A Paradigm Shift: Sharing Patient Reported Outcome via a National Infrastructure

Digital solutions transform the way clinical services can be provided and make it possible for patients to participate in decisions concerning their own treatment. With the aim to support a better and more efficient healthcare system in Denmark, it has been agreed among authorities and care providers to establish a national infrastructure for sharing data between hospitals, municipalities, general practitioners and patients and concurrently develop standardized national digital cross-sector questionnaires for the purpose. Sharing data via the national infrastructure enables proactive involvement through patient reported outcomes (PRO). The national infrastructure forms a paradigm shift 1) for collaboration by moving from a baton-passing workflow to sharing-based workflow and 2) for the development of digital cross-sector questionnaires. Cross-sector questionnaire definitions are stored in a national questionnaire repository, and are used in local PRO applications to capture the patients' responses.

Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Objectives

Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient's quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting.

Methods

This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument's construct validity. Cronbach's alpha coefficients were used to determine internal consistency.

Results

A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors-psychological, physical-social and spiritual wellbeing-resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450-0.718 for psychological wellbeing (12 items), 0.394-0.740 for physical-social wellbeing (14 items) and 0.449-0.727 for spiritual wellbeing (seven items). The overall Cronbach's alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively.

Conclusion

The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF.

Arabic Translation, Validation and Cultural Adaptation of the 7-Item Hamilton Depression Rating Scale in Two Community Samples

Objectives

Depression is a common mental disorder, the severity of which is frequently assessed via interview-based clinical scales such as the 7-item Hamilton Depression Rating Scale (HAMD-7). The current study aimed to translate and examine the validity of an Arabic version of the HAMD-7 scale.

Methods

This study took place between February and March 2016 in the Psychiatry Department of King Saud University, Riyadh, Saudi Arabia. The HAMD-7 scale was translated into Arabic using forward and backward translation methods. A total of 153 Arabic speakers were recruited to test the translated scale, including 57 medical students and 96 members of the general public. The Arabic version of the HAMD-7 scale was completed by trained investigators during face-to-face interviews with the participants. In order to assess convergent validity, participants also completed an Arabic version of the self-assessed Patient Health Questionnaire-9 (PHQ-9) scale. Subsequently, the test-retest reliability of the translated HAMD-7 scale was evaluated two weeks later during a second interview.

Results

Overall, HAMD-7 scores were positively correlated with PHQ-9 scores (r = 0.633-0.749). Moreover, the translated HAMD-7 scale proved to be reliable in terms of test-retest reliability (intra-class correlation coefficient: 0.807; P <0.001). With regards to internal consistency, the Cronbach's α values ranged between 0.607-0.756.

Conclusion

The Arabic HAMD-7 scale was found to be reliable and valid among two samples of Arabic speakers in Saudi Arabia. However, further research among Arab-speaking patients diagnosed with depression is needed in order to establish its usefulness in assessing the severity of depressive symptoms.

Supporting the Self-Management of Chronic Pain Conditions with Tailored Momentary Self-Assessments

To better support the self-management of chronic pain, this paper investigates how those living with the condition prefer to self-assess their pain levels using smartphones. Our work consists of three stages: design ideation and review, an in-lab user study with 10 participants resulting in nine candidate interfaces, and a 3 week field trial of two further honed measures with 12 participants. This research firstly yields a better understanding of participants' strong and sometimes contrasting preferences regarding their self-assessment of pain intensity. We additionally contribute two novel interfaces that support accurate, quick, and repeated use along with other participant-valued interactions (e.g., familiar, relatable, and highly usable). In particular, we focus on designing tailored measures that both enhance respondent motivation as well as minimize the difficulty of meaningful self-assessment by supporting the cog-nitive effort in translating a subjective experience into a single numerical value.

Validation of a Persian Short-Form Version of a Standardised Questionnaire Assessing Oral Cancer Knowledge, Practice and Attitudes Among Dentists

OBJECTIVES

Oral cancer is a global health problem; however, many dentists lack the necessary skills, knowledge and capacity to diagnose oral cancers early. This study aimed to examine the validity and reliability of a Persian short-form version of a standardised questionnaire to assess dentists' knowledge, practice and attitudes towards oral cancer.

METHODS

This cross-sectional analytical study was carried out in May 2015 in Tehran, Iran. An original 39-item English-language questionnaire developed by Yellowitz et al. was translated into Persian using forward and backward translation methods. A total of 15 dental professionals were asked to assess the questionnaire for content validity. Based on their feedback, a 20-item short-form version was prepared, including six demographic, six knowledge, four attitude and four practice items. The translated short-form questionnaire was subsequently distributed to 973 general dental practitioners attending a dental conference in Tehran. Internal consistency and reliability were assessed with Cronbach's alpha coefficient and item-total correlation calculations.

RESULTS

A total of 13 professionals and 313 general dentists participated in the study (response rates: 86.7% and 32.2%, respectively). After the elimination of six items (two knowledge, two attitude and two practice items), the validity and reliability of the questionnaire was confirmed.

CONCLUSION

The final Persian 14-item version of the questionnaire had acceptable validity and internal consistency. These results indicate that researchers can use this translated short-form version to evaluate oral cancer knowledge, attitudes and practices among Persian-speaking dentists; this will allow for a comparison of data between different populations.

Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders

BACKGROUND

Dysphagia as a common condition affecting many aspects of the patient's life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient's quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia.

METHODS

A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach's alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC).

RESULTS

The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach's alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC.

CONCLUSION

The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

Development and psychometric evaluation of an information literacy self-efficacy survey and an information literacy knowledge test

OBJECTIVE

To develop and psychometrically evaluate an information literacy (IL) self-efficacy survey and an IL knowledge test.

METHODS

In this test-retest reliability study, a 25-item IL self-efficacy survey and a 50-item IL knowledge test were developed and administered to a convenience sample of 53 chiropractic students. Item analyses were performed on all questions.

RESULTS

The IL self-efficacy survey demonstrated good reliability (test-retest correlation = 0.81) and good/very good internal consistency (mean κ = .56 and Cronbach's α = .92). A total of 25 questions with the best item analysis characteristics were chosen from the 50-item IL knowledge test, resulting in a 25-item IL knowledge test that demonstrated good reliability (test-retest correlation = 0.87), very good internal consistency (mean κ = .69, KR20 = 0.85), and good item discrimination (mean point-biserial = 0.48).

CONCLUSIONS

This study resulted in the development of three instruments: a 25-item IL self-efficacy survey, a 50-item IL knowledge test, and a 25-item IL knowledge test. The information literacy self-efficacy survey and the 25-item version of the information literacy knowledge test have shown preliminary evidence of adequate reliability and validity to justify continuing study with these instruments.

Low back pain functional disability in athletes; conceptualization and initial development of a questionnaire

Background:

Low Back Pain (LBP) is one of the most prevalent causes of disability not only in the general population but also in athletes. Despite a large number of self-reported back specific disability questionnaires, there is no specific, well documented, outcome measure for athletes suffering from back pain.

Objectives:

This study aimed to identify the main descriptive themes representing functional disability in athletes due to LBP.

Patients and Methods:

We conducted a qualitative study using in-depth interviews to characterize the experiences of athletes with LBP. Twenty athletes with LBP were recruited and the main descriptive elements of their LBP related disability were extracted. Then a preliminary questionnaire using these themes was proposed.

Results:

The main disability indicators were pain intensity; stretching exercises, strengthening exercises, sport specific skills, back range of motion (ROM), sitting, walking, sleep patterns, self-care, and recreational activities, fear of pain and avoidance behavior, and changes in sexual activity.

Conclusions:

The findings of this study suggest that apart from non-sports items, some sport related items should be included in the assessment of LBP disability levels in athletes. Our results have also been organized as a preliminary LBP disability questionnaire for athletes.

U.S. census data uses

"This article examines the principal applications of the statistics yielded by the 1990 U.S. Census of Population and Housing. Before doing so, however, a framework of census policy and operational features that directly influenced the content of the questionnaires will be outlined.... Having established this background, the uses of census data will be addressed, citing case examples in some instances, for...major groups of data users."

HIV risk behaviors, intentions, and perceptions among Namibian youth as assessed by a theory-based questionnaire

Considerable progress has been made in the United States and Europe regarding HIV risk prevention efforts targeting adolescents. However, in Africa less progress has been made to date. This article address three questions: Can risk assessment questionnaires developed in Western countries be modified so as to be appropriate for use in African countries? Are social cognitive models appropriate in African settings? Does covariation among risk behaviors occur among youth residing in African countries? The data was obtained from a cross-sectional survey conducted among 922 youth ages 12 to 18 years living in school-based hostels in Namibia. Data were collected using a theory-based risk assessment questionnaire. One third of the youth were sexually experienced, three quarters of whom had engaged in sexual intercourse in the previous 6 months. Over one third of these youth had had more that one sexual partner in the previous 6 months and over one half had not used a condom at last episode of intercourse. The psychometric properties of the questionnaire and the relationship between perceptions and behaviors provide evidence that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. The data also provide strong evidence of covariation between risk behaviors among Namibian youth.

An adolescent and young adult condom self-efficacy scale

The purpose of this study was to initially test the psychometric properties of an adolescent and young adult condom self-efficacy scale. The sample consisted of 209 participants (13 to 26 years old) who voluntarily completed a 19-item scale. The items were developed based on a review of the literature and a review by experts in adolescents' and young adults' condom use. Item analysis was conducted and five items were deleted. Principal axis factor analysis with varimax rotation yielded three factors: communication abilities related to condom use, consistent condom use abilities, and correct condom use abilities. The three factors accounted for 42% of the variance. The alpha coefficient was .85 for the total scale. The scale could be used to assess perceived condom self-efficacy and to evaluate effectiveness of strategies to increase perceived condom self-efficacy among adolescents and young adults.

Sexual Assertiveness Scale (SAS) for women: development and validation

Four studies were conducted to develop and validate the Sexual Assertiveness Scale (SAS), a measure of sexual assertiveness in women that consists of factors measuring initiation, refusal, and pregnancy-sexually transmitted disease prevention assertiveness. A total of 1,613 women from both university and community populations were studied. Confirmatory factor analyses demonstrated that the 3 factors remained stable across samples of university and community women. A structural model was tested in 2 samples, indicating that sexual experience, anticipated negative partner response, and self-efficacy are consistent predictors of sexual assertiveness. Sexual assertiveness was found to be somewhat related to relationship satisfaction, power, and length. The community sample was retested after 6 months and 1 year to establish test-retest reliability. The SAS provides a reliable instrument for assessing and understanding women's sexual assertiveness.

Sexual Assertiveness Scale (SAS) for women: development and validation

Four studies were conducted to develop and validate the Sexual Assertiveness Scale (SAS), a measure of sexual assertiveness in women that consists of factors measuring initiation, refusal, and pregnancy-sexually transmitted disease prevention assertiveness. A total of 1,613 women from both university and community populations were studied. Confirmatory factor analyses demonstrated that the 3 factors remained stable across samples of university and community women. A structural model was tested in 2 samples, indicating that sexual experience, anticipated negative partner response, and self-efficacy are consistent predictors of sexual assertiveness. Sexual assertiveness was found to be somewhat related to relationship satisfaction, power, and length. The community sample was retested after 6 months and 1 year to establish test-retest reliability. The SAS provides a reliable instrument for assessing and understanding women's sexual assertiveness.

An oral contraceptive perception scale for female adolescents

This study sought to develop the initial psychometric properties of a female adolescent oral contraceptive perception scale. Based on qualitative data, a 39-item scale of perceived benefits and barriers was developed, reviewed by adolescence experts and adolescents, and voluntarily completed by 407 female adolescents enrolled in family planning clinics. After item analysis, 15 items were deleted. Maximum likelihood factor analysis with varimax rotation yielded two barrier (relationship-oriented and oral contraceptive regimen) and four benefit (relationship-oriented, pregnancy prevention related to self, pregnancy prevention related to others, personal responsibility) factors that accounted for 53% of the variance. The scale had acceptable reliability (alpha coefficients ranged from 0.71 to 0.87). The scale should be beneficial to further research in this area.

The measurement of public opinion on abortion: the effects of survey design

A factorial experiment examined the effects of the wording and sequence of survey questions on the measurement of attitudes toward abortion. When a first-trimester pregnancy is specified, 55% of respondents agree that a woman should be able to obtain a legal abortion for any reason, compared with 44% when no pregnancy duration is stated. Specifying first-trimester pregnancies has little effect on the proportion of respondents who agree that abortion should be available for maternal health, fetal defects or rape, but it significantly increases the proportion who agree that a woman should be able to obtain an abortion if she is single, has financial constraints or wants no more children. When gestational lengths from one to six months are presented to respondents in ascending order, agreement that a woman should be able to obtain an abortion for any reason is lower for any given length of gestation than when pregnancy durations are presented in descending order. Forty-eight percent of respondents agree that abortion should be legal for any reason when that question is posed after a series of specific reasons; however, 60% do so when it is the first question in the sequence. The difference in agreement with abortion for any reason between Catholics and non-Baptist Protestants, and between Republicans and Democrats, is much smaller when the question is asked first than when it is presented last.

Identifying the social contexts of effective sex refusal

A factorial survey was conducted to identify social situations that inhibit or promote college students' sex-refusal skills. Respondents evaluated five different situations in which sexual intercourse might occur and ranked each according to how certain the respondent would be to refuse to have sexual intercourse in that context. Regression analysis of the survey data showed that knowing the other person well, being with one's boyfriend or girlfriend, having condoms available, wanting to have sex, and both persons' wanting to have sex reduced the probability of refusal. On the other hand, having no condoms and the presence of drugs in the situation increased the probability the individual would refuse to have sex. In addition, men, individuals with previous sexual experience, and drinkers displayed diminished ability to refuse sex. However, the lack of condoms, when combined with these three respondent characteristics, acted to increase the ability to refuse sex.

Verbal autopsy as a tool for diagnosing HIV-related adult deaths in rural Uganda

BACKGROUND

In general, information on the causes of adult deaths in developing countries is scarce. More specifically, relatively little is known about the effect of HIV-1 associated disease on adult mortality in general populations. In this study we have used a verbal autopsy technique to ascertain whether adult deaths were associated with HIV-1 in a rural population with a prevalence of HIV-1 infection of 8%, and used HIV-1 antibody status to validate the verbal autopsy findings.

METHODS

All adult deaths in the population cohort that occurred between December 1990 and November 1993 were identified through a monthly death registration system. Approximately 2 months after death, a relative of the deceased was interviewed by a trained nurse, and questionnaires were assessed by at least two independent clinicians; all were unaware of the HIV serostatus of the deceased.

RESULTS

A total of 155 adult deaths was assessed, i.e. 53% of all recorded adult deaths. Of those assessed half were HIV-1 positive. In all 47% of deaths were classified as HIV-related. The overall specificity and positive predictive value of the verbal autopsy tool were both 92%; in those aged 13-44 years (83 adults) the corresponding values were 85% and 95% respectively. The verbal autopsy estimated HIV-1 attributable mortality fraction was similar to the calculated fraction based on prospective data.

CONCLUSIONS

The results of this study suggest that verbal autopsy studies may assist in providing data on HIV-associated mortality in general populations and may be useful as surveillance tools.

A methodological comparison of survey techniques in obtaining self-reports of condom-related behaviors

To obtain more accurate accounts of sexual attitudes and practices, researchers must explore innovative ways to overcome the reluctance of individuals to disclose sensitive and perhaps incriminating information about themselves. The differences among selected modes of inquiry and survey techniques used to gather self-reports about sensitive contraceptive behaviors among young adults were examined in this study. Comparisons were made between the randomized response versus the direct-inquiry survey techniques and personal interview versus self-administered modes of inquiry relative to the reporting of sensitive condom-related sexual practices of 352 students at a large northeastern university. Findings indicated that the "controlled-choice" randomized-response technique was less effective in obtaining self-reports about condom-related practices than were direct-inquiry techniques. Recommendations for investigations are proposed.

Incidence of induced abortion determined by the randomised response technique

OBJECTIVE

To estimate the incidence of induced abortion using the randomised response technique, and to compare the results with estimates obtained by direct questioning.

DESIGN

Cross-sectional study.

SETTING

Medical Officer of Health area, Homagama.

SUBJECTS

Married women in the reproductive age group.

RESULTS

The annual incidence of induced abortion for the three year period 1988 to 1990 was 15.7 per 1000 married women of the reproductive age group as estimated by the randomised response technique. Direct questioning led to 30.5% under-reporting of induced abortion. The application of the method failed only in 8.1% of the population studied.

CONCLUSIONS

The randomised response technique is a feasible method to use in our population and provides the best estimates of induced abortion.

The epidemiology of HIV infection in a rural area of Guinea-Bissau

OBJECTIVES

To determine the prevalence of HIV infection and its relationship to age, sex and other factors.

DESIGN AND SETTING

Cross-sectional survey of a rural community in Guinea-Bissau.

METHODS

Questionnaire-administration and screening of sera from subjects aged > or = 15 years.

RESULTS

Of the 2770 subjects tested, 220 (7.9%) were HIV-2-seropositive, four (0.1%) were HIV-1-seropositive and 10 (0.4%) were dually reactive. Overall prevalence of HIV-2 was 9.3% in women, peaking at 17.2% in the 35-44 age group, and 6.6% in men, peaking at 19.1% in the 45-54 age group. The mean age of the four subjects with HIV-1 infection was 24 years, which was significantly lower than those with HIV-2 infection. HIV-2 infection was more prevalent among women who were widowed or divorced, women whose husbands were living away from the study area, and women who had lived in the capital, Bissau. The majority of subjects with an infected spouse remained uninfected and none of the women aged < 25 years whose husbands were infected were seropositive. The prevalence varied significantly between settlements within the study area.

CONCLUSIONS

The pattern of HIV-2 infection in this rural community has similarities to that found in urban Bissau, and prevalence in both areas peaks in older subjects than in HIV-1 foci. The findings support previous suggestions that HIV-2 is not a recent introduction to Guinea-Bissau, and that it is less pathogenic and less readily transmitted than HIV-1.

National Family Health Survey

The authors outline the organization and administration of India's National Family Health Survey, for which data collection was scheduled for completion in June 1993. Data analysis and survey objectives are discussed, as well as some political factors affecting data collection. It is noted that "the National Family Health Survey is...a large-scale sample survey covering 97 per cent of the population and involving more than 90,500 households.... Another feature of the NFHS is its uniformity in questionnaire design, sample design, data collection and analysis. This uniformity provides an opportunity for inter-state comparison."

Assessing response reliability of health interview surveys using reinterviews

Data from interview surveys of households or health facilities are used to assess community parameters such as health status and factors related to the ability and willingness of individuals to pay for health services. Although the effect of sample size on confidence intervals is generally well understood by the survey designers and policy-makers who use the results, the typical survey is also subject to non-sampling errors whose magnitude may exceed that of the sampling errors. The non-sampling errors associated with surveys are only rarely assessed and reported, even though they may have a major effect on the interpretation of findings. The present study reports the non-sampling errors associated with a household survey in Sierra Leone by comparing the results of reinterviews with the responses given during the original interviews. Certain types of questions were subject to greater non-sampling errors than others. The findings should be of use to designers of similar surveys and to those who rely on such surveys for making policy decisions.

The validation of interviews for estimating morbidity

Health interview surveys have been widely used to measure morbidity in developing countries, particularly for infectious diseases. Structured questionnaires using algorithms which derive sign/symptom-based diagnoses seem to be the most reliable but there have been few studies to validate them. The purpose of validation is to evaluate the sensitivity and specificity of brief algorithms (combinations of signs/symptoms) which can then be used for the rapid assessment of community health problems. Validation requires a comparison with an external standard such as physician or serological diagnoses. There are several potential pitfalls in assessing validity, such as selection bias, differences in populations and the pattern of diseases in study populations compared to the community. Validation studies conducted in the community may overcome bias caused by case selection. Health centre derived estimates can be adjusted and applied to the community with caution. Further study is needed to validate algorithms for important diseases in different cultural settings. Community-based studies need to be conducted, and the utility of derived algorithms for tracking disease frequency explored further.

Sexual behaviour among youth clinic visitors in Sweden: knowledge and experiences in an HIV perspective

OBJECTIVE

To study the knowledge and experience of sexuality, contraception and sexually transmitted diseases among sexually active adolescents in Sweden.

SUBJECTS

Youth clinic visitors.

SETTING

Seventy-four youth clinics from all over the country of Sweden.

METHODS

A questionnaire with 17 multiple choice and nine open questions was distributed to all visitors at participating youth clinics during a 2-month period.

RESULTS

A total of 9277 young persons answered the questionnaire. Their mean age was 17.5 years. Ninety-three percent were females. Knowledge on STD and STD protection was wide-spread and good. Chlamydia and HIV was recognised as STDs by 90% and 87% respectively. More than 99% knew of the condom method as a means for STD protection. Knowledge on contraceptive methods for pregnancy protection was also good. Ninety-three percent of the investigated adolescents had had coitus. Nine percent had experienced pregnancies and 17% STDs. The mean number of life-time sexual partners was 3.2.

CONCLUSIONS

In spite of good knowledge on preventive measures among Swedish youth clinic visitors their sexual behaviour carriers risks for future health. Further interventions are needed to minimise these risks.

Ethnic group and the British census: the search for a question

"The 1991 census contained, for the first time, a question on the ethnic group of each member of the population of Great Britain. This paper reports on how a question was developed which has a sufficiently high degree of acceptance from all the main ethnic groups, and which is answered sufficiently accurately, to justify inclusion in the census."

Estimating maternal mortality in Djibouti: an application of the sisterhood method

In many developing countries even crude estimates of the level of maternal mortality are lacking and the prospects of fulfilling this need using conventional sources of vital registration and health service statistics are not encouraging. The constraint this imposes on the effective planning, management and evaluation of the programmes now being launched to reduce these neglected deaths is self-evident. It is less obvious how the majority of developing countries can be expected to meet the call for reliable estimates of maternal mortality by 1995. The sisterhood method provides a means of obtaining population-based estimates using household surveys for data collection. This paper describes the application of the method in Djibouti in the context of a rapid multi-purpose household survey in difficult field circumstances. In recent years the reduction of the level of maternal mortality in developing countries has become a priority for both national governments and international agencies. Attention has been drawn to the wide range of levels within and between countries and to the huge discrepancies in the lifetime risk of maternal death for women in the developed compared with the developing world. This risk has been estimated to range from 1 in 19 in West Africa to almost 1 in 10,000 in Northern Europe.

Evaluation by women consulting in a family planning centre of their risk of HIV infection

In order to assess women's self-perception of their risk of infection by HIV, research was performed among 654 women who had consulted in a family planning centre in the Paris region. Of the 452 (69%) women who took part in this research, 77% considered themselves as 'not at risk of carrying the AIDS virus', 11% as 'at risk' and 12% did not give a specific answer. The most important risk factors noted by the patient and the doctor were found to be the number of partners, the use of syringes and the non- or faulty use of condoms. Estimates of the risk of infection by physicians had a high correlation with those of the women, although there were wide differences between the opinions of the six doctors involved. In one case out of three the doctors were unable to decide whether or not their patient was at risk. The evident difficulties experienced by these physicians show an urgent need for the development of specific medical training programmes. The seroprevalence of 2.4% of HIV infection among the women studied, and 1.1% of those who consulted during the study period, confirm the importance of carrying out specific studies on women consulting in family planning centres.

The contribution of the World Fertility Surveys to an understanding of the relationship between women's work and fertility

A consistent negative association between women's paid work and fertility in developed countries has emerged from many years of research. Results from research in developing countries are more ambiguous, with as many examples of a positive association as of a negative one. Lack of data comparability has often hampered interpretation of results. The World Fertility Surveys (WFS)--undertaken in 40 developing countries between 1974-81, using a common core questionnaire that included numerous questions on women's work--have created a unique opportunity to evaluate this association in a comparative framework. This article reviews and interprets the major findings on the work-fertility relationship from this and other published research on women's work and fertility, and assesses the data limitations. The article concludes with recommendations for the treatment of women's work in the design of future fertility and family planning surveys.

Coitus and contraception: the utility of data on sexual intercourse for family planning programs

The Demographic and Health Surveys (DHS) program has included several questions on sexual intercourse in its model questionnaires that have been used in more than 25 surveys in Latin America, Africa, and Asia over the last five years. This article assesses the quality of the data on sexual intercourse for 12 DHS surveys and shows how these data may be useful for understanding contraceptive use dynamics and for organizing the management of family planning programs. The data show that there is considerable variation among countries in exposure to pregnancy prior to first marriage. Within marriage, the level of coital frequency varies with duration of marriage, fertility intentions, and type of contraceptive method used. Finally, in all countries there is some overlap between contraceptive use and sexual abstinence. This information can be useful in family planning programs for targeting particular populations, for assisting women to choose a method, and for assessing the effect of contraceptive use on fertility.

Psychiatric morbidity and acceptability following medical and surgical methods of induced abortion

Ninety-one women were asked to complete a standardized multiple choice questionnaire (modified from the Edinburgh Postnatal Depression Scale) to screen for anxiety and depression before and after legal abortion in early pregnancy achieved either by using mifepristone in combination with a prostaglandin (n = 54) or by vacuum aspiration under general anaesthesia (n = 37). Before abortion over 60% in both groups had high scores (compatible with psychiatric morbidity), but after the abortion there was a significant and equal fall in scores so that by 1 month less than 10% of either group had high scores. There was no difference between the two groups. Both methods of abortion were acceptable to the majority of women, although only 75% of the medical group indicated they would have the same method if a future termination was ever required, compared with 94% in the surgical group. However, in 13 women who had experience of both methods, the medical approach was preferred by 10 (77%). Thus, medical abortion is acceptable to the majority of women and is associated with the same low rate of short term psychiatric morbidity as has been recorded with surgical methods of termination, despite greater patient involvement and awareness of the abortion process.

Adolescents' attitudes towards AIDS precautions and intention to use condoms

This study investigated attitudes toward AIDS precautions of 370 15- and 16-yr.-old secondary school students. Attitudes reflected levels of apathy, denial, and confusion high enough to lead to concern for this potentially high-risk group. Intention to use condoms in future sexual encounters was related to sex, conflict and confusion about AIDS precautions, plus other attitudinal variables.

Oral contraceptive therapy and the surgical management of ENT patients: a review of current clinical practice

The current policy of British Otolaryngologists with regard to the preoperative cessation of the oral contraceptive pill is reported. This is based on a confidential questionnaire sent to all members of the British Association of Otolaryngologists. The overall response rate was 66%, 91% of which were from practising otolaryngologists and forms the basis of this report, the remaining 9% being from respondents not engaged in active surgery. Although there is evidence to show an increased risk of developing thromboembolic complications after major abdominal, gynaecological and hip surgery in those patients taking the oestrogen-containing contraceptive pill, the risk following minor and intermediate surgery (which forms the bulk of the otolaryngologist's workload) is not known. Not surprisingly therefore the results of the survey show a varied policy across the country with 36.5% of respondents choosing to continue the pill and 25% always stopping the pill preoperatively. The remainder elect to stop the pill only in certain circumstances.

Adolescents' attitudes towards AIDS precautions and intention to use condoms

This study investigated attitudes toward AIDS precautions of 370 15- and 16-yr.-old secondary school students. Attitudes reflected levels of apathy, denial, and confusion high enough to lead to concern for this potentially high-risk group. Intention to use condoms in future sexual encounters was related to sex, conflict and confusion about AIDS precautions, plus other attitudinal variables.

An evaluative instrument based on patient's perception of health for the monitoring of primary medical care in rural areas in Thailand

The evaluative instrument for the monitoring of primary medical care services in rural areas in Thailand, consisting of health risk, sickness-related dysfunction, health-specific coping index and health care of the patient's family, was developed and tested by 2,394 patients in the 4 regions. The patients had high health risk (70.8 +/- 14.0), high health-specific coping index (71.3 +/- 16.4), high health care of patient's family (76.1 +/- 10.0), and very low sickness-related dysfunction (13.4 +/- 15.6). The average time used for assessing the patients' perception of health was 37.9 minutes by sanitarians, 32.9 midwives, 29.9 by nurses and 24.8 by medical doctors. The reliability of the instrument was tested by paired interviewers; sanitarians and midwives, medical doctors and nurses, and was highly reliable for health risk and health-specific coping index. Language was the major obstacle in interviewing in the South.

The prevalence and impact of pain after day-care tubal ligation surgery

Empirical data from controlled studies using standardized, reliable measures on the amount and quality of pain after laparoscopic tubal ligation and the consequences of this pain on the activities of daily living are extremely scarce. In a study of 54 women admitted to a day-care unit for this procedure, validated measures were utilized to assess the incidence, intensity and duration of pain after tubal ligation (McGill Pain Questionnaire) and the impact of pain on the activities of daily living (Modified Functional Assessment Inventory). Psychological measures (Brief Symptom Inventory, Kranz Health Opinion Survey, and the State-Trait Anxiety Inventory) were employed to test their use as possible predictors for pain, analgesic usage and the time taken to resume a normal activity level after tubal ligation surgery. The results showed that pain is a significant problem after tubal ligation although pain rating scores over the 7-day study period were lower than those reported after major abdominal surgery. Eighty-five percent of our sample reported that pain and/or fatigue impacted on their recovery and contributed to an average delay of return to normal activity level of 4.4 days, not including the day of surgery. The psychological measures did not prove to be strong predictors of postoperative pain, time of return to normal activity level or analgesic usage. The most powerful predictor of return to normal activity was the total amount of pain experienced, as measured by the McGill Pain Questionnaire, during the 7 day post-operative period.