Concordance of retrospective and prospective reporting of menstrual irregularity by women in the menopausal transition.

OBJECTIVES: First, to compare retrospective self-report of irregular and skipped periods by women in the menopausal transition to information recorded concurrently on calendars; and, second, to describe how participants' definitions of irregularity and skipping affected reporting. METHODS: The sample was 161 women who returned both complete menstrual calendars and questionnaires in any year between 1997 and 2002. Irregular and skipped periods documented on menstrual calendars were compared with self-reports. Data were z-score adjusted for repeated observations in women and analyzed using Cohen's kappa. RESULTS: Agreement between calendar and questionnaire reporting of cycle irregularity was weak (kappa = 0.192). Participants' definitions of irregularity and skipping differed markedly from those of the researchers. Agreement about skipping was stronger overall and increased after a definition of skipping was provided to study participants (kappa pre-definition = 0.597; post-definition = 0.765). Counts of skipped cycles led to the greatest differences between researchers and participants. DISCUSSION: Accuracy of self-reports of menstrual cycle irregularity or skipping is not sufficient without explanations about what is meant by those terms. Researchers and clinicians who solicit information from women about menstrual cycle patterns need to define explicitly the phenomenon of interest to insure accurate information.

A training program to improve domestic violence identification and management in primary care: preliminary results.

Domestic violence as encountered in day-to-day practice is greatly underidentified. It is estimated that only 3% of cases are presently being identified, and practitioners are uncertain of what to do if a case is discovered. In this paper, a training program to improve identification and management of domestic violence (DV) in primary care and the providers' responses to the program are described. A multimodal training program was undertaken to demonstrate and practice the incorporation of didactic content into practice for the health care teams. Two medical centers from a large staff-model HMO were chosen at random from five volunteering for training. The entire adult health care medical center teams, including physicians, physician assistants, RNs, LPNs, medical assistants, and receptionists, were the recipients of the training. Assessment of provider valuation of the components of the training program was performed by administering a standardized 5-point Likert-scaled questionnaire 9 months after the training. This time interval was chosen because we were interested in lasting program effects. Core didactic content, such as the epidemiology of DV, identification and management of victims and batterers, and legal issues, was highly rated. Delivery of the content through role-playing, start-stop videos and presentations by former victims received lesser but solid support. Follow-up assessment 9 months post training demonstrates solid support for many components of the program: highest for specific information content areas, but strong for techniques and processes. The training program appears to be a promising method to improve provider skills in DV management.