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Journal of Global Health Dec 2020Accurate estimation of intervention coverage is a vital component of malaria program monitoring and evaluation, both for process evaluation (how well program targets are... (Review)
Review
BACKGROUND
Accurate estimation of intervention coverage is a vital component of malaria program monitoring and evaluation, both for process evaluation (how well program targets are achieved), and impact evaluation (whether intervention coverage had an impact on malaria burden). There is growing interest in maximizing the utility of program data to generate interim estimates of intervention coverage in the periods between large-scale cross-sectional surveys (the gold standard). As such, this study aimed to identify relevant concepts and themes that may guide future optimization of intervention coverage estimation using routinely collected data, or data collected during and following intervention campaigns, with a particular focus on strategies to define the denominator.
METHODS
We conducted a scoping review of current practices to estimate malaria intervention coverage for insecticide-treated nets (ITNs); indoor residual spray (IRS); intermittent preventive treatment in pregnancy (IPTp); mass drug administration (MDA); and seasonal malaria chemoprevention (SMC) interventions; case management was excluded. Multiple databases were searched for relevant articles published from January 1, 2015 to June 1, 2018. Additionally, we identified and included other guidance relevant to estimating population denominators, with a focus on innovative techniques.
RESULTS
While program data have the potential to provide intervention coverage data, there are still substantial challenges in selecting appropriate denominators. The review identified a lack of consistency in how coverage was defined and reported for each intervention type, with denominator estimation methods not clearly or consistently reported, and denominator estimates rarely triangulated with other data sources to present the feasible range of denominator values and consequently the range of likely coverage estimates.
CONCLUSIONS
Though household survey-based estimates of intervention coverage remain the gold standard, efforts should be made to further standardize practices for generating interim measurements of intervention coverage from program data, and for estimating and reporting population denominators. This includes fully describing any projections or adjustments made to existing census or population data, exploring opportunities to validate available data by comparing with other sources, and explaining how the denominator has been restricted (or not) to reflect exclusion criteria.
Topics: Chemoprevention; Cross-Sectional Studies; Female; Humans; Insecticide-Treated Bednets; Insecticides; Malaria; Mass Drug Administration; Mosquito Control; Pregnancy
PubMed: 33110575
DOI: 10.7189/jogh.10.020413 -
Health Psychology : Official Journal of... Sep 2013This research examines how access to information on peer health behaviors affects one's own health behavior. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This research examines how access to information on peer health behaviors affects one's own health behavior.
METHODS
We report the results of a randomized field experiment in a large corporation in which we introduced walkstations (treadmills attached to desks that enable employees to walk while working), provided employees with feedback on their own and their coworkers' usage, and assessed usage over 6 months. We report how we determined our sample size, and all data exclusions, manipulations, and measures in the study.
RESULTS
Walkstation usage declined most when participants were given information on coworkers' usage levels, due to a tendency to converge to the lowest common denominator-their least-active coworkers.
CONCLUSION
This research demonstrates the impact of the lowest common denominator in physical activity: people's activity levels tend to converge to the lowest-performing members of their groups. This research adds to our understanding of the factors that determine when the behavior of others impacts our own behavior for the better-and the worse.
Topics: Access to Information; Female; Health Behavior; Humans; Male; Motor Activity; Occupational Health; Peer Group; Social Behavior
PubMed: 24001253
DOI: 10.1037/a0033849 -
Journal of Thrombosis and Haemostasis :... Sep 2006
Review
Topics: Atherosclerosis; Humans; Metabolic Syndrome; Risk Factors; Thromboembolism; Venous Thrombosis
PubMed: 16961596
DOI: 10.1111/j.1538-7836.2006.02138.x -
Developmental Science Mar 2018Many students' knowledge of fractions is adversely affected by whole number bias, the tendency to focus on the separate whole number components (numerator and...
Many students' knowledge of fractions is adversely affected by whole number bias, the tendency to focus on the separate whole number components (numerator and denominator) of a fraction rather than on the fraction's magnitude (ratio of numerator to denominator). Although whole number bias appears early in the fraction learning process and under speeded conditions persists into adulthood, even among mathematicians, little is known about its development. Performance with equivalent fractions indicated that between fourth and eighth grade, whole number bias decreased, and reliance on fraction magnitudes increased. These trends were present on both fraction magnitude comparison and number line estimation. However, analyses of individual children's performance indicated that a substantial minority of fourth graders did not show whole number bias and that a substantial minority of eighth graders did show it. Implications of the findings for development of understanding of fraction equivalence and for theories of numerical development are discussed.
Topics: Adult; Attention; Bias; Child; Comprehension; Female; Humans; Knowledge; Learning; Mathematics; Students
PubMed: 28229555
DOI: 10.1111/desc.12541 -
BMJ Quality & Safety Apr 2013Medication administration errors (MAEs) are a problem, yet methodological variation between studies presents a potential barrier to understanding how best to increase... (Review)
Review
BACKGROUND
Medication administration errors (MAEs) are a problem, yet methodological variation between studies presents a potential barrier to understanding how best to increase safety. Using the UK as a case-study, we systematically summarised methodological variations in MAE studies, and their effects on reported MAE rates.
METHODS
Nine healthcare databases were searched for quantitative observational MAE studies in UK hospitals. Methodological variations were analysed and meta-analysis of MAE rates performed using studies that used the same definitions. Odds ratios (OR) were calculated to compare MAE rates between intravenous (IV) and non-IV doses, and between paediatric and adult doses.
RESULTS
We identified 16 unique studies reporting three MAE definitions, 44 MAE subcategories and four different denominators. Overall adult MAE rates were 5.6% of a total of 21 533 non-IV opportunities for error (OE) (95% CI 4.6% to 6.7%) and 35% of a total of 154 IV OEs (95% CI 2% to 68%). MAEs were five times more likely in IV than non-IV doses (pooled OR 5.1; 95% CI 3.5 to 7.5). Including timing errors of ±30 min increased the MAE rate from 27% to 69% of 320 IV doses in one study. Five studies were unclear as to whether the denominator included dose omissions; omissions accounted for 0%-13% of IV doses and 1.8%-5.1% of non-IV doses.
CONCLUSIONS
Wide methodological variations exist even within one country, some with significant effects on reported MAE rates. We have made recommendations for future MAE studies; these may be applied both within and outside the UK.
Topics: Drug Administration Schedule; Humans; Medication Errors; Medication Systems, Hospital; Quality Assurance, Health Care; Risk Factors; Safety Management; United Kingdom
PubMed: 23322752
DOI: 10.1136/bmjqs-2012-001330 -
Social Science & Medicine (1982) Apr 2023In the closing decades of the 20th century, a method of calculating numerical probabilities based on populations-at-risk emerged in public health/epidemiology and then...
In the closing decades of the 20th century, a method of calculating numerical probabilities based on populations-at-risk emerged in public health/epidemiology and then moved into clinical medicine. This new method had its own autonomous social life as it reorganised the fields of clinical perception and clinical practice. This paper documents that revolution in the epistemological basis of medicine by investigating, through primary sources, when and how the social life of a new method undermined the professional status of medicine and changed the doctor-patient relationship.
Topics: Humans; History, 20th Century; Physician-Patient Relations; Public Health; Probability
PubMed: 36905758
DOI: 10.1016/j.socscimed.2023.115811 -
Seminars in Dialysis 2008A number of denominators for scaling the dose of dialysis have been proposed as alternatives to the urea distribution volume (V). These include resting energy... (Comparative Study)
Comparative Study Review
A number of denominators for scaling the dose of dialysis have been proposed as alternatives to the urea distribution volume (V). These include resting energy expenditure (REE), mass of high metabolic rate organs (HMRO), visceral mass, and body surface area. Metabolic rate is an unlikely denominator as it varies enormously among humans with different levels of activity and correlates poorly with the glomerular filtration rate. Similarly, scaling based on HMRO may not be optimal, as many organs with high metabolic rates such as spleen, brain, and heart are unlikely to generate unusually large amounts of uremic toxins. Visceral mass, in particular the liver and gut, has potential merit as a denominator for scaling; liver size is related to protein intake and the liver, along with the gut, is known to be responsible for the generation of suspected uremic toxins. Surface area is time-honored as a scaling method for glomerular filtration rate and scales similarly to liver size. How currently recommended dialysis doses might be affected by these alternative rescaling methods was modeled by applying anthropometric equations to a large group of dialysis patients who participated in the HEMO study. The data suggested that rescaling to REE would not be much different from scaling to V. Scaling to HMRO mass would mandate substantially higher dialysis doses for smaller patients of either gender. Rescaling to liver mass would require substantially more dialysis for women compared with men at all levels of body size. Rescaling to body surface area would require more dialysis for smaller patients of either gender and also more dialysis for women of any size. Of these proposed alternative rescaling measures, body surface area may be the best, because it reflects gender-based scaling of liver size and thereby the rate of generation of uremic toxins.
Topics: Body Surface Area; Energy Metabolism; Female; Humans; Kidney Diseases; Kidney Function Tests; Liver; Male; Organ Size; Renal Dialysis; Sex Factors
PubMed: 18945324
DOI: 10.1111/j.1525-139X.2008.00483.x -
The Journal of Antimicrobial... Oct 2018To quantify the impact of varying the at-risk days definition on the overall report of at-risk days and on the calculated standardized consumption rates (SCRs) for...
OBJECTIVES
To quantify the impact of varying the at-risk days definition on the overall report of at-risk days and on the calculated standardized consumption rates (SCRs) for piperacillin/tazobactam, amikacin, daptomycin and vancomycin.
METHODS
Data were evaluated for two system hospitals, an 894 bed academic centre and a 114 bed community hospital. Aggregate inpatient antibiotic administration and occupancy data were extracted from electronic databases at the facility-wide level. Occupancy data were reported from admission-discharge-transfer systems. At-risk days were defined as hospital days present (DP), patient days (PD), persons present (PP) and billing days (BD). Inpatient antimicrobial days of therapy (DOT) across four major antimicrobial agents were used to calculate facility-wide SCRs using each denominator and were evaluated by least-squares regression and R2 values.
RESULTS
Within the 894 bed academic hospital, the average monthly facility-wide days were 28 424, 22 198, 15 957 and 14 789 by the DP, PP, PD and BD definitions, respectively. Within the 114 bed community hospital, the average monthly facility-wide days were 5175, 3523 and 2816 by the DP, PP and PD definitions, respectively. Strong concordance was observed between facility-wide SCRs using the DP and PP definitions in both the academic (R2 = 0.99, y = 0.78x - 0.001) and community (R2 = 0.99, y = 0.68x - 0.03) centres across all four inpatient antibiotics evaluated. In an analysis of piperacillin/tazobactam SCRs, rates were over-predicted by 28%-93% at the facility-wide level across centres using alternative denominators.
CONCLUSIONS
We found that data source and definitions of at-risk denominator days meaningfully impact antibiotic SCRs. Centres should carefully consider these potential sources of variation when setting consumption benchmarks and internally evaluating use.
Topics: Academic Medical Centers; Anti-Bacterial Agents; Antimicrobial Stewardship; Data Interpretation, Statistical; Drug Utilization; Hospitals, Community; Humans; Inpatients
PubMed: 30085084
DOI: 10.1093/jac/dky275 -
The New Zealand Medical Journal Feb 2002Maori and Pacific mortality rates are underestimated due to different recording of ethnicity between mortality and census data--the so-called numerator-denominator bias....
AIMS
Maori and Pacific mortality rates are underestimated due to different recording of ethnicity between mortality and census data--the so-called numerator-denominator bias. Ethnicity and deprivation are strongly associated with mortality in New Zealand, but it is unclear what are the independent and overlapping effects of each on health. The objectives of this study were first, to determine the effect of adjusting for numerator-denominator bias on ethnic-specific age-standardised all-cause mortality rates among 0-74 year olds during 1991-94: second, to determine the effect of adjusting for numerator-denominator bias on analyses of the independent associations of ethnic group and small area deprivation with all-cause mortality in New Zealand.
METHODS
Direct standardisation methods were used to calculate rates of mortality by ethnic and small area deprivation groupings.
RESULTS
Unadjusted for numerator-denominator bias, Maori had a 70% and 101% higher standardised mortality rate than non-Maori non-Pacific for males and females, respectively. Adjusting for numerator-denominator bias, the excess Maori mortality burden increased to 126% and 158%. For Pacific people, excess mortality increased from -5% and -13% (ie apparently lower mortality rates) to 58% and 54% after adjustment, for males and females respectively. Using data adjusted for numerator-denominator bias, about a third of the Maori to non-Maori non-Pacific disparity in mortality among 0-54 year olds was explained by small area deprivation. Conversely, about a quarter of the mortality gradient by deprivation in New Zealand was explained by ethnic group.
CONCLUSIONS
Numerator-denominator bias causes a marked underestimate of the ethnic disparities in mortality in New Zealand for the 1991-4 period, both overall and within strata of deprivation. The distribution of small area deprivation by ethnicity explains some of the ethnic disparities in mortality.
Topics: Adolescent; Adult; Aged; Bias; Censuses; Child; Child, Preschool; Cultural Deprivation; Ethnology; Female; Humans; Infant; Infant, Newborn; Male; Mathematical Computing; Middle Aged; Mortality; New Zealand; Pacific Islands
PubMed: 11942514
DOI: No ID Found -
AAOHN Journal : Official Journal of the... Jun 1999Needlestick injuries among health care workers are a recognized health hazard, with 400,000 needlesticks occurring annually among the 4 million health care workers in... (Review)
Review
Needlestick injuries among health care workers are a recognized health hazard, with 400,000 needlesticks occurring annually among the 4 million health care workers in the United States. Existing needlestick injury literature primarily focuses on hospital sites and may not be generalizable to other health care settings such as nursing homes, home health care sites, clinics, and emergency response units. Nurses were at high risk of needlestick injury from syringes and i.v. equipment relative to the other health care workers. Recapping, prohibited by the OSHA Bloodborne Pathogens Standard, continues to be an identified cause of injury. The literature supports comprehensive injury prevention and control strategies in conjunction with the use of safer needle devices. Health care organizations should assess their worksites to identify hazards and select products and strategies to correct the problem. Future research should clarify accurate needlestick injury rates (e.g., establish consistent denominators), address non-hospital setting risks, validate self reported data, and evaluate comprehensive interventions that employ engineering strategies to minimize the risk.
Topics: Accidents, Occupational; Bias; Databases, Factual; Health Personnel; Humans; Internet; Needlestick Injuries; Population Surveillance; Risk Factors; United States; United States Occupational Safety and Health Administration
PubMed: 10633592
DOI: No ID Found