Case-Mix Adjustment of the CAHPS® Hospital Survey

Objectives: To develop a model for case-mix adjustment of Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) Hospital survey responses, and to assess the impact of adjustment on comparisons of hospital quality.
Data Sources: Survey of 19,720 patients discharged from 132 hospitals.
Methods: We analyzed CAHPS Hospital survey data to assess the extent to which patient characteristics predict patient ratings ("predictive power") and the heterogeneity of the characteristics across hospitals. We combined the measures to estimate the impact of each predictor ("impact factor") and selected high impact variables for adjusting ratings from the CAHPS Hospital survey.
Principle Findings: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service. Adjustment for GHS and education affected scores in each of the three services, while age and being non-Hispanic black had important impacts for those receiving surgery or medical services. Circulatory disorder, Spanish language, and Hispanic affected scores for those treated on surgery, obstetrics, and medical services, respectively. Of the 20 medical conditions we tested, only circulatory problems had an important impact within any of the services. Results were consistent for the overall ratings of nurse, doctor, and hospital. Although the overall impact of case-mix adjustment is modest, the rankings of some hospitals may be substantially affected.
Conclusions: Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals.     

Methods Used to Streamline the CAHPS® Hospital Survey

Objective. To identify a parsimonious subset of reliable, valid, and consumer-salient items from 33 questions asking for patient reports about hospital care quality.
Data Source. CAHPS^® Hospital Survey pilot data were collected during the summer of 2003 using mail and telephone from 19,720 patients who had been treated in 132 hospitals in three states and discharged from November 2002 to January 2003.
Methods. Standard psychometric methods were used to assess the reliability (internal consistency reliability and hospital-level reliability) and construct validity (exploratory and confirmatory factor analyses, strength of relationship to overall rating of hospital) of the 33 report items. The best subset of items from among the 33 was selected based on their statistical properties in conjunction with the importance assigned to each item by participants in 14 focus groups.
Principal Findings. Confirmatory factor analysis (CFA) indicated that a subset of 16 questions proposed to measure seven aspects of hospital care (communication with nurses, communication with doctors, responsiveness to patient needs, physical environment, pain control, communication about medication, and discharge information) demonstrated excellent fit to the data. Scales in each of these areas had acceptable levels of reliability to discriminate among hospitals and internal consistency reliability estimates comparable with previously developed CAHPS instruments.
Conclusion. Although half the length of the original, the shorter CAHPS hospital survey demonstrates promising measurement properties, identifies variations in care among hospitals, and deals with aspects of the hospital stay that are important to patients' evaluations of care quality.     

农民工艾滋病危险行为变化趋势及感染状况调查分析

目的 了解农民工群体艾滋病知识态度、行为特征变化趋势以及艾滋病感染情况.方法 2012-2014年连续三年采用固定场所连续抽样法,对大理市农民工进行问卷调查和HIV抗体检测,样本量为每年400人.结果 农民工艾滋病知识知晓率从79.8％上升到98.5％(x2=80.17,P＜0.001),多因素分析显示文化程度、是否接受过艾滋病干预服务、年龄为艾滋病知晓率的独立影响因素.农民工商业性行为时安全套坚持使用率无明显趋势变化(r=-0.238,P=0.149);临时性行为坚持使用安全套的比例分别为28.6％、46.4％和56.3％;与配偶坚持使用安全套比例从4.8％增加到6.3％(r=0.048,P=0.031).农民工三年HIV感染率为分别为0.0％、0.0％和0.5％.结论 针对农民工群体的艾滋病干预取得了一定成效,但安全套使用率仍然处于较低水平,临时性行为比例出现上升,应引起关注.今后应进一步加强部门合作,针对该群体继续加强艾滋病的综合干预,特别加强对文化程度较低和年龄较大的农民工的干预,扩大干预和HIV检测覆盖面.     

开远市CSW人群HIV／AIDS／STI监测结果分析

[目的]了解开远市暗娼人群HIV／AIDS／STI流行状况，及相关知识知晓现状，为进一部宣传教育和行为干预活动方案的制定，提供科学依据。[方法]使用标准问卷进行一对一调查，实验室HIV和梅毒检测用项目统一方法，调查结果全部输入计算机用SPSS统计软件包进行分析。[结果]共调查366人，合格问卷363份，问卷合格率为99．18％，其中梅毒阳性率为11．82％，HIV阳性率为16．16％。[结论]暗娼人群、HIV／STIS流行形势较为严竣。目标人群相关知识、知晓率有待进一步提高。     

Market Surveys to Determine Availability of Reduced Glycemic Load/High Fiber Products

Availability of prepared foods in today’s market that provide healthy diets for consumers 65 and older is lacking. A general market survey, covering nine grocery stores and approximately 400 items in the greater Baton Rouge area, was conducted on snack foods, frozen meals, and dry products. Two other surveys included a survey of pasta items and a blind consumer survey targeting consumers ages 65 and older. In each survey, products were categorized as high, medium, or low in fiber and low, medium, or high glycemic load. Prepared meals with high levels of dietary fiber and low glycemic loads were found to be rare. Results from the blind consumer survey found that key unsatisfactory characteristics in commercial products were texture and color. Our research suggests that there is a need for the development of healthier prepared meals in the grocery store market.     

Identifying Chinese populations in the UK for epidemiological research: experience of a name analysis of the FHSA register

Definition of Chinese. For the purposes of this study, Chinese refers to residents of the UK who either on the basis of name (face-to-face contact not made), or self-definition and appearance (contact made) had origins in China and included those born in the UK and others migrating to the UK via a third country (for example Vietnam, Singapore, Hong Kong etc). This is a pragmatic definition.There is a paucity of research on health in the UK Chinese community partly due to the difficulties of identifying and accessing study populations. For a survey of cardiovascular disease we aimed to identify and recruit all Chinese adults aged 25–64 y living in Newcastle-upon-Tyne, UK. One thousand, eight hundred and sixty-five potential subjects were identified using a variety of methods. Of the 1702 potential subjects identified from a name analysis of the 1991 FHSA register (FHSA group), 638 students in halls of residence were excluded and the remaining 1064 were invited to participate. Non-respondents were followed up. Of the 1064, 658 (65.5%) addresses were no longer valid, 21 (2%) were reclassified as non-Chinese and no contact was made with 18 individuals (1.6%). A further 163 subjects (non-FHSA group) came forward in response to publicity, giving a total of 530 Chinese actually identified in Newcastle. Three hundred and eighty subjects took part in the study. Compared to the 1991 Census, the recruitment procedure underestimated the total population size, particularly for men and younger ages. In the FHSA group, men were significantly more likely to be current drinkers, and women were more likely to smoke and have a lower educational attainment that the non-FHSA group. There were no other important differences in the distribution of CHD risk markers in the two groups. Our experience indicates that the FHSA register is suitable for identifying Chinese but should be used alongside other complementary methods to augment samples for ethnicity and health research.     

武威市2010年吸毒人群艾滋病哨点监测结果分析

目的了解武威市吸毒人群艾滋病、丙肝、梅毒感染状况及艾滋病相关知识知晓现状,为武威市制订宣传教育和行为干预活动方案提供科学依据。方法采用国家艾滋病哨点监测方案对2010年武威市戒毒所及社区吸毒人员进行问卷调查和血清学调查。结果共调查合格问卷460份,其中HIV阳性率为0.40%,HCV阳性率为4.30%,梅毒阳性率为4.60%。结论应大力推广100%安全套使用,进一步加大干预覆盖面,有针对性地进行行为干预,降低其危险行为,切断吸毒人群在我市艾滋病传播中的桥梁作用。     

对艾滋病高流行区普通人群HIV/AIDS和避孕套基本知识与观念的定性调查

目的:了解四川省艾滋病高流行区域普通人群对HIV/AIDS、避孕套等基本知识、观念和态度,为在该地区实施干预性项目提供科学依据。方法:2002年9～10月采用定性调查—小组访谈方法对该区域不同类型人群进行相关知识、观念和态度的调查。结果:大多数社区负责人对艾滋病相关知识有所了解,而大部分社区普通人群对艾滋病相关知识了解较少,并存在一些误解和恐惧心理;大多数社区群众知道避孕套有避孕作用,但对其有预防HIV/AIDS的作用知道不多。结论:有必要在该地区普通人群中开展HIV/AIDS等基本知识的宣传,尤其是对避孕套预防HIV/AIDS作用的宣传。     

The effect of a lindane and mercury polluting incident on the health of a community: The Somerton Health Survey

Objectives: This study sought to identify possible illnesses of people exposed to lindane and methyl mercury following a pollution incidence in Somerton, Somerset, UK.Methods: A self-administered questionnaire survey was posted to 1500 residents in three selected areas of Somerton to identify symptoms of possible illnesses over a 3 month period.Results: There was a 74% response rate. People living near the stream had higher levels of reported mental symptoms and itching skin than in controls. Poisoning as the cause of the mental symptoms was excluded as the individuals had normal blood levels of lindane or mercury. Other symptoms were no higher in one area than another or from one time period to another.Conclusions: The survey, using controls in time and space, was able to explore, the pollution incident's contribution to the toxicity of residents and how this related to mental symptoms experienced by the residents.     

浦东新区川沙镇流动人口性病艾滋病KAP调查及影响因素分析

[目的] 了解浦东新区川沙镇流动人口对性病艾滋病(STD/HIV)的认知、态度和行为(KAP)的现状,为下一步健康教育干预提供依据。 [方法] 采用分阶段抽样的方法随机抽取1 034名流动人口,发放自填式匿名问卷。[结果] 93.5％被调查者对STD/HIV的相关知识有一定的了解;STD/HIV知识知晓情况与性别、年龄、教育程度、收入等因素相关(P<0.01);被调查者赞同婚前性行为和婚外性行为者分别为45.2％、26.1％,男女性别差异有显著性(P<0.01);被调查者安全套的使用率仅为7.2％。 [结论] 川沙镇流动人口对STD/HIV知识还缺乏一定的认识,存在感染STD/HIV的高危态度和行为。因此,有必要针对性地对流动人口开展形式多样的综合干预。     

性商业服务者HIV/AIDS的KABP调查

目的　了解性商业服务者 (CSW )对艾滋病的预防知识、行为和态度 ,为今后在CSW中开展同伴教育奠定基础。方法　采用面对面交流方式对CSW中的志愿者进行访谈、问卷调查。结果　CSW对艾滋病防治知识的正确率为 12 5 0 %～ 79 6 9% ,30天每次性行为安全套的使用率 4 5 31% ,主动进行检测抗 HIV者极少 (2 81% ) ,多数CSW(76 5 0 % )希望获得医务人员帮助。结论　行为改变是今后CSW健康教育中值得关注的问题     

Association of Nut Consumption with Cardiometabolic Risk Factors in the 2008/2009 New Zealand Adult Nutrition Survey

Nut consumption has been associated with improvements in risk factors for chronic disease in populations within North America, Europe and Iran. This relationship has not been investigated in New Zealand (NZ). The associations between nut consumption and cardiometabolic risk factors among New Zealanders were examined. Data from the 24-h diet recalls of 4721 participants from the NZ Adult Nutrition Survey 2008/2009 (2008/2009 NZANS) were used to determine whole and total nut intake. Anthropometric data and blood pressure were collected, as well as blood samples analysed for total cholesterol (total-C) and HDL cholesterol (HDL-C), glycated haemoglobin (HbA1c), C-reactive protein (CRP) and folate. Participants were classified according to their five-year cardiovascular disease (CVD) risk. Both whole and total nut consumers had significantly lower weight, body mass index (BMI), waist circumference and central adiposity than non-nut consumers (all p ≤ 0.044). Whole blood, serum and red blood cell folate concentrations were significantly higher among whole nut consumers compared to non-whole nut consumers (all p ≤ 0.014), with only serum folate higher in total nut consumers compared to non-total nut consumers (p = 0.023). There were no significant differences for blood pressure, total-C, HDL-C and HbA1c; however, significant negative associations between total nut consumption and CVD risk category (p < 0.001) and CRP (p = 0.045) were apparent. Nut consumption was associated with more favourable body composition and a number of risk factors, which could collectively reduce chronic disease.     

医院患者就医满意度问卷调查法和电话调查法的差异化比较

目的：研究问卷调查和电话调查两种方法调查患者满意度的优劣。方法分别采用问卷调查法和电话调查法对出院患者就医满意度进行调查,比较两种方法每小时的调查人数和患者的满意度。结果问卷调查组每小时调查的患者人数为8人,电话调查组每小时调查的患者人数为15人;电话随访组病人满意度为90.73%,问卷调查组患者满意度为95.61%。两种调查方式比较,每小时的调查人数和患者的满意度差异均有统计学意义（P 〈0.01）。结论电话随访调查法优于问卷调查法。     

海口市秀英区按蚊种类、分布及季节消长调查

目的 了解海口市秀英区2018年按蚊种类、分布及季节消长情况,为评估疟疾传播风险,制订消除疟疾后的防控策略和方案提供科学依据。 方法 采用灯光诱捕法(诱蚊灯法)、动物诱捕法(动物帐诱法)、人诱捕法(人诱停落法),在秀英区6个乡镇中每个乡镇随机抽取1个自然村进行按蚊种类及分布调查;选取1个自然村为监测点,研究媒介按蚊季节消长规律。 结果 6个调查点共捕获按蚊6种458只,其中中华按蚊218只(47.60%),棋斑按蚊187只(40.83%),迷走按蚊44只(9.61%),乌头按蚊4只(0.87%),须喙按蚊3只(0.66%)、带足按蚊2只(0.44%)。季度消长监测点1—12月共捕获按蚊7种1 421只。其中中华按蚊、棋斑按蚊、迷走按蚊所占比例分别为44.76%、39.55%、15.20%。按蚊数量从4月份开始增多,9月达到高峰,5—11月捕获数占全年89.23%;中华按蚊全年都有活动。 结论 2018年海口市秀英区主要按蚊种类为中华按蚊、棋斑按蚊和迷走按蚊,未发现以往的主要传疟媒介微小按蚊。按蚊密度在2018年5—11月有一持续高峰,其他月份密度均处于较低水平。     

Trends in oral contraceptive use in a Southern German population: Results of the MONICA project Augsburg: surveys 1984/85 and 1989/90

In the surveys of the MONICA project Augsburg, conducted in1984/85 (S1) and 1989/90 (S2), data on oral contraceptive (OC)use were gathered in two independent representative population-basedsamples of women aged 25–44 years (medication historyover the previous seven days). OCs were categorized accordingto their oestrogen content (< 50mg, 50mg) and according totheir progestogen component. The prevalence of OC use was unchangedbetween the two points in time (23.4% in S1 and 23.7% in S2).OCs with low oestrogen content were used in 49.0% of the OCusers in S1 and in 76.6% in S2. The use of the progestogen componentchanged also: norethindrone (acetate), levonorgestrel, and lynestrenolwere used less, desogestrel more often in S2. Gestoden and norgestimatewere used by 15% of the OC users in S2. In conclusion, we cansay that there was no change in the prevalence of OC use inthe study population; however, a change in hormone content towardspreparations with lower hormone content was observed.     

青海省东部猪带绦/囊虫病流行病学调查

[目的]了解和掌握青海省东部人体猪带绦虫病和囊虫病的流行现状及其影响因素。[方法]①问卷调查居民排节片史、食米猪肉史；②应用改良加藤氏厚涂片法镜检人体肠道带绦虫卵；③ELISA法查血清抗体；④CT/MRI检查结果。[结果]粪便检查7714人，查出猪带绦虫感染者11例，感染率为0.14%；检测血清3370人份，囊虫病阳性233例，阳性率为6.91%。[结论]青海省猪带绦/囊虫病的感染以经济欠发达的浅山地区感染较高；儿童和青壮年为高危人群。由于该病危害严重，应积极普及健康教育，大力加强该病的预防控制工作。