Introduction of Chlamydia trachomatis screening for young women in Germany.

Screening for genital Chlamydia trachomatis infections for young sexually active women was incorporated into routine medical care of German statutory health insured patients starting in January 2008. The primary goal of this new preventive measure is the reduction of severe sequelae for women such as tubal infertility and ectopic pregnancies. The course of the deliberations leading to the Federal Joint Committee's decision is summarized in this review.

International versions of the Menopause Rating Scale (MRS).

BACKGROUND: Symptom scales for aging women have clinically been used for years and the interest in measuring health-related quality of life (HRQoL) has increased in recent years. The Menopause Rating Scale (MRS) is a formally validated scale according to the requirements for quality of life instruments. The aim of this paper is to review the current state of the instrument particularly concerning versions of the scale in different languages. MRS VERSIONS AVAILABLE: The translations were performed following international methodological recommendations for the linguistic & cultural adaptation of HRQoL instruments. The first translation was done from the German original scale into English (UK & USA). The English version was used as the source language for the translations into French, Spanish, Swedish, Mexican/Argentine, Brazilian, Turkish, and Indonesian languages (attached as additional PDF files). CONCLUSION: The MRS scale is obviously a valuable tool for assessing health related quality of life of women in the menopausal transition and is used worldwide. The currently available 9 language versions have been translated following international standards for the linguistic and cultural translation of quality of life scales. Assistance is offered to help interested parties in the translation process.

The Aging Males' Symptoms (AMS) scale: review of its methodological characteristics.

BACKGROUND: The current paper reviews data from different sources to get a closer impression on the psychometric and other methodological characteristics of the Aging Males' Symptoms (AMS) scale gathered recently. The scale was designed and standardized as self-administered scale to (a) to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and post androgen replacement therapy. The scale is in widespread use (14 languages). METHOD: Original data from different studies in many countries were centrally analysed to evaluate reliability and validity of the AMS. RESULTS: Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size was sometimes small. VALIDITY: The internal structure of the AMS in healthy and androgen deficient males, and across countries was sufficiently similar to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. The comparison with other scales for aging males or screening instruments for androgen deficiency showed sufficiently good correlations, illustrating a good criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF36 where also high correlation coefficients have been shown. Methodological analyses of a treatment study of symptomatic males with testosterone demonstrated the ability of the AMS scale to measure treatment effect, irrespective of the severity of complaints before therapy. It was also shown that the AMS result can predict the independently generated (physician's) opinion about the individual treatment effect. CONCLUSION: The currently available methodological evidence points towards a high quality of the AMS scale to measure and to compare HRQoL of aging males over time or before/after treatment, it suggests a high reliability and high validity as far as the process of construct validation could be pressed ahead yet. But certainly more data will become available, particularly from ongoing clinical studies.

The Menopause Rating Scale (MRS) scale: a methodological review.

BACKGROUND: This paper compiles data from different sources to get a first comprehensive picture of psychometric and other methodological characteristics of the Menopause Rating Scale (MRS) scale. The scale was designed and standardized as a self-administered scale to (a) to assess symptoms/complaints of aging women under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and postmenopause replacement therapy. The scale became widespread used (available in 10 languages). METHOD: A large multinational survey (9 countries in 4 continents) from 2001/ 2002 is the basis for in depth analyses on reliability and validity of the MRS. Additional small convenience samples were used to get first impressions about test-retest reliability. The data were centrally analyzed. Data from a postmarketing HRT study were used to estimate discriminative validity. RESULTS: Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size for test-retest reliability was small. VALIDITY: The internal structure of the MRS across countries was astonishingly similar to conclude that the scale really measures the same phenomenon in symptomatic women. The sub-scores and total score correlations were high (0.7-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. Norm values from different populations were presented showing that a direct comparison between Europe and North America is possible, but caution recommended with comparisons of data from Latin America and Indonesia. But this will not affect intra-individual comparisons within clinical trials. The comparison with the Kupperman Index showed sufficiently good correlations, illustrating an adept criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF-36 where also a sufficiently close association has been shown. CONCLUSION: The currently available methodological evidence points towards a high quality of the MRS scale to measure and to compare HRQoL of aging women in different regions and over time, it suggests a high reliability and high validity as far as the process of construct validation could be completed yet.

The Aging Males' Symptoms (AMS) scale: update and compilation of international versions.

BACKGROUND: The interest of clinical research in aging males increased in recent years and thereby the interest to measure health-related quality of life (HRQoL) and symptoms of aging men. The Aging Males' Symptoms scale (AMS) became the most commonly used scale to measure HRQoL and symptoms in aging males in many countries worldwide. The aim of this paper is to review the current state of the instrument particularly concerning versions of the scale in different languages in the light of the quality of the translation process. AMS VERSIONS AVAILABLE: Most of the translations were performed following international methodological recommendations for linguistic & cultural adaptation of HRQoL instruments. Mainly the English version was used as source language for the translation into Dutch, Spanish, Portuguese, Italian, Swedish, and Japanese (attached as additional PDF-files). Preliminary versions that were derived only from forward translations are of secondary quality and available in Finnish, Flemish, and Russian. It is recommended to complete the translation process for the latter languages before using them in international studies. TRANSLATIONS IN PROCESS: The AMS scale is in the process of consensus finding of two existing French versions, and the versions in the Korean, Thai, and Indonesian languages have not yet been completed in the translation process. CONCLUSION: The AMS scale is obviously a valuable tool for assessing health related quality of life in aging men, because it is used worldwide. It is a standardized scale according to psychometric norms. Most of the currently available language versions were translated following international standards for linguistic and cultural translation of quality of life scales. Assistance is offered to help interested parties in the translation process.

Scale for Quality of Sexual Function (QSF) as an outcome measure for both genders?

BACKGROUND: For years, there has been interest in sexual dysfunction and its impact on quality of life but usually focused on one gender. Therapeutic options that became available raised the interest to evaluate effects on the other partner but there is no standardized instrument applicable for both genders. This paper reports first data regarding the development of a new general "Quality of Sexual Function" (QSF) scale. METHODS: The raw scale was based on our own gender-specific scales and the pertinent literature. The scale was applied in over 700 persons of a cross-sectional survey in Germany. Factorial analyses were performed to describe the internal structure (domains) of the scale and for item reduction. Internal consistency reliability and some aspects of validity were analyzed with the same community sample preliminary reference values determined. RESULTS: The scale consists of 32 specific items and eight general questions. Four dimensions were identified: "psycho-somatic quality of life,""sexual activity,""sexual (dys)function-self-reflection," and "sexual (dys)function-partner's view." The internal consistency reliability coefficients of the total scale and the subscales were good as were the total-domain correlations. Content validity was promising. CONCLUSION: This self-administrable 40-item QSF scale can measure and compare quality of sexual function for both genders. The scale was well accepted by the respondents. It is easy to answer and the evaluation is simple. Only a few results of reliability and validity have been established in this early stage of the development of the new instrument. Further research is needed to complete many missing aspects of reliability and the construct validity, particular its sensitivity to treatment effects.

A household panel as a tool for cost-effective health-related population surveys: validity of the "Healthcare Access Panel".

BACKGROUND: Random sample surveys of the population are time consuming and expensive, particularly if international sampling is planned. METHOD: The Healthcare Access Panel was developed as an alternative to face to face or telephone health survey interviews to estimate prevalence or even incidence rates of health-relevant variables in the population. It is the objective of this paper to demonstrate the validity of health-related data obtained with the Healthcare Access Panel compared with results from other, population-based data sources. The example is Germany, where the Panel consists of more than 78,000 individuals aged between 0 and 79 years. RESULTS: The Healthcare Access Panel reflects the population concerning age, sex, and regional structure with a good correlation. The hospitalisation rate obtained with the Panel matches the official National Hospital Discharge Statistics. Annual consultations with major medical disciplines were found to be almost identical in the Healthcare Access Panel as compared with the German National Health Survey (GNHS). The Healthcare Access Panel data matched the GNHS prevalence results of self-reported medical conditions/diseases. Advantages and disadvantages of the Healthcare Access Panel compared with specially designed population field surveys are discussed. CONCLUSION: It is worthwhile to consider the Healthcare Access Panel approach as a cost-effective alternative to other population-based data collection methods under many circumstances, i.e. considering the specific methodological pros and cons as necessary for any other method.