Development and validation of a condition-specific diary to measure severity, bothersomeness and impact on daily activities for patients with acute urinary tract infection in primary care

BACKGROUND: Urinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities for adult patients with suspected urinary tract infection in primary care; or, in the absence of such a PROM, to test items identified from existing PROMs for coverage and relevance in single and group interviews and to psychometrically validate the resulting PROM. METHODS: The literature was searched for existing PROMs covering the three domains. Items from the identified PROMs were tested in single and group interviews. The resulting symptom diary was psychometrically validated using the partial credit Rasch model for polytomous items in a cohort of 451 women participating in two studies regarding UTI. RESULTS: No existing PROM fulfilled the inclusion criteria. Content validation resulted in one domain concerning symptom severity (18 items), one concerning bothersomeness (18 items), and one concerning impact on daily activities (7 items). Psychometrical validation resulted in four dimensions in each of the first two domains and one dimension in the third domain. CONCLUSIONS: Domains were not unidimensional, which meant that we identified dimensions of patient-experienced UTI that differed substantially from those previously found. We recommend that future studies on UTI, in which PROMs are to be used, should ensure high content validity of their outcome measures and unidimensionality of the included dimensions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12955-017-0629-5) contains supplementary material, which is available to authorized users

Evaluation of the Danish version of the Prenatal Parental Reflective Functioning Questionnaire in early pregnancy as a screening tool

ACKNOWLEDMENTS This study was supported by grants from the Capital Region of Copenhagen, Trygfonden, and Lundbeckfonden. We declare that these funders had no input to the study design, collection, analysis, interpretation of data or to the drafting of the manuscript. Funding information Capital Region of Copenhagen, Grant/Award Number: 19035774; Trygfonden, Grant/Award Number: 125227; Lundbeckfonden, Grant/Award Number: PW021220Peer reviewedPublisher PD

Poor self-rated health did not increase risk of permanent nursing placement or mortality in people with mild Alzheimer's disease

BACKGROUND: Self-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality. However, the predictive value of SRH to NH placement and mortality among elderly people is not consistent. This may be due to cognitive impairment. Since the SRH item is widely used, it is important to know whether SRH has different predictive value among people with cognitive impairments. We aimed to examine SRH and the risk of permanent NH placement and mortality among people with mild Alzheimer’s disease (AD). METHODS: Data are from The Danish Alzheimer Intervention StudY (DAISY), a large randomized controlled trial of psychosocial intervention for patients with mild dementia and their caregivers with 3-years’ follow-up. Five out of 14 Danish counties participated and 321 home-living elderly (mean age: 76.2 years) with mild AD (46.4 % male) were included during 2004 and 2005. Self-rated SRH, cognitive function (MMSE), quality of life (proxy-rated QOL-AD), activities of daily living (ADCS-ADL), insight, and socio-demographics were assessed at baseline. Comorbidities and information about NH placement and mortality was obtained over 3-years’ follow-up from registries. With Cox proportional hazard regression we analysed the association between SRH (dichotomised into good vs. poor) and NH placement and mortality adjusted for potential confounders. RESULTS: At baseline 66 % reported excellent or good, and 34 % fair, poor or very poor SRH. Mean MMSE was 24.0 (range: 20–30). NH placement and mortality totalled 28.1 % and 16.5 % at 3-years’ follow-up, respectively. Poor SRH at baseline was not related to increased risk of NH placement or to increased mortality neither in the univariable nor in multivariable analysis: In the fully adjusted models HR was 0.63 (95 % CI 0.38-1.05) and 1.28 (95 % CI 0.67-2.45), respectively. CONCLUSIONS: When poor SRH was present we found no increased risk for NH placement or death among elderly people with mild AD. SRH is a widely used parameter in clinical and epidemiological research but may not be a valid indicator of health in patients with AD due to loss of insight

Symptom-based screening tool for asthma syndrome among young children in Uganda

Under-diagnosis of asthma in ‘under-fives’ may be alleviated by improved inquiry into disease history. We assessed a questionnaire-based screening tool for asthma among 614 ‘under-fives’ with severe respiratory illness in Uganda. The questionnaire responses were compared to post hoc consensus diagnoses by three pediatricians who were guided by study definitions that were based on medical history, physical examination findings, laboratory and radiological tests, and response to bronchodilators. Children with asthma or bronchiolitis were categorized as “asthma syndrome”. Using this approach, 253 (41.2%) had asthma syndrome. History of and present breathing difficulties and present cough and wheezing was the best performing combination of four questionnaire items [sensitivity 80.8% (95% CI 77.6–84.0); specificity 84.7% (95% CI 81.8–87.6)]. The screening tool for asthma syndrome in ‘under-fives’ may provide a simple, cheap and quick method of identifying children with possible asthma. The validity and reliability of this tool in primary care settings should be tested