Assessing the prevalence of hypertension in populations: are we doing it right?

BACKGROUND: Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. OBJECTIVE: To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. DESIGN: Population-based survey of BP and follow-up information. SETTING AND PARTICIPANTS: All residents aged 25-64 years in an area of Dar es Salaam (Tanzania). MAIN OUTCOME MEASURES: Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device.RESULTS BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading--or the average of the second and third readings--at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. CONCLUSIONS: Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.

Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down's syndrome.

OBJECTIVE: To 'map' the current (2004) state of prenatal screening in Europe. DESIGN: (i) Survey of country policies and (ii) analysis of data from EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers. SETTING: Europe. POPULATION: Survey of prenatal screening policies in 18 countries and 1.13 million births in 12 countries in 2002-04. METHODS: (i) Questionnaire on national screening policies and termination of pregnancy for fetal anomaly (TOPFA) laws in 2004. (ii) Analysis of data on prenatal detection and termination for Down's syndrome and neural tube defects (NTDs) using the EUROCAT database. MAIN OUTCOME MEASURES: Existence of national prenatal screening policies, legal gestation limit for TOPFA, prenatal detection and termination rates for Down's syndrome and NTD. RESULTS: Ten of the 18 countries had a national country-wide policy for Down's syndrome screening and 14/18 for structural anomaly scanning. Sixty-eight percent of Down's syndrome cases (range 0-95%) were detected prenatally, of which 88% resulted in termination of pregnancy. Eighty-eight percent (range 25-94%) of cases of NTD were prenatally detected, of which 88% resulted in termination. Countries with a first-trimester screening policy had the highest proportion of prenatally diagnosed Down's syndrome cases. Countries with no official national Down's syndrome screening or structural anomaly scan policy had the lowest proportion of prenatally diagnosed Down's syndrome and NTD cases. Six of the 18 countries had a legal gestational age limit for TOPFA, and in two countries, termination of pregnancy was illegal at any gestation. CONCLUSIONS: There are large differences in screening policies between countries in Europe. These, as well as organisational and cultural factors, are associated with wide country variation in prenatal detection rates for Down's syndrome and NTD.

Yrittäjyyskasvatuksen arvoja etsimässä. Design-tutkimus opettajankoulutuksen opetussuunnitelmien kehittämisessä

This research is a survey on values related to entrepreneurship education and a participatory action research on entrepreneurship education curricula in teacher education. Research problems, rising from the practical development work, were solved by several methods, following the principles of design-based research. Values related to entrepreneurship education were studied among teachers, headmasters, teacher educators, researchers and officers in the field of entrepreneurship education in 16 European Union countries. Fifteen most important values related to entrepreneurship education were listed based on two qualitative surveys (N 124 and N 66). Values were also surveyed among Finnish teacher trainees (N 71). Results of the surveys show that the values given by the teacher trainees did not differ much from the ones given by the professionals already working in the field. Subsequently, emergence of these values was studied in documents that steer education. The values gathered in the surveys did not occur in the documents to a substantial degree. Development of entrepreneurship education curricula in teacher education was conducted by means of participatory action research. The development project gathered 55 teacher trainers from 15 teacher education organisations in Finland. The starting point of the phenomenon based project (see Annala and Mäkinen 2011) was the activity plan created for developing entrepreneurship education curricula. During the project, the learning of the teacher educators proceeded in a balanced way as brightening visions, stronger motivation, increasing understanding and new practices, following Shulman and Shulman’s model (2004). Goals of the development project were set to each teacher educator acquiring basic knowledge on entrepreneurship education, organization of obligatory courses on entrepreneurship education, and making entrepreneurship education a cross-curricular theme in teacher education. The process increased the understanding and motivation of teacher educators to develop and teach entrepreneurship education. It also facilitated collaboration as well as creating visions on entrepreneurship education. Based on the results, the concept of enterprisingness was defined, and recommendations were given for developing curricula in entrepreneurship education.

Consumer perceptions on a content-based digital service:the usage and service quality of Masennusinfo.fi

Kuluttajat käyttävät sisältöpohjaisia digitaalisia palveluita jatkuvasti saadakseen lisää tietoa terveydestään. Samalla he arvioivat käyttämiensä palveluiden laatua. Jotta yritykset voisivat suunnitella ja tarjota parhaita mahdollisia digitaalisia palveluita kuluttajille, yritysten tulisi tunnistaa ja analysoida kuluttajien kokemuksia ja käyttötarkoituksia heidän palveluissaan. Tämän tutkimuksen tarkoituksena on kuvailla kuluttajien näkemyksiä Masennusinfo.fi:stä, joka on sisältöpohjainen digitaalinen palvelu, ja joka tarjoaa käyttäjilleen tietoa masennuksesta. Päämääränä on selvittää, kuinka kuluttajat kokevat lääkeyrityksen tarjoaman palvelun laadun ja mihin tarkoituksiin sitä käytetään. Tutkimuksen tarkoitus voidaan jakaa kolmeen osa-ongelmaan: Mihin tarkoituksiin kuluttajat käyttävät sisältöpohjaisia digitaalisia palveluita? Miten kuluttajat kokevat näiden palveluiden laadun? Kuinka käyttötarkoitus ja koettu laatu eroavat eri käyttäjäryhmissä? Tutkimus toteutetaan web-pohjaisella kyselytutkimuksella. Mittarit tehdään teoreettisen viitekehyksen pohjalta, joka perustuu aikaisempaan tutkimukseen. Tutkimuksen empiirinen osuus suoritetaan pop-up tutkimuksella, joka sijoitetaan tutkittavalle sivustolle antaen näin kaikille palvelun käyttäjille mahdollisuuden vastata kyselyyn. Tulokset osoittavat, että palvelua käyttävät suurimmaksi osaksi naiset, suhteellisen nuoret 16−29- vuotiaat, tai yli keski-ikäiset 50−65-vuotiaat henkilöt, jotka ovat joko työssäkäyviä tai opiskelijoita ja korkeasti koulutettuja. Masennusinfo.fi nähdään laadukkaana palveluna kaikissa käyttäjäryhmissä sekä sen käytettävyyden että sisällön perusteella. Käyttötarkoituksetkin ovat jokseenkin samankaltaisia eri käyttäjäryhmissä. Yleensä palvelua käytetään tiedon hakemiseen sairauden alkuvaiheessa. Löydöksien perusteella esitetään, että palvelua muokataan vastaamaan yhä paremmin sen käyttötarkoituksia ja tyypillistä käyttäjäprofiilia. Koska muutamia pieniä eroja käyttäjäryhmien näkemyksissä havaittiin, palveluiden tuottaja päättää, minkä ryhmän mieltymyksiä se noudattaa.

Measuring curriculum integration in the junior grades: the design of an instrument

This study \Alas initiated in response to the Junior Division Review (1985) publ ished by the Ministry of Education for the Province of Ontario. Curriculum integration is an element used within the educational paradigm designed by the Ontario Ministry of Education. It is a term frequent1y verbal ized b>' educators in this province, but because of 1 imi ted resource support regarding this methodology, it was open to broad interpretation resulting in an extreme v ar i at i on i nit simp 1 eme n tat i on • I n de ed, the Min i s try intimated that it was not occurring to any significant degree across the province. The objective of this thes is was· to define integration in the junior classroom and de-:.ign a meas.ur·ement in-:.tr-ument which would in turn high 1 i gh t indicators of curriculum integration. The :.tudy made a prel iminary, field-based survey of educa tiona 1 professionals in order to generate a relevant description of integrated curr-iculum programm i ng as def i ned in the j un i or classroom. The description was a compilation of views expressed by a random selection of teachers, consultants, supervisory officers and principals. The survey revea 1 ed a much more comprehens i ve vi et·<,l of the attributes of integrated programming than tradition would dictate and resulted in a functional definition tha t was broader than past prac t ices. Based on the information generated by this survey, an instrument ou t 1 in i ng program cr iter i a of was devised. an integrated junior cla~·sroom Th i s measuremen t i nstrumen t , designed for all levels of educators, was named uThe Han~.son I nstrumen t for the Measuremen t of Program Integrat ion in the Jun i or Cl assroom". It refl ected five categories intrinsic to the me thodol ogy of integration: Teacher Behaviour, Student Behaviour, Classroom Layout, Cl as~·r oom Environment and Progr amm i ng. Each category and the items therein were successfully tested in val idi ty and rel iabi 1 i ty checKs. Interestingly, the individual class was found to be the major variable programming in in the measuremen t the j un i or d i vis i on • of The integrated instrument demonstrated potential not onl)' a~· an initial measure of the degree of integrated curriculum, but as a guide to strategies to implement such a methodology.

Study of baleen whales’ ecology and interaction with maritime traffic activities to support management of a complex socio-ecological system

Thesis written in co-mentorship with Robert Michaud.

Whither RDS? An investigation of respondent driven sampling as a method of recruiting mainstream marijuana users.

Background: An important challenge in conducting social research of specific relevance to harm reduction programs is locating hidden populations of consumers of substances like cannabis who typically report few adverse or unwanted consequences of their use. Much of the deviant, pathologized perception of drug users is historically derived from, and empirically supported, by a research emphasis on gaining ready access to users in drug treatment or in prison populations with higher incidence of problems of dependence and misuse. Because they are less visible, responsible recreational users of illicit drugs have been more difficult to study. Methods: This article investigates Respondent Driven Sampling (RDS) as a method of recruiting experienced marijuana users representative of users in the general population. Based on sampling conducted in a multi-city study (Halifax, Montreal, Toronto, and Vancouver), and compared to samples gathered using other research methods, we assess the strengths and weaknesses of RDS recruitment as a means of gaining access to illicit substance users who experience few harmful consequences of their use. Demographic characteristics of the sample in Toronto are compared with those of users in a recent household survey and a pilot study of Toronto where the latter utilized nonrandom self-selection of respondents. Results: A modified approach to RDS was necessary to attain the target sample size in all four cities (i.e., 40 'users' from each site). The final sample in Toronto was largely similar, however, to marijuana users in a random household survey that was carried out in the same city. Whereas well-educated, married, whites and females in the survey were all somewhat overrepresented, the two samples, overall, were more alike than different with respect to economic status and employment. Furthermore, comparison with a self-selected sample suggests that (even modified) RDS recruitment is a cost-effective way of gathering respondents who are more representative of users in the general population than nonrandom methods of recruitment ordinarily produce. Conclusions: Research on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on 'at-risk' populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation.

Variance estimation with highly stratified sampling designs with unequal probabilities

It is common practice to design a survey with a large number of strata. However, in this case the usual techniques for variance estimation can be inaccurate. This paper proposes a variance estimator for estimators of totals. The method proposed can be implemented with standard statistical packages without any specific programming, as it involves simple techniques of estimation, such as regression fitting.

Sampling, WLS, and Mixed Models

Mixed models may be defined with or without reference to sampling, and can be used to predict realized random effects, as when estimating the latent values of study subjects measured with response error. When the model is specified without reference to sampling, a simple mixed model includes two random variables, one stemming from an exchangeable distribution of latent values of study subjects and the other, from the study subjects` response error distributions. Positive probabilities are assigned to both potentially realizable responses and artificial responses that are not potentially realizable, resulting in artificial latent values. In contrast, finite population mixed models represent the two-stage process of sampling subjects and measuring their responses, where positive probabilities are only assigned to potentially realizable responses. A comparison of the estimators over the same potentially realizable responses indicates that the optimal linear mixed model estimator (the usual best linear unbiased predictor, BLUP) is often (but not always) more accurate than the comparable finite population mixed model estimator (the FPMM BLUP). We examine a simple example and provide the basis for a broader discussion of the role of conditioning, sampling, and model assumptions in developing inference.

A new sampling strategy to reduce the effect of autocorrelation on a control chart

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Design of alternative energy storage systems for hybrid vehicles based on statistical processing of driving cycles information

Hybrid vehicles represent the future for automakers, since they allow to improve the fuel economy and to reduce the pollutant emissions. A key component of the hybrid powertrain is the Energy Storage System, that determines the ability of the vehicle to store and reuse energy. Though electrified Energy Storage Systems (ESS), based on batteries and ultracapacitors, are a proven technology, Alternative Energy Storage Systems (AESS), based on mechanical, hydraulic and pneumatic devices, are gaining interest because they give the possibility of realizing low-cost mild-hybrid vehicles. Currently, most literature of design methodologies focuses on electric ESS, which are not suitable for AESS design. In this contest, The Ohio State University has developed an Alternative Energy Storage System design methodology. This work focuses on the development of driving cycle analysis methodology that is a key component of Alternative Energy Storage System design procedure. The proposed methodology is based on a statistical approach to analyzing driving schedules that represent the vehicle typical use. Driving data are broken up into power events sequence, namely traction and braking events, and for each of them, energy-related and dynamic metrics are calculated. By means of a clustering process and statistical synthesis methods, statistically-relevant metrics are determined. These metrics define cycle representative braking events. By using these events as inputs for the Alternative Energy Storage System design methodology, different system designs are obtained. Each of them is characterized by attributes, namely system volume and weight. In the last part the work, the designs are evaluated in simulation by introducing and calculating a metric related to the energy conversion efficiency. Finally, the designs are compared accounting for attributes and efficiency values. In order to automate the driving data extraction and synthesis process, a specific script Matlab based has been developed. Results show that the driving cycle analysis methodology, based on the statistical approach, allows to extract and synthesize cycle representative data. The designs based on cycle statistically-relevant metrics are properly sized and have satisfying efficiency values with respect to the expectations. An exception is the design based on the cycle worst-case scenario, corresponding to same approach adopted by the conventional electric ESS design methodologies. In this case, a heavy system with poor efficiency is produced. The proposed new methodology seems to be a valid and consistent support for Alternative Energy Storage System design.

Opinions on registering trial details: a survey of academic researchers

BACKGROUND: The World Health Organization (WHO) has established a set of items related to study design and administrative information that should build the minimum set of data in a study register. A more comprehensive data set for registration is currently developed by the Ottawa Group. Since nothing is known about the attitudes of academic researchers towards prospective study registration, we surveyed academic researchers about their opinion regarding the registration of study details proposed by the WHO and the Ottawa Group. METHODS: This was a web-based survey of academic researchers currently running an investigator-initiated clinical study which is registered with clinicaltrials.gov. In July 2006 we contacted 1299 principal investigators of clinical studies by e-mail explaining the purpose of the survey and a link to access a 52-item questionnaire based on the proposed minimum data set by the Ottawa Group. Two reminder e-mails were sent each two weeks apart. Association between willingness to disclose study details and study phase was assessed using the chi-squared test for trend. To explore the potential influence of non-response bias we used logistic regression to assess associations between factors associated with non-response and the willingness to register study details. RESULTS: Overall response was low as only 282/1299 (22%) principal investigators participated in the survey. Disclosing study documents, in particular the study protocol and financial agreements, was found to be most problematic with only 31% of respondents willing to disclose these publicly. Consequently, only 34/282 (12%) agreed to disclose all details proposed by the Ottawa Group. Logistic regression indicated no association between characteristics of non-responders and willingness to disclose details. CONCLUSION: Principal investigators of non-industry sponsored studies are reluctant to disclose all data items proposed by the Ottawa Group. Disclosing the study protocol and financial agreements was found to be most problematic. Future discussions on trial registration should not only focus on industry but also on academic researchers.

The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

Urban built environment analysis: evidence from a mobility survey in Madrid

Applications involving travel behavior from the perspective of land use are dating from the 1990s. Usually, four important components are distinguished: density, diversity and design (3D?s of Cervero and Kockelman) and accessibility (introduced by Geurs and van Wee). But there is not a general agreement on how to measure each of those 4 components. Density is used to be measured as population and employment densities, but others authors separate population density between residential and building densities. A lot of measures have been developed to estimate diversity: among others, a dissimilarity index to indicate the degree to which different land uses lie within one another?s surrounding, an entropy index to quantify the degree of balance across various land use types or proximities to commercial-retail uses. Design has been characterized by site design, and dwelling and street characteristics. Lastly, accessibility has become a frequently used concept, but its meaning on travel behavior field always refers to the ability ?to reach activities or locations by means of a travel mode?, measured as accessibility to jobs, to leisure activities, and others. Furthermore, the previous evidence is mainly based on US data or on north European countries. Therefore, this paper adds some new evidence from a Spanish perspective to the research debate. Through a Madrid smartphone-based survey, factor analysis is used to linearly combine variables into the 3D?s and accessibility dimensions of the built environment. At a first step for future investigations, land use variables will be treated to define accurately the previous 4 components.

Optimum Design of Electromagnets for Magnetic Levitation of Transport Systems based on the Inverse Problem Solutions

Article is devoted to design of optimum electromagnets for magnetic levitation of transport systems. The method of electromagnets design based on the inverse problem solution of electrical equipment is offered. The method differs from known by introducing a stage of minimization the target functions providing the stated levitation force and magnetic induction in a gap, and also the mass of an electromagnet. Initial values of parameters are received, using approximate formulas of the theory of electric devices and electrical equipment. The example of realization of a method is given. The received results show its high efficiency at design. It is practical to use the offered method and the computer program realizing it as a part of system of the automated design of electric equipment for transport with a magnetic levitation.