Giovanna Meystre-Agustoni

Anxiety in a cohort of Swiss women participating in a mammographic screening programme

OBJECTIVES:To follow up anxiety in a cohort of women screened for breast cancer. METHODS:Within the framework of a pilot screening programme for breast cancer in the Canton of Vaud (Switzerland), a cohort of 924 participants aged 50–70 years were invited to answer questions on anxiety related to mammography screening. Anxiety was measured using a specific tool, the psychological consequences questionnaire (PCQ), and a new single item, direct question, breast cancer anxiety indicator (BCA). Participants were asked to fill in the questionnaire at four different phases: at screening, before the result, and 2 and 8 weeks after the result. The final response rate was 93.7%. Predictors of anxiety at each phase were assessed using multiple regression. RESULTS:Among those screening negative (94.7%), anxiety at screening was very low and remained so during the screening process. Among those screening false positive, anxiety was significantly higher 8 weeks after having received a negative diagnosis. Predictors of anxiety before screening were lower education and higher age, with a strong exogenous anxiety component. For subsequent phases, the initial anxiety score and education were the main determinants. Furthermore, a false positive result at screening was the most important predictor of anxiety 2 months after negative diagnosis. Anxiety measured with the BCA was strongly correlated with the PCQ. CONCLUSION:Anxiety was very low at screening and remained so during the process for negative women. Initial anxiety level was a strong predictor of anxiety during the entire process, up to 8 weeks after a negative result, and could be easily assessed using the BCA. The sustained higher anxiety level among those screening false positive is an undesirable side effect of the programme.

Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q

Objectives Advances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level. Methods We identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty. Results Deprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (rs=−0.539). Conclusion The DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.

Patterns of sex work contact among men in the general population of Switzerland, 1987–2000

Objectives: To analyse the prevalence of lifetime recourse to prostitution (LRP) among men in the general population of Switzerland from a trend and cohort perspective. Methods: Using nine repeated representative cross-sectional surveys from 1987 to 2000, age-specific estimates of LRP were computed. Trends and period effect were analysed as the evolution of cross-sectional population estimates within age groups and overall. Cohort analysis relied on cohorts constructed from the 1989 survey and followed in subsequent waves. Age and cohort effects were modelled using logistic regression and non-parametric monotone regression. Results: Whereas prevalence for the younger groups was found to be logically lower, there was no consistent increasing or decreasing trend over the years; there was no significant period effect. For the 17–30 year age group, the mean estimate over 1987–2000 was 11.5% (range 8.3 to 12.7%); for the 31–45 year group, the mean was 21.5% (range over 1989–2000 20.3 to 23.0%). Regarding cohort analysis, the prevalence of LRP was found to increase steeply in the youngest ages before reaching a plateau near the age of 40 years. At the age of 43 years, the prevalence was estimated to be 22.6% (95% CI 21.1% to 24.1%). Conclusions: The steep increase in the cohort-wise prevalence of LRP in younger ages calls for a concentration of prevention activities in young people. If the plateauing at approximately 40 years of age is not followed by a further increase later in life, which is not known, then consumers of paid sex would be repeat buyers only, a fact that should be taken into account by prevention.

Etude du devenir des toxicomanes pris en charge à l'aide de méthadone dans le canton de Vaud (1976–1986) — Résultats préliminaires

A survey of a methadone treated population of 562 heroin addicts was undertaken to determine which factors linked to certain characteristics of the individual or to the cures, might be associated with either a positive outcome or failure. Furthermore it enabled the recording of various modifications with regard to social and professional integration, as well as tracing the penal career, both during the cure and to the cut-off date (31 July 1986). This paper presents the preliminary results of the survey in relation, firstly, to certain aspects of the individuals career in drug abuse, within a specific population; secondly, the various efforts towards detoxification and lastly the situation with regard to their state of drug addiction at the cut-off date.