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Keywords: elderly people, home environmental hazards, injuries Introduction In both the United States and Australia, injury ranks sixth as a cause of death and morbidity in older people [1, 2]. [...]

This study assessed the accuracy of self-reported Pap smear utilisation over four different time frames, examining the magnitude of errors in self-report and sociodemographic predictors of accuracy. Self-report data on women's cervical screening was collected by interview in a random household survey (Hunter Region, NSW, Australia), with pathology laboratory data collected by a search of records within laboratories. The magnitude of error in self-report was assessed by comparing it against longer intervals in pathology laboratory data. Sociodemographic predictors of accuracy were explored using chi square analyses. Low values for specificity and positive predictive value across all four time frames indicate a considerable degree of inaccuracy in women's reporting of those instances where, in truth, screening has not occurred. Of women reporting a smear within the last three years, only 61.2% were verified within pathology laboratory records. Allowing women some 'leeway' in their reporting, comparing self-report to longer intervals of pathology laboratory data, did not greatly improve the accuracy of reporting, confirming that the magnitude of inaccuracy involved is of real clinical significance. Demographic variables were not related to the accuracy of self-report and, while a woman's certainty of her response was predictive, this had little impact on the measures of agreement. Self-report of Pap smear histories consistently results in over-reporting of screening. Other means of assessing the prevalence of screening may be preferable to self-report. Where self-report data is collected, techniques to improve accuracy should be employed, and care should be taken in comparing screening rates obtained by different methods. Key words - Pap smear, self-report, accuracy

Past studies have demonstrated that the majority of health care visits are made to general practitioners, and that socio-economically disadvantaged individuals are significantly more likely to use such services. Relatively little is known, however, about the quality of general practice care provided to patients of different socio-economic status. The specific aims of the study were to determine whether an association existed between consultation duration and patient educational and occupational status, and if an association was evident, to determine the extent of association after taking into account a range of identified confounding variables and the effect of a clustered sample design. Consecutive consultations from a randomly selected sample of general practitioners were audiotaped and their durations measured electronically. Patient education and occupational status were obtained by questionnaire. Information concerning a range of additional patient, practitioner and consultation variables was also assessed in order to identify possible confounders of the association between consultation duration and patient occupational and educational status. No association was evident between consultation duration and level of patient educational qualification, Independent of identified confounding variables and the effect of a clustered sample design, general practitioners spent less time with those patients employed in unskilled occupations. Unskilled patients received 2.1 min or 21% less time per consultation than patients in professional occupations. The odds of patients in unskilled occupations receiving a long consultation (> 10 min) were 26% less than the odds of patients in professional occupations. The finding of an occupational status differential in the duration of general practice consultations suggests that socio-economically disadvantaged patients may not be receiving the health care they require. Further research is required to confirm these findings and to identify whether similar differentials are evident in more specific elements of general practice care. Key words - general practice, socio-economic status, consultation duration

Guidelines for breast cancer treatment were evaluated by groups of cancer patients, doctors, and nurses. Results of this study showed different groups had different priorities. Doctors gave some aspects of preparation lower priorities, while patients and nurses emphasized consistent information, patient assistance, and a medical team that prepares patients., Guidelines for preparing cancer patients for threatening medical procedures were developed and refined and their perceived relevance and importance rated by three concerned groups--84 breast cancer patients, 64 doctors, and [...]

Socio-economically disadvantaged individuals experience significantly greater mortality and morbidity relative to advantaged individuals. General practitioners have been suggested to occupy a position which has the capacity to ameliorate the health consequences of socio-economic disadvantage. Community studies of preventive care status suggest, however, that socio-economically disadvantaged individuals are less likely to receive appropriate preventive care. Using a convenience sample of 22 general practitioners, 579 consultations were audiotaped to determine whether practitioner provision of preventive care was associated with the educational and occupational status of patients. Practitioner provision of preventive care was assessed in terms off the proportion of consultations in which discussion of at least one preventive care topic occurred; the number of preventive care topics discussed; and the proportion of consultations in which each of six specific preventive care topics were discussed. Practitioners were significantly less likely to discuss at least one preventive care topic with patients of high occupational status. No significant differences were observed between patient groups in the number of preventive care topics discussed, and in the likelihood of receiving preventive care discussion concerning each of six preventive topics. However, a consistent trend of practitioners being less likely to discuss preventive care topics with patients of high educational or occupational status was evident for all outcome variables. The pattern of results suggests that previously reported findings of socio-economically disadvantaged individuals having a poorer preventive care status may not be attributable to differentials in practitioner's provision of preventive care. Greater attention should therefore be given to identifying and resolving barriers other than practitioner-based barriers to preventive care provision if these differentials in preventive care status are to be reduced. Key words - socio-economic status, social class, preventive care, general practice, direct observation

Objectives. Outdoor workers are at high risk of developing skin cancer. Primary prevention in this group can potentially reduce the incidence of skin cancer, and also potentiates the spontaneous remission of existing solar keratoses. A randomized controlled trial was conducted to evaluate a solar protection intervention targeting outdoor workers. Methods. Outdoor workers are randomly allocated to an intervention (n = 65) or control group (n =77). The intervention group received individual skin screening by a dermatologist and participated in an education session. Pre- and posttest outcome measures included solar protection behavior (assessed using a validated diary), knowledge, and attitudes. Results. There was a significant increase (16%) in the percentage of outdoor workers who were using a high level of solar protection at posttest compared to pretest in the intervention group, but there was no change in the control group. Although both groups improved in their knowledge score, the intervention group showed a significantly greater improvement at posttest. No changes in attitudes were detected. Conclusions. The findings suggest that changes in solar protection are achievable with outdoor workers. (Am J Public Health. 1994;84:77-81), Preventive screening and education appear to be effective interventions for increasing outdoor workers' use of sun protection. Researchers assigned 65 workers to receive individual skin screening and education and 77 workers to no intervention for comparison. Pre-test skin damage, sun protection behavior and knowledge did not differ among the two groups. After the study, 66% of the intervention group used sun protection measures such as clothing/hats, shade and sunscreen lotion, compared to 49% of the comparison group. The proportion of workers using high levels of sun protection increased by 16% in the intervention group, while remaining stable in the comparison group. Both groups improved significantly in their average knowledge scores after the study. However, the intervention group significantly increased their scores by an average of 62%, compared to 58% in the comparison group. Neither group experienced attitude changes.

Objectives. The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. Method. Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. Results. Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. Conclusions. Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.(Am J Public Health. 1993;83:1284-1288), Restaurateurs and their customers in New South Wales, Australia disagree to a remarkable degree about the need to provide smoke-free restaurants or at least non-smoking areas. A study of 365 restaurateurs in two cities and 1,327 of their customers shows that customers favor non-smoking areas far more than restaurants provide them. According to the survey of restaurateurs, under 2% of restaurants prohibited smoking altogether, and only 22% provided smoke-free areas. This suggests that the policy of allowing restaurants to regulate themselves regarding provision of smoke-free areas is a failure. In contrast, nearly 90% of customers favored either separate smoking areas or a ban on smoking. Restaurant owners should pay greater attention to the needs and desires of their customers, and customers should actively demand segregation of smokers in restaurants.

Abstract Background Smoking during pregnancy is harmful to the unborn child. Few smoking cessation interventions have been successfully incorporated into standard antenatal care. The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women. Design A pilot randomised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ($20 vs. $40AUD), compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic. Method Ninety (90) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified, will be block randomised into one of three groups: a. No incentive control group (n=30), b. $20 incremental incentive group (n=30), and c. $40 incremental incentive group (n=30). Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation. Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved. Cash rewards will increase incrementally for each period of smoking abstinence. Discussion Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into standard antenatal practice is of utmost importance. A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12612000399897

Abstract Background Colorectal cancer (CRC) is among the leading causes of cancer-related morbidity and mortality worldwide. Despite clinical practice guidelines to guide surveillance care for those who have completed treatment for this disease as well as screening for first degree relatives of people with CRC, the level of uptake of these recommendations remains uncertain. If outcomes for both patients and their families are to be improved, it is important to establish systematic and cost-effective interventions to improve adherence to guideline recommendations for CRC surveillance and screening. Methods/Design A randomized controlled trial will be used to test the effectiveness of a print-based intervention to improve adherence to colonoscopy surveillance among people with CRC and adherence to CRC screening recommendations among their first degree relatives (FDRs). People diagnosed with CRC in the past 10 months will be recruited through a population-based cancer registry. Consenting participants will be asked if their first degree relatives might also be willing to participate in the trial. Information on family history of CRC will be obtained from patients at baseline. Patients and their families will be randomized to either minimal ethical care or the print-based intervention. The print-based intervention for FDRs will be tailored to the participant's level of risk of CRC as determined by the self-reported family history assessment. Follow up data on surveillance and screening participation will be collected from patients and their FDRs respectively at 12, 24 and 36 months' post recruitment. The primary analyses will relate to comparing levels of guideline adherence in usual care group versus print-based group in the patient sample and the FDR sample respectively. Discussion Results of this study will provide contribute to the evidence base about effective strategies to a) improve adherence to surveillance recommendation for people with CRC; and b) improve adherence to screening recommendation for FDRs of people with CRC. The use of a population-based cancer registry to access the target population may have significant advantages in increasing the reach of the intervention. Trial registration This trial is registered with the Australian and New Zealand Clinical Trials Registry Registration Number (ACTRN): ACTRN12609000628246.

Abstract Background Adolescents and young adult (AYA) cancer survivors may have unique physical, psychological and social needs due to their cancer occurring at a critical phase of development. The aim of this study was to develop a psychometrically rigorous measure of unmet need to capture the specific needs of this group. Methods Items were developed following a comprehensive literature review, focus groups with AYAs, and feedback from health care providers, researchers and other professionals. The measure was pilot tested with 32 AYA cancer survivors recruited through a state-based cancer registry to establish face and content validity. A main sample of 139 AYA cancer patients and survivors were recruited through seven treatment centres and invited to complete the questionnaire. To establish test-retest reliability, a sub-sample of 34 participants completed the measure a second time. Exploratory factor analysis was performed and the measure was assessed for internal consistency, discriminative validity, potential responsiveness and acceptability. Results The Cancer Needs Questionnaire - Young People (CNQ-YP) has established face and content validity, and acceptability. The final measure has 70 items and six factors: Treatment Environment and Care (33 items); Feelings and Relationships (14 items); Daily Life (12 items); Information and Activities (5 items); Education (3 items); and Work (3 items). All domains achieved Cronbach's alpha values greater than 0.80. Item-to-item test-retest reliability was also high, with all but four items reaching weighted kappa values above 0.60. Conclusions The CNQ-YP is the first multi-dimensional measure of unmet need which has been developed specifically for AYA cancer patients and survivors. The measure displays a strong factor structure, and excellent internal consistency and test-retest reliability. However, the small sample size has implications for the reliability of the statistical analyses undertaken, particularly the exploratory factor analysis. Future studies with a larger sample are recommended to confirm the factor structure of the measure. Longitudinal studies to establish responsiveness and predictive validity should also be undertaken.

Abstract Background Recruiting large and representative samples of adolescent and young adult (AYA) cancer survivors is important for gaining accurate data regarding the prevalence of unmet needs in this population. This study aimed to describe recruitment rates for AYAs recruited through a cancer registry with particular focus on: active clinician consent protocols, reasons for clinicians not providing consent and the representativeness of the final sample. Methods Adolescents and young adults aged 14 to19 years inclusive and listed on the cancer registry from January 1 2002 to December 31 2007 were identified. An active clinician consent protocol was used whereby the registry sent a letter to AYAs primary treating clinicians requesting permission to contact the survivors. The registry then sent survivors who received their clinician's consent a letter seeking permission to forward their contact details to the research team. Consenting AYAs were sent a questionnaire which assessed their unmet needs. Results The overall consent rate for AYAs identified as eligible by the registry was 7.8%. Of the 411 potentially eligible survivors identified, just over half (n = 232, 56%) received their clinician's consent to be contacted. Of those 232 AYAs, 65% were unable to be contacted. Only 18 AYAs (7.8%) refused permission for their contact details to be passed on to the research team. Of the 64 young people who agreed to be contacted, 50% (n = 32) completed the questionnaire. Conclusions Cancer registries which employ active clinician consent protocols may not be appropriate for recruiting large, representative samples of AYAs diagnosed with cancer. Given that AYA cancer survivors are highly mobile, alternative methods such as treatment centre and clinic based recruitment may need to be considered.

Abstract Background Adolescent and young adult (AYA) cancer survivors require psychometrically rigorous measures to assess their psychosocial well-being. Without methodologically adequate scales the accuracy of information obtained on the prevalence of needs, predictors of risk, and the potential success of any interventions, can be questioned. This review assessed the psychometric properties of measures designed specifically to identify the psychosocial health of this unique population. Methods Medline, PsycINFO, CINAHL and EMBASE databases were searched to identify measures developed to assess the psychosocial health of AYA cancer survivors. Searches were limited to the years 1998-2008. A search of Medline revealed that the number of publications related to the assessment of psychosocial well-being in AYA cancer survivors prior to this period were minimal. The psychometric properties of identified measures were evaluated against pre-determined and generally accepted psychometric criteria including: reliability (internal consistency and test-retest); validity (face, content, construct, and criterion); responsiveness; acceptability; and feasibility. Results Seven quality of life measures met the inclusion criteria. No measures of unmet need were identified. All seven measures reported adequate internal consistency, face, content, and construct validity. Test-retest reliability, criterion (predictive) validity, responsiveness, acceptability, and feasibility were rarely examined. Conclusions There is a need to further evaluate the psychometric properties of existing quality of life measures for AYA cancer survivors. Valid, reliable, and acceptable measures which can assess the psychosocial needs of this population should also be developed.

Abstract Background Well-designed trials of strategies to improve adherence to clinical practice guidelines are needed to close persistent evidence-practice gaps. We studied how the number of these trials is changing with time, and to what extent physicians are participating in such trials. Methods This is a literature-based study of trends in evidence-practice gap publications over 10 years and participation of clinicians in intervention trials to narrow evidence-practice gaps. We chose nine evidence-based guidelines and identified relevant publications in the PubMed database from January 1998 to December 2007. We coded these publications by study type (intervention versus non-intervention studies). We further subdivided intervention studies into those for clinicians and those for patients. Data were analyzed to determine if observed trends were statistically significant. Results We identified 1,151 publications that discussed evidence-practice gaps in nine topic areas. There were 169 intervention studies that were designed to improve adherence to well-established clinical guidelines, averaging 1.9 studies per year per topic area. Twenty-eight publications (34%; 95% CI: 24% - 45%) reported interventions intended for clinicians or health systems that met Effective Practice and Organization of Care (EPOC) criteria for adequate design. The median consent rate of physicians asked to participate in these well-designed studies was 60% (95% CI, 25% to 69%). Conclusions We evaluated research publications for nine evidence-practice gaps, and identified small numbers of well-designed intervention trials and low rates of physician participation in these trials.

Abstract Background This study examined the effectiveness of seven different interventions designed to increase the proportion of general practitioners (GPs) accepting an offer of free access to an online evidence-based resource. Methods Australian GPs (n = 14,000) were randomly selected and assigned to seven intervention groups, with each receiving a different letter. Seven different strategies were used to encourage GPs to accept an offer of two years free access to an online evidence-based resource (BMJ Clinical Evidence). The first group received a standard letter of offer with no experimental demands. Groups two to seven received a standard letter of offer outlining the requirements of the study. They were asked to complete an initial online questionnaire, agree to complete a 12-month follow-up questionnaire, and agree to having data about their usage of the online evidence-based resource provided to researchers. Groups three to seven also had additional interventions included in the letter of offer: access to an online tutorial in use of the resource (group three); provision of a pamphlet with statements from influential opinion leaders endorsing the resource (group four); offer of eligibility to receive professional development points (group five); offer of eligibility for a prize of $500 for registration at a medical conference of their choice (group six); and a combination of some of the above interventions (group seven). Results In the group with no research demands, 27% accepted the offer. Average acceptance across all other groups was 10%. There was no advantage in using additional strategies such as financial incentives, opinion leader support, offer of professional development points, or an educational aid over a standard letter of offer to increase acceptance rates. Conclusion This study showed low acceptance rates of the offer of access to the online resource when there was an associated requirement of response to a short online questionnaire and non-obtrusive monitoring of GP behaviour in terms of accessing the resource. If we are to improve care and encourage evidence-based practice, we need to find effective ways of motivating doctors and other health professionals to take part in research that can inform our implementation efforts.

Background: Being diagnosed with dementia is a confronting experience for any individual and their caregiver. However, a diagnosis provides opportunity for future preparation for management of the condition. This study investigated attitudes toward dementia and preferences for diagnosis among a sample of health service consumers in Japan.Methods: Participants were patients or accompanying support persons (n = 217) who visited the specialty outpatient clinic of four hospital departments. The survey was conducted using an iPad with answers sent automatically to a secure server. The survey included items about the participants' most feared diseases and the reasons behind those fears, estimates of dementia prevalence in Japan, and preferences regarding a diagnosis of dementia and the reasons for their preference.Results: The most feared disease was cancer (43.8 %), followed by dementia (18 %). Those selecting dementia most commonly reported practical, emotional and social impacts as the reasons why they most feared this condition. Almost all participants preferred to know the diagnosis of dementia as soon as possible for themselves, with significantly fewer preferring their spouse to know as soon as possible if they had dementia (95.9 % for self vs. 67.5 % for partner/spouse, p < 0.001). On average, participants estimated that 18.1 % of Japanese people are diagnosed with dementia by age 65, while they thought that 43.7 % of Japanese people are diagnosed with dementia by age 85.Conclusions: The findings highlight a need for community education about the significant impacts of dementia on the lives of individuals and their caregivers. People were more reluctant for their spouse to receive a diagnosis as soon as possible if they had dementia. Physicians should sensitively disclose diagnosis and ensure they involve both the patient and their relatives in discussions about diagnosis disclosure. [ABSTRACT FROM AUTHOR]

Objective There are published guidelines on the care that should be provided to cancer patients upon finishing treatment (i.e. follow-up care). Gaps in care may arise where patients' reported experiences of care do not align with guideline recommendations. The aim of this study was to explore whether oncology patients report gaps in patient-centered follow-up care. Methods This study was a cross-sectional survey of adult cancer patients receiving follow-up care within four outpatient oncology clinics. Patients were approached in clinic waiting rooms and asked to complete an electronic survey. The survey examined patients' self-report of receiving six aspects of follow-up care. Results A total of 239 participants completed the survey (study consent rate = 83%). Only 49% of participants received all six items of care. Patients reported high rates of being told who to contact if they have any questions or concerns (95%); who to contact if signs or symptoms occur (91%); and what to expect in their follow-up care (90%). A lower proportion of patients indicated they were informed about the role of their GP after treatment has finished (79%); what symptoms or signs might suggest the cancer had returned (74%); or were given a written care plan (71%). Conclusions: The study highlights that there is a gap between some aspects of optimal patient-centered care, and the actual care received by patients. Health care providers and researchers should consider how to improve follow-up care experiences to ensure best practice cancer care delivery during this important stage in cancer survivorship. [ABSTRACT FROM AUTHOR]