Study objectives-To assess the psychological impact of mammographic screening on women with non-malignant outcomes after attending the Netherlands' National Breast Cancer Screening Programme. Design-During one year all women with false positive test results (95) in a screening area were invited for the study. Each false positive was matched with two women with normal mammograms with respect to age and municipality. A random reference group of 400 was drawn from the female population in an area not yet included in the screening programme. Experiences with screening and psychological status of subjects were assessed 8-10 weeks after screening (T1) and again after six months (T2), by interviews as well as questionnaires. References completed two questionnaires with a six months' interval. Participants-74 (78%) women with false positive outcomes and 113 (59%) women with negative outcomes participated at TI, of these 65 (88%) and 105 (93%) at T2, respectively; 238 references returned questionnaires at Ti (59%), of these 143 (60%) at T2.Main results-At 8-10 weeks after the screening, the women who received false positive test results scored higher on most of the variables indicating psychological disfunctioning than women with normal mammograms, but did not notably differ on the same variables from the nonscreened reference group. Women with normal mammograms had the lowest scores on all the variables in the study at both assessments. The same situation was observed six months later. Although 61% of the women who received false positive mammograms reported that they had experienced the "false alarm" as a stressful event, this experience had apparently no adverse effects on their psychological functioning, as assessed 8-10 weeks after screening. Conclusions-Overall, breast screening is not likely to generate adverse psychological effects in "healthy" women, even if the outcome is false positive. Differences in psychological functioning between false positives and negatives are more likely ascribable to feelings of relief in the negative group than to raised anxiety and distress in the false positive group. (7 Epidemiol Community Health 1997;51:705-7 10) Not only will the number of women who may benefit from regular mammography increase by the diffusion of population based screening, but also the number of women who may be affected by psychological side effects. Side effects can arise from different stages of the screening process, from the invitation for mammography confronting women with the possibility of having breast cancer to the diagnosis of a breast cancer that was not suspected. The comparatively few studies on the subject suggest that the psychological impact of breast screening followed by a negative outcome is negligible or non-existent in "psychologically healthy" women, but that a false positive outcome can cause emotional disturbances up till six months or more after being informed that the abnormal mammogram did not imply breast cancer."-3 Women with false positive outcomes and subsequent clin...

depressive reactions did not occur as long as patients experienced improvement in physical functioning but became manifest as recovery appeared to stagnate. No significant differences in this respect were found between hip fracture patients and patients with other injuries.

Objectives: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. Design: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. Setting: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. Subjects: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site. Outcome measure: self-reported grades of dif®culties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. Results: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the ®nal assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. Conclusions: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5±6 months after the injury.

Elderly patients with somatic illness are at increased risk of depression. The authors studied the prevalence and persistence of depressive symptoms during the first year after the events of myocardial infarction, congestive heart failure, fall-related injury, and the diagnosis of cancer and their putative pre-event risk factors. The GLAS study contains data from 614 patients who experienced post-baseline myocardial infarction, cancer, heart failure, or fall-related injury of the extremities within 5 years after the baseline assessment. Follow-up was conducted 8 weeks, 6 months, and 1 year after the somatic event. The authors studied the relative importance of 21 baseline risk factors for experiencing significant depressive symptoms during follow-up and the persistence of depression. Depressive symptoms were prevalent in 38.3% of the subjects during the post-event year; in about 19.1%, symptoms were mild. For a majority of patients (67.5%), symptoms persisted until the next assessment. Significant pre-event risk factors were depressive symptoms at baseline, age, smoking, poor general health, poor well-being, and neuroticism. Within the depressed group, only neuroticism was related to the persistence of symptoms. Neuroticism increases the risk of experiencing post-event depressive symptoms and is related to their persistence, which suggests the existence of a depression-prone personality.

This study examined the predictive role of perceived control in recovery of physical functions after fall-related injuries in a cohort of 165 older people who had completed preinjury baseline assessments including physical functioning and perceived control. Follow-up assessments of functioning were made at 8 weeks, 5 months, and 12 months. Indicators for perceived control were mastery and self-efficacy expectations. Physical functioning referred to self-reported difficulties with activities of daily living. Covariates included age, gender, level of education, preinjury health status, preinjury levels of social support and disability, and, additionally, the severity of the injury. Separate regression equations were estimated with disability as outcome at 8 weeks, 5 months, and 12 months post injury. Although significant at 8 weeks and borderline significant at 5 months post injury, the predictive role of perceived control appeared to be comparatively small. Preinjury levels of disability were highly predictive for disability at 8 weeks, 5 months, and 12 months post injury. The severity of the injury is the predominant contributor to disability in the short term but becomes insignificant over time, whereas the influence of age on recovery becomes important after 5 months.