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Objectives: To compare the data quality, logistics, and cost of a self-administered sexual behavior questionnaire administered either using a computer-assisted survey instrument (CASI) or by paper and pencil in a primary care clinic. Study Design and Setting: A self-administered sexual behavior questionnaire was administered to 16-29 year olds attending general practice. Questionnaires were administered by either paper and pencil (paper) or CASI. A personal digital assistant was used to selfadminister the CASI. Results: A total of 4,491 people completed the questionnaire, with 46.9% responses via CASI and 53.2% by paper. Completion of questions was greater for CASI than for paper for sexual behavior questions: number of sexual partners [odds ratio (OR), 6.85; 95% confidence interval (CI): 3.32, 14.11] and ever having had sex with a person of the same gender (OR, 2.89; 95% CI: 1.52, 5.49). The median number of questions answered was higher for CASI than for paper (17.6 vs. 17.2; P ! 0.01). CASI was cheaper to run at $8.18 per questionnaire compared with $11.83 for paper. Conclusion: Electronic devices using CASI are a tool that can increase participants' questionnaire responses and deliver more complete data for a sexual behavior questionnaire in primary care clinics. [ABSTRACT FROM AUTHOR]

Abstract: The present study examined the equivalency and test–retest reliability of two administration methods (paper-and-pencil and computerized) of the Aggression Questionnaire (AQ), Barratt Impulsiveness Scale-11 (BIS-11), and SF-36 Health Survey (SF-36) in a sample of 97 veterans. The two-week test–retest reliability for the conventional paper-and-pencil administrations of the AQ, BIS-11, and the SF-36 in the veteran population were generally reliable and comparable to the test–retest reliability of these measures noted in the research for other populations. Equivalence of the computer vs. paper-and-pencil administrations were examined and results indicated that for the AQ, ICCs for all four subscales and total score were substantially lower for the PC administration. For the BIS-11, ICCs were comparable with the exception of the Motor subscale, which was lower in the PC condition. For the SF-36, two of the domains were higher in the PC condition, with four more being comparable. Overall, the computerized administration of the BIS-11 and SF-36 was found to be equivalent to the “gold standard” paper-and-pencil administration of these measures and can be utilized successfully among veterans. The computerized administration of the AQ, however, was not found to be equivalent to the paper-and-pencil administration of the measure. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to examine the reliability, equivalence and respondent preference of a computerized version of the General Health Questionnaire (GHQ-12), Symptom Checklist (SCL-90-R), Medical Outcomes Study Social Support Survey (MOSSSS), Perceived Stress Scale (PSS) and Utrecht Coping List (UCL) in comparison with the original version in a general adult population. Internal consistency, equivalence and preference between both administration modes was assessed in a group of participants (n =130) who first completed the computerized questionnaire, followed by the traditional questionnaire and a post-assessment evaluation measure. Test–retest reliability was measured in a second group of participants (n =115), who completed the computerized questionnaire twice. In both groups, the interval between first and second administration was set at one week. Reliability of the PC versions was acceptable to excellent; internal consistency ranged from α =0.52–0.98, ICC’s for test–retest reliability ranged from 0.58–0.92. Equivalence was fair to excellent with ICC’s ranging from 0.54–0.91. Interestingly, more subjects preferred the computerized instead of the traditional questionnaires (computerized: 39.2%, traditional: 21.6%, no preference: 39.2%). These results support the use of computerized assessment for these five instruments in a general population of adults. [Copyright &y& Elsevier]

Introduction: In January 2015, Rouen University Hospital's information system experienced serious issues. It was necessary to rapidly switch from the computerized provider order entry (CPOE) system towards a paper-based order entry (PBOE) system. This was an opportunity to evaluate prescriber opinion on the two provider order entry (POE) systems.Methods: All residents were asked to fill an augmented version of the POE satisfaction and usage survey for both POE systems. The results were compared to identify the strengths and weaknesses of each system.Results: Fifty-one respondents had used the CPOE system and the PBOE system. Overall, satisfaction was higher with PBOE than CPOE (odds ratio (OR)=3.74; p<0.001). Usability (OR=4.00; p<0.001), reliability (OR=8.54; p<0.001), time consumption (OR=0.50; p<0.05 - survey statement was formulated negatively), and communication with nurses (OR=14.27; p<0.0001) reached statistically better agreement. The more experience with CPOE the more residents were disillusioned with the reliability (OR=6.55; p<0.01), the usability (OR=5.68; p<0.01) and the patient safety (OR=0.27; p<0.05 - survey statement was formulated negatively) of CPOE. Although safety issues were reported for both systems, the causes were different; PBOE imposed frequent rewriting of the order while CPOE lack of usability might be unsafe. Another important issue with both POE systems was time consumption.Conclusion: Residents did not report any increase in safety issues with the rapid switch from CPOE to PBOE. They even seemed more satisfied with the rollback to paper, which remains a possible degraded mode in case of health information technology collapse. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Getting the right information to providers can improve quality of care. We set out to provide patient-specific Electronic Medical Record (EMR)-based clinical summaries for providers taking care of HIV-positive adult patients in the resource-limited setting of Mbarara, Uganda. Methods: We evaluated the impact of implementing these clinical summaries using time-motion techniques and provider surveys. Results: After implementation of EMR-based clinical summaries, providers spent more time in direct care of patients (2.9min vs. 2.3min, p <0.001), and the length of patient visits was reduced by 11.5min. Survey respondents indicated that clinical summaries improved care, reduced mistakes, and were generally accurate. Current antiretroviral medication, patient identifying information, adherence information, current medication, and current medical problems were among the highest-rated elements of the summary. Conclusions: By taking advantage of data stored in EMRs, efficiency and quality of care can be improved through clinical summaries, even in settings with limited resources. [Copyright &y& Elsevier]

Abstract: Objective: To assess how web-based recruitment is comparable to postal surveys. Study Design and Setting: In 2002, we invited female users of major Norwegian websites to join a women''s health study on the Internet. The results of this study on the prevalence of urinary incontinence (UI) were compared with similar data collected by post in a previous epidemiological study, EPINCONT (Epidemiology of Urinary Incontinence in Nord-Trøndelag). Results: Altogether 1,812 web respondents compared with 27,936 postal respondents from the EPINCONT study. The Internet sample was younger than the EPINCONT sample (37 vs. 48 years, P <0.05). The proportion of women 60 years or older was 3.3% in our study and 29.0% in the EPINCONT study. Unadjusted prevalence of UI was lower in our study (20%) than in the EPINCONT study (25%), but stratified prevalence rates were higher in all individual age groups. In the Internet sample, we found less slight UI in all age groups, and more moderate (30–39 and 50–59-year age groups) and severe UI (30–39, 40–49, and 50–59-year age groups). Conclusion: We attracted a younger population with more severe UI than the EPINCONT study. Web-based approaches are less appropriate for studies on conditions concerning the older population than postal methods. [Copyright &y& Elsevier]

Objective: To investigate the effect of font size and paper thickness on the response to, and completion of, a self-completion postal questionnaire among older people with joint pain.Study Design and Setting: Randomized trial. People aged 50 years and older with joint pain who consulted a general practitioner at one of five general practices in Central Cheshire were sent a postal questionnaire. Questionnaire format (large or small font size, thick or thin paper) was randomly allocated using a 2 x 2 factorial design.Results: Questionnaires were received from 502 out of 650 participants (crude response 77%). Response was significantly higher for participants receiving questionnaires with a larger font size (79.3% vs. 75.2%; hazard ratio 1.26, 95% confidence interval: 1.02, 1.56). Paper thickness had no significant effect on response. Completion (measure by assessing double-page turnover error) was increased in participants receiving questionnaires printed on thicker paper (3.2% vs. 7.1%; P=0.049) but was not affected by font size.Conclusion: This study demonstrates that questionnaires in larger font and on thicker paper may produce higher and more complete responses than surveys using standard size font and standard thickness paper, and should therefore be considered in studies among older people. [ABSTRACT FROM AUTHOR]

• Empirical framework for estimating income growth effect and income distribution. • Mincer model, OLS and GMM methods. • CHNS surveys from rural residents during 1991–2015. • Energy poverty threatens individual health and household efficiency. • Energy poverty harms resident income growth. This paper proposes a novel empirical framework for inclusive growth estimation by extending the traditional Mincer model. Based on the 42,126 observations from 1991 to 2015 obtained in the China Health and Nutrition Survey, this paper applies the ordinary least squares regression and generalized system method of moments estimation to explore the growth effect and inclusiveness of energy out-of-poverty on rural resident income. The results confirm the significant income inclusive growth effect prompted by energy out-of-poverty. Those with water infrastructure accessibility and medical insurance gain more than those without energy out-of-poverty in rural China. The better-educated benefit more than their counterparts from energy out-of-poverty in the eastern and middle regions. This paper provides valuable insights to understand the positive and vital role of energy out-of-poverty on income-inclusive growth. [ABSTRACT FROM AUTHOR]

This study uses the China Health and Nutrition Survey data to investigate the relationship between infrastructure construction and health inequality, particularly by exploring a quasi-natural experiment, namely, high-speed rail (HSR) projects. We find that HSR accessibility improves the health of local residents with a coefficient of 0.298, which means that HSR operation will lead to a 2.30% increase in health. HSR accessibility also increases individual income, per capita household income, and the probability of purchasing medical insurance, thereby increasing the health level of individuals. Further analysis shows that HSR reduces the health gap across gender and urban–rural areas. Unfortunately, HSR also increases the health gap among different income groups. • This paper evaluates the health effects of high-speed rail (HSR). • HSR accessibility improves the health of local residents. • HSR accessibility have increased the health gap among different income groups. • HSR layout should be complementary with medical resources. [ABSTRACT FROM AUTHOR]

Space, beyond standard urban/rural divisions, plays a leading role in the diffusion of educational access. In this paper, using geo-localisation and Demographic and Health Surveys (DHS) we analyse spatial inequality in educational access (primary, lower secondary and upper secondary levels) for 13,000 communities from 22 countries in the Eastern and Western African regions. We find that: (i) space matters for educational access after accounting for communities' contextual backgrounds in spatial econometric models, (ii) the extent of spatial inequality in educational access is higher in countries with lower levels of women's empowerment, and (iii) spatial educational inequality operate more powerfully in marginalised communities. Educational policies aimed at boosting educational access should consider space-based interventions, looking beyond the traditional rural-urban or regional boundaries. • Study spatial educational inequality (SEI) on educational access for 13,000 communities. • Assess association of SEI with lack of womenŠs empowerment in 22 African countries. • Find that space matters for educational access net of communitiesŠ contextual backgrounds. • SEI operates more powerfully in marginalised communities. • Inequalities in proximal communities have an impact on inequalities in nearby communities. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.Methods: The Sixth National Audit Project (NAP6) of the Royal College of Anaesthetists examined the incidence, predisposing factors, management, and impact of life-threatening perioperative anaphylaxis in the UK. NAP6 included: a national survey of anaesthetists' experiences and perceptions; a national survey of allergy clinics; a registry collecting detailed reports of all Grade 3-5 perioperative anaphylaxis cases for 1 yr; and a national survey of anaesthetic workload and perioperative allergen exposure. NHS and independent sector (IS) hospitals were approached to participate. Cases were reviewed by a multi-disciplinary expert panel (anaesthetists, intensivists, allergists, immunologists, patient representatives, and stakeholders) using a structured process designed to minimise bias. Clinical management and investigation were compared with published guidelines. This paper describes detailed study methods and reports on project engagement by NHS and IS hospitals. The methodology includes a new classification of perioperative anaphylaxis and a new structured method for classifying suspected anaphylactic events including the degree of certainty with which a causal trigger agent can be attributed.Results: NHS engagement was complete (100% of hospitals). Independent sector engagement was limited (13% of approached hospitals). We received >500 reports of Grade 3-5 perioperative anaphylaxis, with 266 suitable for analysis. We identified 199 definite or probable culprit agents in 192 cases.Conclusions: The methods of NAP6 were robust in identifying causative agents of anaphylaxis, and support the accompanying analytical papers. [ABSTRACT FROM AUTHOR]

Nearly 100 years ago, the philosopher and mathematician Bertrand Russell warned of the social dangers of widespread envy. One view of modern society is that it is systematically developing a set of institutions -- such as social media and new forms of advertising -- that make people feel inadequate and envious of others. If so, how might that be influencing the psychological health of our citizens? This paper reports the first large-scale longitudinal research into envy and its possible repercussions. The paper studies 18,000 randomly selected individuals over the years 2005, 2009, and 2013. Using measures of SF-36 mental health and psychological well-being, four main conclusions emerge. First, the young are especially susceptible. Levels of envy fall as people grow older. This longitudinal finding is consistent with a cross-sectional pattern noted recently by Nicole E. Henniger and Christine R. Harris, and with the theory of socioemotional regulation suggested by scholars such as Laura L. Carstensen. Second, using fixed-effects equations and prospective analysis, the analysis reveals that envy today is a powerful predictor of worse SF-36 mental health and well-being in the future. A change from the lowest to the highest level of envy, for example, is associated with a worsening of SF-36 mental health by approximately half a standard deviation (p < .001). Third, no evidence is found for the idea that envy acts as a useful motivator. Greater envy is associated with slower -- not higher -- growth of psychological well-being in the future. Nor is envy a predictor of later economic success. Fourth, the longitudinal decline of envy leaves unaltered a U-shaped age pattern of well-being from age 20 to age 70. These results are consistent with the idea that society should be concerned about institutions that stimulate large-scale envy. [ABSTRACT FROM AUTHOR]

The European Human Biomonitoring Initiative (HBM4EU) is a joint program evaluating humans' exposure to several environmental substances and their potential health effects. One of the main objectives of HBM4EU is to make use of human biomonitoring (HBM) to assess human exposure to chemicals in Europe to better understand the associated health impacts and to improve chemical risk assessment. In parallel to HBM studies, health examination surveys (HESs), nutrition/dietary surveys, and disease specific health surveys are conducted in many European countries. In HESs, information collected by questionnaire(s) is supplemented with physical examinations and analysis of clinical and biological biomarkers in biological samples. HBM and health examination survey (HES) use similar data collection methods and infrastructures hence the feasibility of combining these two is explored in this paper. Within HBM4EU, three feasibility studies (in Finland, Germany, and UK/England) were conducted to evaluate opportunities and obstacles of combining HBM and health studies. In this paper we report lessons learned from these feasibility studies. The Finnish feasibility study called KouBio-KUOPIO study was a new initiative without links to existing studies. The German feasibility study added a HBM module to the first follow-up examination of the LIFE-Adult-Study, a population-based cohort study. The UK feasibility integrates a sustainable HBM module into the Health Survey for England (HSfE), an annual health examination survey. Benefits of combining HBM and HESs include the use of shared infrastructures. Furthermore, participants can receive additional health information from HES, and participation rates tend to be higher due to the potential to obtain personal health information. Preparatory phases including obtaining ethical approval can be time-consuming and complicated. Recruitment of participants and low participation rates are common concerns in survey research and therefore designing user-friendly questionnaires with low participant burden is important. Unexpected events such as the COVID-19 pandemic can cause substantial challenges and delays for such studies. Furthermore, experiences from several countries demonstrated that long-term funding for combined studies can be difficult to obtain. In the future, incorporating HBM modules into existing HESs can provide a feasible and cost-effective method to conduct HBM studies and obtain a wide range of relevant data to support public health policies and research. [ABSTRACT FROM AUTHOR]

• We will monitor compliance with the intervention and adverse events. • Data will be analyzed following intention-to-treat principles. • A cost-effectiveness analysis will be performed. This a priori statistical analysis plan describes the methods of analysis for the Trial Of Prevention Strategies for low back pain (TOPS). TOPS aimed to investigate the effectiveness and cost-effectiveness of exercise and education classes compared with a minimal intervention control in preventing recurrence of low back pain (LBP) in people who have recently recovered from an episode of LBP. TOPS is a superiority, pragmatic, parallel-group randomized controlled trial with allocation concealment, blinded outcome assessors, and intention-to-treat analysis. Participants were randomized to a physical therapist-led exercise and education program for 12 weeks or minimal intervention. The primary outcome was days to recurrence of an episode of LBP. The three key secondary outcomes were days to recurrence of an episode of LBP resulting in (1) activity limitation, (2) care seeking for LBP; and (3) work absence of at least 1 day. Differences in survival curves for the primary (days to recurrence) and secondary outcome (days to LBP with activity limitation, days to care seeking due to LBP, and days to work absence due to LBP) will be compared using Cox regression. Hazard ratios (HRs) and median survival times with 95% confidence intervals (CI) will be calculated. The number of adverse events, including serious adverse events will be reported and the proportion of adverse events between groups will be compared using a Chi-squared test. This paper will provide a detailed description of the planned analyses for the TOPS trial. Australian New Zealand Clinical Trials Registry (ACTRN12615000939594). [ABSTRACT FROM AUTHOR]

• We propose a country-level index, the "housing environment for protection" (HEP) index. • Using DHS data for 41 developing countries, this index combines seven easily-monitored indicators of housing conditions. • Only 8% of households have all identified housing conditions, and only 3% of households in Sub-Saharan Africa. • A poor HEP is associated with worse health outcomes among children, even after controlling for income, poverty, and literacy. • We find that children in the developing world face housing environments that offer only very limited protection from illness. We propose and test an internationally-comparable country-level index of the adequacy of the housing environment for protecting children from ill-health. The housing environment for protection (HEP) index combines seven easily-monitored indicators of housing conditions related to communications, density of occupants, toilet and handwashing facilities, the use of finished construction materials, and cooking facilities. In calibrating and validating the HEP index, the paper uses infant mortality, the incidence of child illnesses and child stunting. We calculate the HEP index for the 41 developing countries with complete recent data from the Demographic and Health Surveys. We find that only 8% of households fully comply with all our identified housing conditions, though there is considerable variation across countries, with full compliance varying from virtually zero to almost 60% of households. A poor HEP is found to be associated with significantly worse health outcomes among children. This finding is robust to adding controls for likely confounders such as income and poverty. Our results suggest that reducing the incidence of ill-health among children is in part achieved by reducing income poverty, but also depends crucially on how much income gains tend to directly improve housing conditions. [ABSTRACT FROM AUTHOR]

While the Healthy China strategy is being implemented, the China Geological Survey has proposed and deployed a health geological survey project, starting a new journey of health geological survey and evaluation to support and serve the construction of Healthy China. However, there are still many urgent problems to be solved in this project, such as the survey vision, the framework of the evaluation indicators, the risk identification method, and the service scopes of the potential achievements. Therefore, in this paper, a framework for health geological survey and evaluation was proposed, which includes regional health geological survey zoning and local ecological risk identification. At regional scale, the framework of indicators, grading standard, score calculation, zoning method of health geological survey, identification of beneficial and harmful health geological factors, and application of achievements were proposed. These contents were presented based on the core evaluation indicators (e.g., the chemical composition, physicochemical properties, topography, and climate of the crustal surface environment caused by geological evolution processes) and the optional evaluation indicators (e.g., sanitary condition, economic level and geo-environment). At local scale, the selection of evaluation area, workflow, risk identification and the application of achievements were proposed to avoid the ecological risks of harmful trace elements and develop beneficial health geological resources. • Proposal of the framework of health geology survey and evaluation. • Presentation of regional health geological survey zoning evaluation indicator and method. • Establishment of the criterion for ecological risk evaluation at a local scale. [ABSTRACT FROM AUTHOR]

The Population Census is an important source of statistical information in most countries that is capable of producing reliable estimates of population characteristics for small geographic areas. One limitation of a census is that there are many population characteristics that cannot be collected due to respondent burden or cost. This means that statistical agencies have to conduct population based surveys to provide social, economic and demographic characteristics for a target population which are not captured by a large-scale census. These surveys are usually capable of producing direct estimates at the national level and high level regions but often cannot produce reliable estimates for smaller areas. Due to the increasing demand for comprehensive statistical information not only at the national level but also for sub-national domains, there is a wide discussion in the literature about the use of statistical techniques that combine survey with census data to provide more detailed, finer-level estimates. Where censuses and sample surveys are based on the same reporting units, statistical matching techniques can be employed to link the records from survey and census data where exact matching of reporting units is impossible due to confidentiality restrictions. These techniques can then provide the detailed social, economic and demographic information required for small areas. An approach is developed in this paper in which a close-to-reality synthetic population of individuals and households is generated from available census tables using an iterative proportional updating (IPU) method. Statistical matching using a nearest neighbour method is then used to impute survey data to the individuals and households in the synthetic population. To evaluate this approach, 2011 Bangladesh census data is used to generate a district-specific synthetic population of individuals and households. Matching is then performed by imputing the nearest possible records among the 2011 Bangladesh Demographic and Health Survey to estimate the wealth index for each household within the synthetic population. The results show that using the method presented in this paper helps with achieving more representative estimates (comparing with direct survey estimates) particularly for areas with small sample sizes where not many population units with different socio-demographic characteristics are included. [ABSTRACT FROM AUTHOR]

Highlights • Novel method to measure vulnerability to stunting without using a panel. • Use of DHS surveys merged with satellite data on climatic shocks. • Categorization of kids into consistently stunted, vulnerable and non-vulnerable. • Estimates of vulnerability to stunting in the Sahel. Abstract This paper presents a simple simulation framework for understanding and analyzing vulnerability to stunting. We utilize Demographic and Health Surveys merged with satellite data on climatic shocks. Children aged 0–5 years are grouped into three categories: consistently stunted, vulnerable, and non-vulnerable. The first group constitutes those who are stunted and will also be stunted in any hypothetical period. Non-vulnerable are those whose likelihood to be stunted is zero. The vulnerable face a probability between 0 and 1 of being stunted. The probability is calculated as the share of years in which the child would be stunted, given the village level distribution of weather shocks over the period 2000–2013. We provide estimates of vulnerability to stunting in Burkina Faso, Northern Ghana, Mali, Northern Nigeria, and Senegal by aggregating over villages, districts and countries. [ABSTRACT FROM AUTHOR]

Abstract Recent research finds a significant difference in voting behavior of workers with secure employment and those without. What is less understood are the conditions in which the divergent political choices of these two groups overlap. Focusing on two types of labor market policies—unemployment insurance and active labor market programs, this paper examines how more generous government spending on different types of welfare programs shapes the electoral behavior of individuals with adverse labor market experience. By using multilevel analysis of individual surveys from 18 European countries (1999–2015), I find that unemployed and temporary workers are more likely to vote against traditional left-wing parties and to withdraw from voting at all. The greater spending on unemployment insurance, however, alters the outcome by realigning insecure workers with old left parties such as social democratic and center-left socialist parties. By contrast, expenditure on active labor market programs has a weak conditional impact in general. The important implication of this study is that while government policy does moderate the effect of adverse labor market experience, types of social policy matters in understanding policy feedback effects. I further discuss this point in relation to the different implications of income support and activation programs for risk mitigation. [ABSTRACT FROM AUTHOR]

This paper estimates the impact of economic insecurity on the mental health of Australian adults. Taking microdata from the 2001–2011 HILDA panel survey, we develop a conceptually diverse set of insecurity measures and explore their relationships with the SF-36 mental health index. By using fixed effects models that control for unobservable heterogeneity we produce estimates that correct for endogeneity more thoroughly than previous works. Our results show that exposure to economic risks has small but consistently detrimental mental health effects. The main contribution of the paper however comes from the breadth of risks that are found to be harmful. Job insecurity, financial dissatisfaction, reductions and volatility in income, an inability to meet standard expenditures and a lack of access to emergency funds all adversely affect health. This suggests that the common element of economic insecurity (rather than idiosyncratic phenomena associated with any specific risk) is likely to be hazardous. Our preferred estimates indicate that a standard deviation shock to economic insecurity lowers an individual's mental health score by about 1.4 percentage points. If applied uniformly across the Australian population such a shock would increase the morbidity rate of mental disorders by about 1.7%. [ABSTRACT FROM AUTHOR]

This paper proposes an assessment of the association between income and unmet health needs in 29 European countries included in the European Health Interview Survey (EHIS) in 2015. Income-related inequalities for four categories of unmet needs are estimated by the Erreygers Index (EI). Unmet needs are organised into two categories: on the one side, unmet needs directly associated with households' budget constraints; on the other side, unmet needs not directly associated with budget constraints, as waiting lists and transportation problems. Results show that all categories of unmet needs fall on lower-income people for most European systems. Furthermore, when analysing the determinants of unmet needs, those directly associated with budget constraints are led by the economic drivers, while income-related unmet needs due to long waiting lists and distance or transportation problems are more related to institutional factors such as the low quality of government. • The association between income and unmet health needs in 29 European countries is investigated. • Unmet needs are organised into two categories: due to budget constraints and not. • All categories of unmet needs fall on lower-income people for most European systems. • Unmet needs directly associated with budget constraints are led by the economic drivers. • Other unmet needs are more related to institutional factors. [ABSTRACT FROM AUTHOR]

In company with rapid economic growth, Chinese consumers have seen a remarkable nutrition improvement and a dramatic dietary change. This article investigates the driving forces behind these changes with use of the China Health and Nutrition Survey (CHNS) data. This paper first proposes 10 different indices to measure nutrition improvement and dietary change from different perspectives, and then adopts semiparametric panel data models to capture the complicated nonlinear relationship between these nutrition indices and income growth, while controlling for other variables parametrically. This enables us to directly predict the nutrition improvement and dietary change at different income levels from different aspects. This paper particularly finds that nutrition improvement and dietary change will continue in China but will slow down in the future with further income growth. [ABSTRACT FROM AUTHOR]

Summary Household-level impacts of environmental shocks are often negative, but may vary considerably due to heterogeneous vulnerability. This paper considers how differential vulnerability among households affects inequality within rural communities in Ethiopia. This study makes novel use of the Demographic and Health Surveys (DHS) and a NASA agro-climatology dataset. Results show that rainfall deficits have an equalizing effect on within-community livestock inequality in parts of Ethiopia, but regional differences are observed. A non-significant effect is observed with respect to asset inequality. As an initial study on this topic, this paper outlines an agenda for future data collection and analysis efforts. [ABSTRACT FROM AUTHOR]

Background Delivering vaccination services during the second year of life (2YL) 1 Abbreviations: 2YL, denotes Second Year of Life or 2nd Year of Life. 1 provides countries with an opportunity to achieve greater coverage, to provide booster doses and vaccines missed during the first year of life, as well as contribute towards disease control and elimination goals. Methods Using data from demographic health surveys (DHSs) conducted during 2010 to 2016, this paper explores the proportion of missed opportunities for vaccinations generally provided during routine immunization among children in their 2YL. Results DHS data in 46 countries surveyed 478,737 children, from which 169,259 children were 12–23 months old and had vaccination/health cards viewed by surveyors. From this group, 69,489 children aged 12–23 months had contact with health services in their 2YL. Three scenarios for a missed opportunity for vaccinations were analysed: (1) a child received one vaccine in the immunization schedule and was eligible for another vaccine, but did not receive any further vaccination, (2) a child received a vitamin A supplementation (VAS) and was due for a vaccine, but did not receive vaccines that were due, and (3) a child was taken to a health facility for a sick visit and was due (and eligible) for a vaccine, but did not receive the vaccine. A total of 16,409 (24%) children had one or more missed opportunities for vaccinations. Conclusion This analysis highlights the magnitude of the problem of missed opportunities in the 2YL. The global community needs to provide better streamlined guidance, policies and strategies to promote vaccination screenings at well-child and sick child visits in the 2YL. Where they do not exist, well-child visits in the 2YL should be established and strengthened. [ABSTRACT FROM AUTHOR]

Summary A large literature has documented a complex and interdependent relationship between domestic violence, women empowerment, domestic risk factors, and violence-related health injuries. In this paper, we evaluate this relationship using data drawn from the Nepal Demographic and Health Survey, 2011. We simultaneously estimate the impact of women empowerment and domestic risk factors on domestic violence, and the impact of domestic violence on health consequences. Specifically, an IV ordered probit regression strategy is used, which addresses both the endogenous nature of domestic violence and the ordinal nature of health outcome variables. Our study finds evidence that it is not the autonomous power of women, but a cooperative decision-making environment in a marital relationship that reduces violence. Additionally, education decreases domestic violence and domestic risk factors, including alcohol and multiple unions exacerbate domestic violence. Finally, in terms of adverse health outcomes, we find that domestic violence has a non-linear impact on health injuries. At low levels of violence, the likelihood of injuries is low and injuries are generally not threatening, and as the level of violence increases, it considerably increases the probability of multiple and more serious health injuries. [ABSTRACT FROM AUTHOR]

Sleep assessment is a fundamental part of health evaluation. In fact, many diseases (such as obesity, diabetes, or hypertension, as well as psychiatric, neurological, and cardiovascular diseases) produce sleep disorders that are often used as indicators, diagnosis (symptoms), or even as predictors (eg, for depression) of health. For this reason, many efforts have been devoted to designing methods to control and report on sleep quality. Two of the most used sleep assessment tools are sleep questionnaires and sleep diaries. Both methods have a very low cost are easy to administer do not require a sleep centre (unlike, eg, polysomnography), and can be self-administered. Most important, as it has been shown in recent studies, their accuracy is relatively high. In this survey, we systematically review and compare these tools. We examine the evolution of sleep questionnaires and diaries over time, and compare their structure and usage. We also review the validation studies and comparatives performed in previous studies. This allows us to compare the relative sensitivities and specificities of these methods. Modern sleep diaries come in the form of an app. Therefore, we also present the most advanced and used apps, and discuss their advantages over classical paper diaries. [ABSTRACT FROM AUTHOR]

Individuals suffering from prolonged grief disorder (PGD) show severe grief reactions after the death of a significant other, even beyond a period of grieving that is within a person's cultural and religious context. In addition to this core element, PGD can manifest in various ways. Symptoms may include persistent preoccupation, intense emotional pain, or impairment in important life domains. The symptoms, furthermore, have to be of culturally or religiously inappropriate extent or severity, taking into account different norms of grieving. PGD is discussed as a distinct diagnostic category in the revision of the International Classification of Diseases (ICD-11). Nosology of PGD has been highly debated surrounding the suggested inclusion in the DSM-5, which had been declined due to insufficient evidence. This paper addresses the latent nature of PGD. Using a short form of the Inventory of Complicated Grief-Revised (ICG-R), we applied three popular taxometric methods: MAXEIG, MAMBAC and L-Mode. Data stemmed from a subsample of N = 1445 bereaved individuals that participated in a large representative German population survey ( N = 2520). The analysis strongly indicated a dimensional latent structure of PGD. Implications of the conceptualization of PGD on a continuum are discussed, regarding measurement, diagnosis, etiology and future research. [ABSTRACT FROM AUTHOR]

Introduction: This study assessed patient-perceived levels of scar assessment and burn-specific quality of life (QOL) in Korean burn patients admitted to burn care centers and identified differences in scar assessment and QOL based on various patient characteristics.Methods: A cross-sectional descriptive study using anonymous paper-based survey methods was conducted with 100 burn patients from three burn centers specializing in burn care in South Korea.Results: Mean subject age was 44.5 years old, and 69% of the subjects were men. The overall mean QOL was 2.91 out of 5. QOL was lowest for the work subdomain (2.25±1.45) followed by the treatment regimen subdomain (2.32±1.16). The subjects' mean total scar assessment score was 35.51 out of 60, and subjects were most unsatisfied with scar color. Subjects with low income, flame-source burns, severe burns, visible scars, and scars on face or hand reported significantly lower QOL. Subjects with severe burn degree and burn range perceived their burn scar condition to be worse than that of others.Conclusion: The results show that burn subjects experience the most difficulties with their work and the treatment regimen. Subjects with severe burn and visible scarring have a reduced QOL and a poor scar status. Scar management intervention may improve QOL of burn patients especially those with severe burn and visible scars. Further studies are warranted to evaluate the relationship between scar assessment and QOL. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this research is to analyze the relationship between neighborhood characteristics and obesity among adults. Using data from 7200 adult respondents in the 2007 Los Angeles County Health Survey, a binary logistic regression model is tested to examine whether land use patterns and the built environment characteristics of residential neighborhoods are associated with one’s probability of being obese. The result has shown that living in a neighborhood with higher household density, closeness to rail stations, and better bus services are associated with a lesser likelihood to be obese, which implies that people in a well-designed transit-oriented neighborhood tend to use active transportation modes to reach their daily activities and access transit services. Increased use of active transportation gives people an opportunity to engage in a moderate-level of exercise, so as to reduce their weight and enhance their health condition. This paper contributes an approach to analyze and estimate the health impact of an integrated land use-transportation plan. The model estimated in the paper can be used to analyze public health issues as a result of different land use policies, built environment improvements, and future demographic change. [Copyright &y& Elsevier]

Abstract: The literature has shown strong associations between health, financial and social life events and mental health. However, no studies as yet have looked at the temporal nature of the effects of life events on stated mental health nor have they included the effects of the events befalling partners within a household. This paper looks at the spillover in mental health, measured with the SF-36 scale, from one partner to the other, using life events to identify this relationship. We propose a new model that allows for both a temporal spacing of effects (anticipation and adaptation) as well as a spillover factor, which we define as the degree to which the events that are experienced by the partner affect us in the same way as if these events were to happen to us. We use data from 51,380 person-year observations of the Household, Income and Labour Dynamics in Australia survey (2002–10) which consistently measures nine distinct events, including illnesses, social shocks and financial shocks. We find that the events befalling a partner on average have an effect about 15% as large as the effect of own events. We use the estimates to compute the compensation required to offset own and partner's life events. The methodology in this paper is potentially useful for estimating other spillover parameters such as the effects of others in the family or in the neighbourhood. [Copyright &y& Elsevier]

Context: Pain localization is an important part of pain assessment. Development of pain tools for self-report should include expert and patient input, and patient testing in large samples. Objectives: To develop a computerized pain body map (CPBM) for use in patients with advanced cancer. Methods: Three studies were conducted: 1) an international expert survey and a pilot study guiding the contents and layout of the CPBM, 2) clinical testing in an international symptom assessment study in eight countries and 17 centers (N = 533), and 3) comparing patient pain markings on computer and paper body maps (N = 92). Results: Study 1: 22 pain experts and 28 patients participated. A CPBM with anterior and posterior whole body views was developed for marking pain locations, supplemented by pain intensity ratings for each location. Study 2: 533 patients (286 male, 247 female, mean age 62 years) participated; 80% received pain medication and 81% had metastatic disease. Eighty-five percent completed CPBM as intended. Mean ± SD number of marked pain locations was 1.8 ± 1.2. Aberrant markings (15%) were mostly related to software problems. No differences were found regarding age, gender, cognitive/physical performance, or previous computer experience. Study 3: 70% of the patients had identical markings on the computer and paper maps. Only four patients had completely different markings on the two maps. Conclusion: This first version of CPBM was well accepted by patients with advanced cancer. However, several areas for improvement were revealed, providing a basis for the development of the next version, which is subject to further international testing. [ABSTRACT FROM AUTHOR]

Nationally representative human biomonitoring data on persistent organic pollutants (POPs) including organochlorine pesticides (OCs), polychlorinated biphenyls (PCBs) brominated flame retardants (BFRs) and perfluoroalkyl substances (PFASs) are available through the Canadian Health Measures Survey (CHMS). We have used a systematic approach building on the reference interval concept proposed by the International Federation of Clinical Chemistry and Laboratory Medicine and the International Union of Pure and Applied Chemistry to derive human biomonitoring reference values (RV95s) for selected POPs in blood plasma in the general Canadian population. Biomarkers were chosen based on specific selection criteria including their detection in most Canadians (>66% detection rate). Age and sex were evaluated as possible partitioning criteria and separate RV95s were derived for the sub-populations in cases where partitioning was deemed necessary. RV95s for OCs, PCBs, and BFRs were derived both on a whole weight of blood plasma and on a lipid weight adjusted basis whereas they were derived only on a whole weight basis for PFASs. RV95s ranged from 0.018μg/L (PCB 201) to 21μg/L (perfluorooctane sulfonate) and from 3.1μg/kg lipid (PCB 201) to 1400μg/kg lipid (p,p'-DDE). The 22 RV95s reported in this paper represent the first set of reference values for POPs in the Canadian general population against which individual and population human biomonitoring data may be compared. [ABSTRACT FROM AUTHOR]

A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization. [ABSTRACT FROM AUTHOR]

Toxicological studies of defined chemical mixtures assist human health risk assessment by establishing how chemicals interact with one another to induce an effect. This paper reviews how antiandrogenic chemical mixtures can alter reproductive tract development in rats with a focus on the reproductive toxicant phthalates. The reviewed studies compare observed mixture data to mathematical mixture model predictions based on dose addition or response addition to determine how the individual chemicals in a mixture interact (e.g., additive, greater, or less than additive). Phthalate mixtures were observed to act in a dose additive manner based on the relative potency of the individual phthalates to suppress fetal testosterone production. Similar dose additive effects have been reported for mixtures of phthalates with antiandrogenic pesticides of differing mechanisms of action. Overall, data from these phthalate experiments in rats can be used in conjunction with human biomonitoring data to determine individual hazard indices, and recent cumulative risk assessments in humans indicate an excess risk to antiandrogenic chemical mixtures that include phthalates only or phthalates in combination with other antiandrogenic chemicals. [ABSTRACT FROM AUTHOR]

This paper presents a study of the effect of alcohol consumption on individual health status and health care utilization in Ireland using the 2007 Slán National Health and Lifestyle Survey, while accounting for the endogenous relationship between alcohol and health. Drinkers are categorized as those who never drank, non-drinkers, moderate drinkers, or heavy drinkers, based on national recommended weekly drinking levels in Ireland. The drinking-status equation is estimated using an ordered probit model. Predicted values for the inverse mills ratio are generated, which are then included in the health and health-care utilization equations. Differences in health status for each category of drinker are examined, and the relationship between both alcohol consumption and health with a host of other personal and socio-economic variables is also identified. Given that the measure of health status available is self-assessed, the effect of alcohol consumption on health-care utilization is also analyzed as an alternative measure of health. Findings show that in Ireland, moderate drinkers enjoy the best health status. More moderate drinkers report having very good or excellent health compared with heavy drinkers, non-drinkers, or those who never drank. While heavy drinkers do not report having as good a health status as moderate drinkers, they are better off in terms of health when compared with non-drinkers and those who are lifetime abstainers. [ABSTRACT FROM AUTHOR]

Purpose Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. Methods and Materials A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. Results Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. Conclusions Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up. [ABSTRACT FROM AUTHOR]

In this paper we suggest that older adults undergo a misalignment between societal age norms and personal lived experience, and attempt reconciliation through discursive strategies: They rewrite how they frame chronological age as well as their subjective relations to it. Using a sample of 4041 midlife and older adults from the 2004–2006 wave of the National Survey of Midlife Development in the United States (MIDUS II), we explore associations of age and gender with subjective age and at what age respondents felt people enter later life. Our results confirm that as men and women age, they push up the age at which they think people enter later life, and slow down subjective aging (there is a growing gap between subjective and chronological age). Relations between a person's age and at what age they think people enter later life were stronger for men than for women. For every year they get older get older, men push up when they think people enter later life by 0.24 years, women by 0.16 years. Age norms surrounding the transition to later life may be more prominent for men than for women, and the difference in their tendencies to push up when they mark entry into later life may be a reflection of this greater prominence. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Noise is increasingly recognised as a potentially important environmental pollutant but most studies on human responses to noise exposure relate to steady state situations. Effects may differ when noise changes rapidly, e.g. after noise mitigation interventions or with changes in road or airport configurations. Methods: A systematic review of studies on human reactions to changes in environmental noise exposures published from 1980 to March 2011 was conducted. Results: 41 papers satisfied the inclusion criteria. The most commonly studied outcomes were annoyance (23 papers) and sleep disturbance (11 papers). Other reactions were well-being, activity disturbance and use of living environment. No studies including physiological or disease measures were identified. The most commonly used study design was a written survey. Studies were methodologically diverse and it was not possible to conduct a formal meta-analysis. Annoyance was not necessarily decreased by reducing noise exposure. Non-acoustical factors influenced annoyance ratings and some of these were not identical to those in steady state conditions. There was insufficient evidence to recommend sleep disturbance as an alternative measure of reactions in changed noise conditions. Conclusions: Surveys of health effects in changed noise situations should be conducted both before and after the change. Annoyance as a reaction indicator should be evaluated with caution as non-acoustical factors play an important role in annoyance ratings. Technical interventions reducing noise levels may therefore not have impacts on annoyance proportionate to their impacts on sound levels. Further studies, investigating impacts on health endpoints (e.g. blood pressure) in changed noise situations are needed. [Copyright &y& Elsevier]

Extensive evidence has shown that working nonstandard hours, such as evening or night shifts, impacts negatively on workers' own health, and a growing literature suggests such impacts extend to the health of workers’ children. Using matched parent and child data from a large Australian panel survey this paper explores the effects of parental work schedules on the mental and physical health of adolescents aged 15–20 in sole-parent families. Random-effects models indicate adolescents have marginally worse emotional and physical health when their parent works nonstandard hours, based on SF-36 component summary scores, associated primarily with emotional or physical role limitations. Parental weekend schedules are particularly detrimental to adolescent physical health. Evidence is found that the effects of nonstandard work schedules on adolescent wellbeing are transmitted through increased work-family conflict and exacerbated where parents have low job control. [ABSTRACT FROM AUTHOR]

Introduction: Pathological fractures represent an adverse prognostic factor in primary and metastatic bone tumours. The purpose of this study was to evaluate the results of tumour silver-coated prosthesis implanted after pathological fractures.Materials and Methods: A retrospective analysis was conducted on 30 patients with pathological limb fracture after primary or metastatic bone tumours treated by the same surgeon with wide margin resection and tumour prosthesis implant between 2005 and 2015. Silver-coated prostheses were implanted in 17 patients and uncoated prostheses were implanted in 13 patients. The primary outcome of the study was to evaluate the infective risk, the secondary outcomes were survival and functional level (visual analogue scale [VAS], 36-Item Short Form Health Survey [SF 36], and Musculoskeletal Tumour Society [MSTS] score) obtained at the longest follow-up available. A multivariate analysis was performed considering age, sex, tumour histology, grading and location, resection size, concomitant radiotherapy/chemotherapy, use of mesh for soft tissue reconstruction and local complications (dislocation, relapse, implant breakage). Scanning electron microscopy (SEM) analysis of explanted prosthesis was performed to study the residual silver-coating.Results: The average age of patients in the study was 56.2 years (range 12-78 years). Silver-coated prostheses were implanted in 56.7% of patients, and uncoated tumour prostheses were used in the remaining 43.3%. The mean follow-up was 40.7 months. A total of 26.7% of patients died at a median time of 28.6 months after surgery. The overall rate of complications was 30%, with 16.7% due to infection. A total of 11.8% of the patients treated with silver-coated implants developed infection compared with 23.1% of the patients treated with uncoated tumour prostheses. There were no cases of early infection in the silver-coated prosthesis group, whereas early infection occurred in 66.7% of patients in the uncoated prosthesis group. All the functional outcomes were significantly improved after surgery. None of the other parameters analysed can be considered a significant negative prognostic factor for infection. The SEM analyses showed severe silver-coating degradation 2 years after first implant. No case of silver toxicity was demonstrated.Discussion: There are few papers in the literature about infective complications in tumour prosthesis after pathological fracture. Silver-coated implants showed a protective action against early infection. Late infection rate was similar between the groups, thereby indicating a reduction of antimicrobial activity for the silver-coating over time.Conclusions: Silver-coated prostheses are a protective factor against early infections in limb salvage surgery after pathological fractures, so may represent the first-choice of implants in this type of surgery. [ABSTRACT FROM AUTHOR]

There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important. [ABSTRACT FROM AUTHOR]

Abstract: Background: Numerous studies analyzed concentrations of persistent organic pollutants (POPs) in human samples, and in many types of foods; however, food consumption is less commonly included in studies on the determinants of POP concentrations in humans, and these approaches are rarely integrated with surveys of food intake to estimate the amount and safety of human POP intake from food. Objective: To analyze the main characteristics and findings of all studies conducted in Spain that quantitatively assessed the influence of diet on human concentrations of POPs. Methods: Studies published until December 2010 (with no other time restrictions) were identified through Medline/PubMed, ISI-Thomson, ScienceDirect, and SciELO databases. Results: We identified 25 papers, from 19 different studies. Twelve papers were published in 2009–2010. All studies but one were based on subgroups not representative of the general population, and over half were limited to women. Serum was the most used biological matrix, while p,p′-DDE, HCB and PCBs were the most frequently analyzed compounds. Food intakes were measured with heterogeneous food frequency questionnaires. The most consistent association was between fish consumption and PCBs and HCB, followed by dairy products and PCBs. A few studies observed a relationship between meat and some POPs, whilst intake of vegetables, fruits and cereals was rarely related to POP levels. Only 3 studies did not find any relationship between dietary habits and POP concentrations. Conclusions: In spite of methodological heterogeneity, the studies were able to quantify to what extent consumption of foods from animal origin (fish, milk, dairy products and meat) is related to higher body concentrations of POPs. As in a few other countries, in Spain food consumption is increasingly analyzed as a major determinant of human POP intake. [Copyright &y& Elsevier]

Abstract: Home care is the fastest growing segment of Canada’s health care system. Since the mid-1990s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario’s home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Uncertainty regarding the accuracy of the computer as a data collection or patient screening tool persists. Previous research evaluating the validity of computer health surveys have tended to compare those responses to that of paper survey or clinical interview (as the gold standard). This approach is limited as it assumes that the paper version of the self-report survey is valid and an appropriate gold standard. Objectives: First, to compare the accuracy of computer and paper methods of assessing self-reported smoking and alcohol use in general practice with biochemical measures as gold standard. Second, to compare the test re-test reliability of computer administration, paper administration and mixed methods of assessing self-reported smoking status and alcohol use in general practice. Methods: A randomised cross-over design was used. Consenting patients were randomly assigned to one of four groups; Group 1. C–C : completing a computer survey at the time of that consultation (Time 1) and a computer survey 4–7days later (Time 2); Group 2. C–P: completing a computer survey at Time 1 and a paper survey at Time 2; Group 3. P–C: completing a paper survey at Time 1 and a computer survey at Time 2; and Group 4. P–P: completing a paper survey at Time 1 and 2. At Time 1 all participants also completed biochemical measures to validate self-reported smoking status (expired air carbon monoxide breath test) and alcohol consumption (ethyl alcohol urine assay). Results: Of the 618 who were eligible, 575 (93%) consented to completing the Time 1 surveys. Of these, 71% (N =411) completed Time 2 surveys. Compared to CO, the computer smoking self-report survey demonstrated 91% sensitivity, 94% specificity, 75% positive predictive value (PPV) and 98% negative predictive value (NPV). The equivalent paper survey demonstrated 86% sensitivity, 95% specificity, 80% PPV, and 96% NPV. Compared to urine assay, the computer alcohol use self-report survey demonstrated 92% sensitivity, 50% specificity, 10% PPV and 99% NPV. The equivalent paper survey demonstrated 75% sensitivity, 57% specificity, 6% PPV, and 98% NPV. Level of agreement of smoking self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.95 to 0.98 in each group and hazardous alcohol use self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.90 to 0.96 in each group. Conclusion: The collection of self-reported health risk information is equally accurate and reliable using computer interface in the general practice setting as traditional paper survey. Computer survey appears highly reliable and accurate for the measurement of smoking status. Further research is needed to confirm the adequacy of the quantity/frequency measure in detecting those who drink alcohol. Interactive computer administered health surveys offer a number of advantages to researchers and clinicians and further research is warranted. [Copyright &y& Elsevier]

Abstract: Objective: Handheld computers (personal digital assistant, PDA) have the potential to reduce the logistic burden, cost, and error rate of paper-based health research data collection, but there is a lack of appropriate software. The present work describes the development and evaluation of PDACT, a Personal Data Collection Toolset (www.healthware.org/pdact/index.htm) for the Palm™ Pilot handheld computer for interviewer-administered and respondent-administered data collection. Methods: We developed Personal Data Collection Toolkit (PDACT) software to enable questionnaires developed in QDS™ Design Studio, a Windows™ application, to be compiled and completed on Palm™ Pilot devices and evaluated in several representative field survey settings. Results: The software has been used in seven separate studies and in over 90,000 interviews. Five interviewer-administered studies were completed in rural settings with poor communications infrastructure, following one day of interviewer training. Two respondent-administered questionnaire studies were completed by learners, in urban secondary schools, after 15min training. Questionnaires were available on each handheld in up to 11 languages, ranged from 20 to 580 questions, and took between 15 and 90min to complete. Up to 200 Palm™ Pilot devices were in use on a single day and, in about 50 device-years of use, very few technical problems were found. Compared with paper-based collection, data validation and cleaning times were reduced, and fewer errors were found. PDA data collection is easy to use and preferred by interviewers and respondents (both respondent-administered and interviewer-administered) over paper. Data are compiled and available within hours of collection facilitating data quality assurance. Although hardware increases the setup cost of the first study, the cumulative cost falls thereafter, and converges on the cumulative cost of paper-based studies (four, in the case of our interviewer-administered studies). Conclusion: Handheld data collection is an appropriate, affordable and convenient technology for health data collection, in diverse settings. [Copyright &y& Elsevier]

Abstract: The number of slums has significantly increased in Bangladesh over the last three decades along with the expansion of cities and towns. Rapid urbanization, caused largely by heavy influx of migrants from rural areas, has exerted severe pressure on urban housing and public services in the metropolitan city of Khulna with which the expansion of infrastructure and basic urban services could not cope. This situation coupled with the destitute economic condition of poor migrants has given rise to the formation of a large number of slums where service inadequacies have been compounded and multiplied on a massive scale, resulting in hazardous environmental condition. Against this background the study was performed. Data has been collected from field survey, some secondary sources and focused group discussion. Some experts and several officials were also interviewed whose agencies are likely to responsible for the extension of the services to the slum in the event of upgrading work being taken up. The study reveals that status and practice regarding water, sanitation and hygiene. This paper has also explored that assessment of water resource availability and quality at source point of consumption; problems faced in getting safe drinking water; and knowledge of the features of hygienic latrine; awareness about health. In addition to the above, the survey maintained a specific focus on adult man, women and young generation. The paper may attribute to further research on water supply and sanitation study it will guide those who will work to improve the present. [Copyright &y& Elsevier]

Abstract: This paper uses data from the Scottish Health Survey 2003 and the comparable Health Survey for England 2003 to look at whether Scotland''s poor health image and mortality profile is reflected in regional inequalities in prevalence of four risk factors for cardiovascular disease: fruit and vegetable consumption, smoking, obesity and diabetes. It also looks at the “Scottish effect” – how much of any difference between and within Scotland and England remains once socio-demographic factors have been taken in to account. The paper then uses regional analyses to determine the extent to which areas within England and Scotland contribute to their national health advantage and disadvantage. All 2003 strategic health authorities in England and Scottish health boards were compared with Greater Glasgow health board as the reference category. The results showed that significant geographic variation in the risk factors remained once individual economic status was taken into account, but the relationship was complex and varied in strength and direction depending upon risk factor involved and gender of respondent. A small number of areas had significantly lower odds of fruit and vegetable consumption of five portions or more a day in men, compared with Greater Glasgow. In contrast some areas had significantly higher odds of fruit and vegetable consumption for women compared with Greater Glasgow. There was greater geographic variation in the odds of smoking in women than in men. Respondents in the south west and southeast of England (areas which usually show health advantage) did not show significantly lower odds of smoking compared with Greater Glasgow once socio-economic variation, age and urban residence was taken into account. It was respondents from central England that had lower odds of smoking than might be expected. Obesity stood out as the single risk factor that had demonstrated a “Scottish effect” in women only. [Copyright &y& Elsevier]

Abstract: Achieving high vaccination rates among health care workers (HCW) is an ongoing challenge. In 2007, the state of New South Wales, Australia instituted a policy directive with compulsory provisions for health care workers to be vaccinated. This study sought to identify staff awareness and attitudes in the early phase of implementation. It involved a self-completed paper-based or electronic survey of HCWs in two tertiary-referral teaching hospitals in Sydney, Australia in 2007. A total of 894/1200 completed the paper survey, whilst a further 185 completed it online. Of the 1079 respondents, 60% (646/1079) were aware of the policy directive but only 10% (63/646) described the specific requirements. Seventy-eight per cent supported the policy; 13% neither supported nor opposed it; and 4% opposed it. This survey provides an early, broad indication of the level of understanding and the attitudes of the HCWs towards the new directive. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the ability of population surveys to estimate the occurrence of maternal morbidities. Study Design and Setting: A literature search was conducted using MEDLINE, EMBASE, POPLINE references from relevant papers and proceedings of scientific meetings. No restrictions were made regarding language, date, design, journal, or country. Potentially relevant papers were independently evaluated by two reviewers. Eligible studies were critically evaluated, particularly with respect to complications: eclampsia and other hypertensive complications, hemorrhages, dystocias, and infections. The questions with the highest combined values for sensitivity and specificity were identified in each study. Results: Seven hospital-based studies involving 2,907 women were included. The gold standard was the clinical records, and the validation strategy consisted of applying questionnaires and comparing them with the gold standard. Questions regarding eclampsia and other hypertensive complications performed satisfactorily in four studies; questions on dystocia and infection in two studies each, and questions regarding hemorrhagic complications in only one study. In general, when the actual prevalence of the condition is low (≤5%), surveys tend to overestimate prevalence. Conclusions: Prior validation of questionnaires on maternal morbidity is fundamental to assure adequate information. Population surveys using validated questionnaires may provide useful information on the prevalence of maternal morbidities. [Copyright &y& Elsevier]