showed a low sensitivity (44.9%). The kappa index was found to be 0.63, which indicated a regular concordance. DISCUSSION: The quality of the medical certification of causes of death is still unsatisfactory in the studied area. This poor quality may affect negatively the interventions in the area of women's health, masking the severity of important problems     

Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification

Causes of death of 625 subjects who died during the 4-year follow-up of a large population-based elderly cohort (Three-City study) were independently classified by the study adjudication committee and the national mortality register. The former used all available data about the cause of death (hospital records, medical data obtained from family physicians or specialists, and proxy interviews) and the latter used internationally standardized recommendations for processing death certificate data. Comparison showed a moderate overall agreement for underlying cause of death between the study adjudication committee and the national register (kappa = 0.51). Differences were found especially for cardiovascular diseases (20.6% of deaths from the study committee vs. 32.5% from the national register) and ill-defined causes of death (22.7 vs. 4%). The proportion of disagreement increased in participants dying at age >85 compared to those dying at age ≤70 (adjusted odds ratio = 2.46, 95% confidence interval = 1.10–5.49). It was also higher when the study committee used hospital record data for defining cause of death, compared to adjudication based on data obtained from proxy (adjusted odds ratio = 1.85, 95% CI = 1.09–3.14). These findings raise questions about the validity of national mortality registers in very old persons. Disease-specific causes of death, especially vascular diseases, could be overestimated in this age group.     

Whom should we ask? A systematic literature review of the arguments regarding the most accurate source of information for valuation of health states

Quality of Life Research - To determine and critically evaluate the arguments in the published literature regarding the most accurate source of information for valuation of health states: values...     

What is the accurate knowledge of the German population regarding sexual HIV transmission?

Objectives:  HIV incidence in Germany is increasing even though the German Federal Centre for Health Education reported that the entire German population (99 %) has sufficient knowledge of sexual HIV transmission. We tried to find out the reason for this discrepancy. Methods:  HIV transmission knowledge was investigated in a Munich population (n = 317) and the findings compared with a nationwide study. Results:  No differences in knowledge regarding needle sharing and HIV/AIDS curability were found but, in relation to sexual HIV transmission, only 55.5 % of Munich respondents had sufficient knowledge of vaginal, anal and oral transmission routes. Conclusions:  The knowledge level reported in the nationwide study is overestimated as a result of the ambiguous character of the questions used. Submitted: 01 March 2008; revised: 16 January 2009, 20 February 2009; accepted: 30 March 2009     

Recording of diabetes on death certificates. Has it improved?

OBJECTIVE: To determine whether the recording of diabetes on death certificates improved from 1986 to 1993. METHOD: Comparison of two National Mortality Follow-back Surveys that selected independent samples of death certificates with the purpose of obtaining information from informants about the decedents. RESULTS: The recording of diabetes on death certificates did not improve from 1986 to 1993. CONCLUSION: Periodic monitoring of the accuracy of death certificates is essential for proper interpretation of mortality statistics which are routinely used to describe the burden of diabetes in our society.     

What do medical students know about cause and epidemiology of the Creutzfeldt-Jakob disease in Germany?

Due to the increase of patients with the variant Creutzfeldt-Jakob disease (vCJD) in Great Britain and the first cases of autochthonous BSE cases in Germany, the study tried to investigate the knowledge of medical students about the epidemiology of CJD in Germany and how they assess the influence of different factors on the etiology of CJD. Altogether 63 first year medical students, 96 third year medical students and 50 nurses were included in an anonymous questionnaire survey. They were asked to estimate the annually incidence of CJD in Germany and to assess, by using analogue-scales, the influence of different factors on the risk of contracting CJD. For the medical students the median was 100 and for the nurses the median was 10 annual CJD cases. All participants, and especially the males, emphasised the influence of "risk behaviour" and "environmental factors" on the risk of contracting CJD, the factor "stress/ emotional strain" was seen as most unimportant. No significant differences between female and male participants in the knowledge about the incidence of CJD in Germany were found. It becomes obvious, that epidemiological knowledge about CJD in medical staff is associated with different and gender-specific views on the etiology. Medical education should consider this to avoid endangering medical staff and patients due to overprotection or insufficient precautions.     

Does medical school cause health anxiety and worry in medical students?

OBJECTIVES: The aim of this study was to investigate the self-reported experience of health anxiety and worry in medical students compared with control subjects. It was hypothesised that medical students would experience more health anxiety as a consequence of being exposed to medical education, compared to students who are not routinely exposed to such knowledge. DESIGN: The design was cross-sectional. SETTING: Participants were recruited from London University (Guy's, King's & St Thomas' School of Medicine and King's College). PARTICIPANTS: Medical students (n = 449) and non-medical students (n = 485) were recruited across Years 1-4. Questionnaires relating to health anxiety and worry were completed at the end of their lectures. MAIN OUTCOME MEASURES: Health anxiety was measured using a questionnaire known as the Health Anxiety Questionnaire (HAQ). Worry was assessed using the Anxious Thoughts Inventory (ANTI). RESULTS: Health anxiety was significantly lower in medical students in Years 1 and 4 than in controls (P = 0.017 and P < 0.001, respectively). Worry was significantly lower in the medical students in all years of study. CONCLUSIONS: Medical students are not a cohort of preselected health-anxious people, nor are they 'worriers'. Medical education at a clinical level was shown to mitigate health anxiety in the medical student population.     

Judging the quality of care at the end of life: can proxies provide reliable information?

A major challenge in research into care at the end of life is the difficulty of obtaining the views and experiences of representative samples of patients. Studies relying on patients' accounts prior to death are potentially biased, as they only represent that proportion of patients with an identifiable terminal illness, who are relatively well and therefore able to participate, and who are willing to take part. An alternative approach that overcomes many of these problems is the retrospective or 'after death' approach. Here, observations are gathered from proxies, usually the patient's next of kin, following the patient's death. However, questions have been raised about the validity of proxies' responses. This paper provides a comprehensive review of studies that have compared patient and proxy views. The evidence suggests that proxies can reliably report on the quality of services, and on observable symptoms. Agreement is poorest for subjective aspects of the patient's experience, such as pain, anxiety and depression. The findings are discussed in relation to literature drawn from survey methodology, psychology, health and palliative care. In addition to this, factors likely to affect levels of agreement are identified. Amongst these are factors associated with the patient and proxy, the measures used to assess palliative care and the quality of the research evaluating the validity of proxies' reports. As proxies are a vital source of information, and for some patients the only source, the paper highlights the need for further research to improve the validity of proxies' reports.     

How reliable is online diffusion of medical information targeting patients and families?

AIM: To determine whether online diffusion of the Ten Warning Signs of Primary Immunodeficiency Diseases(PID)' adheres to accepted scientific standards.METHODS: We analyzed how reproducible is online diffusion of a unique instrument, the Ten Warning Signs of PID, created by the Jeffrey Modell Foundation(JMF),by Google-assisted searches among highly visited sites from professional, academic and scientific organizations;governmental agencies; and patient support/advocacy organizations. We examined the diffusion, consistency of use and adequate referencing of this instrument.Where applicable, variant versions of the instrument were examined for changes in factual content that would have practical impact on physicians or on patients and their families.RESULTS: Among the first 100 sites identified by Google search, 85 faithfully reproduced the JMF model, and correctly referenced to its source. By contrast, the other15 also referenced the JMF source but presented one or more changes in content relative to their purported model and therefore represent uncontrolled variants, of unknown origin. Discrepancies identified in the latter included changes in factual content of the original JMF list(C), as well as removal(R) and introduction(I) of novel signs(Table 2), all made without reference to any scientific publications that might account for the drastic changes in factual content. Factual changes include changes inthe number of infectious episodes considered necessary to raise suspicion of PID, as well as the inclusion of various medical conditions not mentioned in the original.Together, these changes will affect the way physicians use the instrument to consult or to inform patients,and the way patients and families think about the need for specialist consultation in view of a possible PID diagnosis.CONCLUSION: The retrieved adaptations and variants,which significantly depart from the original instrument,raise concerns about standards for scientific information provided online to physicians, patients and families.     

Health information seeking and use outside of the medical encounter: Is it associated with race and ethnicity?

Increasing numbers of adults in the United States of America (USA) are seeking and using health information within their medical encounters. The theory of uncertainty management suggests that patients reduce health care uncertainty by increasing their understanding of disease etiology or treatment options, improving patient–doctor communication, and enhancing knowledge of disease self-management through health information seeking. However, research shows racial and ethnic minorities are less likely than Whites to seek health information and use it in their physician visits. How racial and ethnic minorities use health information outside of their medical encounters is unknown. In this study we used data from the 2007 USA Health Tracking Household survey, a nationally-representative survey of civilian, non-institutionalized Americans (n = 12,549). Using logistic regression we found African Americans were no different from Whites in seeking health information and using it when they talked with their doctors. Latinos were significantly less likely than Whites to seek health information and less likely to use it when they talked with their doctors. But, among those who sought health information, African Americans and Latinos were significantly more likely than Whites to use health information to change their approach to maintaining their health and better understand how to treat illnesses. Also, education significantly moderated the relationship between race/ethnicity and health information seeking. However, results were mixed for education as a moderator in the relationship between race/ethnicity and health information use. Future research should focus on interventions to improve how African Americans and Latinos interface with providers and ensure that health information sought and used outside of their medical encounters augments treatment protocols.     

Are vaccination information leaflets useful for vaccinators and parents?

Three vaccination information leaflets (VIL) were evaluated in the province of Québec in 2002-2003 to examine their use by vaccinators (nurses and physicians), and their success in reaching parents of infants and toddlers. Data were collected from vaccinators and parents by postal survey. Reception of all of the VIL was higher among nurses (98%) than among physicians (39%). Only 14% of parents were familiar with all the VIL. Vaccinators who used the VIL, and the parents who were familiar with them, were satisfied with their presentation, clarity, quantity of information, pertinence and credibility. While the information leaflets were useful for vaccinators, few parents were reached, limiting the impact of this method of promotion.