Self-administered Test Research Articles

Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire.

Since there is a need for cost-effective screening techniques to identify neuropsychological impairment in multiple sclerosis (MS) patients, and because existing methods require cognitive testing with subsequent interpretation by a neuropsychologist, a brief self-report procedure was developed to screen for neuropsychological impairment in MS. In the first phase of the study, a pool of 80 items was generated based on a literature review and consultation with healthcare professionals. The set was reduced to 15 via Rasch analysis. Using these items, a brief (five minute) MS Neuropsychological Screening Questionnaire (MSNQ), including patient- and informant-report forms, was composed. In phase II, 50 MS patients and their caregivers completed the MSNQ. A comprehensive neuropsychological test battery was also administered. Analyses covered the reliability of the MSNQ and correlations between both patient- and informant-report scores and objective neuropsychological testing. Cronbach's alpha coefficients were 0.93 and 0.94 for the patient- and informant-report forms, respectively, and both forms of the test were strongly correlated with a more general cognitive complaints questionnaire. The patient MSNQ form correlated significantly with measures of depression but not with objective tests of cognitive function. In contrast, the informant form was correlated with patient cognitive performance but not depression. A cut-off score of 27 on the informant form of the MSNQ optimally separated patients based on a neuropsychological summary score encompassing measures of processing speed and memory. There were two false-negatives and one false-positive, giving the test a sensitivity of 0.83 and a specificity of 0.97. It is concluded, therefore, that this self-administered neuropsychological screening test is reliable and predicts neuropsychological impairment in MS patients with a reasonable degree of accuracy.

Need for screening for genital Chlamydia trachomatis infection in Australia.

Genital Chlamydia trachomatis is the most common notifiable sexually transmissible infection in Australia and is associated with significant complications, particularly for women. There is no screening program for chlamydia in Australia despite this infection fulfilling the criteria for screening--it is easily diagnosed with acceptable self-administered tests and early treatment prevents complications. Screening for chlamydia reduces the prevalence of infection and the rate of complications and is recommended by several Western countries including the United States, England and Canada. If a screening program was introduced in Australia, several issues would first need to be addressed including who would be screened, how often would they be screened and where would screening be offered. We discuss these issues in this paper in an effort to advance the debate and the introduction of chlamydia screening in Australia.

Educación grupal frente a individual en pacientes diabéticos tipo 2

To compare the effectiveness of group (GE) and individual (IE) health education in type-2 diabetes patients, and identify the improvement in knowledge, metabolic control and risk factors. Randomised clinical trial. Primary care.Participants. 68 patients with type-2 diabetes, diagnosed 6 months before the start of the study and who had not received GE. Patients aged over 75, those with sensory, psychological and/or physical deficiencies and those not monitored in primary care were excluded (alpha=0.05; beta=0.2).Interventions. Patients were selected according to the inclusion criteria and allocated at random to the IE (n=33) or GE (n=35) group. Individual and group lessons were given at the same time for a year. The contents were evaluated with a validated, self-administered test. General, demographic variables, analyses, blood pressure, the Body Mass Index (BMI), the presence of cardiovascular risk factors, diabetes-related complications and therapeutic variables were all measured. The two kinds of education showed no significant differences from each other. The two groups improved the level of knowledge (P<0.001), and reduced HbA1c (P<0.001), HDL-C (P<0.001), the BMI (P=0.001) and systolic pressure (P=0.004), and increased their use of reactive strips (P=0.02). Health education on diabetes improved knowledge of the disease, metabolic control and cardiovascular risk factors. The two educational methods evaluated were equally effective.

Psychoneuroimmunology of health and long survival with HIV/AIDS: questionnaires, semistructured interviews, and laboratory findings

A 5-year research project has compared psychologically and immunologically long survivors with AIDS as well as HIV+ persons who have remained healthy in the face of very low CD4+ cell counts with a group of HIV+ persons without symptomatic AIDS and CD4 counts between 150 and 500 mm 3. Long survival is characterized by a collaborative relationship with physician, and religious/spiritual coping. Optimism characterizes healthy HIV+ persons with low CD4 counts, whose health may be protected by the unusual preservation of normal levels of natural killer cell cytotoxicity (NKCC). Refusal to perceive disease as imminently fatal and coping well with loss correlate positively with NKCC and negatively with viral load; toleration of loss correlates positively with CD4 count. Both specially designed self-administered tests and rated semistructured interviews are useful in discerning psychosocial factors related to health and long survival and their biological correlates.

What sexually transmitted disease screening method does the adolescent prefer? Adolescents' attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination.

To assess sexually active adolescents' attitudes toward 3 screening collection techniques for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using first-void urine (FVU), self-collected vaginal swab specimens, and pelvic examination with clinician-collected endocervical swab specimens. Participants completed a preexamination health survey, provided FVU and self-collected vaginal swab samples, and had a pelvic examination with endocervical swab specimen collection. In a confidential postexamination interview, patients ranked the 3 screening techniques according to preference and responded to qualitative positive and negative descriptors to evaluate each technique. San Francisco area health maintenance organization and university clinics. A convenience sample of 155 ethnically diverse females aged 12 to 21 years, who were sexually active and were to have a pelvic examination. Adolescents' preferences for and evaluations of 3 sexually transmitted disease screening techniques. Participants preferred the FVU test for sexually transmitted disease screening over the pelvic examination and the self-administered vaginal swab test (P<.001). These results were consistent when controlling for potentially mitigating experiences, including previous pelvic examination, tampon or condom use, and prior pregnancy. In evaluating what they liked and disliked about each of the 3 screening methods, participants described the FVU most positively, the pelvic examination most negatively, and the vaginal swab technique slightly less positively than the FVU. Most sexually active adolescents attending clinics for pelvic examination prefer to be screened for sexually transmitted diseases first by the FVU, second by the self-collected vaginal swab test, and last by the pelvic examination.

How good is the pelvic examination, and is it being upstaged by newer technologies?

Close and colleagues measured the reliability of the bimanual examination performed by emergency department physicians. As they point out, such a study of reliability has never been published before. There was poor agreement (17%-32%) between physicians as to whether there was a positive examination finding—cervical motion tenderness, uterine tenderness, adnexal tenderness, or adnexal mass. The unreliability of the pelvic examination is worrying because these positive findings are important in making a clinical diagnosis of pelvic inflammatory disease. Pelvic inflammatory disease is the most common reproductive health problem of young women, and it increases the risk of subsequent ectopic pregnancy and tubal infertility. The poor validity of the pelvic examination in diagnosing pelvic inflammatory disease was shown in a 1969 Swedish study.1 Women were examined by trained gynecologists and then underwent laparoscopy by examiners who were blind to the original clinician's diagnosis. At laparoscopy, the clinicians were found to have made a correct diagnosis in less than two thirds of cases. Before dismissing the pelvic examination altogether, we note that the current study had 4 important limitations. First, there was no objective clinical outcome measure, such as laparoscopy or testing for sexually transmitted infections, and so the clinical meaning and implications of the findings are unclear. Second, many relatively inexperienced clinical trainees were used in the study. Third, sexually active teenagers, who are most at risk for pelvic inflammatory disease, were not included in the study. Finally, apart from the clinician's assessment of uterine size and the presence of an adnexal mass, the variables measured involved the subjective perceptions of pain by the woman being examined. Despite the limitations, the study cautions against relying solely on the pelvic examination in an emergency situation. Examination findings must be combined with the patient's history (particularly risk factors for urgent conditions such as pregnancy, especially ectopic pregnancy, and sexually transmitted infections) and appropriate laboratory tests and procedures. Great strides have been made in developing noninvasive, highly sensitive urine-based tests for pregnancy and sexually transmitted infections that can assist in making a diagnosis in the acute care setting. Urinalysis can now be used as a screening test for common infections related to pelvic inflammatory disease, such as chlamydia and gonorrhea. The Food and Drug Administration will shortly approve the use of self-administered vaginal swabs for diagnosing sexually transmitted infections. The evidence is accumulating that physicians cannot always make clinical judgments based on the often inaccurate and insensitive pelvic examination. But additional and evolving adjunctive tests and procedures are now available to help with acute care quandaries. The pelvic examination may not be the final determining step in the diagnosis of acute pelvic conditions because of its inherent insensitivity and the evolution of better diagnostic tools. The accuracy of diagnostic imaging, for example, will continue to improve and will determine more accurately than the bimanual pelvic examination the presence of pelvic disease. For most asymptomatic young women in need of sexually transmitted infection screening, urine-based sexually transmitted infection screening for chlamydia appears sufficient.2,3 The future will bring rapid bedside tests for other bacterial and viral agents. More broad-based sexually transmitted infection screening is at hand with the development of self-administered tests of urine and vaginal specimens. Home testing for sexually transmitted infection similar to the current urine-based pregnancy tests is likely not far in the future. Finally, clinical algorithms will continue to be developed to help determine what factor or factors are most important in specific clinical diagnoses. Clearly, the role of the pelvic examination in clinical practice is changing with the evolution and application of new technologies.

Clock drawing: analysis in a retirement community.

To test the hypothesis that performance on a clock-drawing test in a mailed survey to an older cohort is associated with known and potential risk and protective factors for Alzheimer's disease. The Leisure World Cohort Study is an ongoing study, begun in 1981, of nearly 14,000 older adults. In November 1992, the 8,406 living cohort members were mailed a follow-up questionnaire. Leisure World Laguna Hills, a southern California retirement community. The study population is a predominantly white, well-educated, upper-middle-class community; approximately two-thirds are women. Data from 4,843 cohort members (mean age 80 years; range 52-101) were analyzed. The questionnaire included a clock-drawing task: a predrawn circle 3 1/4 inches (8.3 cm) in diameter was provided with instructions "In the circle below, draw in the numbers as on a clock face. Make no erasures." Clocks were scored on 7 items: all numbers 1-12 present without adding extra or omitting numbers, sequencing of numbers, position of numbers, orientation of numbers to circle, consistent number style (either Arabic or Roman), tilt of numbers, and superfluous marks. A total clock score was calculated by summing the number of correct individual items (0-7). We also classified individuals as cognitively impaired by a previously suggested method: individuals were affected if they did not have three numbers drawn in the upper left quadrant of the clock face. Ninety percent or more of the participants across all ages placed the numbers 1 to 12 on their clocks without omissions or additions; 35% completed the clock drawing without error. The mean total clock scores decreased with each successive 5-year age group in both men and women. Regression analysis indicated a significant effect for age (b = -0.15, P <.0001), education (b = 0.05, P =.0001), smoking (b = 0.13, P =.03), and female gender (b = -0.05, P =.05) and a marginally significant effect of nonrheumatoid arthritis (b = 0.05, P =.07) on total clock score. No other measured variable had a significant effect. Cognitively impaired individuals were more likely to be female and older. After adjusting for age and gender, they were also more likely to be hypertensive and to have taken blood pressure medication and less likely to be college graduates, have glaucoma or arthritis, and to have taken vitamin supplements. The clock-drawing task is an appealing measure of cognitive function for large epidemiological studies because it is a simple, self-administered test that is easily adapted to mail surveys and correlates with more-detailed and more-time-consuming cognitive screens. Although it is relatively free of influence by language, cultural, or ethnic factors, our study shows that even in a highly educated population, clock drawing is influenced by educational level and other known risk factors for Alzheimer's disease. Thus a clock-drawing task may help predict cognitive frailty and future disability in older people. Such determination can direct high-risk individuals to earlier diagnosis, potential therapies, and better management.

Point prevalence of alcoholism in hospitalized patients: continuing challenges of detection, assessment, and diagnosis

To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems. On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-administered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a discharge diagnosis of alcoholism. The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consultative services during their hospitalization. Serum gamma-glutamyltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic patients received a discharge diagnosis of alcohol abuse or dependence. The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Physician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism.

Analysis of the performance characteristics of the University of Washington Quality of Life instrument and its modification (UW-QOL-R).

During a 5-year period, we analyzed 3 patient subsets from the University of Washington Quality of Life (UW-QOL) Registry and published the results. In each instance, editorial review has raised legitimate concerns regarding the UW-QOL instrument that deserve public comment. We present our response to these criticisms. Since our original publication (1993), we have added domains to the original UW-QOL instrument. These additions reflected our concern that we might be missing important elements in the spectrum of disease-specific response to treatment. Using the data we have accumulated in the last 5 years, we present an analysis of the internal consistency of the UW-QOL. We have identified those domains that are responsive (or not responsive) to treatment effect and have revised the UW-QOL accordingly to create the UW-QOL-R, which is recommended for future use. The project began January 1, 1993, after approval by the UW Human Subjects Committee. Critical comments offered by external review were collated and responded to. Internal consistency was evaluated by interitem correlation matrix (Cronbach alpha) testing. All new patients presenting to the UW Medical Center (Seattle) with a diagnosis of head and neck cancer were asked to participate in a prospective analysis of QOL changes during and after treatment. Patients completed the pretreatment QOL questionnaire on the day of their initial workup. The format for the pretreatment test was an interviewer-supervised self-administered test; the subsequent tests were self-administered and were completed at 3, 6, 12, 24, and 36 months. Other data entered for each patient included site, stage, treatment, histologic classification, reconstruction, and current status. A QOL registrar was responsible for patient follow-up, data collection, and collation. All data were entered into the departmental relational database. Criticisms by external review included the following: "it is improper to call it [UW-QOL] a measure of quality of life"; "the summary scale is problematic because it implies that each of the subscales are weighted or 'valued' equally"; "some domain questions relate to surgery specific issues. while others are specific to radiation"; "we were confused by the scoring"; and "the UW-QOL index does not specifically address the psychological impact of the disease and its treatment." After evaluation of internal consistency, the UW-QOL was modified by removing 2 domains that correlated poorly with the others. This resulted in a 10-item instrument (UW-QOL-R) with an overall internal consistency score of 0.85. The UW-QOL can be effectively and accurately used to compare treatment effects in the management of head and neck cancer. With this revised instrument, the 10 items appear to measure the domains of overall QOL in a highly consistent and reliable fashion over time.

Pilot detection study of alpha(1) antitrypsin deficiency in a targeted population.

Screenings for the genetic disorder alpha(1) antitrypsin deficiency (AAT Deficiency) have been one of two models: large screenings of general populations and small targeted detection programs in high-risk groups. The most appropriate screening and detection methodologies in terms of target populations, subject participation and yield of positive tests, however, have not been well defined. The major objective of this pilot study was to evaluate the effectiveness in terms of participation of two different AAT Deficiency detection programs using a self-administered fingerstick blood test. Individuals ages 30-60 under the care of a pulmonary physician and with a diagnosis of emphysema, COPD, chronic bronchitis, or bronchiectasis were the targeted population. Participants were offered AAT Deficiency testing in the pulmonary physician's office compared with testing offered through mail. Participation (i.e., frequency of subject participation in the detection program) of two different AAT Deficiency detection programs. Non-participation was due to fear of self-administered testing and research studies; women were more likely to participate than men. Eligible subjects were significantly more likely to participate when offered testing by their pulmonary physician in-office (83%) than mail-only (42%) (P < 0.02). Although self-administered genetic testing is available, highest participation in AAT Deficiency detection program was found when offered directly by the physician. This finding may have implications for screening and detection of other genetic diseases. Future studies need to evaluate the yield (i.e., frequency of positive tests) of these detection methodologies in highly targeted populations.

Health insurance status and mood during pregnancy and following birth: a longitudinal study of multiparous women

Objective: The objective of this study was to investigate the relationship between health insurance status and mood during pregnancy and following childbirth.Method: 320 women were recruited in the early stage of pregnancy to participate in a longitudinal, prospective study of the psychological aspects of childbirth among multiparous women. Study volunteers were surveyed during each trimester of pregnancy and 2 and 8 months following childbirth. A range of self-administered psychometric tests were used to assess mood (Profile of Mood State), locus of control, defence style and partner support. Demographic information including health insurance status was noted at study entry.Results: Public patients consistently had a more disturbed mood compared with private patients. This difference reached statistical significance during the second and third trimesters of pregnancy and 8 months after birth. Multivariate analysis was undertaken to identify predictors of mood during pregnancy and following birth. A better mood score was positively associated with private health insurance, a more caring partner and mature defence style, and negatively associated with external locus of control and immature defence style. A distinct mood pattern during pregnancy and following childbirth was observed and is described.Conclusions: Public patients have a more disturbed mood during pregnancy and following childbirth compared with private patients. This information is relevant when planning social, psychological and psychiatric services that target childbearing women.

Health Insurance Status and Mood During Pregnancy and Following Birth: A Longitudinal Study of Multiparous Women

The objective of this study was to investigate the relationship between health insurance status and mood during pregnancy and following childbirth. 320 women were recruited in the early stage of pregnancy to participate in a longitudinal, prospective study of the psychological aspects of childbirth among multiparous women. Study volunteers were surveyed during each trimester of pregnancy and 2 and 8 months following childbirth. A range of self-administered psychometric tests were used to assess mood (Profile of Mood State), locus of control, defence style and partner support. Demographic information including health insurance status was noted at study entry. Public patients consistently had a more disturbed mood compared with private patients. This difference reached statistical significance during the second and third trimesters of pregnancy and 8 months after birth. Multivariate analysis was undertaken to identify predictors of mood during pregnancy and following birth. A better mood score was positively associated with private health insurance, a more caring partner and mature defence style, and negatively associated with external locus of control and immature defence style. A distinct mood pattern during pregnancy and following childbirth was observed and is described. Public patients have a more disturbed mood during pregnancy and following childbirth compared with private patients. This information is relevant when planning social, psychological and psychiatric services that target childbearing women.

Quality of life in patients with head and neck cancer: lessons learned from 549 prospectively evaluated patients.

To summarize our quality-of-life (QOL) research findings for patients with head and neck cancer, to suggest areas for future productive QOL research, and to discuss how to undertake QOL studies in a cost-effective manner. Review of previously published analyses of advanced larynx cancer, advanced oropharynx cancer, and neck-dissection cases and current data from the complete set of patients. From January 1, 1993, through December 31, 1998, data on 549 patients were entered in our head and neck database. Of these patients, 364 met additional criteria for histologic findings (squamous cell carcinoma) and the restriction of their cancer to 4 major anatomical sites (oral, oropharynx, hypopharynx, or larynx). Of these, 339 patients were more than 1 year beyond initial treatment. Complete baseline TNM staging and QOL data were obtained for 260 of these patients, of whom 210 presented with an untreated first primary tumor (index cases) to the University of Washington, Seattle. Pretreatment QOL was assessed with an interviewer-supervised self-administered questionnaire. Subsequent self-administered tests were completed at 3, 6, 12, 24, and 36 months. Other data collected on each patient included cancer site, stage, treatment, histologic findings, type of surgical reconstruction, and current disease and vital status. It is difficult to achieve "statistically significant" results in a single-institution setting. The "composite" QOL score may not be a sufficiently sensitive tool. Analysis of separate domains may be more effective.

Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.

Blood Spot Self-administered Test and Assay

Blood Spot Self-administered Test and Assay

The Crohn’s and colitis knowledge score: a test for measuring patient knowledge in inflammatory bowel disease

OBJECTIVE: The aim of this study was to develop a valid and reliable questionnaire assessing patient knowledge of inflammatory bowel disease (IBD) and its treatment—the Crohn’s and Colitis Knowledge (CCKNOW) Score. METHODS: A total of 30 multiple choice questions were constructed into a draft questionnaire. This was piloted on a random selection of participants with differing IBD knowledge levels; junior doctors, nurses, and ward clerks. Factor analysis eliminated questions with poor discriminant ability. The resulting 24-item questionnaire (CCKNOW score) was retested on the three groups, and a Kruskal-Wallis test determined the questionnaire’s ability to discriminate between the groups. Reliability and readability were tested using Cronbach’s α and the Flesch Kincaid reading score. The validated CCKNOW was then tested on patients from the Leicestershire IBD database. RESULTS: CCKNOW scores differed significantly across the groups of doctors, nurses, and ward clerks (median 22, 16, and five, respectively) T = 40.35, p < 0.0001. The reliability was very good with a Cronbach’s α of 0.95 and the readability was also high. The median score on the CCKNOW for IBD patients was 10, with no significant difference between ulcerative colitis and Crohn’s disease. Patients who are members of NACC (National Association of Crohn’s and Colitis) achieve statistically significantly higher scores than do nonmembers (difference in medians 4, 95% confidence interval 4–6, p < 0.0001). CONCLUSIONS: The CCKNOW score provides a valuable index of overall knowledge. It is self-administered and psychometric tests show it to be valid, reliable, and readable. It may be used in the future as a tool to evaluate patient education programs.

The Crohn's and Colitis Knowledge Score: a test for measuring patient knowledge in inflammatory bowel disease.

The aim of this study was to develop a valid and reliable questionnaire assessing patient knowledge of inflammatory bowel disease (IBD) and its treatment--the Crohn's and Colitis Knowledge (CCKNOW) Score. A total of 30 multiple choice questions were constructed into a draft questionnaire. This was piloted on a random selection of participants with differing IBD knowledge levels; junior doctors, nurses, and ward clerks. Factor analysis eliminated questions with poor discriminant ability. The resulting 24-item questionnaire (CCKNOW score) was retested on the three groups, and a Kruskal-Wallis test determined the questionnaire's ability to discriminate between the groups. Reliability and readability were tested using Cronbach's a and the Flesch Kincaid reading score. The validated CCKNOW was then tested on patients from the Leicestershire IBD database. CCKNOW scores differed significantly across the groups of doctors, nurses, and ward clerks (median 22, 16, and five, respectively) T = 40.35, p < 0.0001. The reliability was very good with a Cronbach's alpha of 0.95 and the readability was also high. The median score on the CCKNOW for IBD patients was 10, with no significant difference between ulcerative colitis and Crohn's disease. Patients who are members of NACC (National Association of Crohn's and Colitis) achieve statistically significantly higher scores than do nonmembers (difference in medians 4, 95% confidence interval 4-6, p < 0.0001). The CCKNOW score provides a valuable index of overall knowledge. It is self-administered and psychometric tests show it to be valid, reliable, and readable. It may be used in the future as a tool to evaluate patient education programs.

Prevalence of cervical cancer and feasibility of screening in rural China: a pilot study for the Shanxi Province Cervical Cancer Screening Study.

For cervical cancer screening to be feasible in developing countries, it must be accurate, inexpensive, and easy to administer. We conducted a pilot study in rural Shanxi Province, People's Republic of China, to determine disease prevalence and study feasibility in preparation for a large-scale comparative trial of 6 screening tests. One-hundred and thirty-six nonpregnant women with no history of hysterectomy, pelvic radiation, or Papanicolaou tests were screened in a rural clinic. Ten percent of the women enrolled reported abnormal vaginal bleeding and 45% reported abnormal vaginal discharge. The tests were the Papanicolaou test (both conventional and ThinPrep), a self-administered swab test by Hybrid Capture II for high-risk human papillomavirus (HPV), a test for high-risk HPV from residual PreservCyt medium, fluorescence spectroscopy, and visual inspection of the cervix by a clinician. All women also underwent colposcopy and biopsies as the reference standard. Biopsies showed 12 of 136 women had >/= high-grade squamous intraepithelial lesions (HGSIL). Screening was completed in 5 half-day sessions, the procedures went smoothly, and local cooperation was enthusiastic. Disease prevalence in Xiangyuan and Yangcheng Counties, Shanxi Province, can be estimated at 8.8% (95% CI, 4.5% to 15.0%). Screening 1000-2000 patients would be sufficient to detect a 10% difference in accuracy between diagnostic tests. The proposed large-scale trial is feasible.

Psychosocial stress and treatment outcome following assisted reproductive technology

This study investigated the association between psychosocial stress and outcome of in-vitro fertilization and gamete intra-Fallopian transfer treatment. Ninety women, enrolled for treatment at a private infertility clinic, completed two self-administered psychometric tests (Bi-polar Profile of Mood States, POMS; and State-Trait Anxiety Inventory, STAI) and a questionnaire to ascertain demographic and lifestyle characteristics before the start of treatment. Approximately 12 months later an outcome measure was determined for each participant in terms of whether she was pregnant or not pregnant and the number of treatment cycles undertaken to achieve clinical pregnancy. The women's scores on the psychological tests were similar to published normative scores. On univariate analysis, history of a previous pregnancy was positively related to the probability of pregnancy and full-time employment, a more 'hostile' mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable-hostile and elated-depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome but indicate that the relationships are complex. Further studies are required to validate whether these findings can be generalized to other populations.

The Alcohol Use Disorders Identification Test was not affected by ethnic and sex bias

Steinbauer JR, Cantor SB, Holzer CE III , et al. Ethnic and sex bias in primary care screening tests for alcohol use disorders. Ann Intern Med1998 Sep 1; 129 :...