The CUPID (Cultural and Psychosocial Influences on Disability) Study: Methods of Data Collection and Characteristics of Study Sample

Background: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. Methods/Principal Findings: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three-to fivefold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI). Conclusions/Significance: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.

What do our schoolchildren know about marine environments?. Using seagrasses as a case of study

Trabajo realizado por: Ramírez, M. C., Ariza, A., Azcárate, P., Brun, F. G.

[Knowledge, attitude and reservations of medical students about organ transplantation: results of a survey during the first year of study]

AIM: Establish a list of first year medical students' attitudes, doubts, and knowledge in the fields of organ transplantation and donation. METHOD: Anonymized questionnaire handed out to students during class lectures. RESULTS: 183 questionnaires were distributed and 117 returned (participation: 64%). The average age of the students was 21.6 +/- 2.7 years (range 18 to 38 years); the sample included 71 women (60.7%) and 48 men (39.3%). Only 2 students (2%) were not interested in the subject of organ donation. The students knew very little of the legal aspects of organ donation and 1/4 of them thought there was even a Federal law regarding organ transplantation. When asked if they knew whether a law existed in the Canton of Berne, 44% replied yes, but only 24 (20%) knew that this is contradictory. There was no gender difference in the answers to these question. From 57 students (48%) 246 individual comments on doubts and concerns were analyzed. In this respect, the students mainly questioned whether the donor was truly dead when donation took place (n = 48), if illegal transplantation could be eliminated (n = 44) and if transplantation was truly necessary (n = 43). Some also mentioned religious/ethical doubts (n = 42). In regard to organ donation by a living individual, 27 students were concerned about the health of this donor. 20 students had doubts regarding the pressure possibly applied by family members and friends and as many voiced doubts in regard to premature diagnosis of brain death of potential donors. Only 2 students were concerned about the post-mortem presentation. 45 students (48%) indicated discomfort with the donation of certain organs. They ranked the kidney as the first organ to donate, followed by the pancreas, heart, cornea, intestine, lung and liver. CONCLUSION: The interest in organ donation and transplantation is already strong in fist year medical students in the pre-clinical stage. However, differences from lay public are not readably detectable at this stage of medical training. Adequate information could influence future physicians in their mediatory role.

Systematic review of the empirical evidence of study publication bias and outcome reporting bias

BACKGROUND: The increased use of meta-analysis in systematic reviews of healthcare interventions has highlighted several types of bias that can arise during the completion of a randomised controlled trial. Study publication bias has been recognised as a potential threat to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. Until recently, outcome reporting bias has received less attention. METHODOLOGY/PRINCIPAL FINDINGS: We review and summarise the evidence from a series of cohort studies that have assessed study publication bias and outcome reporting bias in randomised controlled trials. Sixteen studies were eligible of which only two followed the cohort all the way through from protocol approval to information regarding publication of outcomes. Eleven of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had a higher odds of being fully reported compared to non-significant outcomes (range of odds ratios: 2.2 to 4.7). In comparing trial publications to protocols, we found that 40-62% of studies had at least one primary outcome that was changed, introduced, or omitted. We decided not to undertake meta-analysis due to the differences between studies. CONCLUSIONS: Recent work provides direct empirical evidence for the existence of study publication bias and outcome reporting bias. There is strong evidence of an association between significant results and publication; studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported. Publications have been found to be inconsistent with their protocols. Researchers need to be aware of the problems of both types of bias and efforts should be concentrated on improving the reporting of trials.

Effects of study precision and risk of bias in networks of interventions: a network meta-epidemiological study

BACKGROUND Empirical research has illustrated an association between study size and relative treatment effects, but conclusions have been inconsistent about the association of study size with the risk of bias items. Small studies give generally imprecisely estimated treatment effects, and study variance can serve as a surrogate for study size. METHODS We conducted a network meta-epidemiological study analyzing 32 networks including 613 randomized controlled trials, and used Bayesian network meta-analysis and meta-regression models to evaluate the impact of trial characteristics and study variance on the results of network meta-analysis. We examined changes in relative effects and between-studies variation in network meta-regression models as a function of the variance of the observed effect size and indicators for the adequacy of each risk of bias item. Adjustment was performed both within and across networks, allowing for between-networks variability. RESULTS Imprecise studies with large variances tended to exaggerate the effects of the active or new intervention in the majority of networks, with a ratio of odds ratios of 1.83 (95% CI: 1.09,3.32). Inappropriate or unclear conduct of random sequence generation and allocation concealment, as well as lack of blinding of patients and outcome assessors, did not materially impact on the summary results. Imprecise studies also appeared to be more prone to inadequate conduct. CONCLUSIONS Compared to more precise studies, studies with large variance may give substantially different answers that alter the results of network meta-analyses for dichotomous outcomes.

Completeness of Follow-Up Determines Validity of Study Findings: Results of a Prospective Repeated Measures Cohort Study.

BACKGROUND Current reporting guidelines do not call for standardised declaration of follow-up completeness, although study validity depends on the representativeness of measured outcomes. The Follow-Up Index (FUI) describes follow-up completeness at a given study end date as ratio between the investigated and the potential follow-up period. The association between FUI and the accuracy of survival-estimates was investigated. METHODS FUI and Kaplan-Meier estimates were calculated twice for 1207 consecutive patients undergoing aortic repair during an 11-year period: in a scenario A the population's clinical routine follow-up data (available from a prospective registry) was analysed conventionally. For the control scenario B, an independent survey was completed at the predefined study end. To determine the relation between FUI and the accuracy of study findings, discrepancies between scenarios regarding FUI, follow-up duration and cumulative survival-estimates were evaluated using multivariate analyses. RESULTS Scenario A noted 89 deaths (7.4%) during a mean considered follow-up of 30±28months. Scenario B, although analysing the same study period, detected 304 deaths (25.2%, P<0.001) as it scrutinized the complete follow-up period (49±32months). FUI (0.57±0.35 versus 1.00±0, P<0.001) and cumulative survival estimates (78.7% versus 50.7%, P<0.001) differed significantly between scenarios, suggesting that incomplete follow-up information led to underestimation of mortality. Degree of follow-up completeness (i.e. FUI-quartiles and FUI-intervals) correlated directly with accuracy of study findings: underestimation of long-term mortality increased almost linearly by 30% with every 0.1 drop in FUI (adjusted HR 1.30; 95%-CI 1.24;1.36, P<0.001). CONCLUSION Follow-up completeness is a pre-requisite for reliable outcome assessment and should be declared systematically. FUI represents a simple measure suited as reporting standard. Evidence lacking such information must be challenged as potentially flawed by selection bias.

Effects of Study Area Size on Geographic Characterizations of Health Events: Prostate Cancer Incidence in Southern New England, USA, 1994-1998.

ABSTRACT : BACKGROUND : We consider how representations of geographic variation in prostate cancer incidence across Southern New England, USA may be affected by selection of study area and/or properties of the statistical analysis. METHOD : A spatial scan statistic was used to monitor geographic variation among 35,167 incident prostate cancer cases diagnosed in Massachusetts, Connecticut and Rhode Island from 1994 to 1998, in relation to the 1990 populations of men 20+ years of age living in that region. Results from the combined-states analysis were compared to those from single-states. Impact of scanning procedures set to examine up to 50% or no more than10% of at-risk populations also was evaluated. RESULTS : With scanning set to 50%, 5 locations in the combined-states analysis were identified with markedly distinct incidence rates. Fewer than expected cases were estimated for nearly all Connecticut, Rhode Island and West Central Massachusetts, whereas census tracts on and around Cape Cod, and areas of Southwestern Connecticut and adjacent to greater Boston were estimated to have yielded more than expected incidence. Results of single-state analyses exhibited several discrepancies from the combined-states analysis. More conservative scanning found many more locations with varying incidence, but discrepancies between the combined- and single-state analysis were fewer. CONCLUSION : It is important to acknowledge the conditional nature of spatial analyses and carefully consider whether a true cluster of events is identified or artifact stemming from selection of study area size and/or scanning properties.

Vocation in the insertion of the university student and the graduate

The work plan aims at deepening the analysis of the theoretic assumptions which support the practice in Vocational Guidance: analyzing the incidence of endogenous and exogenous factors both in the election and studying of a particular course of study and in the occupational resolution of the graduate. This analysis enables the revision and the new theoretic conceptualization which is afterwards transferred to the course, and to different groups and provincial institutions where the practice of Vocational Guidance occurs, as well as to other schools in the Northwest provinces of Argentina. Semiotic analysis, statistical elaboration and the research-action approach which, while surveying data renders a service to the milieu, provide the base for the project. Said project focuses on the following individuals: 1) freshmen, who offer us the following aspects to be considered: a) factors which either favor or hinder the insertion of the students attending the first years of the course; b) the conditions making up the learning situation in each subject, from the teaching point of view; c) the influence of institutional dimension in the insertion process; 2) graduands: the characteristics of the situation following graduation from University, those of the labor field and the different ways of gaining access to it are investigated. This analysis is carried out in the courses of study of Psychology and English (education of Professionals in English and English for Professionals).

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.

Vocation in the insertion of the university student and the graduate

The work plan aims at deepening the analysis of the theoretic assumptions which support the practice in Vocational Guidance: analyzing the incidence of endogenous and exogenous factors both in the election and studying of a particular course of study and in the occupational resolution of the graduate. This analysis enables the revision and the new theoretic conceptualization which is afterwards transferred to the course, and to different groups and provincial institutions where the practice of Vocational Guidance occurs, as well as to other schools in the Northwest provinces of Argentina. Semiotic analysis, statistical elaboration and the research-action approach which, while surveying data renders a service to the milieu, provide the base for the project. Said project focuses on the following individuals: 1) freshmen, who offer us the following aspects to be considered: a) factors which either favor or hinder the insertion of the students attending the first years of the course; b) the conditions making up the learning situation in each subject, from the teaching point of view; c) the influence of institutional dimension in the insertion process; 2) graduands: the characteristics of the situation following graduation from University, those of the labor field and the different ways of gaining access to it are investigated. This analysis is carried out in the courses of study of Psychology and English (education of Professionals in English and English for Professionals).

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.

Vocation in the insertion of the university student and the graduate

The work plan aims at deepening the analysis of the theoretic assumptions which support the practice in Vocational Guidance: analyzing the incidence of endogenous and exogenous factors both in the election and studying of a particular course of study and in the occupational resolution of the graduate. This analysis enables the revision and the new theoretic conceptualization which is afterwards transferred to the course, and to different groups and provincial institutions where the practice of Vocational Guidance occurs, as well as to other schools in the Northwest provinces of Argentina. Semiotic analysis, statistical elaboration and the research-action approach which, while surveying data renders a service to the milieu, provide the base for the project. Said project focuses on the following individuals: 1) freshmen, who offer us the following aspects to be considered: a) factors which either favor or hinder the insertion of the students attending the first years of the course; b) the conditions making up the learning situation in each subject, from the teaching point of view; c) the influence of institutional dimension in the insertion process; 2) graduands: the characteristics of the situation following graduation from University, those of the labor field and the different ways of gaining access to it are investigated. This analysis is carried out in the courses of study of Psychology and English (education of Professionals in English and English for Professionals).

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.