Siri Steine

Indicators of childhood sexual abuse in gynaecological patients in a general practice

OBJECTIVE To find indicators of a history of childhood sexual abuse in patients consulting for a gynaecological examination in a general practice. DESIGN Semistructured interview after a consultation. SETTING General practice in the city of Oslo, Norway. PARTICIPANTS Of 117 women aged 20-49 with a gynaeco- logical problem, 85 were interviewed. MAIN OUTCOME MEASURE History of childhood sexual abuse. RESULTS 24 (28%) of 85 women interviewed by their female GP when consulting for a gynaecological problem reported childhood sexual abuse. In total they reported 32 abusive events, quite different as to the type of assault, the relation to the offender, and the duration. A history of pelvic pain or gynaecological surgery showed a significant association with reported childhood sexual abuse with odds ratios of 4.0 (CI 1.0-15.8) and 4.1 (CI 1.0-17.0), respectively. As adverse sexual experiences may lead to somatization as a coping strategy, certain findings might be indicators of unknown childhood sexual abuse in patients presenting for gynaecological disorders. CONCLUSION A history of pelvic pain and gynaecological surgery may be indicators of sexual abuse in childhood.

A New Instrument to Measure Patient Satisfaction with Mammography Validity, Reliability, and Discriminatory Power

OBJECTIVES The benefit of mammography depends on repeated use. Therefore, surveying the mammographic quality as judged by the users addresses an important topic. The authors assess the practicality, validity, reliability, and discriminatory power of a new, brief, multidimensional questionnaire for measuring patient satisfaction with mammography. Items measuring discomfort and attitudes toward repeat adherence were included. METHODS A self-administered questionnaire was given to women from six radiology departments in Norway. Four hundred eighty-eight out of 550 women referred for screening or diagnostic mammography were included. Seventy-seven patients also completed the test/retest study, and 44 women additionally completed an Australian questionnaire. Scores for patient satisfaction on the structure, process, discomfort, and general satisfaction scales of the questionnaire were used as the main outcome measures. RESULTS Response rate was 89%, and rate of completion was more than 95%. Strict psychometric criteria for construct validity and reliability were satisfied. Because lower levels of satisfaction were detectable with the new questionnaire but not with the Australian questionnaire and because an acceptable degree of variability in response was detected, support for discriminatory power was found. CONCLUSIONS The discomfort dimension contributed substantially to validity and discriminatory power. Patient behavior with time may be monitored with the new questionnaire, thus representing a valuable tool for scientific and practical purposes.

White coat hypertension in a general practice: Prevalence, cardiovascular risk factors and clinical implications

OBJECTIVE To examine the prevalence of white coat hypertension (WCH) and white coat effect (WCE) in a general practice. Background and biochemical characteristics, triglycerides, total cholesterol, HDL cholesterol, fasting blood glucose, microalbuminuria, ECG, smoking habits, height and weight of patients with white coat hypertension were compared to patients with sustained hypertension. DESIGN Blood pressure measurements among mild hypertensives in clinic visits by doctor and at home by the patients. SETTING A primary health centre in Oslo, Norway. SUBJECTS Sixty-eight patients with mild hypertension (41 females and 27 males) aged 20-75 years. MAIN OUTCOME MEASURES Patients had their blood pressure measured in clinic visits by general practitioners and by themselves at home to study the prevalence of WCH and the WCE. WCH was defined as a consistently increased blood pressure in the clinic and a normal home-measured blood pressure. WCE was defined as a difference in mean systolic blood pressure measured by physician and patients of 10 mmHg, or more. An individual risk score for myocardial infarction was calculated. Subjects with and without WCH/WCE were compared in relation to background characteristics and biochemical differences. RESULTS Fourteen patients (21%) were found with WCH, while 25 (37%) had WCE. Patients with WCH differed significantly from hypertensives in age, total cholesterol, and heart rate. In multivariate analysis, increasing age and heart rate were significant negative predictors for WHC. CONCLUSION WCH may be a significant clinical challenge in general practice, especially among younger patients.

The Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient involvement in general practice patients with complex health problems: Psychometric testing and development of a final version

The Patient Perspective Survey (PPS) is designed to enhance consultation outcome and patient participation among general practice patients with complex health problems. This article presents the final version of the survey. This version is more condensed, tested for psychometric and clinical properties, and with increased emphasis on coping. The development and testing was performed in two phases with two groups of GPs and patients. Indications for use and criteria for rejection of items were defined, based on comprehensive data analysis and clinical judgement. The number of items was reduced to 38 items. The majority of diagnoses were related to psychosocial or musculoskeletal disorders. For the surveys main dimensions (psychological and somatic items, everyday life situation and coping) sound psychometric properties were identified. Seven open-ended questions were found useful for obtaining important new information and stimulating processes, often related to coping aspects. The revised 38-item PPS represents a condensed and final version, with increased focus on coping, and sound psychometric properties.