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Nonresponse bias and early versus all responders in mail and telephone surveys.

Mail and telephone survey methods, with or without follow-up by other methods, are cost-effective alternatives to the conventional home interview approach. However, it has long been thought that they are especially susceptible to nonresponse bias. The study addressed this issue in the context of parallel mail and telephone health surveys carried out in Montreal. The mail strategy among 1,555 adults achieved 68.5% response and follow-up by telephone and home interview increased response to 80.9%. Respondents were adequately representative of the entire sample with respect to socioeconomic status, number of adults in household, and ethnic distribution. The 68.5% initial stage respondents were similar to all respondents on the above variables as well as on age, sex, education and reported health status. Odds ratios of smoking and respiratory symptoms hardly differed between initial stage and all respondents. The telephone survey among 1,595 adults achieved 72.7% response and follow-up by mail and personal interview increased response to 88.2%. Comparisons between respondents and the entire sample and between initial stage respondents and all respondents gave similar results to those found in the mail strategy, although there was some change in a symptom-smoking odds ratio from the initial stage respondents to all respondents. In both survey strategies, there was no evidence of substantial nonresponse bias and estimates of morbidity and health care would not have differed much if the fieldwork had stopped at the initial mail or telephone stage.

Adolescent↗

Validity and reproducibility of a physical activity questionnaire in women.

PURPOSE: To determine the validity and reproducibility of a self-administered physical activity questionnaire that assesses the frequency, intensity, and duration of recreational, household, and occupational activity in women. METHODS: The questionnaire was administered by mail twice to 131 participants 1 yr apart. During this interval, participants completed four 1-wk activity logs corresponding to different seasons throughout the year. RESULTS: The intraclass correlation coefficients used to measure reproducibility were 0.82 for total activity, 0.79 for moderate activity, 0.86 for vigorous activity, 0.80 for recreational activity, and 0.73 for household activity. The distribution of activity scores was similar between the questionnaires and the average of the four logs, indicating the participants' ability to incorporate seasonal variation into their recall on a questionnaire. The correlations between the questionnaire-based activity scores and log-based activity scores, indicating validity, were 0.26 for total activity, 0.15 for moderate activity, and 0.52 for vigorous activity. Women younger than age 50 tended to have higher validity scores than women aged 50 yr and older (r = 0.31 vs r = 0.19, respectively, for total activity). CONCLUSION: These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of current activity, particularly vigorous activity, over a 1-yr period.

Adult↗

Retention, perceived usefulness, and use of family health card in the Bangladesh Health and Population Sector Programme.

A client-retained Family Health Card (FHC) was distributed to all households of 2 districts of Bangladesh under the Health and Population Sector Programme. This study assessed the extent and factors relating to retention of FHC, its perceived usefulness, and the extent of use. Quantitative and qualitative data were collected from randomly selected subdistricts. Nearly half of clients retained FHC. The card retainers were married, females, and educated, and sought services for their children. Multivariate analysis confirmed that educational attainments, sex, clients' perceived usefulness of FHC, and enforcement by service providers for bringing FHC were significantly associated with retention of FHC. Both clients and service providers perceived FHC as a useful tool that supports the service-delivery system. The client provider observations identified some omissions made by the providers in filling up the sections contained screening checklists thus they missed the opportunity asking about the additional needs of the family. FHC was used for referring about one-fifth of clients. More orientation of service providers with particular emphasis on sections containing screening checklists in FHC is needed for better identification of additional family-health needs. Ample opportunities exist promoting FHC for tapping the missed opportunities to address unmet needs of a whole family.

Adolescent↗

[Correlation between homicide rates and economic indicators in São Paulo, Brazil, 1996].

Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of São Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100,000 inhabitants) in municipalities with a population smaller than 10,000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.

Brazil↗

Socioeconomic position and health in a population of Brazilian elderly: the Bambuí Health and Aging Study (BHAS).

OBJECTIVE: Despite the vast scientific literature on the social determinants of health, there is still a debate on the extent to which this relationship remains in old age. The objective of this study was to examine the association between socioeconomic circumstances and health among older adults in a small town in Brazil. METHODS: The study was carried out in Bambuí, a town of around 15 000 inhabitants that is located in the state of Minas Gerais, which is in southeastern Brazil. From 1 177 residents aged 65 years or older, 1 074 of them (91.2%) were interviewed and 997 (84.7%) were examined (physical measurements and blood tests). Those in the lowest third of the distribution of total household monthly income, with an income of less than US$ 240 per month, were compared with those who had an income above that level. RESULTS: Lower family income was independently associated with: (1) some lifestyle risk factors (less consumption of fresh fruits or vegetables and less frequent exercise during leisure time in the preceding 30 days), (2) several indicators of worse health status (General Health Questionnaire score, self-rated health, self-rated visual acuity, level of difficulty in walking 300 meters, inability to perform routine activities because of a health problem in the preceding 2 weeks, and seropositivity for Trypanosoma cruzi), (3) a higher number of nonprescribed medications used in the preceding 3 months, and (4) a higher number of hospitalizations in the preceding 12 months. Obesity was more frequent in the higher-income group. CONCLUSIONS: The results of this study do not confirm observations in some developed countries of a lack of association between socioeconomic status and health among the aged. Our results showed that a small difference in monthly family income was sufficiently sensitive to identify elderly persons in worse health, even within a community that appears to be uniformly poor.

Aged↗

Consumer demand for patient-oriented pharmacy services.

The purpose of this study was to investigate the extent of consumer demand for patient-oriented pharmacy services. Data, collected via a self-administered questionnaire distributed to 300 households, were analyzed using Kruskal's program for additive conjoint analysis. The results indicate substantial consumer demand for making advisory services available on request, moderate demand for provision of patient medication records, and little demand for voluntary provision of advisory services.

Counseling↗

Evaluation of deltamethrin-impregnated bed nets and curtains for control of zoonotic cutaneous leishmaniasis in a hyperendemic area of Iran.

In the study carried out in the rural district of Borkhar (Isfahan, Iran) from March 2003 to March 2004 efficacy of deltamethrin impregnated bed nets (IBs) and curtains (ICs), polyester mesh size 156 holes/ inch2, (25 holes/cm2) were compared to that of non-impregnated bed nets (NIBs) and curtains (NICs), in relation to zoonotic cutaneous leishmaniasis (ZCL) control. Deltamethrin impregnated bed nets and curtains at 25 mg a.i./m2 were distributed among 168 households in one of the villages and NIBs plus NICs among the same number of households in another village. In the third village similar numbers of households were used as control. Health education messages were disseminated to ensure the population's compliance with the proper use of bed nets and curtains in the two intervention areas. Entomological surveys using sticky paper traps were carried out in ten households in each village for the collection of sand flies from indoors and outdoors, every two weeks to assess the impact of insecticide impregnated bed nets and curtains on the density of Phlebotomus papatasi. Deltamethrin susceptibility tests and also bioassay tests were carried out on this species by WHO standard method. Case findings were done by house-to-house visits once a season and all the inhabitants of the selected households in each village were examined. The results showed that IBs and ICs can provide a definite personal protection against sand fly bites and interrupted the transmission of ZCL in the intervention village. NIBs and NICs did not provide any protection against the disease. There was no significant difference in monthly density of P. papatasi in indoors and outdoors among the villages (P > 0.05). Susceptibility tests showed that this species was susceptible to deltamethrin in the field population in the area. Bioassays confirmed that the treated nets with deltamethrin remain effective for more than three months and was an excellent mean of individual protection. It is recommended that IBs and ICs can be used widely in the control of ZCL in other similar foci such as hyperendemic and mesoendemic areas of Iran.

Adolescent↗

Evaluation of HIV/AIDS education initiatives among women in northeastern Thai villages.

A longitudinal, naturalistic experimental design was used in an evaluation of the effects of an HIV/AIDS educational pamphlet controlling for secular trends (most specifically media coverage of HIV/AIDS) in Northeastern Thailand. Nine hundred and fifty-four women from 18 villages completed KAP interviews either in the autumn of 1991 or 1992 with HIV/AIDS education pamphlets distributed to every household in 12 of these villages in the spring of 1992. Pamphlets influenced women's perceptions of personal risk from casual sources and the degree to which they volunteered that condoms were a means of prevention of HIV transmission. Both results were related to the content and style of presentation of information about sources of risk and about condoms in the pamphlets. Secular trends and an increase in communication between villagers had a significant influence on knowledge, perceived efficacy of self protection, readiness to use condoms, and perception of levels and sources of personal risk.

Adolescent↗

[The present and future of providing iodinated salt to the population].

Iodine content was estimated in 401 samples of table salt (out of which 365 from the distribution network and 101 from households). The values of 85.5% of samples from the distribution network were in normal range (i.e. 25 +/- 10 mg KI/kg) while 9.8% of samples showed the values below that range. The samples from households showed lower values, only 70.2% being in normal range and 28.6% below that which was 3 times more than in those from the distribution network. Such difference may be explained by the loss of iodine from the salt during the storage due to the effects of moisture, temperature and light. However, less satisfactory iodine levels were found in the salt imported from Poland (9 of 28 samples below the normal range, i.e. 32%), Austria (5 from 9 samples below normal range, i.e. 55%) and in the sea salt (7 from 11 samples below normal range, i.e. 63%), while satisfactory values were found in the salt from Germany (all 5 samples examined were in normal range). From 1126 samples from the distribution network examined during 1981-1986 were 63.6 in normal range, while 88.4% out of 612 samples examined during the period 1987-1990 hat their iodine levels in normal range. Present data show satisfactory iodine content in the salt which justifies the assumption of satisfactory iodine intake in the population of Slovakia. (Tab. 2, Ref. 6.).

Humans↗

Migration models incorporating interdependence of movers.

"In this paper we describe a development of the Poisson model in which households are assumed to migrate independently, but the expected number of migrants is given by a Poisson distribution generalized by an empirically given household-size distribution.... The model is fitted to data on short-distance migration within the English county of Hereford and Worcester.... The data set used comes from the Special Migration Statistics (series II) produced as part of the 1981 British Census." The sparse nature of the data raises problems in assessing goodness of fit, because the deviance value is unusually low. This is tackled using simulation methodology.

Demography↗

Time trends in the intrafamily distribution of dietary energy in rural India.

The intrafamily distribution of dietary energy in 5,458 households from seven states in India was assessed from 24-hour dietary recall data collected by the National Nutrition Monitoring Bureau during 1996-97. The energy consumption, expressed as percentage of recommended dietary intake (%RDI), of preschool children, schoolchildren, and adolescents was compared with that of adult men and women in the same households. Time trends in the intrafamily distribution of dietary energy were assessed by comparing the data with those collected in 1975-80 using the same procedures in the same villages. About one-third of the preschool children had an inadequate intake of energy, even when their adult counterparts had an adequate intake, whereas only about 7% of the preschoolers and their parents were consuming inadequate amounts of energy. The extent of energy inadequacy was much less in adolescents and school-age children than in preschool children. This was true even when the adults in the same households had an adequate energy intake. In 1996-97, there was a significant increase in the proportion of households with preschool children consuming inadequate energy, although both adult men and women were consuming energy-adequate diets as compared with the dietary data collected in the same villages in 1975-80. The results indicate the need to provide effective nutrition education for parents regarding the nutritional needs of their children.

Adolescent↗

The epidemiology of cancer in animals.

The principles of epidemiology are applicable to the study of the distribution and determinants of cancer in both human and animal populations. There are many examples of epidemiologic factors (host, environment, agent and time) related to cancer in animals. Certain host characteristics such as age, sex and breed are related to risk of developing cancer. Some environmental influences are illustrated by differences in the geographical distribution of certain types of animal cancer. Aggregations of cancer cases have been reported in herds, families and households. However, the usual distribution of cases in a population does not resemble epidemics typical of infectious diseases. Several factors (radiological, chemical, dietary, parasitic, mechanical, genetic and viral) have been identified as influences that affect the development of animal tumors. Animal species that have been domesticated live longer and consequently malignant disease develops in more of them. Cancer incidence rates now available from data compiled by an animal neoplasm registry in Alameda and Contra Costa counties, California, indicate that some of the frequent sites of cancer in man (skin, breast and the hemic and lymphatic systems) are among the most frequent sites in dogs and cats, man's closest animal associates.

Animal Feed↗

Remittances and income distribution.

"The paper studies the effects of [foreign] remittances on the pattern of income distribution in Yugoslavia. It is found that remittances raise the Gini coefficient, although unequally as between different social groups. One reason may be that in social groups where the diffusion of information is relatively even (as among urban households) migration is more uniform across income groups than it is in social groups where the access to information depends primarily on the level of income (e.g. rural households). In the latter groups distribution of migrants is more skewed towards higher income groups and remittances increase the level of inequality more substantially." Data are from household surveys conducted in Yugoslavia in 1973, 1978, and 1983.

Communication↗

[Single-parent households in Taiwan: estimation from one percent 1990 census data].

"This research employs one percent [data from the] random sample from the 1990 Census...in Taiwan...[to estimate] the proportion of single-parent households [of]...overall households...as 3.9%.... We also report the frequency and percentage distribution of ¿single-parent household' by 23 administration districts in Taiwan." (SUMMARY IN ENG)

Asia↗

Assessing spatial fluctuations, temporal variability, and measurement error in estimated levels of disinfection by-products in tap water: implications for exposure assessment.

AIMS: To assess spatial fluctuations, temporal variability, and errors due to sampling and analysis in levels of disinfection by-products in routine monitoring tap water samples and in water samples collected in households within the same distribution system for an exposure assessment study. METHODS: Mixed effects models were applied to quantify seasonal effects and the degree to which trihalomethane (THM) levels vary among households or locations relative to variation over time within seasons for any given location. In a separate analysis, the proportion of total variation due to measurement error arising from sampling and analysis was also quantified. RESULTS: THM levels were higher in the summer relative to other seasons. Differences in the relative magnitude of the intra- and inter-household components of variation were observed between the two sets of THM measurements, with a greater proportion of the variation due to differences within seasons for the routine monitoring data and a greater proportion of the variation due to differences across locations for the exposure assessment study data. Such differences likely arose due to differences in the strategies used to select sites for sampling and in the time periods over which the data were collected. With the exception of bromodichloromethane, measurement errors due to sampling and analysis contributed a small proportion of the total variation in THM levels. CONCLUSIONS: The utility of routine monitoring data in assigning exposure in epidemiological studies is limited because such data may not represent the magnitude of spatial variability in levels of disinfection by-products across the distribution system. Measurement error contributes a relatively small proportion to the total variation in THM levels, which suggests that gathering a greater number of samples over time with fewer replicates collected at each sampling location is more efficient and would likely yield improved estimates of household exposure.

Chlorine↗

[Private households according to socioeconomic classification in national accounting: the model of the Federal Statistical Office].

The author notes that "for calculating income distribution and expenditure by groups of households, annual averages are required concerning the number of private households by household groups and...the structure of the household members in a socio-economic classification." Problems of adjusting such household data so that they are compatible with data from other sources such as employment statistics are discussed, and a procedure for adjusting annual micro-census data on households in the Federal Republic of Germany is described. "Results for the year 1982 are presented, showing the main development trends as compared with the year 1972. Finally, the quality of forecasting with the adjustment procedure is studied." (summary in ENG)

Censuses↗

[Ecology of mosquitoes (Diptera: Culicidae) in areas of Serra da Bocaina National Park, Brazil. I. Habitat distribution].

OBJECTIVE: To assess the mosquito fauna in Serra da Bocaina National Park (PNSB), by collecting information through a general survey, and investigating the population behavior in habitats within the park with different vegetation. METHODS: Human bait collections were conducted once a month for both the forest and households, in diurnal and nocturnal periods, three time a day, throughout 24 months, from January 1991 to December 1992. RESULTS: A total of 11, 808 adult mosquitoes belonging to 28 species were collected. Runchomyia reversa and Anopheles cruzii were the most abundant, reaching 52.5% and 17.9% of the total collected specimens, respectively. In the dense forest, Ru. reversa comprised 59.4% of the total, followed by Ru. frontosa with 10.5%, and An. cruzii with 9.9%. In the high altitude fields and in gallery forest, An. cruzii was the most abundant (48.1%) followed by Ru. reversa (28.1%). Inside households An. cruzii was also the most prominent species, representing 73.7% of the total for that location. Coquillettidia chrysonotum was the only species mainly seen in the household surroundings, where its distribution was: 14.9% (indoors), 19.4% (close to the house), and 65.7% (outdoors). An. cruzii and Ru. reversa were found throughout the whole year and captured every month. CONCLUSIONS: Mosquitoes in PNSB present an assynanthropic behavior, except for Cq. chrysonotum which lives preferentially in the household environment. Though An. cruzii is an assynantropic species it may approaches live near households and even invades and infest them for the blood meals. The occurrence of Aedes serratus in the household vicinity emphasizes its epidemiological importance as a potential vector of arboviruses. Sabethini are all exclusively sylvatic species.

Animals↗