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Inverse probability weighting (IPW) is frequently used to reduce or minimize the observed confounding in observational studies. IPW creates a pseudo-sample by weighting each individual by the inverse of the conditional probability of receiving the treatment level that he/she has actually received. In the pseudo-sample there is no variation among the multiple individuals generated by weighting the same individual in the original sample. This would reduce the variability of the data and therefore bias the variance estimate in the target population. Conventional variance estimation methods for IPW estimators generally ignore this underestimation and tend to produce biased estimates of variance. We here propose a more reasonable method that incorporates this source of variability by using parametric bootstrapping based on intra-stratum variability estimates. This approach firstly uses propensity score stratification and intra-stratum standard deviation to approximate the variability among multiple individuals generated based on a single individual whose propensity score falls within the corresponding stratum. The parametric bootstrapping is then used to incorporate the target variability by re-generating outcomes after adding a random error term to the original data. The performance of the proposed method is compared with three existing methods including the naïve model-based variance estimator, the nonparametric bootstrap variance estimator, and the robust variance estimator in the simulation section. An example of patients with sarcopenia is used to illustrate the implementation of the proposed approach. According to the results, the proposed approach has desirable statistical properties and can be easily implemented using the provided R code. [ABSTRACT FROM AUTHOR]

Backgrounds: Meta-analyses can be a powerful tool but need to calibrate potential unrepresentativeness of the included trials to a target population. Estimating target population average treatment effects (TATE) in meta-analyses is important to understand how treatments perform in well-defined target populations. This study estimated TATE of paliperidone palmitate in patients with schizophrenia using meta-analysis with individual patient trial data and target population data. Methods: We conducted a meta-analysis with data from four randomized clinical trials and target population data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Efficacy was measured using the Positive and Negative Syndrome Scale (PANSS). Weights to equate the trial participants and target population were calculated by comparing baseline characteristics between the trials and CATIE. A calibrated weighted meta-analysis with random effects was performed to estimate the TATE of paliperidone compared to placebo. Results: A total of 1,738 patients were included in the meta-analysis along with 1,458 patients in CATIE. After weighting, the covariate distributions of the trial participants and target population were similar. Compared to placebo, paliperidone palmitate was associated with a significant reduction of the PANSS total score under both unweighted (mean difference 9.07 [4.43, 13.71]) and calibrated weighted (mean difference 6.15 [2.22, 10.08]) meta-analysis. Conclusions: The effect of paliperidone palmitate compared with placebo is slightly smaller in the target population than that estimated directly from the unweighted meta-analysis. Representativeness of samples of trials included in a meta-analysis to a target population should be assessed and incorporated properly to obtain the most reliable evidence of treatment effects in target populations. [ABSTRACT FROM AUTHOR]

In 2016, the Kenya National Immunization Technical Advisory Group requested additional programmatic and cost effectiveness data to inform the choice of strategy for a national influenza vaccination program among children aged 6–23 months of age. In response, we conducted an influenza vaccine demonstration project to compare the performance of a year-round versus campaign-mode vaccination strategy. Findings from this demonstration project will help identify essential learning lessons for a national program. We compared two vaccine delivery strategies: (i) a year-round vaccination strategy where influenza vaccines were administered throughout the year at health facilities. This strategy was implemented in Njoro sub-county in Nakuru (November 2019 to October 2021) and Jomvu sub-county in Mombasa (December 2019 to October 2021), (ii) a campaign-mode vaccination strategy where vaccines were available at health facilities over four months. This strategy was implemented in Nakuru North sub-county in Nakuru (June to September 2021) and Likoni sub-county in Mombasa (July to October 2021). We assessed differences in coverage, dropout rates, vaccine wastage, and operational needs. We observed similar performance between strategies in coverage of the first dose of influenza vaccine (year-round strategy 59.7 %, campaign strategy 63.2 %). The coverage obtained in the year-round sub-counties was similar (Njoro 57.4 %; Jomvu 63.1 %); however, more marked differences between campaign sub-counties were observed (Nakuru North 73.4 %; Likoni 55.2 %). The campaign-mode strategy exceeded the cold chain capacity of participating health facilities, requiring thrice monthly instead of once monthly deliveries, and was associated with a two-fold increase in workload compared to the year-round strategy (168 vaccines administered per day in the campaign strategy versus 83 vaccines administered per day in the year-round strategy). Although both strategies had similar coverage levels, the campaign-mode strategy was associated with considerable operational needs that could significantly impact the immunization program. [ABSTRACT FROM AUTHOR]

Some research on the population in a European country, referred to as the target population, may not provide a sufficient sample size and require pooling multiple national data sources. The researcher can access multiple national data sources one at a time but cannot access them simultaneously at an individual patient level, because of regulation requirements on data sharing. We propose a strategy that enables the combination of information from multiple data sources when IPD are not simultaneously accessible to researchers. This strategy starts with a protocol for extracting information consistently from all data sources. It uses the matching adjusted indirect comparison (MAIC) approach to derive the weights to align the means of the identified covariates of each data source to those of a target study population. The final analysis will be a meta-analysis on the weight adjusted estimates of treatment effect from individual data sources. [ABSTRACT FROM AUTHOR]

Malawi introduced the human papillomavirus (HPV) vaccine nationwide in January 2019, with a target population of nine-year-old girls. Early in rollout, some health facilities reported stockouts, raising questions about the accuracy of the age eligibility of girls registered during the initial population mapping exercise. Mapping results showed that the estimated number of nine-year-old girls registered for vaccination was significantly higher than National Statistical Office (NSO) estimates, resulting in questions about enumeration of the target population. Consequently, the Ministry of Health of Malawi's Expanded Programme on Immunization (MOH-EPI) and immunization partners conducted a post-introduction data verification exercise to validate the eligibility of girls registered during mapping. Data were collected by immunization partners and representatives from national, zonal, and district levels. Dates of birth (DOB) were validated in HPV vaccine mapping registers and compared with information obtained from individual registered girls during school visits and their parents during home visits. HPV vaccine mapping registers were reviewed, showing that 76 percent of girls (n = 957) had DOBs within the vaccination eligibility range. A subset of the 957 girls (4 1 4) were interviewed; of them 74 percent (3 0 7) provided DOBs within the eligible period. Parents of the remaining eligible girls (5 4 3) were interviewed; 55 percent (2 9 7) of them, provided DOBs that were within the eligible period, indicating that, when using parents as an information source, 45 percent of the girls were outside the target age group. The eligibility verification exercise reviewed the accuracy of the mapping exercise and provided lessons for future target setting. Findings validate using NSO population estimates for target setting, incorporating the identification and registration of girls for HPV vaccination into RI microplanning headcounts, and verifying with parents the age and eligibility of girls registered before HPV vaccination is conducted. [ABSTRACT FROM AUTHOR]

Background: China is facing substantial risks of imported coronavirus disease 2019 (COVID-19) cases and a domestic resurgence in the long run, and COVID-19 vaccination is expected to be the long-lasting solution to end the pandemic. We aim to estimate the size of the target population for COVID-19 vaccination at the provincial level in the mainland of China, and summarize the current progress of vaccination programs, which could support local governments in the timely determination and adjustment of vaccination policies and promotional measures. Methods: We conducted a descriptive study of the entire population in the mainland of China, between December 2020 and August 2021. By extracting provincial-stratified data from publicly available sources, we estimated the size of priority target groups for vaccination programs, and further characterized the ongoing vaccination program at the provincial level, including the total doses administered, the coverage rate, and the vaccination capacity needed to achieve the target coverage of 80% by the end of 2021. We used R (version 4.1.0) to complete the descriptive statistics. Results: The size of the target population shows large differences among provinces, ranging from 3.4 million to 108.4 million. As of 31 August, 2021, the speed of vaccine roll-out differs considerably as well, with the highest coverage occurring in Beijing and Shanghai, where 88.5% and 79.1% of the population has been fully vaccinated, respectively. In 22 of 31 provincial-level administrative divisions (PLADs), more than 70% of the population was administered at least one dose by August. With the current vaccination capacity, the target of 80% coverage could be achieved by 2021 in 28 PLADs. Conclusions: Disparities exist in the target population size and vaccination progress across provinces in the mainland of China. China has made great strides in the vaccination speed since roll-out, and could basically achieve the targeted vaccine coverage. [ABSTRACT FROM AUTHOR]

Background: All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. Methods: On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. Results: Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a twodose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. Conclusions: The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Aim/Purpose The purpose of this article is to present clear definitions of the population structures essential to research, to provide examples of how these structures are described within research, and to propose a basic structure that novice researchers may use to ensure a clearly and completely defined population of interest and sample from which they will collect data. Background Novice researchers, especially doctoral students, experience challenges when describing and distinguishing between populations and samples. Clearly defining and describing research structural elements, to include populations and the sample, provides needed scaffolding to doctoral students. Methodology The systematic review of 65 empirical research articles and research texts provided peer-reviewed support for presenting consistent population- and samplerelated definitions and exemplars. Contribution This article provides clear definitions of the population structures essential to research, with examples of how these structures, beginning with the unit of analysis, are described within research. With this defined, we examine the population subsets and what characterizes them. The proposed writing structure provides doctoral students a model for developing the relevant population and sample descriptions in their dissertations and other research. Findings The article describes that although many definitions and uses are relatively consistent within the literature, there are epistemological differences between research designs that do not allow for a one-size-fits-all definition for all terms. We provide methods for defining populations and the sample, selecting a sample from the population, and the arguments for and against each of the methods. Recommendations for Practitioners Social science research faculty seek structured ways in which to present key research elements to doctoral students and to provide a model by which they may write the dissertation. The article offers contemporary examples from the peerreviewed literature to support these aims. Recommendations for Researchers Novice researchers may wish to use the recommended framework within this article when developing the relevant section of the dissertation. Doing so provides an itemized checklist of writing descriptions, ensuring a more complete and comprehensive description of the study population and sample. Impact on Society The scientific method provides a consistent methodological approach to researching and presenting research. By reemphasizing the definitions and applications of populations and samples in research, and by providing a writing structure that doctoral students may model in their own writing, the article supports doctoral students' growth and development in using the scientific method. Future Research Future researchers may wish to further advance novice researcher knowledge in developing models to guide dissertation writing. Future studies may focus on other essential areas of research, including studies about recruitment methods and attrition strategies, data collection procedures, and overall research alignment. Additionally, future researchers may wish to consider evaluating doctoral student foundational knowledge about populations and samples as part of the research process. [ABSTRACT FROM AUTHOR]

• Our evidence has shown that active case-finding of tuberculosis might be effective in high prevalence area with a low economic level, particularly among the elderly and people with a history of TB. • New rapid diagnosis technology should be considered to decrease the TB prevalence in people with a history of TB. • ACF screening could identify more active TB cases than PCF by a TB surveillance system in high prevalence area with underdeveloped economics. Tuberculosis (TB) is a critical global public threat, and limited epidemiology studies have been performed to explore the efficacy of active TB screening. Three sites located in eastern China were chosen in 2013, and three rounds of systematic screenings were performed in permanent residents aged older than 15 years. The TB incidence showed a downtrend after several rounds of active screening at the three sites, and a significant change was observed at site A in the overall population. In the target population at sites A and B, both the elderly and people with a history of TB had a remarkable decline through the first or second round of screening. The implementation of active case-finding identified 2.36 [1.47,3.81] (2013 vs. 2012) and 1.49 [1.1,2.03] (2013–2015 vs. 2010–2012) more potential cases than the passive case-finding by the surveillance system at site A. Active case-finding of tuberculosis might be effective in high prevalence area with a low economic level, particularly among the elderly and people with a history of TB. Additionally, new rapid diagnosis technology should be considered to decrease the prevalence among people with a history of TB. Ultimately, active screening identified more active TB cases than passive case-finding, particularly in high prevalence area with underdeveloped economics. [ABSTRACT FROM AUTHOR]

The definition of the target population of a public policy or program stands in function of the problem construction, this situation has an implication for the design of a social policy, because it has to take in consideration the inclusion or exclusion of some population group in the relationship with governmental attention. Traditionally, the design of social programs in Mexico has identified the target population through the multidimensional poverty approach; however, the literature evidences the need to give priority attention to vulnerability because this approach considers the poor population and also that which may be facing future changes in the environment. Therefore, the objective of this article is to present the usefulness and scope of the vulnerability approach as an additional option to define the target population in social programs, using as an example the "support to female heads of family" program that is implemented in the state of Jalisco since 2013. [ABSTRACT FROM AUTHOR]

In recent years, increasing attention has been paid to problems of external validity, specifically to methodological approaches for both quantitative generalizability and transportability of study results. However, most approaches to these issues have considered external validity separately from internal validity. Here we argue that considering either internal or external validity in isolation may be problematic. Further, we argue that a joint measure of the validity of an effect estimate with respect to a specific population of interest may be more useful: We call this proposed measure target validity. In this work, we introduce and formally define target bias as the total difference between the true causal effect in the target population and the estimated causal effect in the study sample, and target validity as target bias = 0. We illustrate this measure with a series of examples and show how this measure may help us to think more clearly about comparisons between experimental and nonexperimental research results. Specifically, we show that even perfect internal validity does not ensure that a causal effect will be unbiased in a specific target population. [ABSTRACT FROM AUTHOR]

This study aims to identify the effect of the individual regulation method according the doublecoding in improving the vision speed and learning the skills of front and back shots in tennis. The researcher used the experimental method with three equal experimental groups. The study included a random sample of 66 students from the College of Physical Education and Sport Sciences at the University of Baghdad for the academic year 2018-2019. The study sample represents 30% of the target population. The research groups were classified using the double-coding scale. The number of learners in the first group is 24 (image coding), the second experimental group (verbal coding) (n = 20), and the third experimental group (double-coding) (n = 22). [ABSTRACT FROM AUTHOR]

According to Chapter 1.4 of the World Organisation for Animal Health (WOAH) Aquatic Animal Health Code, an entire country or zone can be classified as free of a disease only if there is compelling evidence that all susceptible populations within the country or zone are free. However, the methods for achieving freedom are not prescribed in the WOAH standards and guidelines. Within this context, this paper describes a novel methodology to determine if surveillance results can be extrapolated from a study population to a target population. A framework of six criteria was developed to standardize a method for extrapolating surveillance results to other susceptible populations that have not been sampled. Criteria 1 assesses the internal validity for the freedom claim on the source population. Criteria 2 assesses which other susceptible populations have a non-negligible probability of exposure. Criteria 3 assesses whether the risk of infection upon exposure of the source population is the same or greater than each of the other susceptible populations. Finally, Criteria 4, 5 and 6 assess if the other susceptible populations would transmit the infection to the source population or if they have the same exposure pathways as the source population. We illustrate the use of this novel methodology using two hypothetical case scenarios. The presented methodology has the advantage of being applicable either retrospectively or prospectively. When applied retrospectively, it can be used to assess if the surveillance results of the source population can be extrapolated to the target population. When applied prospectively it can be used to design a more efficient surveillance system by selecting source populations from which it is easier to extrapolate surveillance results to the rest of the target population. Conclusions drawn using this methodology depend on the validity of the assumptions made when working through the methodology. We therefore recommend cautious application of the criteria and thorough review of all assumptions. [ABSTRACT FROM AUTHOR]

This article compares the struggle of two groups in Israel for housing rights. Following Schneider and Ingram’s model, the article analyses the influence of the social construction of each group ‒ residents of the communal rural sector as an advantaged group, and public housing tenants as a dependent group ‒ on its housing rights. The findings fit Schneider and Ingram’s model with one surprising exception: The ‘dependent’ group achieved significant favourable legislation in 1998, whereas the ‘advantaged’ group has not yet succeeded. The article attempts to explain this divergence from the model and the effect of social construction on housing rights in a given society. [ABSTRACT FROM PUBLISHER]

Background The Health Claims Regulation entered into force in January 2007. The European Food Safety Authority (EFSA) has evaluated more than 3000 health claims since then, but EFSA's responsibilities in this area and the extent to which its scientific assessments are in accordance with the current legal framework are still not fully understood. Scope and approach The scope of this paper is to provide insight on the use of scientific knowledge in the area of nutrition for the substantiation of health claims made on food. The reasons why a positive evaluation by EFSA may not be sufficient for the authorisation of a health claim are also discussed. Concrete examples are used to illustrate these aspects. Key findings and conclusions How health claims are scientifically assessed by EFSA has not been fully understood by stakeholders yet. Thorough knowledge on how EU legislation translates into scientific requirements for substantiation is essential to building successful applications. Other factors which may play a role in the authorisation of a claim and which are not evaluated by EFSA, such as the legal status of the food/constituent, its safety, or the compatibility of the claim with national and international dietary recommendations, should also be considered early in the process. EFSA is committed to providing further guidance to stakeholders on how to prepare applications for authorisation by making use of its 10 years of experience on the scientific evaluation of health claims made on food. [ABSTRACT FROM AUTHOR]

Objective To compare the results of two rounds of colorectal cancer screening in Haining, explore the long-term mechanism and interval time of screening during the prevention and control of colorectal cancer, and establish practical basis for the rational prevention and control strategies. Methods Between 2007 to 2010 and 2013 to 2015, a total of 80,000 cases who had completed two rounds of tumor screening were enrolled and analyzed. All cases comes from five towns in Haining. Results The first round of screening was performed in 80 603 cases and 12.92% (n=10 417) were identified as high-risk population. Colonoscopy were completed in 7 796 subjects and 22.05% (n=1 719) of them were found at least one neoplastic lesions ( polyps, adenoma or carcinoma). The population detection rate of all neoplasia was 21.33 per thousand. The detection rate of advanced neoplasia was 4.58% per colonoscopy and 4. 43‰ in the population. A total of 357 advanced neoplasia including 296 advanced adenomas and 61 colorectal cancers were found, 330 of whom were applied to early treatment (92.44% ). A total of 89 403 subjects participated the second round of screening. The detection rate ol high-risk population in the second round (20.81%) was significantly higher than that in the first round (P<0.05). A total of 12 917 subjects completed colonoscopy and 31.97% (n=4 129) of them were found as least one neoplastic lesion. The population detection rate of all neoplasia was 46.18 ‰. Both in the subjects completed colonoscopy and in the screened population, the detection rate of all neoplasia were significantly (P<0.01 ) higher than that of the first round. The detection rate of advanced neoplasia (n=851) in both the subjects completed colonoscopy (6.59‰)and the total screened population (9.52‰) in the second round were also significantly (P<0.01) higher than that of the first round. The difference of early detection rates for the first (92.44%) and the second (97.53%) round screening were not statistically significant ( P> 0.05 ). Conclusions The main technical indicators of the second round of colorectal cancer screening were significantly better than that of the first round, with significant screening effect. A screening interval of 5 years was suggested for the next round of colorectal cancer screening. [ABSTRACT FROM AUTHOR]

In this paper the concepts of general, target and accessible population are explained in response to misconceptions and controversies associated with them, and the fact that the relationships between them have not been explained in the context of qualitative enquiry in any formal study. These concepts are discussed in this study based on a general scenario. We basically attempt to explain the importance of specifying the general, target and accessible populations in a qualitative study when the study population is large. The study depicts how the research goal, contexts and assumptions can dictate the content and concentration of the target and accessible population in qualitative inquiry. It also poses the sampling implications of our explanations and highlights the stages and levels of what we refer to as population refinement. [ABSTRACT FROM AUTHOR]

In this paper a two-phase compressive sensing (CS) and received signal strength (RSS)-based target localization approach is proposed to improve position accuracy by dealing with the unknown target population and the effect of grid dimensions on position error. In the coarse localization phase, by formulating target localization as a sparse signal recovery problem, grids with recovery vector components greater than a threshold are chosen as the candidate target grids. In the fine localization phase, by partitioning each candidate grid, the target position in a grid is iteratively refined by using the minimum residual error rule and the least-squares technique. When all the candidate target grids are iteratively partitioned and the measurement matrix is updated, the recovery vector is re-estimated. Threshold-based detection is employed again to determine the target grids and hence the target population. As a consequence, both the target population and the position estimation accuracy can be significantly improved. Simulation results demonstrate that the proposed approach achieves the best accuracy among all the algorithms compared. [ABSTRACT FROM AUTHOR]

Biostatisticians recognize the importance of precise definitions of technical terms in randomized controlled clinical trial (RCCT) protocols, statistical analysis plans, and so on, in part because definitions are a foundation for subsequent actions. Imprecise definitions can be a source of controversies about appropriate statistical methods, interpretation of results, and extrapolations to larger populations. This paper presents precise definitions of some familiar terms and definitions of some new terms, some perhaps controversial. The glossary contains definitions that can be copied into a protocol, statistical analysis plan, or similar document and customized. The definitions were motivated and illustrated in the context of a longitudinal RCCT in which some randomized enrollees are non-adherent, receive a corrupted treatment, or withdraw prematurely. The definitions can be adapted for use in a much wider set of RCCTs. New terms can be used in place of controversial terms, for example, subject. We define terms specifying a person's progress through RCCT phases and that precisely define the RCCT's phases and milestones. We define terms that distinguish between subsets of an RCCT's enrollees and a much larger patient population. 'The intention-to-treat (ITT) principle' has multiple interpretations that can be distilled to the definitions of the 'ITT analysis set of randomized enrollees'. Most differences among interpretations of 'the' ITT principle stem from an RCCT's primary objective (mainly efficacy versus effectiveness). Four different 'authoritative' definitions of ITT analysis set of randomized enrollees illustrate the variety of interpretations. We propose a separate specification of the analysis set of data that will be used in a specific analysis. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: We review three common methods to estimate predicted probabilities following confounder-adjusted logistic regression: marginal standardization (predicted probabilities summed to a weighted average reflecting the confounder distribution in the target population); prediction at the modes (conditional predicted probabilities calculated by setting each confounder to its modal value); and prediction at the means (predicted probabilities calculated by setting each confounder to its mean value). That each method corresponds to a different target population is underappreciated in practice. Specifically, prediction at the means is often incorrectly interpreted as estimating average probabilities for the overall study population, and furthermore yields nonsensical estimates in the presence of dichotomous confounders. Default commands in popular statistical software packages often lead to inadvertent misapplication of prediction at the means.Methods: Using an applied example, we demonstrate discrepancies in predicted probabilities across these methods, discuss implications for interpretation and provide syntax for SAS and Stata.Results: Marginal standardization allows inference to the total population from which data are drawn. Prediction at the modes or means allows inference only to the relevant stratum of observations. With dichotomous confounders, prediction at the means corresponds to a stratum that does not include any real-life observations.Conclusions: Marginal standardization is the appropriate method when making inference to the overall population. Other methods should be used with caution, and prediction at the means should not be used with binary confounders. Stata, but not SAS, incorporates simple methods for marginal standardization. [ABSTRACT FROM PUBLISHER]

A growing implementation literature outlines broad evidence-based practice implementation principles and pitfalls. Less robust is knowledge about the real-world process by which a state or agency chooses an evidence-based practice to implement and evaluate. Using a major U.S. initiative to reduce long-term foster care as the case, this article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor, and tailoring the model to the practice context. Use of implementation science guidelines and lessons learned from a unique private-public-university partnership are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Poor eating habits are a key priority on the European public health agenda due to their large health and economic implications. Healthy eating interventions may be more effective if consumers perceive their eating habits as a more serious personal health risk. This study investigates European consumers' perceived seriousness of their eating habits, its determinants and relative importance among other potential personal health risks including weight, stress and pollution. Method: A quantitative survey was conducted during Spring 2011 among samples representative for age, gender and region in five European countries (n=3003). Results: Participants were neutral towards the seriousness of their eating habits for personal health. Eating habits were ranked third after stress and weight. Gender, age, country, health motive, body mass index, and subjective health status were important determinants of the perceived seriousness of their eating habits, whereas perceived financial condition, smoking and education were insignificant. Conclusion: Eating habits were perceived more seriously by women, Italians, obese, and younger individuals with stronger health motives and fair subjective health status. Nevertheless, other health risks were often considered more important than eating habits. More or specific efforts are required to increase Europeans' awareness of the seriousness of their eating habits for personal health. [Copyright &y& Elsevier]

Purpose. To determine the feasibility of a community-wide approach integrated with primary care (Cardiovascular Health Awareness Program [CHAP]) to promote monitoring of blood pressure (1W) and awareness of cardiovascular disease risk. Design. Demonstration project. Setting. Two midsized Ontario communities. Participants. Community-dwelling seniors. Intervention. CHAP sessions were offered in pharmacies and promoted to seniors using advertising and personalized letters from physicians. Trained volunteers measured 1W, completed risk profiles, and provided risk- specific education materials. Method. We examined the distribution of risk factors among participants and predictors of multiple visits and elevated BP. Results. Opinion leaders aided recruitment of family physicians (n = 56/63) and pharmacists (n = 18/19). Over 90 volunteers were recruited. Invitations were mailed to 4394 seniors. Over 10 weeks, there were 4165 assessments of 2350 unique participants (approximately 30% of senior residents). 37.5% of attendees had untreated (16%; 360/2247) or uncontrolled (21.5%; 482/2247) high BP. Participants who received a letter (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.1-3.0), had an initial elevated BP (OR 1.2, 95% CI 1.0-1.5), or reported current antihypertensive medication (OR 1.4, 95% CI 1.1-1.6) were more likely to attend multiple sessions (p ⩽ .05 for all). Older age (≥ 70 years; OR 1.5, 95% CI 1.3-1.8), BMI ≥ 30 (OR 1.7, 95% CI 1.4-2.2), current antihypertensive medication (OR 1.6, 95% CI 1.3-1.9), and diabetes (OR 2.4, 95% CI 1.9-3.2) predicted elevated BP (p <.001 for all). Conclusion. The program yielded learning about community mobilization anti identified a substantial number of seniors with undiagnosed/uncontrolled high BP. [ABSTRACT FROM AUTHOR]

Purpose. The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity. Design. Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up. Setting. Individual telephone interviews were conducted with 16 women with confirmed breast anomaly Participants. Low-income women screened through a national breast cancer early detection program. Method. Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package. Results. For women (16, or 72% of case management referrals) below 250% of the poverty level the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants' health decisions. Conclusion. The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development. [ABSTRACT FROM AUTHOR]

Purpose. Assessing food environments often requires using commercially available data. Disparate methods used for classifying food outlets in these databases call for creating a classification approach using common definitions. A systematic strategy for reclassifying food stores and restaurants, as they appear in commercial databases, into categories that differentiate the availability of healthy options is described here. Design and Setting. Commercially available data on food outlets including names, addresses, North American Industry Classification System codes, and associated characteristics was obtained for five New Jersey communities. Analysis. A reclassification methodology was developed using criteria and definitions from the literature to categorize food outlets based on availability of healthy options. Information in the database was supplemented by systematic Internet and key word searches, and from phone calls to food outlets. Results. The methodology resulted in 622 supermarket/grocery stores, 183 convenience stores, and 148 specialty stores in the original data to be reclassified into 58 supermarkets, 30 grocery stores, 692 convenience stores, and 115 specialty stores. Outlets from the original list of 1485 full-service restaurants and 506 limited-service restaurants were reclassified as 563 full- service restaurants and 1247 limited-service restaurants. Reclassification resulted in less than one-seventh the number of supermarkets and grocery stores, more than three times the number of convenience stores, and twice as many limited-service restaurants'a much less healthy profile than the one generated by using exclusively the commercial databases. Conclusion. An explicit and replicable strategy is proposed for reclassifying food outlets in commercial databases into categories that differentiate on the basis of healthy food availability. The intent is to contribute towards building a consensus among researchers on definitions used in public health research for characterizing different types offood outlets. [ABSTRACT FROM AUTHOR]

The study proposes a new stratified adaptive phase II design based on the noted two-stage Fleming design to determine whether a new drug provides benefit to at least one subpopulation of patients. The adaptive method in which the second-stage sample size and decision rules depend on the observed response rates at the first stage is described. The objective of the method to stop drug development in the whole population at the first or second stage is also noted.

To describe the characteristics of participants who enrolled in a commercial web-based weight loss program (SP Health Weight Loss Platform), and assess the reach of the program. Participants were enrolled from 15 August 2007 to 31 May 2008. An enrolment survey captured self-reported data for demographic, anthropometric and eating and exercise behaviours. The target population was defined as any Australian aged 18-75 years, with a body mass index of ≥22, who was using a commercial program to lose or maintain weight and had access to the Internet. The proportion of the target population reached and representativeness were determined from available population data. The 11 341 participants were predominantly obese middle-aged women, of higher socioeconomic status, from major cities within Australia. Men (n = 1531) had a significantly higher mean body mass index, poorer eating and activity habits, and different reasons for eating and attempting weight loss than women ( P < 0.05). Obese participants had a significantly higher mean age and were more likely to be from low socioeconomic and rural areas ( P < 0.05). Approximately 1.6% of the potential target group enrolled in the program (2.0% women and 0.6% men). The highest participation rate was among obese 25- to 35-year-olds. This was true overall (7.7% total), as well as for both sexes (9.0% women and 4.6% men). The present study demonstrates that web-based weight loss programs have the ability to reach a large number of individuals at risk of weight-related morbidity, including 'hard-to-reach' groups such as men and younger clients. [ABSTRACT FROM AUTHOR]

Abstract: To better understand the gap between limited influenza vaccine supply and the target population for vaccination in China, we conducted a retrospective survey to quantify the production capacity, supply and sale of seasonal trivalent inactive vaccine (TIV) from the 2004–2005 through the 2008–2009 season, and estimated the target population who should receive annual influenza vaccine. The maximum domestic capacity to produce TIV was 126 million doses in 2009. A total of 32.5 million doses of TIV were supplied in 2008–2009, with an average annual increase rate of 18% from 16.9 million in 2004–2005. This represents an amount sufficient to vaccinate 1.9% of Chinese population. The average number of doses of TIV for sale by province ranged from <5 to 108 per 1000 people. The differences are explained in part by level of economic development but also influenced by local reimbursement policies in some provinces. Based on national recommendations, we estimated a target population of 570.6 million or 43% of the total population. Supply and domestic production capacity for influenza vaccine is currently insufficient to vaccinate the estimated target population in China. The Government of China should consider measures to improve domestic production capacity of influenza vaccine, expand successful promotional campaigns, and add cost subsidies in high risk groups to further encourage influenza vaccine usage. [ABSTRACT FROM AUTHOR]

Bladder cancer is the seventh most common cancer worldwide in men and the 17th in women with an overall number of 356,000 new cases of urinary bladder cancer worldwide in 2002. It is one of the most expensive cancers from diagnosis to death and the fifth most expensive cancer in terms of total medical care expenditures in the US. A screening program that resulted in detection of bladder cancer at an earlier stage, prior to muscle invasion or metastasis, could render a significant improvement in patient morbidity and overall survival. Acceptance of wide-spread screening strategies requires careful consideration of the competing risks, benefits, and costs associated with such policies. In this article, we will review the pros and cons of bladder cancer screening with a focus on cost-effectiveness and who should be screened. [ABSTRACT FROM AUTHOR]

Purpose. To quantify annual costs attributable to obesity, including both increased medical expenditures and absenteeism, separately for overweight and three categories of obesity (i.e., obesity grades I, II, and III,) among men and women with full-time employment. Design. Standard econometric methods were used to separately estimate overweight and obesity-attributable medical expenditures and absenteeism. Setting. The civilian noninstitutionalized population of the United States. Sample. Two nationally representative and publicly available datasets (with response rates of at least 60%) were restricted to participants 18 to 64 years old and employed full- time for the entire year. The final datasets used to estimate obesity-attributable medical expenditures and absenteeism included 20,329 and 25,427 adults, respectively. Measures. Annual medical expenditures and missed work days due to illness or injury. Analysis Results. Overweight and obesity-attributable costs range front $175 per year for overweight male employees to $2485 per year for grade-II obese female employees. The costs of obesity (excluding overweight,) at a firm with 1000 employees are estimated to be $285,000 per year. Conclusions. Obesity results in significant increases in medical expenditures and absenteeism among full-time employees. Approximately 30% of the total costs result front increased absenteeism, and although those with grade-III obesity represent only 3% of the employed population, they account for 21% of the costs due to obesity. These estimates do not consider other potential costs associated with obesity, including disability and presenteeism. [ABSTRACT FROM AUTHOR]

Purpose. To examine the impact of a 6-week minimal contact intervention on walking behavior, the 10 processes of change of the transtheoretical model (TTM,), and self-efficacy among insufficiently active women. Methods. This study used a pre-experimental design. Of the 43 women who began the study, 36 (84 %) completed questionnaires at baseline and postintervention. They were given brochures and pedometers and were sent e-mails that contained messages designed to positively affect TTM constructs. Changes in time spent walking, use of the 10 processes of change, and self-efficacy were analyzed using Wilcoxon signed rank tests and paired t-tests. Results. Participants significantly increased their total walking minutes (p = .001) and use of counterconditioning, dramatic relief reinforcement management, self-liberation, stimulus control, and social liberation (p <.05). Discussion. The findings of this feasibility study provide preliminary evidence that this theoretically based, minimal contact lifestyle intervention may be an effective, low-cost approach to increase walking among insufficiently active women. [ABSTRACT FROM AUTHOR]

In recent years, the use of adaptive methods in clinical development based on accrued data has become very popular due to its flexibility in modifying trial procedures and/or statistical procedures of on-going clinical trials. However, it is a concern that the actual patient population after the modifications could deviate from the originally targeted patient population. Major modifications of trial procedures and/or statistical procedures of on-going trials may result in a totally different trial, which is unable to address the scientific/medical questions that the trial intends to answer. In this article, the impact on the target patient population, statistical inference, and power analysis for sample size adjustment after changes or modifications made to an on-going clinical trial is studied. [ABSTRACT FROM AUTHOR]

A run-in is a period prior to randomization during which potential participants who have met all entry criteria for a randomized clinical trial are assigned the same regimen, either the control (possibly placebo) or the experimental treatment. Typically, the intention is to exclude from the subsequent study (i.e., randomization) some segment of this cohort, based on their experiences during the run-in period. Selecting patients based on the run-in thereby forces differential representation of certain subpopulations relative to others. Previous studies have addressed the potential for a run-in to jeopardize validity through unintended mechanisms. While these concerns are valid, they leave open the possibility that modifications to the design of the run-in might be able to preserve validity, even if patient selection is based on the results of the run-in. As such, we address the potential for selecting patients based on response during a run-in period to jeopardize validity directly, through its intended effect of overrepresenting (relative to the screened population) some segments in the randomized portion of the trial and underrepresenting others.Sackett D, Vist G. <

Orthpoxvirus infection can spread more easily in a population with a waning immunity with the subsequent emergence/re-emergence of the viruses pertaining to this genus. In the last two decades, several cases of Orthopoxvirus, and in particular Cowpoxvirus infections in humans were reported in different parts of the world, possibly due to the suspension of smallpox vaccinations. To date, in Italy, few investigations were conducted on the presence of these infections, and because of this a serosurvey was carried out to evaluate Cowpoxvirus infection in feline colonies situated in the province of Rome, since these are also susceptible to other zoonotic viruses belonging to Orthopoxvirus, and from which humans may contract the infection. The sample design was set at an expected minimum seroprevalence of 7.5%, a 5% standard error and 95% confidence level. In parallel, a serological investigation was conducted using convenience sampling in domestic, exotic and wild susceptible animals of the Latium and Tuscany Regions, which are areas in the jurisdiction of the Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, coordinating this study. The serological methods employed were indirect immunofluorescence for 36 sera of nonhuman primate and virus neutralization for 1198 sera of different species. All the 1234 sera examined were negative for the presence of antibodies against Cowpoxvirus, indicating its limited circulation in the areas of investigation. The methodology applied for the serosurveillance could be adopted in the case of outbreaks of this infection and for the evaluation of the spread of this infection in the area of interest, to obtain essential information crucial for animal and public health policies according to the One Health concept. [ABSTRACT FROM AUTHOR]

The author discusses several papers about cancer treatment and survivorship given the growing number of cancer survivors worldwide who are enduring side effects they have to manage. These include a study by C Handberg et al which describes the aim of cancer rehabilitation, a pilot study by KM Heinrich et al which describes the efficacy of a high-intensity functional training programme among cancer survivors and one by T Mitchell which focused on healthcare professionals with history of cancer.

Establishing cycling as a prominent utility mode is recognised as central to creating sustainable transport systems in many cities around the world. Strategies of starter cycling cities are often biased to the supply of infrastructure along prominent corridors without acknowledging the nature, quantum or location of potential demand for cycling. Decisions are frequently left to local knowledge and experience of local needs, resulting in a bias with little opportunity for repeatability or reproducibility. This study proposes a data-driven approach to estimate the potential market for cycling geographically. Estimates are based on the number of potential cyclists in close proximity to the destinations they want to access. The paper demonstrates the method using Cape Town, South Africa as a case study. Given the virtual absence of utility cycling in the city, characteristics of cyclists in cities where cycling is popular are used to identify potential cyclists. Destination nodes are stratified in terms of the characteristics of their users, while home locations of persons with these characteristics are identified from a publicly available synthetic population for Cape Town. Analysis provides an order of magnitude indication of the cycling potential of selected nodes. It also shows areas with many potential cyclists that are not in proximity of desired destination. The results enable city authorities to focus detailed investigations and interventions where a critical mass of cycling may be achieved with the least effort and in the shortest time. • Spatial estimation of cycling demand • Disaggregate, data-driven approach considers detailed individual characteristics. • Both origin and destination characteristics influence demand potential. • Detailed synthetic population allows for rich analysis. [ABSTRACT FROM AUTHOR]

Purpose. Access and quality of physical activity resources (PARs) influence physical activity (PA) participation. This study examined the type, size, accessibility, features, amenities, and incivilities of PARS in two cities. Design. Researchers identified all PARs within an 800-meter radius of the homes of participants from a larger study. Each PAR was evaluated by a trained assessor. Setting. PARS were evaluated in Houston and Austin, Texas. Patients. The final sample included 1326 PARs in Houston and 297 in Austin, Texas. Measures. The 2010 Physical Activity Resource Assessment (PARA), a direct-observation audit tool, was used to assess the type, size, accessibility, features, amenities, and incivilities of a PAR. Analysis. Both t-tests and analyses of variance were used to determine differences in features, amenities, and incivilities by city, type, and accessibility. Results. Houston PARs had greater amenities (t[421] = 4.445; p < .001) and fewer incivilities (t[3 71] = -6.89; p < .001) than Austin PARs. Combination resources had the highest score for features (M = 9.94; standard deviation [SD] = 5.62); fitness clubs had the highest score for amenities (M = 17.06; SD = 5.27); and trails had the most incivilities (M = 4.23; SD = 4.88). Free PARS had greater features (F[3, 1509] = 16.87; p < .001), amenities (F[3, 1500] 3.13; p = .025), and incivilities (F[3, 1540] = 21.97; p <.001) than pay for use PARs. Conclusion. Improvements to quality and maintenance of existing free PARS may be an economical strategy to increase PA. [ABSTRACT FROM AUTHOR]

Rationale In recent years, numerous research methodologists have argued forcefully that any estimated effect from an observational study or a randomized trial should apply to a ‘target population’– to a finite group of people. Some methods to adjust for confounders heavily draw upon this idea. Aims and Objectives I cite a recently published paper in The American Journal of Epidemiology that linked methods to adjust for confounders to the concept of a ‘target population’. I explain that the requirement to specify a finite population as the target of causal inference is rooted in two extreme models of causation: determinism and stochastic causation. Conclusions I argue that the ‘target population’ epistemology is scientifically irrelevant and so are methods to handle confounders that are founded on this paradigm, namely, standardization, inverse-probability-of-treatment weighting and SMR-weighting. Finally, I propose a simple alternative framework under an indeterministic model of causation. According to my proposed model, a causal parameter is not tied to any finite population and its estimate is a (fallible) scientific conjecture about a homogeneous, individual-level effect. [ABSTRACT FROM AUTHOR]

Background: For several years mobile X-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology department was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may benefit from mobile X-ray, but we need to provide insights into the breadth, depth and gaps in a body of literature.Methods: The scoping review was performed by searching PubMed, Cinahl, Embase, EconLit and Health Technology Assessment. English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009-1.5.2020 about mobile X-ray outside the hospital were included. Participants were patients examined using mobile X-ray as the intervention. PRISMA was used when eligible to build up the review. To extract data from the selected articles, we used a structured summary table.Results: We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health 3. Experience of care and 4. Cost effectiveness. The main findings are that target population could be larger for instance including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population health may be improved, image quality seems to be good and mobile X-ray may be cost effective. Limitations of language, databases and grey literature may have resulted in studies being missed.Conclusions: Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to draw a final conclusion if mobile X-ray examination is a relevant diagnostic offer and for whom. Further studies are needed to assess the feasibility of use in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile X-ray needs more research. [ABSTRACT FROM AUTHOR]

Purpose: Causal effects in epidemiology are almost invariably studied by considering disease incidence even when prevalence data are used to estimate the causal effect. For example, if certain conditions are met, a prevalence odds ratio can provide a valid estimate of an incidence rate ratio. Our purpose and main result are conditions that assure causal effects on prevalence can be estimated in cross-sectional studies, even when the prevalence odds ratio does not estimate incidence.Methods: Using a general causal effect definition in a multivariate counterfactual framework, we define causal contrasts that compare prevalences among survivors from a target population had all been exposed at baseline with that prevalence had all been unexposed. Although prevalence is a measure reflecting a moment in time, we consider the time sequence to study causal effects.Results: Effects defined using a contrast of counterfactual prevalences can be estimated in an experiment and, with conditions provided, in cross-sectional studies. Proper interpretation of the effect includes recognition that the target is the baseline population, defined at the age or time of exposure.Conclusions: Prevalences are widely reported, readily available measures for assessing disabilities and disease burden. Effects on prevalence are estimable in cross-sectional studies but only if appropriate conditions hold. [ABSTRACT FROM AUTHOR]