A direct data entry system for processing dietary records: comparison with manual coding

Forty 7-day weighed food intake records were coded twice, once by transcribing codes and weights manually onto data sheets and once by direct data entry into a microcomputer using a menu-driven food coding program. To reduce the possibility of bias, a crossover design was used: one survey assistant coded the first 20 manually and then the second 20 by direct data entry; the other survey assistant coded the first 20 by direct data entry and the second 20 manually. The direct data entry system was found to reduce coding time by 32% and total processing time by 34%. The number of errors was also substantially reduced (by 39%). Direct data entry therefore represents a considerable improvement in the efficiency of data processing: for every 100 7-day records, 60 h of processing time would be saved.     

A comparison of dietary fibre intakes in South Wales estimated from a questionnaire and weighed dietary records

Intakes of dietary fibre in a random sample of 102 women living in a large South Wales village were measured by a four-day weighed dietary record and by questionnaire. The mean weekly intake of total dietary fibre calculated from the weighed records was 105.8g and that computed from questionnaires was 101.8g. The two methods indicated good agreement (r=0.51). Mean weekly cereal fibre intakes from weighed records and questionnaires were 46.6g and 46.4g respectively (r=0.69), and mean weekly fruit and vegetable fibre intakes were 59.2g and 55.4g respectively (r=0.34). The correlations were also good among a smaller group of 38 ‘health food shoppers’, consuming a high fibre diet. The questionnaire may therefore be used to obtain reliable data on dietary fibre intakes in free-living populations.     

Household factors associated with older Australian's purchasing a varied diet: Results from household expenditure data

Objective: To examine the household factors associated with older Australian's (aged 55 years and over) purchasing a varied diet. Design and methods: National cross‐sectional survey. Setting: All states and territories of Australia. Subjects: A total of 1898 households headed by adults aged 55 years and over. Main outcome measures: Food diversity was measured using the Dietary Variety Score (DVS). The DVS is the total number of food items purchased within a two‐week period, from a possible 110 individual food expenditure items. Data analysis: Negative binomial regression was used to examine the association between the respondent's individual and household characteristics with the DVS, after controlling for all factors in the model. Results: Among the demographic factors, living arrangements, age and education are found to be associated with dietary diversity. Lone males, lone females, and households headed by people with no secondary school education, or aged over 75 years were most likely to experience lower levels of dietary diversity. Conclusions: The finding that both poor education and low income in old age are associated with dietary diversity suggests the need for early life‐course interventions to improve nutritional outcomes. Nutrition education programs that also focus on those with poor education and low income, as well as lone person households and those aged over 75 years, may improve nutritional wellbeing, and thereby reduce public health costs.     

Estimation of food and macronutrient intake by household measures

Nine healthy women aged 21–57 years, ranging in weight from lean to obese, took part in a 12-d metabolic study on energy metabolism. They were provided with two different dietary regimes: a 'Standard' diet with 40% energy from fat and 45% energy from carbohydrate and a 'NACNE' diet with 30% energy from fat and 55% energy from carbohydrate. During both dietary periods they received a 3-d rotating menu. For 3 of the 6 days on each diet, all food and drink consumed was recorded by the women in units based on household measures. This record was used to estimate energy intake based on food composition tables and the subjects' assessment of the portion sizes in served meals. Estimated energy intake by the group averaged 97% of actual intake (range 83% to 112%) on the Standard diet, and 97% (range 67% to 115%) on the NACNE diet. There was a tendency to overestimate carbohydrate intake and underestimate fat intake on both diets. Protein was overestimated on the NACNE diet. There was little evidence of a relationship between body mass index (BMI) of subjects and the accuracy of estimation of total energy intake.     

The impact of a gluten-free diet on adults with coeliac disease: results of a national survey

OBJECTIVE We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (>or=16 years) with biopsy-proven celiac disease (CD). METHODS: A mail-out survey was used. Quality of life was evaluated using the 'SF12', and celiac-specific questions. RESULTS: Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The 'SF12' summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). CONCLUSIONS: Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.     

Dietary supplement use by South Korean adults: Data from the national complementary and alternative medicine use survey (NCAMUS) in 2006

There has been little data on the prevalence of supplement use and the characteristics of the dietary supplement users in the Republic of Korea. This study presents the prevalence and the details of any dietary supplement use and the characteristics of the adults who use dietary supplements in the Republic of Korea. Between May 18 and June 16, 2006, nationwide and population-weighted personal interviews with 6,201 adult aged from 30 to 69 years were conducted and the final sample consisted of 3,000 people with a 49.8% response rate. We examined the prevalence and details of the use of dietary supplements and the characteristics of those who use the dietary supplement among adults. About sixty two percent of adults had taken any dietary supplement during the previous 12-month period in 2006. The most commonly reported dietary supplement was ginseng, followed by multivitamins, glucosamine, probiotics, and vitamin C. Female (versus male), an older age group, a higher family income, those living in metropolitan cities, those with marital experience, those with a higher level of education, and those having medical problems had a greater likelihood of reporting the use of any dietary supplements. The particular relationships differed depending on the type of supplement. The most Korean adults took one more dietary supplement and the dietary supplement users had different demographic and health characteristics compared to those of the nonusers. Research on diet supplements by the medical community is needed in the future.     

Quality of morbidity coding in general practice computerized medical records: a systematic review

BACKGROUND: Increased use of computers and morbidity coding in primary care delivery and research brings a need for evidence of the quality of general practice medical records. OBJECTIVE: Our aim was to assess the quality, in terms of completeness and correctness, of morbidity coding in computerized general practice records through a systematic review. METHODS: Published studies were identified by searches of electronic databases and citations of collected papers. Assessment of each article was made by two independent observers and discrepancies resolved by consensus. Studies were reviewed qualitatively due to their heterogeneity. RESULTS: Twenty-four studies met the inclusion criteria for the review. There was variation in the methodology and quality of studies, and problems in generalizability. Studies have attempted to assess the completeness and correctness of morbidity registers by reference to a gold standard such as paper notes, prescribing information or diagnostic tests and procedures, each of which has problems. A consistent finding was that quality of recording varied between morbidities. One reason for this may be in distinctiveness of diagnosis (e.g. coding of diabetes tended to be of higher quality than coding of asthma). CONCLUSIONS: This review highlights the problems faced in assessing the completeness and correctness of computerized general practice medical records. However, it also suggests that a high quality of coding can be achieved. The focus should now be on methods to encourage and help practices improve the quality of their coding.     

Nutrient intakes of men in South Wales: a comparison of surveys taken in 1980–1983 and 1990

Nutrient intakes calculated from T-day, weighed, intake records obtained from a representative community sample of 98 men in 1990 were compared with those obtained from 665 men in the same community in 1980–83. The total energy intake decreased by 8% and this was accounted for by a fall in the intakes of fat, carbohydrate and alcohol. The percentage of total energy from fat fell from 37.3 to 35.5% and the percentage of food energy from fat fell from 39.5 to 35.5%. The percentages of total energy from saturated and monounsaturated fatty acids decreased from 17.3 to 15.3% and from 15.0 to 13.S%, respectively, and polyunsaturated fatty acids increased from 5.0 to 6.2%. The ratio of polyunsaturated: saturated fatty acids increased from 0.31 to 0.43. There was also a small increase in dietary fibre and vitamin C intakes (2 g/d and 11 mg/d respectively). The increased age of the cohort was found to account for approximately half of the fall in energy intake, but age did not account for some of the other dietary changes observed.     

中国膳食暴露评估数据库食物分类及编码研究

目的 对膳食调查及污染物监测数据进行分类和编码,为构建中国膳食暴露评估数据库奠定基础.方法 采用国际食品法典委员会(Codex Alimentarius Commission,CAC)食品法典(CODEX)的食物分类与我国食物成分表食物分类原则相结合的方式,按照食物所属组别前2位英文字母代表该食物的种类或来源,后4位数字代表该食物在CAC食物分类系统中排列序号的方式,对我国1 810 703条膳食消费量和487 810条污染物监测数据进行分类和编码.凡在CAC食物编码中找到对应编码的,一律采用CAC编码,对CAC编码中没有的食物则按CAC编码原则新增编码.结果 我国膳食消费数据分为6个大类、19个种类、75个组别,污染物监测农产品对应499个编码;相比CAC编码系统新增F(糖果类小食品)与G(饮料)2个大类、4个种类、33个组别、302个编码.新增组别大多为罐头类、饮料类、糖果类、肉制品类等动植物类加工食物,新增食物类别和编码大多是具有中国特色的食物.结论 初步实现了中国食物分类和编码与CAC分类编码系统的接轨,为膳食暴露评估奠定了数据交流的基础.     

Marriage and diet in elderly Australians: results from a large random survey

Living arrangement, marital status and dietary patterns were examined for a representative sample of 2195 people aged 65 years and over residing in Adelaide, South Australia. Several indicators of food consumption patterns, dietary variety, and energy and nutrient intake from a self-completed semiquantitative food-frequency questionnaire were analysed. Elderly men living with a spouse generally had more favourable dietary patterns than those living alone. Women living alone, on the other hand, had largely similar dietary patterns, and nutrient intakes equal to or greater than those of women living with a spouse.     

Prevalence and determinants of smoking in Belarus: A national household survey, 2000

A clear, up-to-date picture of smoking prevalence and its determinants is needed to inform the development of effective tobacco control policy in Belarus and other parts of the former Soviet Union. It is particularly important in view of the way the tobacco industry has targeted this region since transition. A nationally representative household survey designed to explore smoking behaviour and its determinants was undertaken in Belarus in April 2000. Data were available on 1090 individuals aged 18 years and over (response rate 53.4%). Respondents were similar demographically to the population of Belarus. Fifty three percent of men and 9% of women are current smokers and an additional 18% and 7% respectively are ex-smokers. Differences in smoking habits between successive generations were identified. These included a ninefold higher rate of ever-smoking amongst 18–29 years old women compared with those aged over 60 years (p < 0.0001) and a higher proportion of current smokers starting in childhood amongst those aged 18–29 years compared with older smokers (p = 0.0005). Smoking in public places, particularly the workplace where 65% smoke, is common. Smokers are more likely than non-smokers to have positive beliefs about the health impact of active and passive smoking (p < 0.0001). Amongst women the odds of smoking is 13 times higher in those living in large cities compared with those living in villages. In men, disadvantage and a positive attitude to the west appear to increase the likelihood of smoking. To date policy responses have been inadequate. Unless effective tobacco control policies are introduced, tobacco will continue to make an increasingly large contribution to premature morbidity and mortality in Belarus.     

Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

Background

After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services?

Methods

A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics.

Results

Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector.

Conclusions

There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers.     

Comparing estimates of disability prevalence using federal and international disability measures in national surveillance

Background

The National Health Interview Survey (NHIS) is changing the annual inclusion of standardized disability identifiers, reinvigorating the priority to examine existing disability question sets. These sets include questions developed by the United States (U.S.) National Center for Health Statistics in conjunction with the U.S. Census Bureau (the American Community Survey questions, ACS) and United Nations (the Washington Group Short Set questions, WGSS), that are policy relevant, comparable across populations, and short enough to be included in censuses and surveys across countries.

The validity of household budget survey (HBS) data: estimation of individual food availability in an epidemiological context

Household budget surveys (HBS) are conducted in most European countries and they represent a unique source of dietary data. However, the information on food availability is at the family level, which limits the investigation of the dietary habits of individuals. The key stages required to establish the validity of HBS data at the household and individual level are reviewed. Using examples from British data, the paper identifies some of the limitations and valid applications of HBS data. A statistical method is proposed to estimate the food availability of household members of different types, for example different age groups, based on the family composition. The validity of the method is presented by using British data from the National Food Survey and the National Diet and Nutrition Survey.     

Methods and demographic findings of the baseline survey of the NEDICES cohort: a door-to-door survey of neurological disorders in three communities from Central Spain

OBJECTIVE: To describe the methods and general results of the baseline longitudinal survey in a defined cohort of elderly people from three areas of Central Spain (urban and rural). The survey was designed to study dementia, essential tremor, Parkinson's disease and stroke. STUDY DESIGN: A population-based longitudinal study with door-to-door interviews. METHODS: This study was carried out in two phases: Phase 1 (health status questionnaire and screening performed by lay interviewers) and Phase 2 (diagnosis of neurological illnesses by neurologists). RESULTS: The study flow chart, screening instruments for neurological disorders, main demographic data (age, sex, educational attainment, occupation) and general health status of the 5,278 screened participants (2,238 men and 3,040 women) are given for the two phases. The response rate was 85.3%, and participation was higher in men and in the urban area. CONCLUSIONS: Participation rates were good in both phases of the NEDICES baseline study, and this was influenced by age, sex and setting of the participants. Educational attainment, occupation and health status data are analogous to other Spanish studies performed in the elderly. As the study population was large and good participation rates were achieved, precise analysis of morbidity of the neurological disorders investigated will be possible.     

Utilization of traditional healers in South Africa and costs to patients: findings from a national household survey

The use of traditional medicine is widespread in developing countries. We report on the utilization of traditional healers, using data obtained in a 2008 national survey of 4762 households in South Africa. Only 1.2 per cent of survey participants reported utilization of traditional healers. Respondents' reasons for visiting traditional healers included continuity of care and a belief in their effectiveness. Traditional healer utilization rates (0.02 visits per month) were considerably lower compared to utilization rates of public sector clinics (0.18 visits per month) or hospitals (0.09 visits per month). Almost three-quarters of the poorest quintile spent more than 10 per cent of their household expenditure in the previous month on traditional healers. Given the use of two parallel health-care systems, policy-makers should develop strategies to protect poor South Africans from out-of-pocket payments for health care. Simultaneous utilization of these systems evidently absorbs expenditure from low-income households significantly.