Register-based data indicated nonparticipation bias in a health study among aging people

Objectives

To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people.

Study Design and Setting

Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements.

Results

Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups.

Conclusion

Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.     

Overview of the Clinical Consult Case Review of adverse events following immunization: Clinical Immunization Safety Assessment (CISA) network 2004-2009

Background

In 2004 the Clinical Consult Case Review (CCCR) working group was formed within the CDC-funded Clinical Immunization Safety Assessment (CISA) Network to review individual cases of adverse events following immunizations (AEFI).

Methods

Cases were referred by practitioners, health departments, or CDC employees. Vaccine Adverse Event Reporting System (VAERS) searches and literature reviews for similar cases were performed prior to review. After CCCR discussion, AEFI were assessed for a causal relationship with vaccination and recommendations regarding future immunizations were relayed back to the referring physicians. In 2010, surveys were sent to referring physicians to determine the utility and effectiveness of the CCCR service.

Results

CISA investigators reviewed 76 cases during 68 conference calls between April 2004 and December 2009. Almost half of the cases (35/76) were neurological in nature. Similar AEFI for the specific vaccines received were discovered for 63 cases through VAERS searches and for 38 cases through PubMed searches. Causality assessment using the modified WHO criteria resulted in classifying 3 cases as definitely related to vaccine administration, 12 as probably related, 16 as possibly related, 18 as unlikely related, 10 as unrelated, and 17 had insufficient information to assign causality. The physician satisfaction survey was returned by 30 (57.7%) of those surveyed and a majority of respondents (93.3%) felt that the CCCR service was useful.

Conclusions

The CCCR provides advice about AEFI to practitioners, assigns potential causality, and contributes to an improved understanding of adverse health events following immunizations.     

IS PROBABILITY SAMPLING ALWAYS BETTER? A COMPARISON OF RESULTS FROM A QUOTA AND A PROBABILITY SAMPLE SURVEY

Two surveys in the same defined population in Sydney's western suburbs in 1986 and 1987 provided the opportunity to compare results obtained from a quota and a probability sample survey. These surveys were designed to provide information for the planning of local health promotion programs. The quota sample survey was conducted in shopping centres and used quota sampling to select 1727 respondents. In the second survey, area probability sampling was used to select 484 respondents. This survey had a response rate of 65 per cent. There were 15 questions common to both surveys; results of only three differed significantly (p<0.05) between surveys. None of these differences was important from a public health perspective. The agreement between the results of these two surveys probably reflects the fact that the same selection bias has operated in both. Unless a very high response rate can be achieved, quota sample surveys with age and sex quota controls may be an acceptable alternative to probability sample surveys for gathering local data relevant to the development of health programs.     

Elderly Nutrition and Health Survey in Taiwan (1999-2000): research design, methodology and content

The purpose of the Elderly Nutrition and Health Survey in Taiwan (1999-2000) was to assess the diet, nutrition and health of persons aged 65 and above in Taiwan. A multi-staged, stratified, clustered probability sampling scheme was used in the survey. The survey population was stratified into a total of 13 strata. The four strata of "Hakka areas", "Mountain areas", " Eastern areas", and "PengHu islands" were unique in their ethnicity or geographic locations. The remaining areas of Taiwan were stratified into "Northern", "Central", and "Southern" parts with these 3 strata, then each subdivided into a further 3 strata based on population density. The household interview of the survey was arranged such that effect of seasonal variation was taken into account. A total of 1,937 persons completed the interview and 2,432 persons completed the health exam. The following data were collected: (1) Interview data : household information, basic demographics, 24 hour dietary recall, food frequency and habit, knowledge, attitudes and practice, medical history, 36-item Short Form for generic health status, and physical activity. (2) Health exam data: blood sample for measurement of nutritional biochemical indicators and complete clinical chemistry profile, urine sample for urinary electrolytes, anthropometric measurements, ECG, blood pressure, body temperature, pulmonary function, and an osteoporosis assessment. Data from the survey were analyzed using SUDAAN to adjust for the design effect and to obtain unbiased estimates of the mean, standard error and confidence intervals. Survey respondents were slightly younger compared to non-respondents; however, after weighting and adjustment with SUDAAN, the education levels and ethnicity of respondents and non-respondents were similar indicating lack of bias. We anticipate that the results of this survey will be of benefit in understanding the nutritional status of the elderly, the relationship between nutrition and health, and factors influencing elderly persons' nutritional status. Furthermore, this information could be used in the development of public health nutrition policy aimed at improving the nutrition and health of the elderly in Taiwan.     

A baseline survey of the Primary Healthcare system in south eastern Nigeria

A baseline survey to audit the PHC operations and determine community perception and expectations of PHC service delivery was conducted in 72 communities in Enugu state, southeastern Nigeria. The study was intended to facilitate the development of intermediate performance indicators for monitoring the progress of an ongoing health sector reform and to gather baseline data for planning and policy formulation. The tools used for the operations audit assessed indicators for evaluating: (a) Stewardship, (b) Service Provision and (c) Administrative and financial management; while the community survey was assessed by, (a) utilization of health services, (b) perception of service delivery and (c) health care financing. One hundred and sixteen respondents from each of the facilities in the sample frame were interviewed using a structured self-assessment questionnaire and a qualitative assessment was undertaken in 53 of the facilities using an audit guide. Focus group discussions (FGD) were conducted with the policy makers and planners in each of the 17 LGAs in the state. A total of 832 respondents were interviewed in the communities (using a structured questionnaire) and 42 community FGDs were conducted. The results indicate a lack of operational efficiency in the majority of the facilities audited. It was also observed that majority of the facilities do not provide all services required of it, are poorly maintained, do not have enough skilled health workers and operate without a budget. There appears to be no formal financial management system in place and no policy on financial resource generation. The community survey identified two major problems; low utilization of PHCs and poor service provision. The key indicator identified by the community for evaluating performance of the PHCs remains "access to essential drugs". The major prospect was the willingness of an appreciable number of respondents to invest in health financing through insurance schemes and payment of health tax among others. It was evident that poor funding, bad management practices and infrastructural decay is the bane of efficient PHC delivery. Consequently, we propose that cost determination studies, to establish the financial implication of the minimum package for provision of primary healthcare services, should be an essential prerequisite to the reform process. Some critical cross-cutting issues identified from the data obtained which could form the basis for major policy thrust include, development of strategies for sustainable promotion of public-private-partnership for enhanced community involvement in healthcare management, ensuring that interventional investment is proportional to the felt health needs of the populace and funding of healthcare through equitable integration of user fees/charges.     

Conducting the National Lesbian Health Care Survey: First of Its Kind

The authors of the National Lesbian Health Care Survey (NLHCS) describe the process, challenges, and experiences in planning and conducting the first and largest lesbian health survey, which helped define lesbian health and mental health issues. Challenges include lack of funding, lack of awareness that sexual orientation may affect access to care and health outcomes, sexism, homophobia, fear of AIDS, and lack of guidelines for conducting survey research with lesbians. The methodology was designed to reach a broad range of lesbians throughout the United States, including low-income lesbians, nonurban lesbians, lesbians of color, and lesbians with less formal education. Planning the survey took several years and helped frame how lesbians conceptualize health. Planning began in the late 1970s and data were collected during the fall of 1984 and spring of 1985, at a time when AIDS was emerging as a major focus for community services, research, and funding, and this is reflected in the history of conducting the survey. The process of questionnaire distribution and data collection made broad use of lesbian networks throughout the country, creating for respondents a sense of participation in a larger movement with special significance for lesbians. The National Lesbian Health Care Survey resulted in demographic, health, mental health, and community life experiences from 1925 lesbians from all 50 U.S. states and several territories, and is still the most extensive study of lesbians published to date.     

Evaluating Usefulness of Maine’s Syndromic Surveillance System for Hospitals, 2012

Objective

To assess the usefulness and acceptability of Maine’s syndromic surveillance system among hospitals who currently participate.

Introduction

Maine has been conducting syndromic surveillance since 2007 using the Early Aberration Reporting System (EARS). An evaluation of the syndromic surveillance system was conducted to determine if system objectives are being met, assess the system’s usefulness, and identify areas for improvement. According to CDC’s Guidelines for Evaluating Public Health Surveillance Systems, a surveillance system is useful if it contributes to the timely prevention and control of adverse health events. Acceptability includes the willingness of participants to report surveillance data; participation or reporting rate; and completeness of data.

Methods

A survey was created in 2012 to measure usefulness and acceptability among hospital partners who submit emergency department data to Maine CDC for syndromic surveillance. Currently, 24 of Maine’s 37 emergency departments collect syndromic surveillance data and 20 of those receive a weekly syndromic surveillance report from Maine CDC. The survey was included with the report on August 14, 2012, and hospitals were given two weeks for completion. The survey included questions about how useful hospitals find syndromic surveillance and how data is shared back with the hospitals; which syndromes are most and least useful; and chief complaint data collection at individual hospitals.

Results

The survey was completed by 13 out of 22 emergency departments (59% participation rate), and six out of 13 respondents (46%) completed the entire survey. The factors reported as having an influence on a hospital’s decision to submit data for syndromic surveillance were: public health importance of events (6 respondents) and assurance of privacy/confidentiality (5 respondents). The majority of respondents (5 respondents) reported that there are no factors that limit their ability to send emergency department data. Among hospitals that did report factors that limit their ability to send data, lack of information technology support in the hospital (2 respondents) and manually entering data/lack of electronic health records (1 respondent) were the most frequently reported. Six out of seven hospitals who answered (86°%) reported the current method of sharing syndromic surveillance data on a weekly basis, including a statewide data summary, as useful. Respondents also recommended that data be shared back with participants using 30-day line graphs for each syndrome (4 respondents). The three syndromes respondents found most useful were influenzalike illness (7 respondents), gastrointestinal (5 respondents), and respiratory (5 respondents). The three syndromes respondents found least useful were the broad heat syndrome (4 respondents), the narrow heat syndrome (4 respondents), and the other syndrome that captures all visits not classified into any syndrome (4 respondents). Chief complaint data, which is used to classify emergency department visits into syndromes, is most often recorded by a drop-menu (4 respondents).

Conclusions

With a low survey completion rate, it is difficult to generalize responses to all hospitals who participate in syndromic surveillance. Hospitals that did not respond to or complete the survey will be followed up with to determine their reasons for not doing so, as this may be useful information. In general, those who responded have more factors that influence them to contribute to syndromic surveillance than factors that hinder them. Most hospitals find the current method of sharing data back with the hospitals useful. Also, it is advantageous to know which syndromes the hospitals find most useful, as they are the entities that collect and report the data. Opinions differ among system users, which is why it is important to evaluate a system throughout all points of interaction.     

Exploring the characteristics of the research workforce in Aboriginal and Torres Strait Islander health

OBJECTIVE: This study was conducted to better understand the characteristics of current and past researchers in Indigenous health in Australia and the factors that may influence decisions about working in this field. METHODS: A self-administered survey by e-mail or post to all individuals listed as an author on a published paper or who completed a PhD or masters research degree in the field of Indigenous health between 1995 and 2004. RESULTS: We identified 472 papers and 151 theses; from these, 1,067 authors were identified. Completed questionnaires were returned by 373 authors (35%), of whom 32 (9%) identified as Aboriginal and/or Torres Strait Islander. The majority (80%) of respondents were active in research but only 38% considered Indigenous health to be their primary area of research. The most important attractive factor about Indigenous health research (IHR) selected by respondents was "important area/national priority" (35%) and the most unattractive factor was "politics" (30%). There was considerable ambivalence about recommending a career in IHR to an early career researcher. When asked what was required to attract researchers into IHR, respondents cited the need for improved institutional support, mentoring, long-term funding and sustainable career pathways. CONCLUSIONS AND IMPLICATIONS: This study contributes to a greater understanding of Australia's research workforce in Indigenous health. It provides evidence of a strongly perceived need for institutional reform that supports Indigenous health research, for sustainable approaches to funding, and for mentoring initiatives for early career researchers.     

广州市理工院校大学生自杀态度的调查分析

目的了解理工院校大学生心理健康状况及其自杀态度,为大学生自杀预防提供依据。方法采用分层整群随机抽样方法,对广州市理工大学大学生进行问卷调查,内容为自杀态度问卷（SAQ）。结果自杀态度在不同年级的学生间存在差异,对自杀行为、自杀者、安乐死持矛盾中立态度者占多数,对自杀者家属持理解认同态度占多数。结论自杀态度各指标均提示必须加强大学生的心理健康教育以预防自杀行为的发生。     

Deployment of a mixed-mode data collection strategy does not reduce nonresponse bias in a general population health survey

Objective

To assess nonresponse bias in a mixed-mode general population health survey.

Data Sources

Secondary analysis of linked survey sample frame and administrative data, including demographic and health-related information.

Study Design

The survey was administered by mail with telephone follow-up to nonrespondents after two mailings. To determine whether an additional mail contact or mode switch reduced nonresponse bias, we compared all respondents (N = 3,437) to respondents from each mailing and telephone respondents to the sample frame (N = 6,716).

Principal Findings

Switching modes did not minimize the under-representation of younger people, nonwhites, those with congestive heart failure, high users of office-based services, and low-utilizers of the emergency room but did reduce the over-representation of older adults.

Conclusions

Multiple contact and mixed-mode surveys may increase response rates, but they do not necessarily reduce nonresponse bias.     

Influenced from the start: anchoring bias in time trade-off valuations

Purpose

The de facto standard method for valuing EQ-5D health states is the time trade-off (TTO), an iterative choice procedure. The TTO requires a starting point (SP), an initial offer of time in full health which is compared to a fixed offer of time in impaired health. From the SP, the time in full health is manipulated until preferential indifference. The SP is arbitrary, but may influence respondents, an effect known as anchoring bias. The aim of the study was to explore the potential anchoring effect and its magnitude in TTO experiments.

Methods

A total of 1249 respondents valued 8 EQ-5D health states in a Web study. We used the lead time TTO (LT-TTO) which allows eliciting negative and positive values with a uniform method. Respondents were randomized to 11 different SPs. Anchoring bias was assessed using OLS regression with SP as the independent variable. In a secondary experiment, we compared two different SPs in the UK EQ-5D valuation study TTO protocol.

Results

A 1-year increase in the SP, corresponding to an increase in TTO value of 0.1, resulted in 0.02 higher recorded LT-TTO value. SP had little impact on the relative distance and ordering of the eight health states. Results were similar to the secondary experiment.

Conclusion

The anchoring effect may bias TTO values. In this Web-based valuation study, the observed anchoring effect was substantial. Further studies are needed to determine whether the effect is present in face-to-face experiments.

     

我国妇女参加妇女常见病普查的态度及其影响因素

目的了解不同妇女人群参加妇女常见病普查的态度和影响因素,为进一步改善妇女常见病普查服务和健康教育工作提供依据。方法采用多阶段分层随机抽样方法,抽取我国10个省（自治区、直辖市）的7257名妇女进行妇女常见病普查态度和影响因素的问卷调查。结果90.4%的调查对象听说过妇女常见病,分别有67.1%和68.3%的调查对象认为宫颈癌、乳腺癌可以早期发现与诊断。6442名（88.8%）妇女愿意参加妇女常见病普查。妇女病相关知识知晓情况是影响参加妇女常见病普查态度的最重要因素（OR=2.081）。受教育程度低的妇女、老年妇女和无业妇女的普查意愿相对较弱。结论绝大部分妇女有参加妇女常见病普查的意愿,对于不愿参加的妇女人群应加强其对妇女常见病普查的认识,提高参加妇女常见病普查的意愿和参与率。     

Potential role of complementary and alternative health care providers in chronic disease prevention and health promotion: an analysis of National Health Interview Survey data

Objective

To make a preliminary assessment of the potential role of the most frequently used licensed or certified United States complementary and alternative medicine (CAM) providers in chronic disease prevention and health promotion.

Method

This was a secondary analysis of the 2007 United States National Health Interview Survey (NHIS), the most recent to include CAM use. The Adult Core Sample, Person and Adult Complementary and Alternative Medicine data files were included. NHIS's complete survey design structure (strata, cluster and survey weights) was applied in generating national population estimates for CAM usage.

Results

Chiropractic or osteopathic manipulation (8.4%) and massage (8.1%) were most commonly used; acupuncture was used by 1.4% and naturopathy by 0.3% of respondents. Substantial proportions of respondents reported using CAM for wellness and disease prevention, and informed their medical physician of use. Fifty-four percent were overweight or obese, 22.0% physically inactive, and 17.4% smokers; 18.0% reported hypertension, 19.6% high cholesterol, and 9.1% prediabetes or diabetes.

Conclusion

CAM users present with risk factors which are priority public health issues. This implies a need to train CAM providers in evidence-based health promotion counseling. CAM encounters may provide opportunities to coordinate health promotion and prevention messages with patients' primary care providers.     

Selection bias due to non-response in a health survey among patients with rheumatoid arthritis

BACKGROUND: Non-response may lead to bias in health(care) outcomes. METHODS: We compared respondents (n = 334) to a questionnaire survey among patients with rheumatoid arthritis with non-respondents (n = 68) and determined predictors of (non-)response. The bias in prevalence estimates of health characteristics and health care use was quantified. RESULTS: Self-reported pain and health care utilization were the most important predictors of (non-)response with respondents experiencing pain more often and more often using specific health care services. Bias concerned especially an underestimation of 'never having pain' (60%) and 'no contact with health care services' (51%). CONCLUSION: More insight into the phenomenon of non-response is important to assess disease burden and health care burden more precisely.     

A comparison of responses to mailed questionnaires and telephone interviews in a mixed mode health survey

This paper compares respondents to mailed questionnaires with those nonrespondents subsequently interviewed by telephone in a survey of Massachusetts women aged 45-55 years conducted in 1981-1982. This mixed mode approach produced 8,050 responses, giving a response rate of 77%. This rate is similar to rates obtained in many surveys that employed in-person interviews, which are still widely used in health surveys but are increasingly expensive. Telephone respondents differed socioeconomically from mail respondents, suggesting that telephone follow-up of nonrespondents may have reduced nonresponse bias in this survey. Thus, a mixed mode approach may be superior to a mail-only approach with respect to this aspect of data quality. Women responding by mail were more likely to hold professional jobs, to have relatively high household incomes, and to have more years of education. Controlling for these socioeconomic differences did not, however, remove differences in reported health outcomes between mail and telephone respondents. These differences may be explained by less complete recall in the telephone interviews or they may arise from actual differences in health profiles between early (i.e., mail) and late (i.e., telephone) respondents. Although a mixed mode approach may reduce nonresponse bias, more research is required concerning the reasons for response differences between modes and to eliminate any differences caused by problems in data quality.     

The quality of dietary information on the World Wide Web

The quality of dietary information on the World Wide Web (WWW) is determined solely by the organizations and individuals who publish it. To evaluate the accuracy of nutrition resources on the Internet, a survey of WWW sites that provided dietary recommendations were reviewed and compared to the "Canadian Guidelines for Healthy Eating and Nutrition Recommendations for Canadians." Web sites were accessed using "diet," "food," and "nutrition" as keywords in searches. Of the 365 documents accessed, 167 contained dietary recommendations. Forty-five percent (n = 76) of these provided information that was not consistent with one or more of the Canadian eating standards and included information in the forms of advertisements recommending supplements, herbal remedies, weight-loss products, and promotion of specific diets. The total number of web sites that provided information that was inconsistent with Canadian guidelines per each keyword search was 25 (29.8%) for "diet," 11 (13.1%) for "food," and 48 (57.1%) for "nutrition." Sources of differing information included individual web pages (n = 31, 40.8%), private vendors (n = 44, 57.9%), and health organizations (n = 1, 1.3%). Because Internet resources continue to increase at an incredible pace, health professionals need to take an active role in this technology and develop strategies to address inconsistent dietary information provided through this avenue.     

Public response to elevated nitrate in drinking water wells in Wisconsin.

The authors conducted a survey by mail of Wisconsin families who had their well water tested for nitrate to (a) assess their awareness and compliance with the state's health advisories for nitrate, (b) evaluate their reaction(s) to their test results, and (c) compare demographic differences between exposure levels. Owners of contaminated wells (i.e., > 12.9 mg/l nitrate-nitrogen) were more likely to have lived on a farm, had lower annual incomes, and had older and shallower wells than families whose wells were low in nitrate (i.e., < 2.0 mg/l nitrate-nitrogen). Most respondents were aware of the advisories for pregnant women and infants and, in accordance with these advisories, the majority of families with nitrate-contaminated drinking water took no remedial action. Given that many rural families consume nitrate-contaminated water daily, scientists should conduct additional research to determine whether chronic ingestion of nitrate-contaminated water poses a significant health threat to these families.