Development and content validation of a questionnaire measuring patient empowerment in cancer follow-up

Purpose: The aim of this study was to develop and ensure the content validity of a new patient-reported outcome measure, the Cancer Patient Empowerment Questionnaire (CPEQ), to measure the level of, desire for, and enablement of empowerment among cancer patients in follow-up. Methods: An iterative process based on: (i) empowerment theories by Zimmerman and Tengland, (ii) a systematic review of questionnaires measuring empowerment or related concepts among cancer patients, (iii) qualitative data from 18 semi-structured interviews with Danish cancer patients in follow-up, (iv) input from a group of eight cancer patients involved as co-researchers and from an expert steering group, and (v) cognitive interviews with 15 cancer patients in follow-up. Results: The items for the CPEQ were developed and revised and 12 versions of the questionnaire were evaluated. The final version consists of 67 items, covering three different dimensions of empowerment: (A) empowerment outcomes consisting of three components: (A1) the intrapersonal-, (A2) interactional-, and (A3) behavioral component, (B) empowerment facilitators (enablement), and (C) the value of empowerment. Conclusions: This study documents the theoretical and empirical basis for the development of the CPEQ and its content validity. The CPEQ provides a tool for researchers to assess the level of, desire for, and enablement of empowerment among cancer patients. The next steps will be to use the CPEQ in a nationwide study of empowerment in cancer follow-up and subsequently shorten the CPEQ based on psychometric methods in order to make it more relevant in clinical studies

External validation of the Garvan nomograms for predicting absolute fracture risk: The Tromso study

Background: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. Methods: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed.Reclassification analysis was used to compare the models performance. Results: The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. Conclusions: The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction

Phenotypic and Genetic Predictors of Pathogenicity and Virulence in Flavobacterium psychrophilum

strains should be further explored

The effect of five years versus two years of specialised assertive intervention for first episode psychosis - OPUS II: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The Danish OPUS I trial randomized 547 patients with first-episode psychosis to a two-year early-specialised assertive treatment programme (OPUS) versus standard treatment. The two years OPUS treatment had significant positive effects on psychotic and negative symptoms, secondary substance abuse, treatment adherence, lower dosage of antipsychotic medication, and a higher treatment satisfaction. However, three years after end of the OPUS treatment, the positive clinical effects were not sustained, except that OPUS-treated patients were significantly less likely to be institutionalised compared with standard-treated patients. The major objective of the OPUS II trial is to evaluate the effects of five years of OPUS treatment versus two years of OPUS treatment.</p> <p>Methods</p> <p>The OPUS II trial is designed as a randomized, open label, parallel group trial with blinded outcome assessment. Based on our sample size estimation, 400 patients treated in OPUS for two years will be randomized to further three years of OPUS treatment versus standard treatment. The specialized assertive OPUS treatment consists of three core elements: assertive community treatment, psycho-educational family treatment, and social skills training.</p> <p>Discussion</p> <p>It has been hypothesized that there is a critical period from onset up to five years, which represents a window of opportunity where a long-term course can be influenced. Extending the specialized assertive OPUS treatment up to five years may allow the beneficial effects to continue beyond the high-risk period, through consolidation of improved social and functional outcome.</p> <p>Trial registration</p> <p>Clinical Trial.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00914238">NCT00914238</a></p

Municipal solid waste management strategies : impact of waste generation behaviours in rural and urban communities : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Environmental Technology, Massey University, Palmerston North, New Zealand

The waste generation characteristics of households was investigated in relation to waste management principles and philosophies in urban and rural New Zealand, to evaluate current practices regarding municipal solid waste at the national, district- and city council level. Two selected councils, one rural and one urban, were studied in detail. A household sample from each council was surveyed to establish the trends in household waste generation. The results from these surveys were compared using statistical analyses. The initial results suggested that rural and urban households show significant differences. Further analysis, involving a detailed case study of a rural settlement, suggests that these differences arise from the economic signals received from the council and not from population structure and culture, although some subgroups in the population appear to ignore these signals. A householders' survey analysis of waste designated for recycling proved to be unreliable and difficult to interpret. This was caused by the public's general inability to interpret plastic recycling numbers for correct sorting, and to measure volume and weight correctly. Conclusions were reached with regard to paper and household organic waste. While there appears to be little difference in the amounts produced per person in either the wards or between the councils, a proportional analysis suggests that middle income households compost and recycle more than low income households. This has been interpreted as a possible effect of multi-family dwellings and the type of education material used to deliver the recycling messages. An analysis of household waste delivered to the landfills by the collection system in the two selected councils shows that the rural household waste has a higher proportion of organics and a lower proportion of paper waste than do the urban households. The rural households also compost less and visit the landfill more. This supports the conclusion that economic signals dictate the waste generation behaviours of households. The effectiveness, in light of sustainability and economics, of the systems in place in New Zealand were studied and compared with international trends in waste management systems. Economic signals appear to be a strong motivator for individual waste generation behaviours. Composting as a potential waste minimisation system for New Zealand was also investigated. Green waste composting appears to be an economically viable method of waste minimisation for urban and some rural councils. The data collected in the surveys suggest that home composting of household organics can offer a solution to reduce waste from the household source. The methods and effects of implementing this as a strategy require more study

Distributed Learning Environment in Multicultural Context: A Symposium

Globalization of education in a true sense cannot be achieved only by establishing accessibility, developing cost effective technologies. Due to easy accessibility of information, communication, resources and movement of people from one place to another, teachers in a classroom or outside the classroom have to deal with many more different situations than ever before. Present day classrooms (traditional and virtual) consist of students from diverse cultural and ethnic backgrounds. All these issues, challenges and demands cannot be solved overnight or by an individual. Discussions were held on some of these issues during the symposium session through brainstorming, idea generation and visual representation of distributed cognition. General issues of multicultural setup concerning design, delivery and communication in distributed learning environment were discussed. In this article the authors have summarised the points discussed and emerging ideas for future work to be done in this regard