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Aim: The aim of this study was to explore the logistical and methodological strengths and weaknesses of some of the more common research designs which can be used to evaluate the impact of system- or population-level approaches for reducing alcohol-related harms. Method: This paper identifies studies that have evaluated system or population approaches to reduce alcohol-related harms. It highlights the tension caused by a desire for the most rigorous research designs, such as randomized controlled trials (RCTs), the most potentially efficacious interventions and the practical problems in applying the RCT to population-level research. Alternative research designs, which possess methodological rigour and are more feasible, are identified and described. The design with the strongest methodological characteristics and feasibility in allowing the evaluation of population interventions is considered to be the multiple baseline. Results: The multiple baseline design addresses potential problems of sample sizes, selection bias, the suitability and baseline stability of outcome measures, statistical analyses and the practicalities of conducting rigorous research in system- or population-level settings. Conclusion: The multiple baseline design has the capacity to allow methodologically and statistically stringent evaluations with relatively small sample sizes, low cost and fewer of the complications imposed by RCTs. Like all research designs it has limitations, but arguably represents the most practical and methodologically rigorous approach to the evaluation of system- or population-level strategies. [ABSTRACT FROM PUBLISHER]

Examines the psychological therapies for cancer patients. Reduction on the side effects of cancer treatments to improve immune function and longetivity; Evaluation on the nontraditional therapies; Effectiveness of intervention outcomes for each outcome and follow-up period.

Advance research directives (ARDs) are a means by which people can document their wishes about research participation in the event of future incapacity. ARDs have been endorsed in some ethics guidelines and position statements, however, formal legal recognition is limited. A few empirical studies have investigated the views of researchers and other stakeholders on ARDs and tested strategies to implement such directives. To further knowledge in this area, we undertook a survey of dementia researchers in Australia (n = 63) to examine their views on ARDs. Most of the survey respondents (>80%) thought ARDs would promote autonomy in decision-making and enable opportunities for people with cognitive impairment to be included in research. Respondents indicated concern about directives not being available when needed (71%) and that ethics committees would not accept ARDs (60%). Few respondents had used ARDs, but a majority (from 57–80%) would be willing to offer ARDs for a range of research activities, such as observing behaviour and taking measures, blood samples or scans. Nearly all respondents (92%) agreed that current dissent should override prior wishes stated in an ARD. The survey findings are contextualised with attention to ethics guidelines, laws and practices to support advance research planning. [ABSTRACT FROM AUTHOR]

Background and Objectives Primary care physicians (PCPs) have a key role in providing care for people with dementia and their carers, however, a range of barriers prevent them from delivering optimal care. We reviewed studies on PCPs' perceptions of barriers to providing optimal dementia care, including their methodological quality, whether they focused on barriers related to diagnosis and/or management, and the patient-, provider-, and system-level barriers identified. Research Design and Methods Studies were included if they were quantitative studies published since 2006 which reported on PCPs' perceptions of the barriers to providing dementia care. The methodological quality of identified studies was assessed using an adapted version of accepted rating criteria for quantitative studies. Data were extracted from studies which were rated as "moderate" or "strong" quality. Results A total of 20 studies were identified, 16 of which were rated as "moderate" or "strong" methodological quality. Patient-related barriers included a reluctance to acknowledge cognitive decline and patient nonadherence to management plans. Provider-related barriers included a lack of training and confidence. System-related barriers included a lack of time during consultations and lack of support services. Discussion and Implications This review highlights a range of barriers to dementia diagnosis and management from studies rated as being methodologically adequate. Future studies should also utilize theory-driven approaches to exploring a comprehensive range of barriers to optimal dementia care across the care trajectory. [ABSTRACT FROM AUTHOR]

Responds to comments on the authors' article concerning psychological therapies for cancer patients. Psychological needs of patients; Cancer interventions; Randomized controlled trials.

Eswatini has the highest age-standardized incidence and second highest mortality rate related to cervical cancer globally. In Eswatini, community health workers educate communities about cervical cancer screening. They need to have accurate knowledge about cervical cancer and screening to do this effectively. Therefore, the current study aimed to assess knowledge regarding cervical cancer screening among community health workers in Eswatini. A telephone survey of 172 community health workers from eight selected constituencies was conducted. Descriptive analyses were performed to assess participants' socio-demographic and service-related characteristics. Linear regression was applied to investigate factors associated with cervical cancer screening-related knowledge. One hundred and seven (62%) participants answered at least 80% of the questions correctly. However, knowledge regarding cervical cancer risk factors, the meaning of screening results and Eswatini cervical cancer screening guidelines was suboptimal. Community health workers aged 46–55 were more likely (β = 1.27, 95% confidence interval [CI]: 0.39–2.15, p < 0.01) to have a higher cervical cancer screening knowledge score than those aged 30–45 years. Community health workers from Lubombo were marginally less likely (β = −0.83, 95% CI: −1.80 to −0.04, p = 0.05) to have a higher knowledge score than those from Hhohho. This study suggests knowledge deficits amongst community health workers in Eswatini. Knowledge deficits may result in inaccurate information being communicated to clients. While increasing knowledge of these vital health workers may not be sufficient to increase cervical cancer screening rates in Eswatini, it is an essential first step that should be the focus of future educational efforts. [ABSTRACT FROM AUTHOR]

Background: Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time.Objectives: To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011.Methods: Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups.Results: There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P < 0.0001) and decreased for overweight or obesity from 92% to 89% (P = 0.01). There was a small decrease in the sensitivity of detection of alcohol consumption (P = 0.02) and an increase in specificity (P = 0.01).Conclusions: Despite significant investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients. [ABSTRACT FROM AUTHOR]

There is currently uncertainty regarding the relative performance of a retrospective diary (RD) and a quantity–frequency index (QFI) measure of weekly alcohol consumption. While some previous studies have found more consumption reported on an RD than a QFI, others have found the reverse. As yet, however, no study has compared computerized versions of these two measures. This cross-sectional study involved administration of a computerized survey in a community-based drug and alcohol treatment setting. Five hundred and eighty-six clients (420 males) attending counselling for a range of drug- and alcohol-related issues agreed to participate in the study. The major finding was that more alcohol consumption was reported on the RD, than on the QFI. Similarly, the RD detected a greater proportion of both heavy and high-risk drinkers than the QFI. It is argued that the RD may be preferable to the QFI as a measure of weekly alcohol consumption, for use in community-based treatment settings. [ABSTRACT FROM PUBLISHER]

Background. People with a history of stroke or heart disease are at increased risk of future stroke; therefore, identification of risk factors by GPs is critical. Objectives. To compare the following among general practice patients with and without a history of stroke or heart disease: (i) self-reported prevalence rates of lifestyle risk factors; (ii) accuracy of GP detection of patient-reported risk factors and (iii) average proportion of patient-reported risk factors detected by GPs. Methods. Consecutive patients attending a participating general practice clinic were invited to participate in a cross-sectional touchscreen survey assessing lifestyle risk factors in 2010-11. The GP of each consenting patient completed a corresponding survey assessing the patient's risk factors. Demographic characteristics of patients and GPs were obtained. Results. Data from 51 GPs and 564 patients were analysed. Patients without a history of stroke or heart disease reported significantly higher rates of smoking (12%) and risky alcohol consumption (56%) than patients with a history of stroke or heart disease (6% and 36%, respectively). Low sensitivity of GP detection of risk factors was found for all risk factors for all patients. Patients with a history of stroke or heart disease have a significantly higher mean proportion of risk factors detected by their GP compared to patients without a history of stroke or heart disease (P = 0.00). Conclusion. Given low sensitivity and specificity of GP detection of risk factors among patients, alternate methods of identification are needed. Research is required to determine strategies to facilitate secondary care of patients with a history of stroke or heart disease by GPs. [ABSTRACT FROM AUTHOR]

Background. Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. Objective. To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. Methods. A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. Results. Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments. [ABSTRACT FROM AUTHOR]

Introduction: There is growing international interest in the use of financial incentives in smoking cessation, yet little research on public opinion of the scheme. This paper reports on the acceptability of incentives for reducing smoking in pregnant women and the perceived size of incentive that would encourage smoking cessation during pregnancy. Methods: A cross-sectional survey was conducted on a convenience sample of 213 women attending the antenatal clinic of a large public hospital in Australia. Participants completed a questionnaire on their views on the use of incentives with responses measured on a 5-point Likert scale. Results: The majority of participants (60%) did not agree that paying pregnant smokers to quit is a good idea. Opinions regarding the likely effectiveness were mixed with 30% of respondents in agreement and 22% undecided. Most (62%) were not willing to pay smokers any amount to quit. Smokers were more likely to have more favorable views about incentives than nonsmokers (p < .0001) and considered payments of between $100 and >$1,000 acceptable as reward for quitting smoking. Conclusions: Acceptability for the use of financial incentives in reducing antenatal smoking is low among pregnant women. Future research should explore views of a wider audience and continue to gather stronger evidence of the efficacy of rewards for reducing smoking in pregnancy. [ABSTRACT FROM AUTHOR]

The aim of this short report was to describe the output and citation rates of public health. Data-based publications and literature reviews from the year 2008, and their 5-year citation rates were extracted from 10 randomly selected public health journals. In total, 86.2% of publications were descriptive/epidemiological studies, 56.8% used cross-sectional (56.8%) designs and 77.8% were classified as research translation stage 2. Reviews and publications describing randomized controlled trials were the most highly cited, but were infrequently published. Strategies to address the discordance between public health research output and research citation may improve the impact of public health research. [ABSTRACT FROM AUTHOR]

Many cancer patients use psychological therapies because they expect them to cure their cancer or to improve their recovery. Despite these high expectations, both patients and oncologists report being moderately to very satisfied with the results of psychological therapies. Previous reviews of the literature have concluded that psychological therapies may help cancer patients in various ways, ranging from reducing the side effects of cancer treatments to improving patients' immune function and longevity. However, because those reviews lacked methodologic rigor, we critically and systematically reviewed all identifiable publications about psychological therapies used by cancer patients to provide an objective and scientific evaluation of nontraditional therapies. We identified 627 relevant papers that reported on 329 intervention trials by searching MEDLINE, Healthplan, Psychlit, and Allied and Complementary Medicine databases and in the bibliographies of the papers identified. Despite increased use of randomized, controlled trial designs over time, the methodologic quality of the intervention trials, on 10 internal validity indicators, was generally suboptimal, with only one trial achieving a quality rating of "good" for its methodology. Using effectiveness results from 34 trials with psychosocial outcomes, 28 trials with side effect outcomes, 10 trials with conditioned side-effect outcomes, and 10 trials with survival or immune outcomes, we make only tentative recommendations about the effectiveness of psychological therapies for improving cancer patients' outcomes. Nevertheless, by exploring the relative effectiveness of the different intervention strategies for each outcome and follow-up period, we suggest the specific therapies that should be considered for further investigation. In addition, we suggest how future trials can maximize their internal validity by describing the minimal reporting standards that should be required in this field. [ABSTRACT FROM AUTHOR]

Background. Several factors need to be considered when selecting a screening tool for depression including accuracy, level of burden for patients and for staff to administer and follow-up. Objective. This study aimed to explore the utility of a single self-assessment item in identifying possible cases of depression in primary care by examining sensitivity and specificity with the nine-item Patient Health Questionnaire (PHQ-9) at different thresholds. Design. Cross-sectional survey presented on a touchscreen computer. Participants. Adult patients attending 12 urban general practices in Australia completed a health status questionnaire (n = 1004). Main measures. Depression was assessed by the PHQ-9 and a single self-assessment item. Sensitivity, specificity, and positive and negative predictive values were calculated for the single item using a PHQ-9 score of 10 or more as the criterion value. Key results. A total of 1004 participants (61% female, 48% aged 55 years or older) completed both the PHQ-9 and a single self-assessment item. When using a threshold of mild depression or greater, the single item had adequate specificity (76%, 95% CI: 71–80%), with 76 out of every 100 people defined as non-depressed by the PHQ-9 also identified as not depressed by the single item. Sensitivity was high (91%, 95% CI: 84–95%), with the single item identifying 91 out of every 100 true cases (as defined by the PHQ-9). Conclusions. The single self-assessment item has high sensitivity and moderate specificity to identify possible cases of depression when used at a threshold of mild depression or greater. [ABSTRACT FROM PUBLISHER]