Weighted Prevalence Estimates Research Articles

264 PREVALENCE AND RISK FACTORS FOR NOCTURIA IN US MEN: NATIONAL HEALTH AND NUTRITIONAL EXAMINATION SURVEY DATA

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2010264 PREVALENCE AND RISK FACTORS FOR NOCTURIA IN US MEN: NATIONAL HEALTH AND NUTRITIONAL EXAMINATION SURVEY DATA Alayne D. Markland, Theodore M. Johnson, Patricia S. Goode, David T. Redden, and Kathryn L. Burgio Alayne D. MarklandAlayne D. Markland Birmingham, AL More articles by this author , Theodore M. JohnsonTheodore M. Johnson Atlanta, GA More articles by this author , Patricia S. GoodePatricia S. Goode Birmingham, AL More articles by this author , David T. ReddenDavid T. Redden Birmingham, AL More articles by this author , and Kathryn L. BurgioKathryn L. Burgio Birmingham, AL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nocturia is a bothersome lower urinary tract symptom whose prevalence may vary by geographic region and/or race. No US population-based estimates exist for nocturia among men. Our objectives were to estimate nocturia prevalence for the US male population and evaluate risk factors for nocturia. METHODS Data were analyzed for 5297 men (≥20 years) from the 2005-2006 and 2007-2008 cycles of the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the US noninstitutionalized population. Nocturia was assessed with the question: ″During the past 30 days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?″ Getting up 2 or more times at night to urinate was coded as nocturia. Potential risk factors included: age; race/ethnicity; education; body mass index (BMI, kg/m2); self-reported health status; enlarged prostate diagnosis (men ≥40 years of age); self-reported chronic diseases; and depression status from the validated Patient Health Questionnaire-9 (≥10 defined major depression). Analyses included weighted prevalence estimates and weighted Pearson′s chi square test of univariate factors associated with nocturia. Variables significant at a level of P≥0.05 were entered into a multivariable logistic regression analysis using appropriate sampling weights. RESULTS The overall prevalence of nocturia ≥2 times per night was 21% (weighted 95% confidence interval [CI] 19.3-23.0) of men responding on nocturia (n=4659). Nocturia increased in prevalence with age (p<0.001) from 8.2% (95% CI 6.7-10.2) in men aged 20-34 years up to 55.8% (95% CI 51.3-60.2) in men 75 years and older. More African-American men had nocturia (30.2%, 95% CI 26.7-34.1) than other racial/ethnic groups (20.1%, 95% CI 18.1-22.1, p<0.001). Significant risk factors for nocturia in weighted multivariable analysis included: 10-year increase in age (Odds Ratio [OR] 1.6, 95% CI 1.4, 1.7), African American race/ethnicity 2.0 (95% CI 1.4, 2.7), fair/poor self-rated health 1.9 (95% CI 1.4, 2.5), major depression 2.7 (95% CI 1.7, 4.1), and hypertension 1.3 (95% CI 1.0, 1.6). BMI, diabetes, and prostatic enlargement were not risk factors for nocturia. CONCLUSIONS In this population-based study adjusting for US age and race norms, nocturia occurred in >38 million US men (21%), which is significantly higher than other non-US, population-based estimates. African-American men had more nocturia even when controlling for demographic factors and comorbid conditions. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e104 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alayne D. Markland Birmingham, AL More articles by this author Theodore M. Johnson Atlanta, GA More articles by this author Patricia S. Goode Birmingham, AL More articles by this author David T. Redden Birmingham, AL More articles by this author Kathryn L. Burgio Birmingham, AL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can hepatitis C virus prevalence be used as a measure of injection‐related human immunodeficiency virus risk in populations of injecting drug users? An ecological analysis

Human immunodeficiency virus (HIV) outbreaks occur among injecting drug users (IDUs), but where HIV is low insight is required into the future risk of increased transmission. The relationship between hepatitis C virus (HCV) and HIV prevalence among IDUs is explored to determine whether HCV prevalence could indicate HIV risk. Systematic review of IDU HIV/HCV prevalence data and regression analysis using weighted prevalence estimates and time-series data. HIV/HCV prevalence estimates were obtained for 343 regions. In regions other than South America/sub-Saharan Africa (SAm/SSA), mean IDU HIV prevalence is likely to be negligible if HCV prevalence is <30% (95% confidence interval 22-38%) but increases progressively with HCV prevalence thereafter [linearly (beta = 0.39 and R(2) = 0.67) or in proportion to cubed HCV prevalence (beta = 0.40 and R(2) = 0.67)]. In SAm/SSA, limited data suggest that mean HIV prevalence is proportional to HCV prevalence (beta = 0.84, R(2) = 0.99), but will be much greater than in non-SAm/SSA settings with no threshold HCV prevalence that corresponds to low HIV risk. At low HCV prevalences (<50%), time-series data suggest that any change in HIV prevalence over time is likely to be much smaller (<25%) than the change in HCV prevalence over the same time-period, but that this difference diminishes at higher HCV prevalences. HCV prevalence could be an indicator of HIV risk among IDUs. In most settings, reducing HCV prevalence below a threshold (30%) would reduce substantially any HIV risk, and could provide a target for HIV prevention.

Prevalence and Correlates of Current Depressive Symptomatology and Lifetime Diagnosis of Depression in Black Women

There is a paucity of research on depressive symptoms and their correlates among Black women, which may contribute to underdiagnosis, misdiagnosis, and inappropriate treatment. Data were analyzed from the 2006 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged > or =18 years. A total of 10,783 Black women aged 18 to 64 years were interviewed from 38 states, 2 U.S. territories, and the District of Columbia (DC). There were 8,412 (78.0%) women who provided complete responses to questions regarding demographic characteristics, psychosocial variables, current depressive symptomatology, and a lifetime diagnosis of a depressive disorder. Weighted prevalence estimates and 95% confidence limits of current depressive symptomatology and self-reported lifetime diagnosis of depression were derived. Multiple logistic regression models were used to examine the association of each correlate with the depression outcomes. Overall, 13.8% of Black women reported current depressive symptoms, and 14.9% reported a lifetime diagnosis of a depressive disorder by a health care provider. Significant correlates of both outcomes included rarely/never receiving social support, being unable to work, having physical health problems for 14 or more days in the past month, and dissatisfaction with life. This study indicates that a substantial number of Black women suffer from significant symptoms of depression and report that they have been diagnosed with depressive disorders in their lifetime. Health care providers should assess Black women with poor physical health and life dissatisfaction for depressive disorders and not dismiss somatic complaints as solely physically based.

Prevalence of Serious Mental Illness Among Jail Inmates

Prevalence of Serious Mental Illness Among Jail Inmates

Prevalence of Serious Mental Illness Among Jail Inmates

This study estimated current prevalence rates of serious mental illness among adult male and female inmates in five jails during two time periods (four jails in each period). During two data collection phases (2002-2003 and 2005-2006), recently admitted inmates at two jails in Maryland and three jails in New York were selected to receive the Structured Clinical Interview for DSM-IV (SCID). Selection was based on systematic sampling of data from a brief screen for symptoms of mental illness that was used at admission for all inmates. The SCID was administered to a total of 822 inmates-358 during phase I and 464 during phase II. To determine the current (past-month) prevalence of serious mental illness (defined as major depressive disorder; depressive disorder not otherwise specified; bipolar disorder I, II, and not otherwise specified; schizophrenia spectrum disorder; schizoaffective disorder; schizophreniform disorder; brief psychotic disorder; delusional disorder; and psychotic disorder not otherwise specified), interview data were weighted against strata constructed from the screening samples for male and female inmates by jail and study phase. Across jails and study phases the rate of current serious mental illness for male inmates was 14.5% (asymmetric 95% confidence interval [CI]=11.0%-18.9%) and for female inmates it was 31.0% (asymmetric CI=21.7%-42.1%). The estimates in this study have profound implications in terms of resource allocation for treatment in jails and in community-based settings for individuals with mental illness who are involved in the justice system.

Psychological distress and fair/poor health among adults with arthritis: state-specific prevalence and correlates of general health status, United States, 2007

To: 1) estimate U.S. state-specific prevalence of serious psychological distress (SPD) and fair/poor health status (FPH), and 2) identify correlates of FPH among adults with arthritis (ARTH+). Data were from the 2007 Behavioral Risk Factor Surveillance System (n = 414,719). State-specific weighted prevalence estimates of SPD (> or = 13 on the Kessler 6 scale) and FPH status were calculated, and multivariate logistic regression was used to identify correlates of FPH in four domains (physical health, mental health, sociodemographics, behaviors). Prevalence of SPD and FPH were 2 and 3 times higher, respectively, among ARTH+ compared to those without. Among ARTH+, the state-specific prevalence of SPD ranged from 2.7 % to 12.2 % and FPH from 22.1 % to 43.5 %. Health behaviors (physical activity, smoking, heavy drinking) and physical health indicators (e.g. activity limitation, physically unhealthy days, co-morbidity) were the strongest correlates of FPH status. After adjustment, physically active ARTH+ were 50-66 % less likely to report FPH compared to inactive ARTH+. Psychological distress and poor health status are common in arthritis; increasing physical activity may be an intervention point to improve health status.

Chronic Diseases and Risk Factors in Canada’s Northern Populations: Longitudinal and Geographic Comparisons

Chronic diseases are the leading cause of death and disability worldwide and place considerable burden on the Canadian health care system. This research investigates the self-reported prevalence of major chronic diseases and risk factors in northern Canadian populations and compares their prevalence to southern Canadian populations over time. Canadian Community Health Survey (CCHS) cycle 1.1 (2000/01) and 3.1 (2005) data were used for the analyses. Respondents 20 years old or greater in the Yukon, Northwest Territories, and Nunavut comprised the northern Canadian sample. Respondents in the same age group in the rest of Canada comprised the southern Canadian sample. Unadjusted and adjusted weighted prevalence estimates and confidence intervals were calculated and tested for significance using z-tests. Northern Canadian respondents had significantly lower crude prevalence of self-reported hypertension, arthritis/rheumatism, diabetes, heart disease and stroke than southern Canadian respondents, although these associations did not remain significant after adjusting for age and sex. Northern Canadian respondents had significantly lower adjusted prevalence of any chronic disease. However, northern Canadian respondents had significantly higher adjusted prevalence of obesity and smoking than southern Canadian respondents at both time periods. The prevalence of any chronic disease increased significantly from 2000/01-2005 for both northern and southern Canadian respondents. The higher prevalence of key chronic disease risk factors in northern Canadian populations and the increasing prevalence for many chronic diseases in both southern and northern populations signal a need for continual monitoring of chronic diseases and the development of appropriate prevention and management strategies.

Surveillance for health behaviors of American Indians and Alaska Natives-Findings from the behavioral risk factor surveillance system, 2000-2006

The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non-Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions. Behavioral Risk Factor Surveillance System data were aggregated from the years 2000 through 2006 and were used to calculate weighted prevalence estimates by gender for key variables except demographic variables. Compared with NHWs, AI/ANs had lower prevalence estimates for income, educational attainment, insurance coverage, and access to personal healthcare providers. AI/ANs in Alaska and NHWs had similar estimates for diabetes (approximately 6%); however, the prevalence was nearly twice as high among AI/ANs in the other regions. The prevalence of obesity was higher for AI/ANs (29.6%) than for NHWs (20.9%). The prevalence of binge drinking was higher among AI/AN males (24.9%) than among AI/AN females (8.5%). Heavy drinking was more prevalent among NHW females (5.3%) than among AI/AN females (3.5%). AI/ANs were more likely to be current smokers (31.1%) than NHWs (22.8%). The prevalence of AI/ANs who never smoked ranged from 31.5% in Alaska to 56.9% in the Southwest. In 5 of the 6 regions, AI/AN females had lower prevalence estimates of both Papanicolaou and mammography testing than NHW females. The use of colorectal cancer screening tests was more common among NHWs (53.8%) than among AI/ANs (44%). Although cancer health disparities persist among AI/ANs, the current analysis indicated that variation in the prevalence of their chronic disease risk factors may be obscured when national data are not examined by smaller geographic areas such as regions.

A Profile of Concurrent Alcohol and Alcohol-Interactive Prescription Drug Use in the US Population

The risk of adverse events among alcohol-interactive medication users can occur with one standard alcoholic drink. Research on the extent to which this occurs is scant. To examine the prevalence and correlates of concurrent alcohol and alcohol-interactive (AI) medication use across different levels of risk for an alcohol-related adverse event in a nationally representative sample of American adults. Cross-sectional analysis of past year, self-reported drinking history as well as past month, self-reported and visually inspected prescription drug use data from the 1999-2000 and 2001-2002 NHANES questionnaire section (n = 8,246). Medications were considered AI if concurrent use of alcohol and the prescription drug could intensify the effects of alcohol, resulting in increased sedation, drowsiness, or dizziness. Weighted prevalence estimates and polytomous logistic regression accounted for the complex survey design. Overall, 13.5% took prescription AI medications, of which 5.6% reported alcohol consumption of three or more drinks on each drinking occasion. Correlates of such use were being a man [adjusted odds ratio (AOR): 4.37; 95% confidence interval (CI): 1.84-10.35], between the ages of 20 and 54 (AOR=12.28; 95% CI: 3.12-48.25), and currently smoking (AOR: 2.61; 95% CI: 1.28-5.29), with alcohol-abstaining AI users as the referent group. Combining alcohol and AI medications is a common phenomenon, and the risk of alcohol-related adverse drug events may be nontrivial. Screening for alcohol use before prescribing AI medications would be prudent. Better communication regarding the dangers of mixing alcohol with AI medications is warranted.

A Population-based Survey of the Prevalence of HIV, Syphilis, Hepatitis B and Hepatitis C Infections, and Associated Risk Factors Among Young Women in Vitória, Brazil

To estimate the prevalence of HIV, hepatitis B (HBV) and C (HCV), and syphilis infections and associated risk exposures in a population-based sample of young women in Vitória, Brazil. From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a single stage, population-based study. Serological markers of HIV, HBV, HCV, and syphilis infections and associated risk exposures were assessed. Of 1,200 eligible women, 1,029 (85.8%) enrolled. Median age was 23 (interquartile range 20-26) years; 32.2% had < or = 8 years of education. The survey weighted prevalence estimates were: HIV, 0.6% [(95% CI), 0.1%, 1.1%]; anti-HBc, 4.2% (3.0%, 5.4%); HBsAg, 0.9% (0.4%, 1.6%); anti-HCV, 0.6% (0.1%, 1.1%), and syphilis 1.2% (0.5%, 1.9%). Overall, 6.1% had at least one positive serological marker for any of the tested infections. A majority (87.9%) was sexually active, of whom 12.1% reported a previously diagnosed sexually transmitted infection (STI) and 1.4% a history of commercial sex work. Variables independently associated with any positive serological test included: older age (> or = 25 vs. < 25 years), low monthly income (< or = 4x vs. > 4x minimum wage), previously diagnosed STI, > or = 1 sexual partner, and any illicit drug use. These are the first population-based estimates of the prevalence of exposure to these infectious diseases and related risks in young women, a population for whom there is a scarcity of data in Brazil.

Self-reported age-related eye diseases and visual impairment in the United States: results of the 2002 national health interview survey.

We sought to establish national data on the prevalence of visual impairment, blindness, and selected eye conditions (cataract, diabetic retinopathy, glaucoma, and macular degeneration) and to characterize these conditions within sociodemographic subgroups. Information on self-reported visual impairment and diagnosed eye diseases was collected from 31,044 adults. We calculated weighted prevalence estimates and odds ratios with logistic regression using SUDAAN. Among noninstitutionalized US adults 18 years and older, the estimated prevalence for visual impairment was 9.3% (19.1 million Americans), including 0.3% (0.7 million) with blindness. Lifetime prevalence of diagnosed diseases was as follows: cataract, 8.6% (17 million); glaucoma, 2.0% (4 million); macular degeneration, 1.1% (2 million); and diabetic retinopathy, 0.7% (1.3 million). The prevalence of diabetic retinopathy among persons with diagnosed diabetes was 9.9%. We present the most recently available national data on self-reported visual impairment and selected eye diseases in the United States. The results of this study provide a baseline for future public health initiatives relating to visual impairment.

Assessing Population Risk for Postmenopausal Osteoporosis: A New Strategy Using Data From the Behavioral Risk Factor Surveillance System (BRFSS)

Osteoporosis public health measures are hindered by the inability to easily identify subclinical disease. We have now estimated state-specific osteoporosis prevalences using a simple formula (OST Index) to analyze age and weight of 62,882 older women; the prevalences determined are similar to those based on BMD. This new method has potential use for guiding implementation of osteoporosis prevention/treatment programs. Although osteoporosis-related fractures are a major U.S. public health issue, population-based prevention programs have not yet been developed. One contributing factor has been lack of a suitable screening test to detect asymptomatic high-risk individuals. We estimated state-specific prevalences of postmenopausal osteoporosis using the Osteoporosis Self-Assessment Tool Index (OST Index; [self-reported weight in kg - age] x 0.2) to analyze data from 62,882 women >or=50 yr of age who participated in the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The OST Index, designed to assess an individual's risk of disease, has previously been shown to have modest positive and high negative predictive value for osteoporosis defined by BMD criteria. Based on this index, women from each state were distributed among high-, moderate-, and low-risk OST categories. Calculated percentages for each category were weighted to U.S. Census Bureau population projections for 2002. By adjusting results to reflect previously validated percentages of women with osteoporosis in each risk category, we estimated the prevalence of postmenopausal osteoporosis in each state. Our calculated weighted prevalence estimates agreed closely with those of the National Osteoporosis Foundation derived from actual femoral neck BMD measurements obtained in the third National Health and Nutrition Examination Survey (1988-1994) and projected to U.S. census state population predictions for 2002. Comparison of unweighted BRFSS-OST results and NHANES BMD data revealed similar percentages of osteoporosis among all women >or=50 yr of age (BRFSS, 18.5%; NHANES, 18.0%; p = 0.47) and also among white women (BRFSS, 19.0%; NHANES, 20.0%; p = 0.28). However, the percentages of osteoporosis among blacks and Hispanics did not correspond, at least partly because of the lack of race-specific reference standards for BMD measurements and OST index ranges. Analysis of readily available BRFSS data with the OST index formula is a simple, no-cost technique that provides state prevalence estimates of postmenopausal osteoporosis that could be used to guide allocation of resources to statewide osteoporosis prevention programs.

Non-psychotic psychiatric disorders after childbirth: Prevalence and comorbidity in a community sample

Background Postnatal psychiatric morbidity is a frequent and serious complication of childbirth. The aim of the present study was to determine the prevalence and co-occurrence of DSM-IV psychiatric disorders in a community sample of postpartum Spanish mothers. Methods A two-phase cross-sectional study was conducted in which all consecutive women attending the routine 6-week postnatal control visit at the Department of Obstetric and Gynecology of a university-affiliated hospital over a one year period were included. In the first phase, 1453 women were screened with the Edinburgh Postnatal Depression Scale (EPDS). In the second phase, 428 participants stratified according to employment status and EPDS outcomes were randomly selected within each stratum for clinical psychiatric evaluation using the Structured Clinical Interview for DSM-IV. Weighted prevalence estimates were obtained for DSM-IV disorders with or without comorbidity. Results The overall 6-week prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0–21.8) and 2.0% (95% CI 1.2–2.9) of postpartum women met criteria for more than one disorder. Mood disorders was the most prevalent group (9.8%; 95% CI 7.9–12.1) followed by adjustment disorders (4.3%; 95% CI 3.0–6.3), and anxiety disorders (4%; 95% CI 3.0–6.3). Comorbidity was associated to major depressive disorder. Limitations Underestimation of some disorders due to the cross-sectional design and the use of a screening instrument with good psychometric characteristics restricted to depression, anxiety, and adjustment disorders. Conclusions In the context of a 6-week postnatal visit, a high prevalence and heterogeneity of postnatal psychiatric morbidity in a community sample of Spanish women was found.

Survey of Salmonella Contamination of Non–United Kingdom-Produced Raw Shell Eggs on Retail Sale in the Northwest of England and London, 2005 to 2006

This survey was prompted by a change in the epidemiology of Salmonella Enteritidis infections in England and Wales and elsewhere in Europe and, to our knowledge, is the first survey to provide information on Salmonella contamination of non–United Kingdom eggs on retail sale. Based on 10,464 non–United Kingdom eggs (1,744 pooled samples of six eggs) purchased between March 2005 and July 2006, the total weighted prevalence estimate for all Salmonella detected in non–United Kingdom eggs was 3.3%. Of the eggs sampled, most were produced in Spain (66.3%), France (20.0%), or The Netherlands (7.4%). Salmonella was detected from 4.4 and 0.3% of eggs produced in Spain and France, respectively, with weighted prevalence estimates. Eight different Salmonella serotypes were recovered from non–United Kingdom eggs, of which Salmonella Enteritidis predominated, with an estimated prevalence of 2.6%. Salmonella Enteritidis was obtained only from Spanish eggs. Nine different phage types of Salmonella Enteritidis were identified, with phage type 1 found to be the predominant phage type. Most of the Salmonella Enteritidis isolates obtained from Spanish eggs in the survey were resistant to nalidixic acid with concomitant decreased susceptibility to ciprofloxacin (0.125 to 1.0 mg/liter) or ampicillin (8.0 mg/liter). Salmonella Enteritidis phage type 1 until now had not been detected in eggs examined as part of previous United Kingdom egg surveys but has been detected in eggs of Spanish origin examined during recent national outbreaks of Salmonella Enteritidis non–phage type 4 infections in England and Wales. Eggs are a commonly consumed food that may occasionally be contaminated with Salmonella. The rates of contamination may be linked to the origin of the eggs. Consumers and caterers need to be aware of this continuing hazard, adopt appropriate control measures, and follow advice provided by national food agencies in order to reduce the risk of infection.

Depression in terminal illness: the need for primary care-specific research

Palliative care research highlights depression as a common, treatable condition in patients with terminal cancer. Guidance from the European Association for Palliative Care calls for proactive screening and treatment of the disease. However, prevalence of depression among primary care patients with advanced cancer is unknown and it remains uncertain whether existing guidance is appropriate for use by GPs. To estimate the prevalence of depression in a primary care population with terminal cancer. A two-stage community prevalence survey conducted in primary care practices in Merseyside, UK. Adult patients with advanced metastatic cancer were invited to join the study. In phase 1, a depression screening tool (the Edinburgh Depression Scale [EDS]) was used to categorize patients as being high or low risk of depression. In phase 2, samples from each group underwent a diagnostic assessment using the revised Clinical Interview Schedule. Weighted prevalence estimates were calculated. In a final sample of 70 (response rate 47.9%), the prevalence of depression was 4.1% (95% confidence interval 0-8.8%). The sensitivity and specificity of the EDS were poorer than predicted. The prevalence of depression in our sample was lower than expected given findings from previous studies. Screening tools also performed differently in this population. The limitations in our study are discussed; however, our findings raise questions about whether depression guidance from palliative care studies can be directly applied to a primary care setting. We propose the need for development of a primary palliative care evidence base to underpin appropriate clinical care.

Screening for depression in older medical inpatients

Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. Previous studies, mainly outside the UK, report widely differing rates for depression that do not usefully inform UK practice. Thus the aim of this study is to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample (n = 223) was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. The weighted prevalence estimate of ICD-10 depressive disorder was 17.7% (95%CI: 12.9-22.5). Forty-four percent of participants scored above the normally recommended cut-point of >or=5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at >or=7 (sensitivity 0.74, specificity 0.81). This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is >or=7.

Prevalence of overweight misperception and weight control behaviors among normal weight adolescents in the United States

Weight perceptions and weight control behaviors have been documented with underweight and overweight adolescents, yet limited information is available on normal weight adolescents. This study investigates the prevalence of overweight misperceptions and weight control behaviors among normal weight adolescents in the U.S. by sociodemographic and geographic characteristics. We examined data from the 2003 Youth Risk Behavior Survey (YRBS). A total of 9,714 normal weight U.S. high school students were included in this study. Outcome measures included self-reported height and weight measurements, overweight misperceptions, and weight control behaviors. Weighted prevalence estimates and odds ratios were computed. There were 16.2% of normal weight students who perceived themselves as overweight. Females (25.3%) were more likely to perceive themselves as overweight than males (6.7%) (p < 0.05). Misperceptions of overweight were highest among white (18.3%) and Hispanic students (15.2%) and lowest among black students (5.8%). Females (16.8%) outnumbered males (6.8%) in practicing at least one unhealthy weight control behavior (use of diet pills, laxatives, and fasting) in the past 30 days. The percentage of students who practiced at least one weight control behavior was similar by ethnicity. There were no significant differences in overweight misperception and weight control behaviors by grade level, geographic region, or metropolitan status. A significant portion of normal weight adolescents misperceive themselves as overweight and are engaging in unhealthy weight control behaviors. These data suggest that obesity prevention programs should address weight misperceptions and the harmful effects of unhealthy weight control methods even among normal weight adolescents.

Cancer screening and risk factor rates among American Indians.

We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

Sun protective behaviors and sunburn experiences in parents of youth ages 11 to 18

Background Recent studies suggest that parental sun protective behaviors and communication influence their adolescents. However, there is limited information on sun protection for parents of adolescents. Methods A telephone-based, nationally representative prevalence study of sun exposure among youth, aged 11–18, and their parents living in households was conducted in 1998. Separate, independent responses were collected. Weighted prevalence estimates and 95% confidence intervals were estimated and presented for parents only ( n = 1187). Results Approximately one-third of parents planned activities to avoid the sun and used sunscreen. Among parents who used sunscreen, 70% applied it while at the beach or pool, but not as often during other outdoor activities. Almost one-third of parents were participating in water or non-water recreational activities during their most serious sunburn. Differences in sun protection and sunburn experiences were observed by age, gender, sun sensitivity, race and ethnicity, and educational attainment. Conclusions Parents have adopted sun protection habits, but have not surpassed national sun-protection goals. Combined use of sun protection behaviors may reduce sunburn prevalence and number of incident skin cancers. These data may be useful for developing or enhancing current sun protection programs for effective sun protection that include parents and their adolescents.

A contextual profile of club drug use among adults in Chicago.

To better understand the prevalence, correlates, risk factors and context of club drug use among US adults in the City of Chicago. An Audio Computer-Assisted Self Interview was administered to a household probability sample of adults, aged 18-40 years, from June 2001 to January 2002. Subjects were drawn from randomly selected households using a multi-stage area probability design. The data represent 627 randomly selected adult participants. Weighted prevalence estimates with design-effect adjusted confidence intervals of life-time, past 12 month and past 30 day use of any club drug and of specific club drugs; prevalence of rave attendance, other drug use, motivation for use among club drug users; chi2 tests of significance, logistic regression and adjusted odds ratios. Overall club drug prevalence rates were nearly twice those obtained for MDMA alone. Club drug users were more likely to use multiple illicit substances and to report having been in treatment for substance use. A majority of life-time club drug users never attended a rave although rave attendees were more likely to report frequent use of MDMA. Use was associated with gender, race and sexual orientation. Prevention research should be informed by further population-based research on club drug use. Research should not focus exclusively on rave attendees, as they are only a subset of club drug users. Research is needed on neurological and behavioral sequelae across different types of club drugs, gender differences in the impact of sexual orientation on club drug risk and on the effects of personality characteristics such as sensation seeking on club drug use behavior.