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Background: Existing studies on disease course usually apply relatively short follow-up periods and narrow definitions of disease course resulting in too optimistic views on disease prognosis. This study explores the relevance of using a longer and broader (cross-disorder) perspective.Methods: Respondents with a 12-month disorder at baseline and available at 3-, 6- and 9-year follow-up were selected (major depressive disorder, MDD: n = 208; anxiety disorder: n = 220) from a general population study (N = 6646). DSM-IV disorders were assessed with the Composite International Diagnostic Interview. Disease course was described using a short and narrow perspective (i.e., 3-year follow-up, and considering presence of the index disorder only) and a long and broad perspective (9-year follow-up, and considering presence of any mood, anxiety or substance use disorder as outcome).Results: The recovery rates of both MDD and anxiety disorder reduced by half when the perspective switched from short and narrow (MDD: 74.0 %; anxiety disorder: 79.5 %) to long and broad (35.6 % and 40.0 % respectively). At 9-year follow-up, the rates of a persistent disorder (a disorder at each follow-up assessment) tripled when the perspective switched from narrow to broad (MDD: from 4.8 % to 13.9 %; anxiety disorder: from 4.5 % to 15.5 %).Limitations: The findings are not generalizable to the most severe depressed and anxious patients.Conclusions: Most people with MDD or anxiety disorder in the general population have a rather favourable prognosis when a narrow perspective is applied, but an unfavourable prognosis when a long-term and broad perspective is applied. Consequently, MDD and anxiety disorder should not merely be perceived as episodic disorders, and require longer-term disease monitoring and management. [ABSTRACT FROM AUTHOR]

Background: The aim of current study is to assess the cross-sectional association of chronic non-communicable diseases (diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke) with both diagnosed and undiagnosed depression in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1, a study of adults in six low- and middle-income countries.Methods: A total of 41,810 participants, aged ≥ 18 years, were included. Depression status was assessed by standard methods derived from the World Mental Health Survey (WHH-CIDI). Undiagnosed depression was defined as a depressed person who did not report history of diagnosis/treatment for depression. Associations between depression/undiagnosed depression and chronic diseases, adjusting for country of residence, demographics and chronic diseases risk factors were assessed.Results: Depression was detected in 2508 (6.0%) cases, from whom 2098 (87%) were undiagnosed. Diabetes (Odds ratio:1.47[95%CI:1.24,1.75]), arthritis (2.14[1.82,2.52]), asthma (3.36[2.73,4.14]), chronic lung disease (3.74[3.10,4.51]), angina (3.20[2.66,3.85]), and stroke (3.14[2.55,3.86]) were associated with depression (p-values < 0.001). Being older, female, underweight, and having lower education, and lower income were positively associated with depression. The estimated odds ratios were similar for undiagnosed depression.Limitations: Cross-sectional design of study prevent us to determine whether depression followed exposures in time. About 12% of the participant did not have data for depression status and were excluded from the study.Conclusions: Most depression cases were undiagnosed. Depression/undiagnosed depression were strongly associated with chronic diseases; stronger than what has been reported in developed countries. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to identify factors contributing to the worsening or improved mental health of long-term evacuees over three years following the Great East Japan Earthquake. Method The Japanese version of the K6 questionnaire was used as a measure of mental health. The first- and third-year survey results were compared and differences in mental health status calculated. Respondents were then divided into two groups according to worsening or improved mental health status. Differences in stress factors, stress relief methods, and demographics were compared between the two groups. Results Factors associated with exacerbation of poor mental health were the stress factors “Uncertainty about future” ( p = 0.048) and “Loss of purpose in life” ( p = 0.023). Multivariable analysis identified two factors associated with improved mental health, the stress relief methods “Accepting myself” (odds ratio (OR): 2.15, 95% confidence interval (CI): 1.02–4.51) and “Interactions with others” (OR: 3.34, 95% CI: 1.43–7.79). Conclusion While motivation and hope of livelihood reconstruction have gradually risen in the three years since the disaster, anxieties about an uncertain future, loss of purpose in life, and disruption of social networks continue adversely to affect the mental health of survivors. [ABSTRACT FROM AUTHOR]

Background/aims: Alcohol and nicotine are the two most used substances world-wide and associated with increased burden of disease. Since surveys on substance use may be difficult due to response biases, wastewater-based epidemiology (WBE) was developed as a more objective measure of nicotine and alcohol use. This study compares estimates of nicotine and alcohol use from a wastewater sampling campaign in a medium-sized Belgian city with a concurrently executed population survey.Methods: 29,083 letters about participation in an online survey study on weekly alcohol and tobacco use were sent to the inhabitants of Lier, Belgium. Wastewater samples were collected from the associated treatment plant in four bi-weekly periods. Samples were analyzed using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Ethylsulfate was used as alcohol biomarker and cotinine and trans-3'-hydroxycotinine as nicotine biomarker.Results: 263 (1%) surveys were filled out on average per week. According to survey data, alcohol and nicotine were used less than in the rest of Belgium and this was matched by the wastewater data. Nicotine use, but not alcohol use, showed a significant variation over the sampling periods. Both nicotine and alcohol showed increase use during the weekend while only alcohol showed a different use pattern throughout the week.Conclusion: No correlation between WBE and survey data could be demonstrated, possibly due to small sample sizes. However, this study shows that weekly trends in alcohol and nicotine use can be quickly detected from wastewater analysis and the occurrence of major events such as festivals can be identified. [ABSTRACT FROM AUTHOR]

This study developed a short form of the National Adult Reading Test — an inventory that estimates intellectual ability — to produce an instrument suitable for lay administration in population surveys. Data were provided by 816 participants in the dress rehearsal for wave 12 of the Household, Income and Labour Dynamics in Australia Survey. Participants were administered the 50-item National Adult Reading Test (NART) in a brief battery of cognitive assessments. Three methods of short form construction were applied to responses and the measurement properties of the resultant short forms were compared. Use of Item Response Theory (IRT) threshold and slope parameters to choose efficient items with negligible guessing across the full range of ability resulted in a better short form than the more common practice of relying on factor loadings alone. Simulation of an alternative approach involving conditional administration of part of the test was found to yield biased measurements and did not substantially reduce average test length. A 25-item IRT-derived short form of the NART maintains good precision of measurement across a broad spectrum of intellectual ability. Halving the number of items presented will reduce burden, increase acceptability, and increase accuracy of response judgement by test administrators. [ABSTRACT FROM AUTHOR]

Summary The seroprevalence (SP) of measles and rubella virus antibodies is presented by age groups obtained in the IV Serosurvey of the Region of Madrid (2008–2009). The target population is composed of residents with ages ranging between 2 and 60 years in the Region of Madrid. A two-stage cluster sample is used. The SP of measles virus antibodies is 97.8% (CI 95%: 97.3–98.2). The highest SP is observed in the 2–5 year and 41–60 year age groups. The point estimate does not reach 95% in the 16–20 and 21–30 year age groups. The SP of rubella virus antibodies is 97.2% (CI 95%: 96.5–97.7). The SP is over 95% in all of the age groups. In immigrant women between the ages of 16 and 49, the SP is 95.9% (CI 95%: 93.7–97.4). The identification of groups susceptible to the measles virus in young adults could lead to outbreaks as a result of importing the virus. The circulation of the rubella virus is possible among immigrant women aged between 16 and 49 years, which could lead to the appearance of SRC cases. Epidemiological surveillance will allow the impact on the measles and rubella elimination plan to be determined in the future. [ABSTRACT FROM AUTHOR]

Highlights: [•] Small pockets of Exxon Valdez oil remain buried on beaches >20years post-spill. [•] Foraging sea otters could encounter this entrapped oil while digging for clams. [•] Chronic oil contamination purportedly depressed otter numbers in one small area. [•] We re-examine the data and find little evidence that otter numbers were depressed. [•] Confounding factors and focus on a small study site preclude assessment of recovery. [Copyright &y& Elsevier]

Abstract: Background: There has been a policy debate in the United Kingdom about moving beyond traditional measures of life expectancy and economic output to developing more meaningful ways of measuring national well-being. Objective: To test whether quality adjusted life expectancy (QALE) was a useful indicator of health inequalities. Methods: EuroQol five-dimensional questionnaire data from a well-being survey was combined with actuarial life expectancy (LE) data to estimate healthy LE (HLE), that is, years of life lived in good health, and QALE, that is, quality-adjusted life-years (QALYs) lived for Wirral, a borough in the north west of England. Results: The gap between Wirral and the most deprived areas was 4.45 years for LE, 5.34 for QALE, and 7.55 for HLE. The gap in QALE was 20% greater than the gap in LE, while the gap in HLE was 70% greater. Conclusions: The fact that the QALE gap value lies between the HLE value and the LE value suggests that QALE is a more sensitive indicator than HLE, as in this study QALE is derived from 243 possible EuroQol five-dimensional questionnaire profiles whereas HLE is based only on whether or not an individual rates his or her health as good, a binary variable. This study discusses how QALE could be a useful indicator for measuring health inequalities in future, especially as cost utility and QALYs are seen as the gold standard used by the National Institute for Health and Clinical Excellence in the United Kingdom to measure outcomes for health interventions in England, and discusses how a monetary valuation of QALYs could be used to put a societal cost on health inequalities. [Copyright &y& Elsevier]

Abstract: Little is known about whether mental health first aid knowledge and beliefs of young people actually translate into actual behavior. This study examined whether young people''s first aid intentions and beliefs predicted the actions they later took to help a close friend or family member with a mental health problem. Participants in a 2006 national survey of Australian youth (aged 12–25years) reported on their first aid intentions and beliefs based on one of four vignettes: depression, depression with alcohol misuse, psychosis, and social phobia. At a two-year follow-up interview, they reported on actions they had taken to help any family member or close friend with a problem similar to the vignette character since the initial interview. Of the 2005 participants interviewed at follow-up, 608 reported knowing someone with a similar problem. Overall, young people''s first aid intentions and beliefs about the helpfulness of particular first aid actions predicted the actions they actually took to assist a close other. However, the belief in and intention to encourage professional help did not predict subsequent action. Findings suggest that young people''s mental health first aid intentions and beliefs may be valid indicators of their subsequent actions. [Copyright &y& Elsevier]

Objective: To examine the population distribution of different types of relationships between people with chronic conditions and their doctors that influence decisions being made from a shared-decision making perspective. Methods: A survey questionnaire based on recurring themes about the doctor/patient relationship identified from qualitative in-depth interviews with people with chronic conditions and doctors was administered to a national population sample (n =999) of people with chronic conditions. Results: Three factors explained the doctor/patient relationship. Factor 1 identified a positive partnership characteristic of involvement and shared decision-making; Factor 2 doctor-controlled relationship; Factor 3 relationship with negative dimensions. Cluster analysis identified four population groups. Cluster 1 doctor is in control (9.7% of the population); Cluster 2 ambivalent (27.6%); Cluster 3 positive long-term relationship (58.6%); Cluster 4 unhappy relationship (4.4%). The proportion of 18–34 year olds is significantly higher than expected in Cluster 4. The proportion of 65+ year olds is significantly higher than expected in Cluster 1, and significantly lower than expected in Cluster 4. Conclusion: This study adds to shared decision-making literature in that it shows in a representative sample of people with chronic illnesses how their perceptions of their experiences of the doctor–patient relationship are distributed across the population. Practice implications: Consideration needs to be given as to whether it is better to help doctors to alter their styles of interactions to suit the preferences of different patients or if it is feasible to match patients with doctors by style of decision-making and patient preference. [Copyright &y& Elsevier]

Abstract: Objective: To establish associations between physical exercise during leisure time and prevalence, incidence and course of mental disorders. Method: Data were derived from the Netherlands Mental Health Survey and Incidence Study, a 3-wave cohort study in a representative sample (N=7,076) of Dutch adults. Mental disorders were assessed with the Composite International Diagnostic Interview. Physical activity was established by the number of hours per week people spent on taking physical exercise. Results: Physical exercise was negatively associated with presence and first-onset of mood and anxiety disorders after adjustment for confounders. Evidence for a dose–response relationship between exercise levels and mental health was not found. Among those with mental disorder at baseline, exercise participants were more likely to recover from their illness (OR=1.47) compared to their counterparts who did not take exercise. Conclusion: Physical exercise is beneficial to mental health, but it remains uncertain whether this association truly reflects a causal effect of exercise. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to determine the trend in influenza vaccine coverage among community dwelling adults in South Australia aged 65 years and over and compare this prevalence with national and international influenza vaccine coverage. Immunisation prevalence has been measured in South Australia (SA) since 1993 using face to face surveys and Computer Assisted Telephone Interviewing (CATI). There has been an increasing trend in influenza immunisation in South Australia over the last 12 years among community dwelling adults aged 65 years and over. This indicates that policies and campaigns have impacted positively on influenza vaccine uptake. [Copyright &y& Elsevier]

Abstract: In the last two decades, an explosion in information and literature on human biomonitoring data has occurred. Symposia, workshops, and workgroups have been formed to discuss all issues surrounding biomonitoring. One such workgroup, formed by the International Life Sciences Institute''s Health and Environmental Sciences Institute (HESI), developed a wheel which has biomonitoring at its hub; its spokes depict the uses of biomonitoring. As it rolls and picks up speed, the biomonitoring wheel will no doubt gain additional spokes. In this manuscript, we describe and give examples of these biomonitoring uses and some of their further applications as well as some of the issues surrounding biomonitoring. Special emphasis is placed on the uses and limitations of large-scale representative cross sectional studies such as the National Health and Nutrition Examination Surveys in the United States. Priority setting, improved modeling methods for interpreting the biomonitoring data, and an increase in studies designed to associate health indicators and health risks to selected environmental chemicals are needed to increase the power of biomonitoring. [Copyright &y& Elsevier]

Abstract: This study aims to inform strategic policy makers and managers about the value of general population surveys by determining and comparing dimensions of satisfaction in four different health services in Scotland: general practice, domiciliary care, outpatients and inpatients (including day cases). The research design involved secondary data analysis of a national telephone survey conducted to inform the development of a national health plan. The database was created using a stratified quota sample of 3052 people of 16 years and above resident in Scotland in 2000. The main outcome measures investigated were overall measures of patient satisfaction with each type of service. Principal components analysis was used to determine the dimensions. Interest was in the extent to which patients, many of whom were the same (having used more than one service), evaluated different services in similar ways, as well as those factors specific to each service. Using logistic regression, the results demonstrate that interpersonal care and information, and desired improvements in service were universal and key explanatory dimensions in all services, followed by a combination of access, physical facilities, time and quality of food, depending on relevance to the service. These factors, particularly interpersonal care and information, distinguished well the highly satisfied from the others, with age providing further discrimination between non-hospital patients, while gender added to discrimination between inpatients. In conclusion, despite the limitations of telephone interviews, it is feasible to ask about several services at the same time and for the answers to reflect common underlying dimensions of evaluation found in more exhaustive research within each service. These factors offer a set of summary measures by which services can be easily evaluated at a strategic level and point to where efforts to increase patient satisfaction can be maximised. [Copyright &y& Elsevier]

Abstract: Objective: The SF-12 Health Survey is a 12-item questionnaire that yields two summary scores (physical and mental health). Neither score can be computed when an item is missing. We explored imputation methods for missing scores for this instrument. Study design and setting: Using data from a population-based survey, we tested several ways of imputing simulated missing data. Results: Among 1250 participants, 118 (9.6%) had at last one missing SF-12 item. Missing data were more common among women, older respondents, non-Swiss nationals, and health service users. Among the 1132 respondents with complete data, replacement of any item with the mean population item weight yielded good results: the mean correlation between imputed and true score was 0.979 for both the physical and mental score. Results remained satisfactory when up to three of the six key items for each score (items that contribute predominantly to a given score), and any number of non-key items, were replaced by the mean. Application of this imputation algorithm to the original survey reduced the proportion of missing scores to <1%. Respondents with incomplete surveys, hence imputed scores, had lower scores than respondents with complete data (physical score: 44.9 vs. 49.8, p < 0.001, mental score: 44.4 vs. 46.3, p=0.064). Conclusions: A simple imputation algorithm can substantially reduce the proportion of missing scores for the SF-12 health survey, and consequently reduce non-response bias. [Copyright &y& Elsevier]

Aims: To compare menopausal age and the use of oral contraceptives (OC) and hormonal replacement therapy (HRT) between the 32 populations of the WHO MONICA Project, representing 20 different countries.Methods: Using a uniform protocol, age at menopause and the use of OC and HRT was recorded in a random sample of 25–64 year-old women attending the final MONICA population cardiovascular risk factor survey between 1989 and 1997. A total of 39,120 women were included.Results: There were wide variations between the populations in the use of OC and HRT. The use of OC varied between 0 and 52% in pre-menopausal women aged 35–44 years, Central and East Europe and North America having the lowest and West Europe and Australasia the highest prevalence rates. Among post-menopausal women between 45 and 64 years, the prevalence of HRT use varied from 0 to 42%. In general, the use of HRT was high in Western and Northern Europe, North America and Australasia and low in Central, Eastern and Southern Europe and China. With the exception of Canada (45 years), the mean age at menopause differed only little (ranging from 48 to 50 years) between the populations.Conclusion: The use of OC and HRT varies markedly between populations, in general following a regional pattern. Whereas, the prevalence rates are mostly similar within a country, there are remarkable differences even between neighbouring countries, reflecting nation-specific medical practice and public attitudes that are not necessarily based on scientific evidence. [Copyright &y& Elsevier]