Methodology of the 1997 New Zealand National Nutrition Survey

AIMS: To describe the development and use of the methodologies in the 1997 New Zealand National Nutrition Survey (NNS97). METHODS: NNS97 was a voluntary cross-sectional population survey conducted over a twelve month period on 4,636 non-institutionalized urban and rural New Zealand residents aged fifteen years and older. Survey data were collected in the participants' home and included: a self-administered qualitative food frequency questionnaire, including questions on food preparation habits; a three-pass 24-hour diet recall; interviewer-administered questions on diet supplement use, barriers to dietary change and participant perception of household food security; physical measurements including weight, height, three circumferences, two skinfolds and elbow breadth; blood pressure; and a blood sample to determine cholesterol and iron status. RESULTS: New methodologies developed for NNS97 included a computer based interview system, probability analyses for estimating prevalence of inadequate intake of selected nutrients, determination of iron status by both dietary and biochemical assessment, assessments of dietary supplement use and food security. A full range of quality control procedures at each stage of the data collection were also initiated. CONCLUSION: NNS97 has improved on previous New Zealand national nutrition survey methodologies, particularly with direct data capture and rigorous quality control procedures used in the collection of survey data.     

National drug formularies: lessons from Latin America

Although pharmaceuticals comprise up to 40% of the health care budget in developing countries, the majority of the population does not have access to many of the essential drugs needed to treat prevalent diseases. This situation demands the development of a national formulary of essential drugs for the public sector. The approach used in developing countries is to select drugs of choice for the treatment of prevalent morbidities and avoid therapeutic duplication, unacceptably dangerous drugs, or drugs of unproven efficacy. Drugs are selected based on a review of the prevalent morbidities, health care worker training, patient characteristics, and efficacy/risk information resulting from scientifically sound studies. An added component to the formulary is the inclusion of concise, unbiased prescribing information for each drug selected. A number of product selection guidelines were proven to be effective in establishing and maintaining an essential drug formulary for developing countries. These guidelines include: 1. Selection of drugs with proven efficacy and acceptable risk; 2. Selection of minimum number of drugs needed to treat the prevalent diseases; 3. Inclusion of new products only if they are found to have distinct advantages over products currently in use; 4. Inclusion of combination products only when they provide true benefit over single ingredients; 5. Selection of drugs with clear "drug of choice" indications for prevalent diseases; 6. Evaluation of the administrative and cost impact of products; and 7. Selection of drugs with established high quality.     

Neurobehavioral test performance in the third National Health and Nutrition Examination Survey

The third National Health and Nutrition Examination Survey (NHANES III) contained three computerized neurobehavioral tests from the Neurobehavioral Evaluation System (NES): simple reaction time, symbol–digit substitution and serial digit learning. The neurobehavioral data that were collected came from a nationally representative sample of adults 20–59 years old. Performance on the tests was related to sex, age, education level, family income and race-ethnicity. Performance decreased as age increased, and increased as education level and family income increased. Differences in performance between sexes, levels of education and racial-ethnic groups tended to decrease as family income increased. The relationship between age and performance on the symbol–digit substitution test varied by education level and by racial-ethnic group. The relationship between age and performance on the serial digit learning test varied by racial-ethnic group. Questionnaire variables that were related to performance on one or more of the tests included the reported amount of last night's sleep, energy level, computer or video game familiarity, alcoholic beverages within the last 3 h and effort. Persons who took the tests in English or Spanish performed differently on the symbol–digit substitution and serial digit learning tests. Performance on all the tests decreased as test room temperature increased.     

Applying pharmaceutical lessons: learning lessons from the past

Systematic evaluation of a project, product or other successes, and failures, is an important method for improving the performance of a company, as well as that of an individual. One should evaluate and determine if lessons learned can be applied to the systems and procedures being used in the company. Even if the company does not have to adjust its strategies, procedures, portfolio or systems as a result of lessons it has learned, there may be pointers to communicate to staff. It is easy for many aspects of a system to become outdated, particularly in an organization that is growing or changing rapidly. It is therefore generally appropriate to evaluate the company's regulatory compliance, toxicology compliance, clinical auditing practices and other appropriate systems on an annual or biannual basis. Most lessons of success or failure are specific to a single situation because of the combination of people, drug, competition, priorities and many other factors involved, and cannot be extrapolated to other situations. Some general lessons and principles are presented that will facilitate drug discovery, development and marketing.     

Predicted coronary risk for adults with coronary heart disease and low HDL-C: an analysis from the US National Health and Nutrition Examination Survey

ABSTRACT

Purpose: To assess the national prevalence of low levels of high-density lipoprotein cholesterol (HDL-C) among adults with coronary heart disease (CHD) and the relationship between low HDL-C and predicted rates of recurrent CHD events.

Methods: This study used data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) to examine the prevalence of risk factors for recurrent CHD events among survey respondents with existing CHD. The predicted probability of recurrent CHD events in the next 10 years was estimated using published Framingham Heart Study equations for secondary CHD prevention. All data analyses were weighted to produce national estimates using the NHANES sampling weights.

Results: This study included 1291 survey participants aged?≥?40 years who self-reported having coronary heart disease, angina, or heart attack. Of the study subjects with available HDL-C data, the percentage of respondents who had low HDL-C (<?40?mg/dL), intermediate HDL-C (40 to < 60?mg/dL), and high HDL-C (≥?60?mg/dL) was 29%, 50%, and 21%, respectively, based on the national weighted population estimate. For respondents with low HDL-C, the prevalence of diabetes in men and the prevalence of smoking in women were significantly higher than those with high HDL-C (?p?<?0.05). The predicted 10-year coronary risk for subjects with low HDL-C was considerably higher than for subjects with intermediate and high HDL-C. Although subjects with low HDL-C comprised only 29% of the population, they contributed approximately 38% of the subjects with predicted CHD events.

Limitations: The assessment of certain CHD risk factors and the existence of CHD in the NHANES surveys relied on self-reports, which are subject to recall bias.

Conclusions: Study results showed that US adults with CHD and low HDL-C will likely contribute a disproportionately high percentage to total CHD events in the next 10 years, suggesting the need for greater awareness of the consequences of low HDL-C.     

Lead and cognitive function in VDR genotypes in the third National Health and Nutrition Examination Survey

The relationship between the blood lead concentration and cognitive function in children and adults with different VDR genotypes who participated in the third National Health and Nutrition Examination Survey was investigated. The relationship between blood lead and serum homocysteine concentrations was also investigated. In children 12 to 16 years old, performance on the digit span and arithmetic tests as a function of the blood lead concentration varied by VDR rs2239185 and VDR rs731236 genotypes. Decreases in performance occurred in some genotypes, but not in others. In adults 20 to 59 years old, performance on the symbol-digit substitution test as a function of the blood lead concentration varied by VDR rs2239185–rs731236 haplotype. In the 12 to 16 year old children and adults 60 or more years old, the relationship between the serum homocysteine and blood lead concentrations varied by VDR genotype. The mean blood lead concentrations of the children and adults did not vary by VDR genotype.     

Contribution of dietary patterns to blood heavy metal concentrations in Korean adults: Findings from the Fifth Korea National Health and Nutrition Examination Survey 2010

The aim of the present study was to evaluate the associations between dietary patterns and blood levels of lead and mercury in Korean adults. A total of 858 Korean adults (⩾20 years) who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) V-1 2010 were included in this study. Data of biochemical measurements including blood lead and mercury levels, nutrients intakes and anthropometric measurements were acquired. ‘Balanced diet’, ‘Grain and kimchi’, and ‘Alcohol and noodle’ dietary patterns were derived from a factor analysis, and the subjects were divided into tertiles by each dietary pattern score. A logistic multiple regression analysis showed that the balanced diet pattern was negatively associated with blood levels of lead before and after adjustment. On the other hand, the alcohol and noodle pattern was positively associated with blood lead and mercury levels. These results indicate that the alcohol and noodle dietary pattern characterized by high alcohol consumption and lack of various foods, and the balanced dietary pattern, including vegetable, fish, meat and milk intake, was associated with the blood concentrations of heavy metals in Korean adults.     

Predictors of physical assault victimization: findings from the National Survey of Adolescents

Exposure to interpersonal victimization during childhood and adolescence is prevalent and has been found to be associated with negative physical and mental health outcomes. The present study examined the relations between childhood violence exposure and mental health on subsequent exposure to new physical assault in young adults using longitudinal nationally representative, prospective data from the initial (Wave I) and follow-up interviews (Wave II) of the National Survey of Adolescents (NSA). Among the 1,753 participants who completed both assessment time points, 15.8% reported a new physical assault experience at Wave II. Results indicated that racial/ethnic status, gender, history of child physical abuse, witnessed violence drug use, and family drug problems reported at Wave I were all significant predictors of new physical assault. Implications are discussed.     

Lead and cognitive function in ALAD genotypes in the third National Health and Nutrition Examination Survey

The relationship between the blood lead concentration and cognitive function in children and adults with different ALAD genotypes who participated in the third National Health and Nutrition Examination Survey was investigated. The relationship between blood lead and serum homocysteine concentrations was also investigated. In children 12 to 16 years old, no difference in the relationship between cognitive function and blood lead concentration between genotypes was found. In adults 20 to 59 years old, mean reaction time decreased as the blood lead concentration increased in the ALAD rs1800435 CC/CG group. This represents an improvement in performance. In adults 60 years and older, no difference in the relationship between cognitive function and blood lead concentration between genotypes was found. The serum homocysteine concentration increased as the blood lead concentration increased in adults 20 to 59 years old and 60 years and older, but there were no differences between genotypes. The mean blood lead concentration of children with the ALAD rs1800435 CC/CG genotype was less than that of children with the GG genotype.     

Prevalence of Alcoholic Liver Disease Among Korean Adults: Results From the Fourth Korea National Health and Nutrition Examination Survey, 2009

Background/Aim: Alcohol consumption continues to be a common cause of acute and chronic liver disease. Methods: Data from a representative sample of 7,893 adults in the Korean National Health and Nutrition Examination Survey 2009 were analyzed. Alcoholic liver disease (ALD) was defined through heavy alcohol consumption (≥40 g/day for men or ≥20 g/day for women) and through elevated liver tests. Results: Approximately 6.7% (95% confidence interval [CI], 6.0–7.4) was at heavy alcohol consumption. Of these “heavy alcohol consumers,” one quarter also had ALD. The prevalence of ALD was 1.7% (95% CI, 1.3–2.1). Conclusion: ALD is still a burden in the Korean population.     

Snapshot of unemployed pharmacists from the 2019 National Pharmacy Workforce Survey

BackgroundPrior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market.ObjectivesWe sought to investigate the rate of unemployment and situations of unemployed pharmacists.MethodsData from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed.ResultsOverall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less.ConclusionAn increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts.