Lower utilization of cervical cancer screening by nurses in Taiwan: a nationwide population-based study

ObjectiveUsing a nationwide population-based database in Taiwan, this study compares use of Pap smear testing by nurses and the general population.MethodWe compared 1093 practicing female nurses and 5465 randomly selected female patients from the 2006 National Health Insurance (NHI) database to evaluate the likelihood of receiving at least one Pap smear during a three-year period.ResultsWe found that 48.9% of the nurses and 56.2% of comparison subjects received a Pap test from 2004 to 2006 in Taiwan. Regression analysis showed that practicing female nurses were less likely to receive a Pap smear compared with the general population (OR = 0.42, 95% CI = 0.35–0.50, p < 0.001), after adjusting for monthly incomes, number of ob/gyn ambulatory care visits, urbanization level and the geographic location of the communities where subjects resided.ConclusionNurses were less likely to undergo cervical screening than the general population, despite ease of access and a national health insurance system providing universal coverage to residents of Taiwan. Efforts to raise the Pap screening rate among nurses may require addressing unique cultural and occupational concerns.     

Rasch analysis supports the use of the depression, anxiety, and stress scales to measure mood in groups but not in individuals with chronic low back pain

ObjectiveChronic pain is a common problem that is associated with mood disorders such as depression. The Depression, Anxiety, and Stress Scales (DASS-21) questionnaire is commonly used to help measure disordered mood. In this study, we used Rasch analysis to analyze the clinimetric properties of the DASS-21 in a chronic low back pain sample.Study Design and SettingA Rasch analysis was conducted on data collected as a part of a randomized hospital-based placebo-controlled trial. DASS-21 questionnaires were completed by the 154 enrolled participants.ResultsThe DASS-21 subscales fit the Rasch model. No differential item functioning was detected for age, gender, pain severity, or disability. Reliability for individual use was supported for the depression subscale (Person Separation Index [PSI] = 0.86) but group use only for the anxiety (PSI = 0.74) and stress (PSI = 0.82) subscales. A DASS-21 aggregate score of “negative affect” lacked fit to the Rasch model (χ² = 191.48, P < 0.001).ConclusionThis is the first study that used Rasch analysis to demonstrate that the DASS-21 subscales demonstrate adequate measurement properties for research involving groups with chronic pain. Only the DASS-21 depression subscale demonstrated adequate reliability for use with individuals with chronic pain. The use of a single DASS-21 aggregate score as a measure of “negative affect” was not supported.     

Screening for depression in an elderly population living at home. Interest of the Mini-Geriatric Depression Scale

BackgroundDepression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable. Symptoms of depression present in the elderly can be masked and difficult to recognize. The purpose of this study was to examine prevalence and risk factors for depression in elderly living in their home.MethodsA cross-sectional study of randomly selected homes in randomly selected geographical islets was carried out Monastir City (Tunisia). Questionnaire-based interviews were conducted among the elderly aged more than 65 years living in their home. Depression symptoms were assessed using a Mini-Geriatric Depression Scale. The relationship between the risk of depression and sociodemographic and health-related variables was studied using logistic regression.ResultsOut of 598 (female 66 %, mean (SD) age 72.3 (7.4) years) elderly persons interviewed, 136 (22.7 %) were screened to have a Mini-Geriatric Depression Scale more than or equal to 1. Multiple logistic regression analysis revealed that the following were significant (P < 0.01) independent predictors of risk of depression: female sex (OR = 2.36 [95 % CI = 1.43–3.94]), having a low level of education (OR = 4.02 [95 % CI = 1.38–11.65]), disability (OR = 3.50 [95 % CI = 1.94–6.46]), a history of stroke (OR = 2.90 [95 % CI = 1.20–7.72]) and the use of hypnotic medications (OR = 2.47 [95 % CI = 1.38–4.42]).ConclusionThis study suggests that the risk of depression is a common psychiatric disorder in elderly living in their home, and underlines the usefulness of the Mini-Geriatric Depression Scale to detect the risk of depression in the elderly. This clinical approach should be encouraged in all medical practices to improve the prognosis of depression in the elderly.     

Associations of objectively-assessed physical activity and sedentary time with depression: NHANES (2005-2006)

BackgroundStudies provide conflicting evidence for the protective effects of moderate-to-vigorous-intensity physical activity on depression. Recent evidence suggests that sedentary behaviors may also be associated with depression.PurposeTo examine the associations of accelerometer-derived moderate-to-vigorous-intensity physical activity and sedentary time with depression among a population-based sample.MethodsCross-sectional study using 2,862 adults from the 2005–2006 US National Health and Nutrition Examination Survey. ActiGraph accelerometers were used to derive both moderate-to-vigorous-intensity physical activity and sedentary time.ResultsDepression occurred in 6.8% of the sample. For moderate-to-vigorous-intensity physical activity, compared with those in quartile 1 (least active), significantly lower odds of depression were observed for those participants in quartiles 2 (OR = 0.55, 95% CI, 0.34 to 0.89), 3 (OR = 0.49, 95% CI, 0.26 to 0.93), and 4 (most active) (OR = 0.37, 95% CI, 0.20 to 0.70) (p for trend p < 0.01). In overweight/obese participants only, those in quartile 4 (most sedentary) had significantly higher odds for depression than those in quartile 1 (least sedentary) [quartile 3 vs 1 (OR = 1.94, 95% CI, 1.01 to 3.68) and 4 vs 1 (OR = 3.09, 95% CI, 1.25 to 7.68)].ConclusionThe current study identified lower odds of depression were associated with increasing moderate-to-vigorous-intensity physical activity and decreasing sedentary time, at least within overweight/obese adults.     

The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery

ObjectiveTo develop a tool for identifying and quantifying morbidity following cardiac surgery (cardiac postoperative morbidity score [C-POMS]).Study Design and SettingMorbidity was prospectively assessed in 450 cardiac surgery patients on postoperative days 1, 3, 5, 8, and 15 using POMS criteria (nine postoperative morbidity domains in general surgical patients) and cardiac-specific variables (from expert panel). Other morbidities were noted as free text and included if prevalence was more than 5%, missingness less than 5%, and mean expert-rated severity-importance index score more than 8. Construct validity was assessed by expert panel review, Cronbach’s alpha (internal consistency), and linear regression (predictive ability of C-POMS for length of stay [LOS]).ResultsA 13-domain model was derived. Internal consistency (>0.7) on D3–D15 permits use as a summative score of total morbidity burden. Mean C-POMS scores were 3.4 (D3), 2.6 (D5), 3.4 (D8), and 3.8 (D15). Patient LOS was 4.6 days (P = 0.012), 5.3 days (P = 0.001), and 7.6 days (P = 0.135) longer in patients with C-POMS-defined morbidity on D3, D5, D8, and D15, respectively, than in those without. For every unit increase in C-POMS summary score, subsequent LOS increased by 1.7 (D3), 2.2 (D5), 4.5 (D8), and 6.2 (D15) days (all P = 0.000).ConclusionC-POMS is the first validated tool for identifying total morbidity burden after cardiac surgery. However, further external validation is warranted.     

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments.Study designObservational, cross-sectional survey.LocationPrimary Care Teaching Unit. Madrid.ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed.Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy.ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r =  −0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians’ self-perceived empathy and their patients’ perceptions.ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.     

Transcultural adaptation of the Night Eating Questionnaire (NEQ) for its use in the Spanish population

BackgroundEstablishing valid and reliable methods of assessing night eating symptoms is an important goal to maximize identification and treatment of the night eating syndrome (NES). The 14-item Night Eating Questionnaire (NEQ) is the only published and validated assessment instrument but is not yet adapted to Spanish.MethodsWe examined the factor structure, internal consistency and validity of the NEQ in Spanish. The study had 4 phases: a) translation from English to Spanish; b) back-translation from Spanish to English, c) administration of translated version to a Spanish sample, and d) a re-test in 36 participants two weeks later. Reliability, stability, and scale structure were evaluated by Cronbach's α, test–re-test, and factor analysis, respectively. Divergent validity was assessed by correlation with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II).ResultsTwo-hundred forty-four individuals (181 f; BMI 34.3 ± 10 kg/m²; age 40.5 ± 15 y) completed the questionnaire. The mean NEQ score was 12.5 ± 7. The Cronbach's α coefficient for the total score was 0.79, the intraclass correlation was 0.85, and the factor analysis yielded a similar four factor solution as the original scale. Correlation for the test–re-test total score was 0.86. Total NEQ score was significantly correlated with the BDI-II (r = 0.48 p < 0.001), but this correlation was not significant during the test–re-test (r = 0.28, p = 0.10) or with STAI at either time point (0.05, p = 0.40; r = 0.07, p = 0.69, respectively).ConclusionsThe Spanish version of the NEQ demonstrated adequate internal consistency for the majority of domains and excellent reproducibility. There was divergent validity with anxiety and a relationship between night eating and depression. These results suggest that the Spanish-version of the NEQ is an instrument that is valid for use in clinical research.     

Personal and occupational factors associated with low-back pain in a general working population in France

BackgroundLow-back pain is a major public health concern because of its socioeconomic burden, especially for chronic forms. The purpose of this study was to analyse the associations between low-back pain and occupational and personal factors, with a special focus on interactions between age and occupational exposures.MethodsThe study population comprised a sample of 3958 and 4526 working women and men aged 30 to 59 derived from a national health survey (2002–2003 EDS). Low-back pain was assessed using the French version of the Nordic questionnaire. Weight, height and smoking status were obtained through interview at home. Occupational exposures were self-assessed. The associations between low-back pain for more than 30 days in the previous year and occupational and personal factors were assessed using logistic models. An interaction between age and each occupational exposure was studied.ResultsIn the multivariate models, age was the only personal factor significantly associated with low-back pain for both genders. The other personal factors studied were significantly associated with low-back pain for women only. Handling heavy loads and awkward postures at work were strongly associated with low-back pain for both genders (respectively OR = 1.80 [1.46–2.23] and OR = 1.65 [1.34–2.03] for men, and OR = 1.65 [1.32–2.06] and OR = 1.28 [1.04–1.59] for women). A high level of psychological demands at work and a low level of decision latitude were also associated with low-back pain for both genders (respectively OR = 1.22 [1.03–1.46] and OR = 1.32 [1.11–1.57] for men, and OR = 1.31 [1.10–1.56] and OR = 1.27 [1.06–1.51] for women). Only the interaction between age and awkward postures for men was borderline significant.ConclusionThis study showed strong associations between occupational exposures and persistent/recurrent low-back pain in a general working population in France. Targeting these exposures in prevention programs could be useful.     

An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia

ObjectiveWe evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia.MethodsA 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children <2 y old (n = 698) were purposively sampled from three health facilities (n = 459) and four community posts (n = 77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n = 162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n = 6), health workers (n = 35), and mothers whose children attended all follow-up visits (n = 27).ResultsAnthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score ?0.8 ± 0.7), followed by trained (?0.5 ± 0.6) and untrained (–0.3 ± 0.47; P < 0.05) health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices.ConclusionsThe GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.     

Correlates of moderate-to-vigorous physical activity among preschoolers during unstructured outdoor play periods

ObjectiveQuantify moderate-to-vigorous physical activity (MVPA) and its correlates in preschool children during outdoor unstructured play periods using direct observation.MethodsCross-sectional data consisting of 204 observation periods collected from 51 four- and five-year-old children using the Observation System for Recording Physical Activity in Children — Preschool (OSRAC-P) at a preschool in southern California, autumn and spring 2009–2010. Gender and BMI classification and OSRAC-P environmental codes were related to observed MVPA in multiple logistic regression models.ResultsLess than 21% of intervals were spent in MVPA overall. Boys and normal weight children engaged in higher intensity levels than their respective counterparts. More MVPA was associated with normal weight (OR = 2.49–3.25, R² = 3%), location (grass, playground, looping cycle path; OR = 3.21–4.90, R² = 4–12%), play context (ball/objects, wheel, open space; OR = 2.78–8.51, R² = 9%), and group composition (solitary, one-on-one; OR = 1.34–2.08, R² = 1%).ConclusionOpen spaces located in playgrounds and grass fields, and activity-genic portable equipment, manipulative objects, and riding vehicles are some design and equipment features that appear to foster MVPA. Lowering play space density and engaging children through teacher prompts and teacher-arranged activities may further increase MVPA on playgrounds.     

Impact of socioeconomic status on stage at diagnosis of breast cancer

BackgroundThis study aimed to evaluate the potential impact of social inequalities on stage at diagnosis and long-term outcome of breast cancer patients attending the Institut Curie in Paris (France).MethodsThe study population included 14,610 breast cancer patients diagnosed and treated in the Institut Curie between 1981 and 2001. The socioeconomic status was determined from district of residence, median income for town of residence corrected by the consumption unit and body mass index. Logistic regression models adjusted on socioeconomic factors were used to evaluate clinical and pathologic features at diagnosis. Overall survival and distant metastasis were analysed with log-rank tests and Cox proportional hazards regression models.ResultsPatients living in lower income districts were more likely to be diagnosed with breast tumors size greater than 20 mm (P = 0.01). Residents of high-income urban areas (> 15,770 €) exhibited a significant overall survival and distant metastasis advantage (respectively HR = 0.93 [0.86–0.99]; P = 0.02 and HR = 0.91 [0.85–0.98]; P = 0.01). Breast cancer screening with mammography was independent of district of residence (P = 0.61) or income (P = 0.14). After adjusting for age at diagnosis and period, the risk of having breast cancer with unfavorable prognostic factors such as tumor size greater than 20 mm decreased with 1000 € increase in district income (OR = 0.986 [0.98–0.99]; P < 0.001). Similarly, the risk of cancer death decreased for patients residing in districts with median income greater than 15,770 € (HR = 0.92 [0.86–0.98]; P = 0.01).ConclusionDespite the limitations of the study (aggregate data used to assess socioeconomic status, non representative cohort of French women), we observed that poorer breast cancer prognosis with advanced disease diagnosis and increased risk of breast cancer mortality was related to low socioeconomic status.     

Temporal changes in the nature of disability: U.S. Army soldiers discharged with disability, 1981-2005

BackgroundWe sought to (1) document and describe the relative proportion of disabilities by major type over the study period, (2) describe the population at risk for different types of disability, and (3) document and describe the type of compensation (an indicator of severity) awarded for different types of disability and any temporal changes in these associations.MethodsTime-series, logistic regression analyses, and direct standardization of rates were used to study 108,119 active-duty Army soldiers discharged with permanent disability between 1981 and 2005.ResultsOf all disability, 91% is captured within the top five most prevalent types of disability: musculoskeletal (72%, n = 77,418), neurological (6%, n = 6,896), mental health (5%, n = 5,075), cardiovascular system (4%, n = 4,429), and respiratory (4%, n = 4,202). Musculoskeletal disability rates are increasing rapidly (+2.5% per year); neurological and cardiovascular disability rates are decreasing (−1.3% and −10.0% annually, respectively), and respiratory and mental health disability rates did not change significantly. Demographic risk factors vary by disability type. At greatest risk for musculoskeletal disability were female soldiers, soldiers who were between the ages of 21 and 35 years, white, in lower- to mid-level enlisted ranks with relatively short service tenure, and soldiers without a college education. Compensation awards also varied by disability type: Overall, 77% (n = 83,320) received separation with severance pay, 15% (n = 16,107) received a permanent disability retirement, and 8% (n = 8,692) received separation without benefits. Separation with severance pay was the largest and fastest growing disability disposition for all disabilities and for musculoskeletal disability specifically.ConclusionsDemographic risk factors vary by type of disability and by compensation award. Musculoskeletal disability rates are rapidly increasing as is separation with severance pay—particularly among white, young, lower ranking female soldiers.     

The WHOQOL-100 has good psychometric properties in breast cancer patients

ObjectiveThis prospective follow-up study examines the psychometric properties of the World Health Organization Quality of Life assessment instrument (WHOQOL-100) for assessing quality of life in women suspected of having breast cancer and disease-free breast cancer survivors.Study Design and SettingThe WHOQOL-100 was tested at five points in time in women with a palpable lump in the breast or an abnormality on a screening mammography (N = 356) and breast cancer survivors (N = 140). Furthermore, all participants completed measures of anxiety (State Trait Anxiety Inventory) and depression (Center for Epidemiologic Studies Depression scale). Moreover, women who were diagnosed with breast cancer also completed the EORTC-QLQ-BR-23 at time points 2–5. Reliability (internal consistency; test–retest reliability) and construct validity were tested.ResultsConfirmatory factor analyses on the WHOQOL-100 items showed a good fit with models reflecting six factors (physical health, psychological health, level of independence, social relationships, environment, spirituality/religion/personal beliefs) or four factors (physical health, psychological health, social relationships, environment). Internal consistency was adequate. Test–retest correlations were high. The WHOQOL-100 correlated highly with related constructs and showed low correlations with unrelated constructs.ConclusionThe WHOQOL-100 is a reliable and valid instrument for measuring QOL in women suspected of having breast cancer and disease-free breast cancer survivors.     

Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population

ObjectiveTo investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) in a young Hispanic population.MethodsA cross-sectional study was performed in Bogotá, Colombia, during 2006 in 263 males from the Colombian Air Force (age range 29–54 years). Anthropometric measurements and biochemical determinations (glycemia, lipid profile, insulin, and HOMA-IR) were obtained in order to determine the presence of metabolic syndrome (MS) criteria and insulin resistance in this population. In addition, ultrasound studies were performed to evaluate the presence of NAFLD.ResultsNAFLD was detected in 26.6% (n = 70) of the subjects. Thirty four individuals had complete MS criteria (48.5%). The presence of NAFLD was associated with higher insulin levels (11.0 ± 5.1 vs. 6.6 ± 3.6, p = 0.001), and its prevalence increased from 11% (n = 8), to 24% (n = 17) to 64% (n = 45) from the lowest to the highest HOMA-IR tertile. Body mass index, triglycerides and subcutaneous and visceral fat were found to be independent predictors of NAFLD.ConclusionsThese results suggest that NAFLD is associated with insulin resistance and extrahepatic adiposity in nondiabetic young Hispanic population.     

The HIV epidemic among industrial male miners in Guinea: prevalence, associated factors and trends from 2001 to 2007

BackgroundTo estimate HIV prevalence, associated factors and trends from 2001 to 2007 among male miners in Guinea.MethodsTwo hundred and eighty-six male miners in 2001 and 579 in 2007 were tested for HIV and interviewed about their lifestyles and sexual practices. Investigations were conducted in the five mining companies operating in the country. A standard questionnaire was used for collecting data and SAS Windows 9.2 version (SAS Institute, Cary, North Carolina, USA) for statistical analysis.ResultsMedian age was 45 years in 2001 and 39 years in 2007 (P = 0.001). HIV prevalence was 4.5% (95% Confidence Interval [95% CI]: 2.1–7.0) in 2001 and 6.4% (95% CI: 4.4–8.4) in 2007. In multivariate analysis, HIV prevalence was associated with history of sexually transmitted infections (STIs) (Prevalence Ratio [PR] = 2.21; P = 0.03), and with paying for sex (PR = 6.01; P = 0.04), whereas it was significantly higher in divorced, separated or widowed men. HIV prevalence increased but not significantly between 2001 and 2007, whereas casual sex (P = 0.03) and counseling activities against HIV (P < 0.0007) decreased.ConclusionHIV prevalence is high in this population and, although not statistically significant, the increase observed between 2001 and 2007 is worrying in a context where the population of miners became younger over time. Prevention of HIV/AIDS has to be reinforced among miners in Guinea.     

Factors distinguishing general practitioners who more readily participated in a large randomized trial were identified

ObjectiveTo investigate factors associated with the successful recruitment of general practices to a randomized controlled trial.Study Design and SettingAnalysis of accrual of primary care centers to a randomized controlled trial in the UK.ResultsThose practices promptly agreeing to take part had better target achievement and a higher proportion of white British residents locally. Participating practices had a mean Quality and Outcomes Framework attainment of 92% of the points available, whereas nonparticipating practices achieved 88% (P = 0.009). Participating practices were located in areas with a higher proportion of white British residents (mean 89%), in comparison to nonparticipating practices (mean 84%, P = 0.004). Reasons given by practices to explain nonparticipation were primarily related to internal factors, with 38% of practices approached saying that they could not participate for such reasons.ConclusionThere are some small differences between participating practices and nonparticipants in achievement of government targets and in the local ethnic mix. The primary reason given by practices for nonparticipation was workload or time pressures, with over a third of practices reporting being prevented by issues relating to practice organization. It may be that practices with workload or organizational difficulties require additional support to participate in research.     

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception

ObjectivesThis study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction.Study Design and SettingItem response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n = 116 inpatients, (N3) together with established stress questionnaires as validity criteria.ResultsThe final banks included n = 38 stress exposure items and n = 31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE < 0.32; ρ > 0.90) using 7.0 ± 2.3 (M ± SD) stress reaction items and 11.6 ± 1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6 ± 2.1 for the dimension stress reaction and 10.0 ± 4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations.ConclusionsThe Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.