A comparison of costs and data quality of three health survey methods: mail, telephone and personal home interview

Constructing efficient strata boundaries in stratified sampling using survey cost

For maximum precision in population parameter estimation under the Stratified sampling design, the optimum strata boundaries (OSB) could be constructed based on a continuous study variable rather than a set of categorical variables. If constructed optimally, the OSB results in homogenous units within each stratum leading to optimal stratum sample sizes (OSS) as well. The OSB and OSS may not remain optimum if the problem is considered in terms of a fixed total sample size, especially when a survey design involves a fixed budget. This article suggests a methodology for computing the OSB and OSS when the per unit stratum measurement costs for the survey or its probability density function are known. To plan for such a stratified survey, we demonstrate a design-based stratification empirically by using Wave 18 of the HILDA Survey general release dataset where we estimate the mean level of Gamma-distributed annual total disposable income in Australia, which could potentially be an important variable for policy decision-making. We also provide numerical illustrations for hypothetical study variables that follow exponential and right-triangular distributions respectively. The findings indicate that the suggested method is satisfactory in the sense that it is either more efficient or relatively comparable with other methods aimed at improving the accuracy of population parameter estimates. The proposed technique has been implemented in the updated stratifyR package.

F. Soares J. The prevalence, severity and chronicity of abuse towards older men: Insights from a multinational European survey

BACKGROUND

Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse.

METHODS

Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months.

RESULTS

Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high.

CONCLUSIONS

Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.

Job type and other socio-demographic factors associated with participation in a national, cross-sectional study of Danish employees

OBJECTIVES

Participation in population-based surveys and epidemiological studies has been declining over the years in many countries. The aim of this study was to examine the association between job type and participation in the work environment and health in Denmark survey with/without taking into account other socio-demographic factors.

DESIGN

Cross-sectional survey using questionnaire data on working environment and registry data on job type, industry and socio-economic variables.

SETTING

The work environment and health study.

PARTICIPANTS

A total of 50 806 employees (15 767 in a stratified workplace sample; 35 039 in a random sample) working at least 35 hours/month and earning at least 3000 Danish Krones.

OUTCOME MEASURES

The outcome was participation (yes/no) and logistic regression was used to estimate the OR for participation with 95% CI.

RESULTS

In the random sample, women were more likely to participate than men, and married/non-married couples were more likely to participate than persons living alone or more families living together. Participation increased with higher age, higher annual personal income, higher education and Danish origin, and there were marked differences in participation between job types and geographical regions. For armed forces, craft and related trade workers, and skilled agricultural, forestry and fishery workers, the association between job type and participation was strongly attenuated after adjustment for sex and age. Additional adjustment for annual income, education, cohabitation, country of origin and geographical region generally attenuated the association between job type and participation. Similar results were found in the stratified workplace sample.

CONCLUSION

In this population of Danish employees, participation varied across types of jobs. Some but not all the variation between job types was explained by other socio-demographic factors. Future studies using questionnaires may consider targeting efforts to (sub-)populations, defined by job type and other factors, where response probability is particularly important.

Selection bias and subject refusal in a cluster-randomized controlled trial

Background

Selection bias and non-participation bias are major methodological concerns which impact external validity. Cluster-randomized controlled trials are especially prone to selection bias as it is impractical to blind clusters to their allocation into intervention or control. This study assessed the impact of selection bias in a large cluster-randomized controlled trial.

Methods

The Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) study examined the impact of a remote pharmacist-led intervention in twelve medical offices. To assess eligibility, a standardized form containing patient demographics and medical information was completed for each screened patient. Eligible patients were approached by the study coordinator for recruitment. Both the study coordinator and the patient were aware of the site’s allocation prior to consent. Patients who consented or declined to participate were compared across control and intervention arms for differing characteristics. Statistical significance was determined using a two-tailed, equal variance t-test and a chi-square test with adjusted Bonferroni p-values. Results were adjusted for random cluster variation.

Results

There were 2749 completed screening forms returned to research staff with 461 subjects who had either consented or declined participation. Patients with poorly controlled diabetes were found to be significantly more likely to decline participation in intervention sites compared to those in control sites. A higher mean diastolic blood pressure was seen in patients with uncontrolled hypertension who declined in the control sites compared to those who declined in the intervention sites. However, these findings were no longer significant after adjustment for random variation among the sites. After this adjustment, females were now found to be significantly more likely to consent than males (odds ratio = 1.41; 95% confidence interval = 1.03, 1.92).

Conclusions

Though there appeared to be a higher consent rate for females than for males, the overall impact of potential selection bias and refusal to participate was minimal. Without rigorous methodology, selection bias may be a threat to external validity in cluster-randomized trials.

Trial registration

NCT01983813. Date of registration: Oct. 28, 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-017-0368-7) contains supplementary material, which is available to authorized users.

Study protocol of an equivalence randomized controlled trial to evaluate the effectiveness of three different approaches to collecting Patient Reported Outcome Measures (PROMs) data using the Prostate Cancer Outcomes Registry-Victoria (PCOR-VIC)

BACKGROUND

Patient-reported outcome measures (PROMs) are used by clinical quality registries to assess patients' perspectives of care outcomes and quality of life. PROMs can be assessed through a self-administered survey or by a third party. Use of mixed mode approaches where PROMs are completed using a single or combination of administration method is emerging. The aim of this study is to identify the most cost-effective efficient approach to collecting PROMs among three modes (telephone, postal service/mail and email) in a population-based clinical quality registry monitoring survivorship after a diagnosis of prostate cancer. This is important to assist the registry in achieving representative PROMs capture using the most cost-effective technique and in developing cost projections for national scale-up.

METHODS/DESIGN

This study will adopt an equivalence randomised controlled design. Participants are men diagnosed with and/or treated for prostate cancer (PCa) participating in PCOR-VIC and meet the criteria for 12-month follow-up. Participants will be individually randomized to three independent groups: telephone, mail/postal, or email to complete the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) survey. It is estimated each group will have 229 respondents. We will compare the proportion of completed surveys across the three groups. The economic evaluation will be undertaken from the perspective of the data collection centre and consider all operating costs (personnel, supplies, training, operation and maintenance). Cost data will be captured using an Activity Based Costs method. To estimate the most cost-effective approach, we will calculate incremental cost-effectiveness ratios. A cost projection model will be developed based on most cost-effective approach for nationwide scale-up of the PROMs tool for follow-up of PCa patients in Australia.

DISCUSSION

This study will identify the most cost-effective approach for collecting PROMs from men with PCa, and enable estimation of costs for national implementation of the PCa PROMs survey. The findings will be of interest to other registries embarking on PROMs data collection.

TRIAL REGISTRATION

ACTRN12615001369516 (Registered on December 16, 2015).

Interview Modality

Objectives:To contrast the costs and quality of data collected in person, by telephone, and by self-administered questionnaires in a sample of older persons. Methods: Data collected via interviews with 586 women are contrasted on four dimensions. Results:The cost of data collection was 25% to 30% lower for the self-administered mode than for other modes. Response rates were highest for the inperson interviewand lowest for the self-administered questionnaire. The rate of missing data was highest for the self-administered questionnaire. Significant differences in response effects were found across mode, with respondants to self-administered questionnaires profiling the poorest. Discussion:The costs and quality of data collected by various modes are discussed in terms of their implications for understanding the physical and mental well-being of older people.

Comparison of Patient-Reported Quality-of-Life and Complications in Men With Prostate Cancer, Between Two Modes of Administration

INTRODUCTION

Our purpose was to: (1) assess the level of consistency between the quality-of-life (QOL) scores of men with prostate cancer for urinary/bowel/sexual bother, collected via telephone versus self-administered survey; (2) determine factors associated with variation in level of agreement; and (3) assess the efficacy of telephone interview as a mode of administration against the "gold standard" tool, EPIC-26.

METHODS

Cohen's Kappa coefficients were calculated to investigate test-retest reliability across modes of administration. Logistic regression models explored patients' characteristics associated with the magnitude of urinary/bowel/sexual problem. Sensitivities and specificities of the telephone mode in reference to "gold standard" were further measured.

RESULTS

From 221 men who agreed to participate in the study, 168 (76.0%) returned completed surveys. Kappa-linear model resulted in a moderate agreement across the urinary/bowel/sexual bother scores for both modes of administration; with greatest concordance recorded for bowel bother (90%). Patient's age (<75 years), disease risk, and active treatment type determined a moderate-to-good level of agreement between administration modalities with a Kappa varying between 0.44 and 0.73; χ(2), 8.18; P = .042. Sensitivity tests revealed that 68% of men with a moderate/big problem during the phone interviews would respond to suffering from a moderate/big sexual problem.

CONCLUSION

Results of this pilot study revealed that QOL outcomes from this registry will likely underestimate the true bother experienced by men. More research is required to determine the differences between self-administered and telephone interviews in men with prostate cancer.

Effects of method of administration on oral health-related quality of life assessment using the Child Perceptions Questionnaire (CPQ-G11-14)

OBJECTIVES

Questionnaires that measure oral health-related quality of life (OHRQoL) in children and adolescents have emerged in recent years as an important source of patient-reported outcomes. The aim of this study was to investigate potential effects of the method of administration (face-to-face interview, telephone interview, or self-administered questionnaire) in 11- to 14-year-old children and adolescents on OHRQoL information obtained using the Child Perceptions Questionnaire (CPQ).

MATERIALS AND METHODS

OHRQoL was measured using the German version of the CPQ (CPQ-G11-14). The instrument was administered to 42 children and adolescents aged 11 to 14 years using the three different methods in a randomized order with an interval of 1 week between each administration. Test-retest reliability for the repeated CPQ-G11-14 assessments across the three methods of administration, internal consistency, and convergent validity were determined.

RESULTS

The CPQ-G11-14 mean summary scores did not vary statistically significantly across the three administration methods (P = 0.274). Test-retest reliability was moderate to good (ICC 0.69-0.82), internal consistency was satisfactory (Cronbach's alpha 0.85-0.88), and CPQ-G11-14 mean summary scores were correlated in the expected direction with a global measure of self-reported oral health for all the three administration methods.

CONCLUSION

In conclusion, the method of administration (face-to-face interview, telephone interview, or self-administered questionnaire) did not influence CPQ-G11-14 scores in 11- to 14-year-old children and adolescents to a significant extent.

CLINICAL RELEVANCE

Investigators in German-speaking countries can choose between all three methods of administration to obtain valid and reliable OHRQoL information.

Effect of survey instrument on participation in a follow-up study: a randomization study of a mailed questionnaire versus a computer-assisted telephone interview

BACKGROUND

Many epidemiological and public health surveys report increasing difficulty obtaining high participation rates. We conducted a pilot follow-up study to determine whether a mailed or telephone survey would better facilitate data collection in a subset of respondents to an earlier telephone survey conducted as part of the National Birth Defects Prevention Study.

METHODS

We randomly assigned 392 eligible mothers to receive a self-administered, mailed questionnaire (MQ) or a computer-assisted telephone interview (CATI) using similar recruitment protocols. If mothers gave permission to contact the fathers, fathers were recruited to complete the same instrument (MQ or CATI) as mothers.

RESULTS

Mothers contacted for the MQ, within all demographic strata examined, were more likely to participate than those contacted for the CATI (86.6% vs. 70.6%). The median response time for mothers completing the MQ was 17 days, compared to 29 days for mothers completing the CATI. Mothers completing the MQ also required fewer reminder calls or letters to finish participation versus those assigned to the CATI (median 3 versus 6), though they were less likely to give permission to contact the father (75.0% vs. 85.8%). Fathers contacted for the MQ, however, had higher participation compared to fathers contacted for the CATI (85.2% vs. 54.5%). Fathers recruited to the MQ also had a shorter response time (median 17 days) and required fewer reminder calls and letters (median 3 reminders) than those completing the CATI (medians 28 days and 6 reminders).

CONCLUSIONS

We concluded that offering a MQ substantially improved participation rates and reduced recruitment effort compared to a CATI in this study. While a CATI has the advantage of being able to clarify answers to complex questions or eligibility requirements, our experience suggests that a MQ might be a good survey option for some studies.

Influence of administration method on oral health-related quality of life assessment using the Oral Health Impact Profile

The influence of the administration method used to collect oral health-related quality of life (OHRQoL) data is largely unknown. Therefore, the aim of this study was to determine whether OHRQoL information obtained using the Oral Health Impact Profile (OHIP) differed with different methods of collection (personal interview, via telephone or as a self-administered questionnaire). The OHRQoL was measured using the German version of the OHIP. The instrument was administered to each of 42 patients using three different methods, in a randomized order, about 1 wk apart. The test-retest reliability coefficient for the repeated OHIP assessment across the three methods of administration, and the magnitude of the variance component for administration method, were determined, characterizing the degree of OHIP score variation that is caused by this factor. Whereas OHIP mean score differences of 3.9 points were present between administration methods, the reliability coefficient of 0.90 (95% CI, 0.85-0.95) indicated that 90% of the OHIP score variation was caused by differences between subjects (and not by the administration method or measurement error). The variance component for administration method explained 0.5% of the OHIP score variation. In conclusion, the method of administration (personal interview, telephone interview or self-administered questionnaire) did not influence substantially OHIP scores in prosthodontic patients.

Acurácia de informações sobre classes de medicamentos obtidas com questionário postal aplicado a idosos - Rio de Janeiro, RJ

OBJETIVOS: verificar a confiabilidade e a validade das informações sobre medicamentos obtidas em questionário postal, respondido por idosos, sendo a entrevista face a face o padrão-ouro. MÉTODOS: estudo seccional (Perfil de Utilização de Medicamentos por Aposentados Brasileiros), onde foram utilizadas duas abordagens (postal e domiciliar) para coleta de informações de aposentados pelo Instituto Nacional do Seguro Social (INSS) com sessenta anos de idade ou mais. Foram utilizadas também as estatísticas kappa (simples (k), ajustado (PABAK) e ponderado), índices de correlação intra-classe, indicadores de sensibilidade e especificidade, e o gráfico de Luiz et al. RESULTADOS: 234 idosos (M = 42%; F = 58%) responderam às duas abordagens (média = 71,7 anos). A concordância entre postal e entrevista domiciliar foi excelente (k = 0,94) para hipoglicemiantes; muito boa (k = 0,83-0,82) para inibidores da enzima conversora de angiotensina e anti-hipertensivos; boa (k = 0,71) para diuréticos; e razoável (k = 0,47) para antiinflamatórios não esteróides. A concordância foi boa (k = 0,61) para o número total de medicamentos usados. A validade da abordagem postal foi elevada, às vezes total, para os fármacos empregados no tratamento do diabetes (sensibilidade e especificidade = 100%), seguidos dos anti-hipertensivos. Os menores valores obtidos foram para antiinflamatórios não esteróides (sensibilidade = 64%; especificidade = 88%). CONCLUSÃO: a abordagem postal pode ser usada para se obter informações acuradas sobre classes de medicamentos usados por população com idade igual ou superior a 60 anos, considerando idosos com perfil social semelhante ao dos beneficiários do INSS.

The costing and funding of longitudinal birth cohort studies

Key to the success of any longitudinal birth cohort study is the availability of appropriate and long-term levels of funding. The ease or difficulty of obtaining necessary funds to carry out data collection, preparation and documentation efficiently will determine the quality of data and the ease with which it is made available for collaborators. Various strategies for acquiring funding are outlined.

Mange in alpacas, llamas and goats in the UK: incidence and risk

A retrospective postal questionnaire was used to obtain information about the prevalence of mange and its association with husbandry-related risk factors, in alpaca, llama and goat herds in the UK. In total 1797 questionnaires were sent out to members of the British Alpaca Society, the British Llama Society and the British Goat Society, giving response rates of 40.4%, 29.3% and 22.8% from the three groups, respectively. Between January and December 2007, mange was reported in 52.2% (151 of 292), 14% (9 of 66) and 21% (41 of 194) alpaca, llama and goat herds, respectively. However, these figures must be treated with some caution as only 37-51% of the farmers had their diagnosis of mange confirmed by a veterinarian or animal health laboratory. In herds where the causal agent was confirmed: psoroptic, sarcoptic, chorioptic and mixed infections were all reported, with chorioptic mange reported most frequently. Risk analysis showed that the prevalence of reported cases mange in alpacas was significantly associated with herd size and the country from which the animals were imported. Alpaca farmers who had larger herds were more likely to report mange and farmers who imported their animals from Peru were 1.5 times more likely to report mange than farmers who imported animals from elsewhere or who did not import. There was no significant confounding between these two risk factors. The results show that mange continues to be a major problem for camelids and goats in the UK, and suggests that inadequate control on farms and lack of control when in quarantine are two factors that contribute to ongoing problems with mange. However, given the relatively low contribution of imported animals to the national herd each year, it is likely that poor on-farm control may be of greatest importance.

Optimum survey methods when interviewing employed women

BACKGROUND

While survey studies have examined bias much is unknown regarding specific subpopulations, especially women workers.

METHODS

A population based phone, Internet, and mail survey of workplace falls during pregnancy was undertaken. Participation by industry and occupation and survey approach and bias, reliability, and incomplete data were examined.

RESULTS

Of the 3,997 women surveyed, 71% were employed during their pregnancy. Internet responders were most likely to be employed while pregnant and to report a workplace fall at 8.8% compared to 5.8% and 6.1% for mail and phone respondents. Internet responders had the most missing employment data with company name missing for 17.9% compared to 1.3% for phone responders. Mail surveys were best for recruiting those employed in eight of nine industries, and this was especially true for service occupations.

CONCLUSIONS

To decrease bias and increase participation, mixed approaches may be useful with particular attention for collecting occupational data. Am. J. Ind. Med. 52:105-112, 2009. (c) 2008 Wiley-Liss, Inc.

Time-trend of melanoma screening practice by primary care physicians: a meta-regression analysis

OBJECTIVE

To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time.

METHODS

Meta-regression analyses of available data.

DATA SOURCES

MEDLINE, ISI, Cochrane Central Register of Controlled Trials.

RESULTS

Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%-82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were -0.68% (P =0.494), -2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines.

CONCLUSIONS

Considering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon.

Issues in conducting epidemiologic research among elders: lessons from the MOBILIZE Boston Study

Conducting research in elderly populations is important, but challenging. In this paper, the authors describe specific challenges that have arisen and solutions that have been used in carrying out The MOBILIZE Boston Study, a community-based, prospective cohort study in Massachusetts focusing on falls among 765 participants aged 70 years or older enrolled during 2005-2007. To recruit older individuals, face-to-face interactions are more effective than less personal approaches. Use of a board of community leaders facilitated community acceptance of the research. Establishing eligibility for potential participants required several interactions, so resources must be anticipated in advance. Assuring a safe and warm environment for elderly participants and offering a positive experience are a vital priority. Adequate funding, planning, and monitoring are required to provide transportation and a fully accessible environment in which to conduct study procedures as well as to select personnel highly skilled in interacting with elders. It is hoped that this paper will encourage and inform future epidemiologic research in this important segment of the population.

[Spectrum of tuberculous diseases in a pulmonary outpatient clinic]

BACKGROUND

Although the incidence of 6.6 newly diagnosed tuberculosis (TB) cases per 100,000 inhabitants is in decline in Germany, TB remains a disease of significant epidemiologic importance.

PATIENTS AND METHODS

From 04/2001 to 07/2008, a total of 75 TB patients of an internal-pulmonary outpatient clinic had been treated (0.5% of all patients). 58 (77.3%) patients fulfilled the criteria of an active TB, 17 (22.7%) of latent tuberculous infection (LTBI). 68.0% were male (average age men 39.3 +/- 16.9 years [mean +/- standard deviation], women 46.8 +/- 21.5 years; p = not significant). 69.3% of the patients were born in Germany, 30.7% abroad. 84.5% patients had isolated pulmonary, 8.6% additional organ involvement, and 6.9% isolated extrapulmonary TB. 62.1% of active TB cases were microbiologically proven (51.7% microscopically, 43.1% in addition culturally, 6.9% exclusively culturally, 19.0% by polymerase chain reaction [PCR]).

RESULTS

Of 23 tests, 52.2% were fully sensitive against the most important first-line drugs ethambutol (M), isoniazid (H), rifampicin (R), pyrazinamide (Z), und streptomycin (S). 13.0% had an isolated resistance against H (4.4%) or S (8.6%), 4.4% a multiple drug resistance (MDR) against R und H, 30.4% a polyresistance (S and H). Symptoms were quite often unspecific, not taken care of, or misinterpreted.

CONCLUSION

Diagnosis and therapy of an active or latent TB illness remains, an important task and challenge, necessitating an effective cooperation of outpatient, hospital, and health authority institutions.

Adapting a patient satisfaction instrument for low literate and Spanish-speaking populations: comparison of three formats

OBJECTIVE

To compare responses to print versions of the Consumer Assessment of Healthcare Providers and Systems 2.0 survey (CAHPS) to those for an illustration enhanced format and a telephone based interactive voice response format.

METHODS

First, 2015 adult patients awaiting primary care visits completed: demographic information, Test of Functional Health Literacy (S-TOFHLA), CAHPS in one of three formats: print, illustrated, or interactive voice. A second sample of 4800 active patients was randomized to receive alternative formats.

RESULTS

Response rates for the illustrated (31.3%) and print (30.4%) formats were significantly higher than for the interactive voice format (18.1%). The results of the illustrated format were comparable to the traditional text version, but required about 2 min more to complete by both low and high literacy groups. There were almost no invalid responses for the interactive voice format, but the format was associated with lower CAHPS satisfaction scores.

CONCLUSION

Despite extensive efforts to produce formats tailored to individuals with limited literacy, surprisingly we found no consistent advantages to either alternative format. In fact, the interactive voice format yielded lower satisfaction scores and lower response rates.

PRACTICE IMPLICATIONS

Practitioners need to ensure the health instruments they use are aligned with literacy skills and delivery preferences of their consumers. The lack of benefit of the illustrated form does not support investment of resources in these formats to measure satisfaction. The interactive voice response deserves more study--do lower scores register limited access to or use of telephones, irritation or true signal?

Non-participation in a field survey with respect to psychiatric disorders

Aims: Higher rates of psychiatric morbidity among non-participants may lead to biased estimates of prevalence and incidence in epidemiological studies of psychiatric disorders. We had a unique opportunity to explore psychiatric morbidity and non-participation in a large epidemiological survey including questionnaires and a clinical examination. Methods: Members of the Northern Finland 1966 Birth Cohort were included in the study. In phase I, a postal questionnaire was mailed to all those with a known address in 1997 (N=11,540). In phase II, all subjects living in northern Finland or the Helsinki area (N=8463) were invited to a clinical examination. In phase III, clinical examination participants were given a questionnaire with psychological subscales to be filled in at home and returned by mail. The data on hospital-treated psychiatric disorders were obtained from the Finnish Hospital Discharge Register. Educational level was obtained from Statistics Finland. Results: The participation rates were 76%, 71% and 61% in phases I, II and III, respectively. Subjects with any psychiatric disorder participated less actively than those without any psychiatric disorder in all phases, in both genders and at all educational levels. Participation was not found to vary across specific disorders. Gender or education did not explain the association of psychiatric disorders with participation. Conclusions: Owing to non-participation, the true prevalence of psychiatric disorders may be higher than the prevalence estimated from epidemiological field surveys.

Comparison of the self-administered and interviewer-administered modes of the child-OIDP

Background

The mode of questionnaire administration may affect the estimates and applicability of oral health-related quality of life indicators. The aim of this study was to compare psychometrically the self-administered Child-OIDP index with the original interviewer-administered instrument.

Methods

This was a cross-sectional study of 144 consecutive children aged 9–16 years referred to orthodontic clinics in Bedfordshire. To compare the two administration modes of the Child-OIDP, the sample was randomly split in two groups. The two groups were analysed in terms of baseline characteristics, self-perceived measures (self-rated oral health, self-perceived need for braces, happiness with dental appearance, frequency of thinking about dental appearance), Child-OIDP performance scores and overall score and psychometric properties (criterion validity and internal reliability).

Results

No significant difference between the two groups was found in relation to their sociodemographic profile and self-perceived measures. The self- and interviewer-administered Child-OIDP had identical mean scores and did not differ in recording any of the eight performances (p ≥ 0.206). For criterion validity, the correlation coefficients of the Child-OIDP with self-perceived measures were not different between the two modes of administration (p ≥ 0.118). Furthermore, the Cronbach's alpha values of the two groups were similar (p = 0.466).

Conclusion

This study demonstrated that the self-administered Child-OIDP performed the same as the original interviewer-administered mode, while at the same time reducing administration burden. This provides support for the use of the self-administered Child-OIDP. Further studies should focus on a more comprehensive psychometric evaluation.

Trends in influenza vaccination coverage rates in Germany over five seasons from 2001 to 2006

Background

To assess influenza vaccination coverage from 2001 to 2006 in Germany, to understand drivers and barriers to vaccination and to identify vaccination intentions for season 2006/07.

Methods

9,990 telephone-based household surveys from age 14 were conducted between 2001 and 2006. Essentially, the same questionnaire was used in all seasons.

Results

The influenza vaccination coverage rate reached 32.5% in 2005/06. In the elderly (≥60 years), the vaccination rate reached 58.9% in 2005/06. In those aged 65 years and older, it was 63.4%. Perceiving influenza as a serious illness was the most frequent reason for getting vaccinated. Thirteen percent of those vaccinated in 2005/06 indicated the threat of avian flu as a reason. The main reason for not getting vaccinated was thinking about it without putting it into practice. The major encouraging factor to vaccination was a recommendation by the family doctor. 49.6% of the respondents intend to get vaccinated against influenza in season 2006/07.

Conclusion

Increasing vaccination rates were observed from 2001 to 2006 in Germany. The threat of avian influenza and the extended reimbursement programs may have contributed to the recent increase.

Program design features that can improve participation in health education interventions

Background

Although there have been reported benefits of health education interventions across various health issues, the key to program effectiveness is participation and retention. Unfortunately, not everyone is willing to participate in health interventions upon invitation. In fact, health education interventions are vulnerable to low participation rates. The objective of this study was to identify design features that may increase participation in health education interventions and evaluation surveys, and to maximize recruitment and retention efforts in a general ambulatory population.

Methods

A cross-sectional questionnaire was administered to 175 individuals in waiting rooms of two hospitals diagnostic centres in Toronto, Canada. Subjects were asked about their willingness to participate, in principle, and the extent of their participation (frequency and duration) in health education interventions under various settings and in intervention evaluation surveys using various survey methods.

Results

The majority of respondents preferred to participate in one 30–60 minutes education intervention session a year, in hospital either with a group or one-on-one with an educator. Also, the majority of respondents preferred to spend 20–30 minutes each time, completing one to two evaluation surveys per year in hospital or by mail.

Conclusion

When designing interventions and their evaluation surveys, it is important to consider the preferences for setting, length of participation and survey method of your target population, in order to maximize recruitment and retention efforts. Study respondents preferred short and convenient health education interventions and surveys. Therefore, brevity, convenience and choice appear to be important when designing education interventions and evaluation surveys from the perspective of our target population.

Influenza Vaccination Coverage Rates in 5 European Countries: a Population-Based Cross-Sectional Analysis of the Seasons 02/03, 03/04 and 04/05

INTRODUCTION

Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups

OBJECTIVES

The objective of this survey was to assess and compare the level of influenza vaccination coverage during three consecutive influenza seasons (02/03, 03/04, 04/05) in the five European countries United Kingdom, France, Italy, Germany and Spain, understand the driving forces and barriers to vaccination now and 3 years ago and determine vaccination intentions for the following winter.

METHODS

We conducted a random-sampling, telephone-based household survey among non-institutionalized individuals representative of the population aged 14 and over. The surveys used the same questionnaire for all three seasons. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness.

RESULTS

The overall sample consisted of 28,021 people. The influenza vaccination coverage rate increased from 21.0% in season 02/03 to 23.6% in season 03/04 and then to 23.7% in season 04/05. The differences between the seasons are statistically significant (p = 0.01). The highest rate over all countries and seasons had Germany in season 04/05 with 26.5%, Spain had in season 02/03 with 19.3% the lowest rate totally. The coverage rate in the target group composed of person's aged 65 and over or working in the medical field or suffering from a chronic illness was 49.7% in season 02-04 and 50.0% in season 04/05. The driving forces and barriers to vaccination did not change over the years. The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid, having received advise from the family doctor or nurse to be vaccinated and not wanting to infect family and friends. Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza, not having considered vaccination before and not having received a recommendation from the family doctor to be vaccinated. Options encouraging influenza vaccination are: recommendation by the family doctor or nurse, more available information on the vaccine regarding efficacy and tolerance and more information available about the disease. The adjusted odds ratio of receiving influenza vaccine varied between 2.5 in Germany and 6.3 in the United Kingdom in any risk group.

CONCLUSION

The vaccination coverage rate increased from the first season (21.0%) to the third season (23.7%) by 2.6%. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

Participation Rates in Epidemiologic Studies

Participation rates for epidemiologic studies have been declining during the past 30 years with even steeper declines in recent years. This wholesale decrease in participation rate, or at the very least the increase in refusal, has, quite understandably, occasioned some concern among epidemiologists who have long considered a high study participation rate as one of the hallmarks of a "good" epidemiologic study. In this review we synthesize the issues that are central to epidemiologic thinking around declining study participation rates. We consider the reasons why study participation has been declining, summarize what we know about who does participate in epidemiologic studies, and discuss the implications of declining participation rates. We conclude with a discussion of methods that may help improve study participation rates.

Agreement Between Self-Reports and Medical Records Was Only Fair in a Cross-Sectional Study of Performance of Annual Eye Examinations Among Adults With Diabetes in Managed Care

BACKGROUND

Despite consensus about the importance of measuring quality of diabetes care and the widespread use of self-reports and medical records to assess quality, little is known about the degree of agreement between these data sources.

OBJECTIVES

To evaluate agreement between self-reported and medical record data on annual eye examinations and to identify factors associated with agreement.

RESEARCH DESIGN AND SUBJECTS

Data from interviews and medical records were available for 8409 adults with diabetes who participated in the baseline round of the Translating Research Into Action for Diabetes (TRIAD) Study.

MEASURES

Agreement between self-reports and medical records was evaluated as concordance and Cohen's kappa coefficient.

RESULTS

Self-reports indicated a higher performance of annual dilated eye examinations than did medical records (75.9% vs. 38.8%). Concordance between the data sources was 57.9%. Agreement was only fair (kappa coefficient = 0.25; 95% confidence interval, 0.23-0.26). Nearly two-thirds (64.6%) of discordance was due to lack of evidence in the medical record to support self-reported performance of the procedure. After adjustment, agreement was most strongly related to health plan (chi = 977.9, df = 9; P < 0.0001), and remained significantly better for 3 of the 10 health plans (P < 0.00001) and for persons younger than 45 years of age (P = 0.00002).

CONCLUSIONS

The low level of agreement between self-report and medical records suggests that many providers of diabetes care do not have easily available accurate information on the eye examination status of their patients.

Naming and recognition of six foot lesions of sheep using written and pictorial information: a study of 809 English sheep farmers

In 2005, 3000 questionnaires were sent to a random sample of English sheep farmers from a list kept by the English Beef and Lamb Executive (EBLEX) to investigate whether farmers could correctly name six common foot lesions in sheep from a characteristic picture and a written description. The lesions were interdigital dermatitis (ID), footrot (FR), contagious ovine digital dermatitis (CODD), shelly hoof, foot abscess and toe granuloma. In addition, farmers were asked to report the total percent of lame sheep in their flock in 2004 and the percent of this lameness attributable to each of the six lesions listed above. The overall response percentage was 44 with a useable response of 32%. Fifty-nine farmers out of 262 (23%) who answered all six questions named all six lesions correctly. This was greater than expected by chance. The same questionnaire of six lesions was presented at a meeting of specialist sheep advisors, primarily veterinarians, 37/47 (79%) responders named all six lesions correctly. From the six lesions listed above, the percent correctly named by farmers was approximately 83%, 85%, 36%, 28%, 65% and 43% and the percent incorrectly attributed to another lesion was 5%, 47%, 10%, 13%, 35% and 7%, respectively. The most commonly used incorrect name was FR, with farmers tending to name any hoof horn lesion as FR. A comparison of the distribution of sheep lame by a lesion correctly named compared with the same lesion incorrectly named as FR suggested that farmers recognised lesions but did not name them correctly; the distribution of lameness fitted the pattern for the correctly named lesion rather than the pattern of lameness attributed to FR. The results were validated with farm visits and a repeatability study of the questionnaire. The mean farmer-estimated prevalence for all lameness was 10.4%; with 6.9%, 3.7%, 2.4%, 1.9%, 0.9% and 0.8% of the sheep lame with ID, FR, CODD, shelly hoof, foot abscess and toe granuloma respectively from respondents who correctly named these lesions. Whilst ID and FR were the most prevalent causes of lameness in most flocks it is possible that in up to 17% flocks the primary cause of lameness was a different lesion.

Tradução e validação para a língua portuguesa (Brasil) de instrumentos específicos para avaliação de qualidade de vida na doença do refluxo gastroesofágico

INTRODUÇÃO: Estudos têm demonstrado ser a doença do refluxo gastroesofágico capaz de alterar a qualidade de vida e a produtividade no trabalho dos doentes por ela acometidos. Instrumentos para esse tipo de avaliação são provenientes, em sua maioria, de países de língua inglesa e/ou francesa. A utilização desses instrumentos em nosso meio demanda criterioso processo de tradução e validação. OBJETIVOS: Traduzir para língua portuguesa os questionários GERD-HRQL (Gastroesophageal Reflux Disease - Health Related Quality of Life), HBQOL (Heartburn Specific Quality of Life Instrument) e GSAS (Gastroesophageal Reflux Disease Symptom Assessment Scale) específicos para avaliação de qualidade de vida na doença do refluxo gastroesofágico. Testar suas propriedades psicométricas de confiabilidade e validade. MÉTODOS: Cento e trinta e dois pacientes com doença do refluxo gastroesofágico (idade média 54,9 anos, ± DP 13,9) atendidos no ambulatório de motilidade digestiva da Universidade Federal de São Paulo, SP, e de gastrocirurgia da Faculdade de Medicina de São José do Rio Preto, SP, aceitaram participar do presente estudo, fornecendo termo de consentimento pós-esclarecimento. Destes, 40 pacientes participaram da fase de pré-teste (28 do sexo feminino e 12 do sexo masculino, com idade média de 55,3 anos, ± DP 14,7) e 92 da fase de validação (64 do sexo feminino e 28 sexo masculino, com idade média 54,7 anos e ± DP 13,7). A tradução e adaptação cultural foi realizada de acordo com o método de GUILLEMIN et al., sendo a validação dos questionários traduzidos (GERD-HRQL, HBQOL e GSAS) realizada em relação aos instrumentos genérico SF-36 e sintomático ESDRGE (SQGERD). RESULTADOS: A adaptação cultural implicou na troca de quatro palavras no GERD-HRQL, seis no HBQOL e nove no GSAS. Posteriormente a esta fase, o questionário GSAS foi abandonado por problemas no cálculo do escore, sendo as propriedades de medidas testadas nos dois questionários remanescentes, esses se mostraram reprodutíveis para uso inter e intra-observador com valores de 0,980 e 0,968, respectivamente, para o GERD-HRQL, e valores que variaram de 0,868 a 0,972, respectivamente, para o HBQOL. O questionário HBQOL demonstrou alta consistência interna (>0,70) para três das quatro dimensões avaliadas (aspecto físico, dor, sono). Os resultados encontrados na fase de validação apresentaram bons níveis de correlação com os questionários SF-36 e ESDRGE (SQGERD). CONCLUSÕES: As versões para a língua portuguesa (Brasil) dos instrumentos GERD-HRQL e HBQOL, adaptadas ao padrão cultural brasileiro, configuram-se em opções válidas, confiáveis, com baixo nível de desgaste do paciente e de fácil aplicação para avaliação de qualidade de vida na DRGE em nosso meio. O instrumento HBQOL é a única opção de avaliação multidimensional de qualidade de vida atualmente disponível para uso no Brasil. A versão em português do instrumento GSAS mostrou-se inadequada para avaliação de qualidade de vida na DRGE em nosso meio.

Patient satisfaction scores for endoscopic procedures: impact of a survey-collection method

BACKGROUND

Many endoscopy units administer patient satisfaction surveys. We hypothesized that the survey collection method would affect satisfaction scores.

OBJECTIVE

To compare satisfaction scores obtained by using on-site (OS) surveys versus mail-back (MB) surveys.

DESIGN

Quasi-randomization based on alternating weeks.

SETTING

Teaching hospital.

PATIENTS

Patients undergoing elective routine outpatient colonoscopy or upper endoscopy.

INTERVENTIONS

Every patient was given an 11-question survey that asked about the patient's satisfaction with the nurses and the physician, wait times, the bowel-preparation process, patient education, procedural comfort, and sedation. Survey collection methods alternated weekly between an OS versus an MB method.

MAIN OUTCOME MEASUREMENTS

Satisfaction scores on a Likert scale ranged from 1 (worst) to 7 (best).

RESULTS

A total of 1698 subjects were included. The response rate was higher for the OS group (95%) than the MB group (62%). OS scores were significantly higher than MB scores for 5 of 11 questions, which concerned nurse satisfaction, physician satisfaction, bowel-preparation comfort, postprocedure education, and overall satisfaction (Bonferroni adjusted P < .05 for all). Younger patients gave lower scores than older patients for all questions, whereas women gave significantly lower scores than men for bowel-preparation satisfaction.

LIMITATIONS

Lack of true randomization and formal validation of the satisfaction survey.

CONCLUSIONS

Survey collection methods may bias not only response rates but also satisfaction scores. OS survey collection methods tend to result in higher satisfaction scores than MB methods. This bias should be noted when comparing scores among studies that used different survey collection methods.

Feasibility, reliability, and validity of adolescent health status measurement by the Child Health Questionnaire Child Form (CHQ-CF): internet administration compared with the standard paper version

Aims

In this study we evaluated indicators of the feasibility, reliability, and validity of the Child Health Questionnaire-Child Form (CHQ-CF). We compared the results in a subgroup of adolescents who completed the standard paper version of the CHQ-CF with the results in another subgroup of adolescents who completed an internet version, i.e., an online, web-based CHQ-CF questionnaire.

Methods

Under supervision at school, 1,071 adolescents were randomized to complete the CHQ-CF and items on chronic conditions by a paper questionnaire or by an internet administered questionnaire.

Results

The participation rate was 87%; age range 13–7 years. The internet administration resulted in fewer missing answers. All but one multi-item scale showed internal consistency reliability (Cronbach’s α > 0.70). All scales clearly discriminated between adolescents with no, a few, or many self-reported chronic conditions. The paper administration resulted in statistically significant, higher scores on 4 of 10 CHQ-CF scales compared with the internet administration (P < 0.05), but Cohen’s effect sizes d were ≤0.21. Mode of administration interacted significantly with age (P < 0.05) on four CHQ-CF scales, but Cohen’s effect sizes for these differences were also ≤0.21.

Conclusion

This study supports the feasibility, internal consistency reliability of the scales, and construct validity of the CHQ-CF administered by either a paper questionnaire or online questionnaire. Given Cohen’s suggested guidelines for the interpretation of effect sizes, i.e., 0.20–.50 indicates a small effect, differences in CHQ-CF scale scores between paper and internet administration can be considered as negligible or small.

Comparisons of the Brief Form of the World Health Organization Quality of Life and Short Form-36 for Persons With Spinal Cord Injuries

OBJECTIVE

This study compared the psychometric performance of the brief form of the World Health Organization Quality of Life (WHOQOL-BREF) with the Short-Form 36 (SF-36) for people with traumatic spinal cord injuries in Taiwan.

DESIGN

From a nationwide registry of traumatic spinal cord injuries, 187 subjects completed telephone interviews. Score distributions, internal consistency, intrainterviewer and interinterviewer test-retest reliabilities, convergent and known-groups validities, and the responsiveness between the WHOQOL-BREF (with an overall quality-of-life facet and four domains) and the SF-36 (with eight domains) were compared.

RESULTS

Both the WHOQOL-BREF and the SF-36 exhibited low missing values (0.9-7.7 vs. 2.1-3.8), very good internal consistencies (Cronbach's alpha coefficients of 0.75-0.87 vs. 0.72-0.98), intrainterviewer reliabilities (intraclass correlation coefficients of 0.84-0.98 vs. 0.71-0.99) and responsive statistics (0.787-1.83 vs. 0-0.92), and fair interinterviewer reliabilities (intraclass correlation coefficients of 0.56-0.95 vs. 0.41-0.98), whereas the WHOQOL-BREF's domains converged with the conceptually related domains of the SF-36. Nonetheless, compared with the SF-36, the WHOQOL-BREF had lower percentages of ceiling (0.0%-0.4% vs. 0.4%-63.8%) and floor (0.0%-1.3% vs. 0.4%-28.1%) values and better known-groups validity and responsiveness.

CONCLUSIONS

The WHOQOL-BREF is an appropriate generic health-related quality of life measure for persons with traumatic spinal cord injuries.

Influenza vaccination coverage rates in the UK: A comparison of two monitoring methods during the 2002–2003 and 2003–2004 seasons

OBJECTIVES

To assess the feasibility of measuring influenza vaccination coverage during 2002-2003 and 2003-2004 seasons using a telephone survey; to compare these findings with routine vaccine uptake monitoring based on data provided by general practitioners.

STUDY DESIGN

Telephone-based survey.

METHODS

We interviewed a random sample of non-institutionalized individuals representative of the population aged 16 years and over. Four target groups were determined for analysis: (1) people aged 65 years and over; (2) healthcare workers; (3) people under 65 years with chronic illnesses, which placed them at risk for influenza; and (4) a group composed of all three previous groups combined.

RESULTS

The overall sample consisted of 4054 people (about 2000 per season). Population influenza vaccine coverage in the UK increased from 22.3% in 2002-2003 to 24.2% in 2003-2004. Vaccine uptake was strongly age dependent, even in people aged 65 years and over (the ages at which all people are routinely targeted). In both seasons, the estimates of vaccine uptake in people aged 65 years and over were remarkably consistent with those obtained through routine monitoring. Vaccine uptake in healthcare workers was markedly suboptimal.

CONCLUSIONS

In the UK, a telephone-based system of monitoring influenza vaccine uptake seems robust enough to generate data that are comparable with routine vaccine monitoring undertaken using data provided by general practitioners. Although such a system cannot easily contribute towards monitoring of vaccination at local and regional levels, it offers a validated method of estimating vaccine uptake that is independent of healthcare workers' time. This may be especially important for a pandemic vaccination programme, especially in countries in which healthcare resources are scarce, or where the configuration of healthcare services is less conducive to internal monitoring than is the case in the UK.

Health complaints and sickness absence in Norway, 1996-2003

BACKGROUND

From 1996 to 2003, the total number of sickness absence days increased by 65% in Norway.

AIM

To investigate if this could be explained by a corresponding increase in the prevalence of self-reported health complaints in the same period.

METHODS

Representative samples of the Norwegian working population in 1996 (n = 838) and 2003 (n = 637) answered the subjective health complaints (SHC) questionnaire. The single items of the SHC questionnaire were matched with the corresponding sickness absence statistics from the National Insurance Administration in 1996 and 2003.

RESULTS

The main finding was a poor concordance between the change in prevalence of health complaints and the change in the prevalence of sickness absence for diagnoses corresponding to these complaints. The prevalence of health complaints in Norway was high and relatively stable from 1996 to 2003. The only complaints that increased in prevalence during the period were allergy and severe asthma. Sickness absence for health complaints, however, showed a general increase. The diagnoses with the largest percentage increase in sickness absence were sleep problems, tiredness, anxiety and palpitation, although the absolute number of individuals with sickness absence for these complaints was small.

CONCLUSIONS

The increased sickness absence in Norway from 1996 to 2003 cannot be explained by an increase in health complaints in the general population in the same period. The increase in sickness absence is most likely to be explained by multifactorial causes, such as changes in working life and health expectations.

Minimum 25-year outcome and functional assessment of lumbar discectomy

STUDY DESIGN

A retrospective, follow-up cohort study.

OBJECTIVE

To evaluate the 25-year (or longer) outcome of discectomy for lumbar disc herniation by validated instruments.

SUMMARY OF BACKGROUND DATA

A comprehensive patient-oriented evaluation should include measurements of pain and disability along with a reliable evaluation of the general health status. There is a paucity of data from validated measuring instruments on the very long-term outcome of lumbar discectomy.

METHODS

We conducted a follow-up study of 201 patients an average of 27.8 years (range 25-32) after lumbar discectomy. The patient-oriented assessment included a Short Form-36 Health Survey questionnaire, Oswestry Disability Index, Cumulative Illness Rating Scale, and a study specific questionnaire dealing with daily life activities and satisfaction with the surgery.

RESULTS

The Short Form-36 Health Survey physical scales and summary scores were similar to the normative values for healthy subjects and were better than the scores of patients with untreated sciatica with respect to reported pain. The mean Oswestry disability score was 17.5. Satisfaction with surgery was expressed by 181 of 201 patients (90%).

CONCLUSIONS

Patients who had undergone lumbar discectomy a minimum of 25 years earlier have a satisfactory self-reported health-related quality of life and less pain than nonsurgically treated subjects.

Measuring use of health services for at-risk drinkers: how brief can you get?

This study examines the validity, utility, and costs of using a brief telephone-administered instrument, the Brief Health Services Questionnaire (BHSQ), for self-reported health care provider contacts relative to collection and abstraction of complete medical records. The study sample was 441 community-dwelling at-risk drinkers who participated in an 18-month longitudinal study. Agreement between BHSQ self-reports and abstracted provider contacts was good to very good for general medical (79% agreement, kappa = .50) and specialty mental health contacts (93% agreement, kappa = .62), but low for "other" miscellaneous health contacts (61% agreement, kappa = .04). Average cost to collect and abstract complete medical records was 424 US dollars per study participant, whereas average cost to administer only the BHSQ was 31 US dollars per participant. Although it is not possible to conduct a formal cost-effectiveness analysis, results suggest the BHSQ is a viable option for collecting self-reported health provider contacts in a sample of at-risk drinkers, with definite cost advantages over more elaborate data collection methods.

Exposure to loud noise and risk of acoustic neuroma

Exposure to occupational loud noise has been previously identified as a possible risk factor for acoustic neuroma in only one relatively small (n = 86 cases) case-control study of men. The goal of the present study was to further examine the role of loud noise in acoustic neuroma etiology. In their population-based case-control study of both sexes conducted from 1999 to 2002 in Sweden, the authors compared reports on type and duration of occupational and nonoccupational loud noise exposure of 146 acoustic neuroma cases and 564 controls. Controls were randomly selected from the study base and were frequency matched on age, sex, and residential area. The authors found that individuals reporting loud noise exposure from any source were at increased risk for acoustic neuroma (odds ratio (OR) = 1.55, 95% confidence interval (CI): 1.04, 2.30). Exposure to loud noise from machines, power tools, and/or construction increased the risk for acoustic neuroma (OR = 1.79, 95% CI: 1.11, 2.89), as did exposure to loud music (OR = 2.25, 95% CI: 1.20, 4.23). The odds ratio for a latency period of 13 or more years since the first loud noise exposure from any source was 2.12 (95% CI: 1.40, 3.20). The findings of an increased risk of acoustic neuroma with loud noise exposure support previous research.

Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States)

The Life After Cancer Epidemiology (LACE) Study, a cohort of 2321 early stage breast cancer survivors, was established in 2000 to examine how modifiable behavioral risk factors affect quality of life and long-term survival. Women were recruited primarily from the Kaiser Permanente Northern California Cancer Registry (KPNCAL) and the Utah cancer registry (UCR), United States. Baseline data were collected, on average, at two years post-diagnosis through self-administered questionnaires that included information on demographics, medical history, anthropometry, diet, supplements, physical activity and quality of life. The purpose of this paper is to describe the creation and baseline characteristics of the cohort. Forty-six percent of women to whom questionnaires were mailed agreed to participate. The cohort which is 80% white, was diagnosed predominantly with Stage I and II breast cancer (93%), and will have been followed for 5.6 years post-diagnosis, on average, by the end of 2004. Women reported slightly over four daily servings of fruit and vegetables, well below the suggested 5-A-Day national guidelines. Compared to women free of cancer, physical activity patterns were similar, while weight gain, especially in younger women, was higher than is typical. These data suggest that in the early years post-diagnosis, breast cancer survivors exhibit similar patterns to the general population in many health behaviors.

Influenza vaccination coverage rates in five European countries-a population-based cross-sectional analysis of two consecutive influenza seasons

INTRODUCTION

Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups.

OBJECTIVES

The objective of this survey was to assess the level of influenza vaccination coverage during two consecutive influenza seasons (2002/2003 and 2003/2004) in six European countries, to understand the driving forces and barriers to vaccination and to determine vaccination intentions for the following winter.

METHODS

We conducted a random-sampling, telephone-based household survey among non-institutionalised individuals representative of the population aged 14 and over. The surveys used the same questionnaire for two consecutive winters: 2002/2003 and 2003/2004 data were used for Germany, Italy, Spain and the United Kingdom. 2001/2002 and 2002/2003 data were used for France. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness.

RESULTS

The overall sample consisted of 20,118 individuals. The influenza vaccination coverage rate increased from 21.3% in the first season to 23.2% in the second season. The increase in coverage is statistically significant (p=0.01). The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid (55.8%), having received advice from the family doctor or nurse to be vaccinated (55.2%) and not wanting to infect family and friends (36.1%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza (40.4%), not having considered vaccination before (33.3%) and not having received a recommendation from the family doctor to be vaccinated (27.3%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (53.1%), more available information on the vaccine regarding efficacy and tolerance (32.1%) and more information available about the disease (26.7%). Adjusted odds ratios for target group vaccination were between 3.6 (Germany) and 13.7 (UK). Vaccination rates among healthcare workers were generally very low. Adjusted odds ratios were between 0.7 (Germany) and 1.5 (Spain).

CONCLUSION

The vaccination coverage during the second season increased in comparison to the first season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We, therefore, suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003]

INTRODUCTION

Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups.

OBJECTIVES

The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter.

METHODS

A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field.

RESULTS

Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%).

CONCLUSION

Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

[Assessment of health-related quality of life with the German SF-8. A comparison of telephone and postal survey modes]

Within a comprehensive comparison of telephone and postal survey methods the SF-8 was applied to assess adult's health-related quality of life. The 1690 subjects were randomly assigned to a telephone survey and a postal survey. Comparisons across the different modes of administration addressed the response rates, central tendency, deviation, ceiling and floor effects observed in the SF-8 scores as well as the inter-item correlation. The importance of age and gender as moderating factors was investigated. Results indicate no or small statistically significant differences in the responses to the SF-8 depending on the actual mode of administration and the health aspect questioned. It was concluded that further investigations should focus on the exact nature of these deviations and try to generate correction factors.

Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias

OBJECTIVES

To estimate differences in self-rated health by mode of administration and to assess the value of multiple imputation to make self-rated health comparable for telephone and mail.

METHODS

In 1996, Survey 1 of the Australian Longitudinal Study on Women's Health was answered by mail. In 1998, 706 and 11,595 mid-age women answered Survey 2 by telephone and mail respectively. Self-rated health was measured by the physical and mental health scores of the SF-36. Mean change in SF-36 scores between Surveys 1 and 2 were compared for telephone and mail respondents to Survey 2, before and after adjustment for sociodemographic and health characteristics. Missing values and SF-36 scores for telephone respondents at Survey 2 were imputed from SF-36 mail responses and telephone and mail responses to sociodemographic and health questions.

RESULTS

At Survey 2, self-rated health improved for telephone respondents but not mail respondents. After adjustment, mean changes in physical health and mental health scores remained higher (0.4 and 1.6 respectively) for telephone respondents compared with mail respondents (-1.2 and 0.1 respectively). Multiple imputation yielded adjusted changes in SF-36 scores that were similar for telephone and mail respondents.

CONCLUSIONS AND IMPLICATIONS

The effect of mode of administration on the change in mental health is important given that a difference of two points in SF-36 scores is accepted as clinically meaningful. Health evaluators should be aware of and adjust for the effects of mode of administration on self-rated health. Multiple imputation is one method that may be used to adjust SF-36 scores for mode of administration bias.

Measuring stroke impact with the stroke impact scale: telephone versus mail administration in veterans with stroke

OBJECTIVES

The purpose of this study was to examine response rate, mode effects, and reliability of the Stroke Impact Scale (SIS) in a veteran stroke population using mail and telephone modes of administration.

METHODS

Patients who had suffered a stroke were identified using national VA administrative data and International Classification of Diseases, 9th Revision codes in 13 participating Veterans Affairs hospital. Stroke was confirmed by reviewing electronic medical records. Patients were randomized to SIS administration by mail or telephone at 12-weeks after their stroke. Comparison of response rate, nonresponse bias, domain scores, administration costs, and instrument reliability were performed.

RESULTS

Four hundred fifty-eight patients with stroke were identified, validated, and randomly assigned into 2 administration groups. No significant cluster effect was observed. Response rates for mail and telephone were 45% and 69%, respectively. Mail nonresponders were more likely to have had severe stokes, cognitive deficits, and be unmarried. No difference was observed between telephone responders and nonresponders. Responders in mail and telephone modes were not different, and the SIS score distribution did not indicate the presence of mode effects. Test-retest reliability was good to excellent in the mail group (0.77-0.99) except social participation (0.62). Test retest reliability was excellent in the telephone mode (0.90-0.99) except emotion (0.68).

CONCLUSIONS

Telephone mode of survey administration yielded a higher response rate, less bias in responder selection, and higher test-retest reliability. The cost of telephone administration was 2 times the cost of mail. Mode effects in SIS score distribution were not observed in this study but additional research with larger sample sizes is needed to provide more definitive evidence.

Is musculoskeletal pain more common now than 40 years ago?: two population-based cross-sectional studies

OBJECTIVE

To test the hypothesis that the prevalence of specific musculoskeletal pain symptoms has increased over time in the northwest region of England. To meet this objective we have examined the difference in the prevalence of low back, shoulder and widespread pain between the 1950s and today using historical data collected by the Arthritis Research Campaign (arc).

METHODS

Two cross-sectional surveys conducted over 40 yr apart in the northwest region of England. The status of two regional pain sites and widespread pain was determined using interview and questionnaire responses, for the earlier and later studies respectively. Subjects were classified positively if they reported low back pain, shoulder pain or widespread pain on the day of the survey. Rates were standardized to the Greater Manchester population.

RESULTS

There were large differences in the prevalence of musculoskeletal pain between the two surveys. For all three symptoms examined prevalence increased from 2- to 4-fold between the two surveys. In both surveys low back pain was more common in women. Shoulder and widespread pain was less prevalent in women than in men in the earlier survey but by the time of the later survey women reported more pain at these sites.

CONCLUSIONS

The prevalence of musculoskeletal pain is much higher than that reported over 40 yr ago. The change in prevalence is unlikely to be entirely due to the study design; other possible explanations such as the increased reporting or awareness of these symptoms is discussed.

Allergy and infectious disease histories and the risk of childhood acute lymphoblastic leukaemia

Infectious disease histories were evaluated in a population-based case-control study of childhood acute lymphoblastic leukaemia (ALL) as it has been hypothesised that delays in early infections are associated with an increased risk of disease. Allergy histories were also assessed as part of a broader evaluation of the role of immune factors in ALL. Cases (n = 255) were diagnosed between 1980 and 1991 at one of four referral centres in a 31-county area of New York State; controls (n = 760) were a random sample of live births from the same region, frequency matched to cases by sex, race and birth year. Data were collected by mailed questionnaire, completed by case and control parents in 1995. Allergy and infectious histories before the age at leukaemia diagnosis for cases and an equivalent age for controls were evaluated. The adjusted odds ratio and 95% confidence interval [CI] associated with a positive history of any allergy was 0.58 [95% CI 0.38, 0.88] compared with a negative allergy history. The occurrence of several common childhood illnesses before 25 months of age and ALL were assessed, with both weak positive and weak inverse associations observed. Overall, these analyses provide little support for the hypothesis that infection delay in early life is associated with an increased risk of ALL. Children with positive allergy histories reported significantly more infections than those with negative histories; however, effect modification of the infection-ALL associations by child allergy history was not observed. Nonetheless, these observations suggest the importance of assessing both allergy and infectious histories and their possible interactions when evaluating the association between these immune factors and childhood ALL.