Introducing an efficient sampling method for national surveys with limited sample sizes: application to a national study to determine quality and cost of healthcare

Cross-continental national nutrition surveys: a narrative review

Many countries use national nutrition surveys (NNSs) to assess their population's health and nutrition needs. However, NNS aims, approaches, tools, and measurements vary among countries. To date, there has been no review evaluating the NNSs and their practices worldwide to help conduct future NSSs. Therefore, this narrative review was conducted to 1) explore and tabulate current NNSs in five continents (Asia, Europe, Africa, North America, and Australia) and 2) help lay the foundation for establishing clear guidelines for future NNSs. The NNSs were identified using two approaches. First, an electronic database search was conducted with key terms in PubMed database. Second, a general web-based search on the survey webpages of governmental organizations was conducted using the same key terms to identify eligible surveys. The review included general adult population (≥ 18 years) with a cross-sectional design, excluding NNSs related to household-only surveys, specific age groups, or insufficient sample sizes. A total of 41 NNSs were identified in 37 countries across four continents: Asia (n = 15), Europe (n = 21), North America (n = 3), and Australia (n = 2). Broad differences between the surveys were identified, including survey purposes and designs, definitions of geographic areas and target groups, and dietary assessments. Currently, there are 26 ongoing NNSs, while 15 have ended. Among the ongoing NNSs, the cycles of the surveys were either at regular intervals (n = 8) or irregular intervals (n = 8). Of the 41 surveys, 24-h dietary recalls were used in 27 surveys, while only 6 surveys used diet diaries and 8 surveys relied on FFQs. Some surveys (n = 17) utilized multiple tools to assess dietary intake. Most of the surveys that assessed biochemical status (n = 12) focused on blood glucose, haemoglobin A1c (HbA1c), and lipid status, whereas some surveys (n = 6) tested for vitamin and mineral status in blood and/or urine samples. The review identified key characteristics, time frames, sampling methods, and dietary and physical assessment methods obtained from different surveys worldwide. The information organized in this review will be important for researchers, policymakers, and public health programme developers in developing and improving NNS.

Effects of Genetic Relatedness of Kin Pairs on Univariate ACE Model Performance

The current study explored the impact of genetic relatedness differences (ΔH) and sample size on the performance of nonclassical ACE models, with a focus on same-sex and opposite-sex twin groups. The ACE model is a statistical model that posits that additive genetic factors (A), common environmental factors (C), and specific (or nonshared) environmental factors plus measurement error (E) account for individual differences in a phenotype. By extending Visscher's (2004) least squares paradigm and conducting simulations, we illustrated how genetic relatedness of same-sex twins (HSS) influences the statistical power of additive genetic estimates (A), AIC-based model performance, and the frequency of negative estimates. We found that larger HSS and increased sample sizes were positively associated with increased power to detect additive genetic components and improved model performance, and reduction of negative estimates. We also found that the common solution of fixing the common environment correlation for sex-limited effects to .95 caused slightly worse model performance under most circumstances. Further, negative estimates were shown to be possible and were not always indicative of a failed model, but rather, they sometimes pointed to low power or model misspecification. Researchers using kin pairs with ΔH less than .5 should carefully consider performance implications and conduct comprehensive power analyses. Our findings provide valuable insights and practical guidelines for those working with nontwin kin pairs or situations where zygosity is unavailable, as well as areas for future research.

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.

Demographic factors, partial social belonging and psychological resources associated with coping

Introduction

The present study investigates the role of perceived partial social belonging (PPSB) in determining societal and individual resilience and positive and negative coping indicators. It is assumed that most people aspire to belong and be integrated into their society. A sense of only partial belonging is therefore distressing for them.

Methods

Two hypotheses are examined in the current study: (a) A higher level of PPSB will predict a lower level of resilience and a higher level of psychological symptoms. (b) PPSB will mediate the associations between three stress-evoking demographic characteristics (younger age, low income, and gender) and the lower psychological resilience and higher distress associated with these demographic characteristics. These hypotheses were examined using a sample of the Israeli Jewish public (N = 1,502) who responded to an anonymous questionnaire about the investigated issues. The data were collected by an internet panel company possessing a database of more than 65,000 residents, representing the varied components of the Israeli society.

Results

The findings supported our hypotheses: (a) PPSB negatively predicted societal and individual resilience and hope and positively predicted distress symptoms and sense of danger. (b) PPSB mediated the effects of the investigated demographic variables on these psychological variables.

Conclusion

These results are discussed in association with the concept of belonging competencies. Our findings display that being unsure about one's belonging to a desired social group, has a major role in increasing psychological distress and sense of danger and in reducing hope and both individual and societal resilience.

Quality and cost of healthcare services in patients with diabetes in Iran: Results of a nationwide short-term longitudinal survey

Aims

To investigate the journey of patients with diabetes in the healthcare system using nationally-representative patient-reported data.

Methods

Participants were recruited using a machine-learning-based sampling method based on healthcare structures and medical outcome data and were followed up for three months. We assessed the resource utilization, direct/indirect costs, and quality of healthcare services.

Results

One hundred fifty-eight patients with diabetes participated. The most utilized services were medication purchases (276 times monthly) and outpatient visits (231 times monthly). During the previous year, 90% of respondents had a laboratory fasting blood glucose assessment; however, less than 70% reported a quarterly follow-up physician visit. Only 43% had been asked about any hypoglycemia episodes by their physician. Less than 45% of respondents had been trained for hypoglycemia self-management. The annual average health-related direct cost of a patient with diabetes was 769 USD. The average out-of-pocket share of direct costs was 601 USD (78.15%). Medication purchases, inpatient services, and outpatient services summed up 79.77% of direct costs with a mean of 613 USD.

Conclusion

Healthcare services focused solely on glycemic control and the continuity of services for diabetes control was insufficient. Medication purchases, and inpatient and outpatient services imposed the most out-of-pocket costs.