BACKGROUND & AIMS: BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. METHODS:From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. RESULTS:Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. CONCLUSION:Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

背景与目标： 背景：心血管疾病（CVD）是中低收入国家（LMIC）男女死亡的主要原因。营养向低盐，高脂肪和高糖，低水果和蔬菜的饮食过渡，同时在低收入和中低收入国家中饮食相关的CVD危险因素的患病率上升，这表明需要采取紧急措施来扭转这一趋势。为了帮助确定最有效的干预措施，至关重要的是要了解与CVD风险相关的饮食行为是否存在性别差异。
方法：从46个国家代表性调查的数据集中，我们纳入了七个国家的数据，这些国家记录了成年人的饮食行为测量值；不丹，埃斯瓦蒂尼，格鲁吉亚，圭亚那，肯尼亚，尼泊尔和圣文森特和格林纳丁斯（2013-2017）。调查了三种饮食行为：积极的食盐使用行为（SUB），符合水果和蔬菜（F＆V）的建议以及在烹饪中使用植物油而非动物脂肪。使用广义线性模型研究饮食行为和腰围（WC）与未诊断和诊断的高血压和糖尿病之间的关联。性别与饮食行为之间的相互作用被添加到性别差异测试中。
结果：24,323位参与者被纳入研究。 SUB阳性的女性多于男性（31.3 vs. 27.2％p值<0.001），但满足F＆V建议的人数较少（13.2 vs. 14.8％，p值<0.05）。以积极的方式报告这三种饮食行为的患病率为2.7％，因国家/地区而异，但没有性别差异。 SUB差与女性未确诊高血压的患病率较高（13.1％vs. 9.9％，p值= 0.04）以及男性未诊断糖尿病的患病率较高（2.4％vs. 1.5％，p值= 0.02）有关）。达到F＆V建议与高WC患病率较高相关（24.4％比22.6％，p值= 0.01），但与未被诊断或诊断的高血压或糖尿病无关。
结论：迫切需要采取干预措施以增加所涉国家的F＆V摄入量和阳性SUB。饮食行为在两性之间没有显着差异。但是，我们的研究结果受到少数饮食活动呈阳性的人群的限制，因此，需要进行进一步的研究以了解与CVD危险因素和性别相互作用的关联是否会随着积极行为的普及而改变。

BACKGROUND & AIMS: BACKGROUND:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India's decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme. METHODS:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds - year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance. RESULTS:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY. CONCLUSION:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.

背景与目标： 背景：印度政府于2018年启动了一项名为Pradhan Mantri Jan Arogaya Yojana（PMJAY）的国家公共医疗保险计划。PMJAY旨在覆盖5亿人，每户每年约7000美元。 PMJAY声称是全球最大的政府资助的医疗计划，并作为全民医疗保险的政策引起了国际关注。印度在较早的针对特定国家和州的PFHI计划的十年经验表明，在金融保护方面效果不佳。印度大多数州已经完成了PMJAY的实施一年，但没有对该重要计划进行评估。
方法：本研究旨在查明在贾蒂斯加尔邦PMJAY项下登记对改善医院服务的利用和财务保护的影响，该市在实施PFHI方面在登记和索赔方面一直处于领先地位。该研究分析了三个重复的横截面。其中两个横截面来自国家抽样调查（NSS）健康调查-2004年没有PFHI，而2014年则是较旧的PFHI计划正在实施。在2019年底收集了主要数据，以涵盖实施PMJAY的第一年，并形成了第三部分。进行多变量分析。此外，运用倾向得分匹配和工具变量法解决了保险业的选择问题。
结果：在恰蒂斯加尔邦，根据PMJAY或其他PFHI计划进行的入学并未增加医院护理的利用率。在PMJAY或其他PFHI计划下，自费支出（OOPE）和灾难性健康支出的发生率并未随入学率而降低。不论PMJAY是否注册，OOPE的规模都显着更大，可用于私营部门。
结论：PMJAY提供的纵向覆盖比印度早期的PFHI方案大得多，但到目前为止，该州仍无法改善访问权限或财务保护。尽管PMJAY计划是一个相对较新的计划，但PFHI计划在过去十年中持续失败，这引发了人们对在印度背景下从私人提供商处购买公共资助的采购是否合适的怀疑。建议在LMIC背景下对此类政策进行进一步研究。

BACKGROUND & AIMS: INTRODUCTION:This study aims to establish the Knowledge, Attitudes and Practices (KAP) of the general population (people with and without diabetes) towards diabetes. The study will examine (a) recognition and understanding of causes, prevention and treatment strategies of diabetes; (b) identify the knowledge gaps and behavioural patterns that may hamper diabetes prevention and control; (c) stigma towards and stigma perceived by people with diabetes and (d) awareness of anti-diabetes campaigns. METHODS AND ANALYSIS:The study is a nationwide, cross-sectional study of Singapore's general population aged 18 years and above (n=3000), comprising Chinese, Malay, Indian and other ethnic groups, who can understand English, Chinese, Malay or Tamil language. The sample was derived using a disproportionate stratified sampling using age and ethnicity. The proportion of respondents in each ethnic group (Chinese, Malay and Indian) was set to approximately 30%, while the proportion of respondents in each age group was set around 20% in order to ensure a sufficient sample size. The respondents will be administered questionnaires on diabetes KAP, stigma towards diabetes, lifestyle, diet and awareness of local anti-diabetes campaigns. The analysis will include descriptive statistics and multiple logistic and linear regression analyses to determine the socio-demographic correlates of correct recognition of diabetes, help-seeking preferences, as well as overall knowledge and attitudes among those with and without diabetes. We will consider a p value ≤0.05 as significant. ETHICS AND DISSEMINATION:This study protocol has been reviewed by the Institutional Research Review Committee and the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref 2018/00430). The results of the study will be shared with policymakers and other stakeholders. There will be a local mass media briefing to disseminate the findings online, in print and on television and radio. The results will be published in peer-reviewed journals and presented in scientific meetings.

背景与目标： 简介：本研究旨在建立普通人群（患有和不患有糖尿病的人）对糖尿病的知识，态度和实践（KAP）。这项研究将检查（a）对糖尿病的病因，预防和治疗策略的认识和理解； （b）找出可能妨碍糖尿病预防和控制的知识差距和行为方式； （c）对糖尿病患者的污名和耻辱感；以及（d）对抗糖尿病运动的认识。
方法和分析：该研究是一项全国性的横断面研究，涉及新加坡华裔，马来人，印度人和其他种族的18岁及以上（n = 3000）的普通人群，他们能够理解英语，中文，马来语或泰米尔语语。该样本是根据年龄和种族使用不成比例的分层抽样得出的。为了确保足够的样本量，每个族裔（中国，马来人和印度裔）的受访者比例设定为大约30％，而每个年龄组的受访者比例设定为20％左右。将对受访者进行有关糖尿病KAP，对糖尿病的污名，生活方式，饮食和对当地抗糖尿病运动意识的问卷调查。该分析将包括描述性统计数据以及多元逻辑和线性回归分析，以确定正确识别糖尿病，寻求帮助的偏好以及在患有或不患有糖尿病的人群中的总体知识和态度的社会人口统计学相关性。我们认为p值≤0.05是有意义的。
道德与传播：本研究方案已由机构研究审查委员会和国家医疗保健集团领域特定审查委员会（NHG DSRB Ref 2018/00430）进行了审查。研究结果将与决策者和其他利益相关者共享。将在当地进行大众媒体简报，以在线，印刷形式以及在电视和广播上传播调查结果。研究结果将发表在同行评审的期刊上，并在科学会议上发表。

BACKGROUND & AIMS: :This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.

背景与目标： ：本文报告了口腔健康调查中使用的正畸治疗需求指数（IOTN）修改版本的可靠性研究结果。十二名非专业的牙科检查员接受了使用改良的IOTN的培训，使用了持续约1.5小时的标准化教学方案。在进行了基于学校的校准练习后，发现几乎所有考官都达成了良好或出色的协议（平均Kappa = 0.74）。平均敏感性和特异性得分分别为0.90和0.84。改进的IOTN似乎克服了非专业人员在口腔健康调查中经常伴随使用正畸指数的培训和可靠性问题。

BACKGROUND & AIMS: :A total of 479 stool specimens were collected from rural communities of Ubon Ratchathani Province, Thailand and examined by two techniques: the modified Kato thick smear and the direct smear. The prevalence of Opisthorchis viverrini (14.8%), hookworm (10.2%), Sarcocystis spp (4.6%), Taenia spp (2.9%), Strongyloides stercoralis (2.1%), Giardia lamblia (1.2%), Echinostoma spp (0.6%), Ascaris lumbricoides (0.4%), Entamoeba histolytica (0.2%), Chilomastix mesnili (0.2%) and Endolimax nana (0.2%) were determined. The morphology of the Sarcocystis spp sporocysts examined by both procedures looked similar and was found to be easily recognizable. Among these specimens, 22 cases (4.6%) were positive for Sarcocystis infection detected by the modified Kato technique, whereas only one case (0.2%) was detected by both techniques. These differences were found to be statistically significant (p < 0.05), indicating that the modified Kato technique was decidedly more sensitive than the direct smear procedure in identifying Sarcocystis infection. An epidemiological survey was conducted in Khon Kaen Province involving 1124 stool samples using the modified Kato technique. The greatest frequency was Opisthorchis viverrini at 32.0% while the second highest was Sarcocystis spp at 8.0%. The prevalences of hookworm, Echinostoma spp, Taenia spp, Trichuris trichiura and Enterobius vermicularis were 2.7, 2.1, 1.0, 0.2 and 0.2%, respectively. Other than opisthorchiasis, northeastern Thailand may be an endemic area for sarcocystosis. This is the first report of the applicability and potential usefulness of the Kato thick smear technique for the diagnosis of Sarcocystis infection in a field survey.

背景与目标： ：从泰国乌汶府农村地区收集了479份粪便标本，并通过两种技术进行了检查：改良的加藤厚涂片和直接涂片。维氏梭菌（14.8％），钩虫（10.2％），肉孢子虫（4.6％），Ta虫（2.9％），硬核纲（2.1％），贾第鞭毛虫（1.2％），棘皮虫（0.6％）的患病率分别测定了A虫（0.4％），溶血性变形虫（0.2％），中型Chilomastix（0.2％）和Endolimax nana（0.2％）。通过两种方法检查的Sarcocystis spp孢子囊的形态看起来相似，并且很容易辨认。在这些标本中，改良的加藤技术检测出22例（4.6％）阳性的肉囊肿感染，而两种技术仅检测到1例（0.2％）。发现这些差异具有统计学显着性（p <0.05），表明改良的Kato技术在确定肉囊肿感染方面肯定比直接涂片检查更加灵敏。使用改进的加藤技术在孔敬府进行了一项流行病学调查，涉及1124份粪便样本。频率最高的是维氏梭菌，为32.0％，第二高的是肉囊藻，为8.0％。钩虫，E棘皮虫，Ta虫、,虫和毛肠Enter虫的患病率分别为2.7％，2.1％，1.0％，0.2％和0.2％。除阿片气管扩张症外，泰国东北部可能是结节病的流行地区。这是在野外调查中，加藤厚涂片技术在诊断肉囊肿感染中的适用性和潜在实用性的首次报道。

BACKGROUND & AIMS: OBJECTIVES:This study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI). DESIGN:Repeated cross-sectional studies. SETTING:Population based. PARTICIPANTS:3500-4000 in national surveys in NI and 5000-9000 in RoI, aged 20-69 years. MEASURES:Educational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries. RESULTS:In both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002). CONCLUSIONS:Interventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries.

背景与目标： 目的：本研究比较了邻国北爱尔兰（NI）和爱尔兰共和国（RoI）与主要心血管危险因素相关的社会经济不平等趋势。
设计：重复的横截面研究。
地点：基于人口。
参加者：年龄在20-69岁之间的国家调查中的3500-4000，在ROI中的国家调查的5000-9000。
指标：教育程度被用作社会经济指标，通过该指标对1997/1998至2007/2011年间NI和RoI中的吸烟，糖尿病，肥胖和身体不活动的不平等趋势的大小和方向进行了研究。使用这两个国家的不平等相对指数（RII）和不平等斜率指数（SII）计算了特定于性别的相对和绝对不平等。
结果：在这两个国家中，糖尿病和肥胖症的患病率随着时间的流逝而增加，而吸烟和缺乏身体活动的水平则下降。在NI中，男女的肥胖症相对不平等现象有所增加（2010/2011年，男性为RII 1.1，女性为2.1），吸烟（男性和女性的RII为4.5，2010 / 2011年女性为4.2，男性所有危险因素的绝对不平等现象均增加了）妇女的糖尿病和肥胖症增加。在投资回报率中，女性尤其是吸烟者（2007年为RII 2.8）和肥胖症（2002年为RII 8.2）和男性因糖尿病（2002年为RII 3.2）观察到更大的不平等。
结论：两国都鼓励采取干预措施以减少危险因素特别是吸烟，肥胖和糖尿病等方面的不平等。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates.

METHODS:One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information.

RESULTS:The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates.

CONCLUSIONS:Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.

背景与目标： 目标：这项研究的目的是描述医学期刊上发表的邮件调查的回复率；确定作为邮件调查的典型目标的主题的响应率如何变化；

方法：摘录了1991年出版的178份手稿，代表了321个不同的邮件调查，确定答复率和调查技术。在后续邮件调查中，这些手稿的113位作者提供了补充信息。

结果：医学期刊上发表的邮件调查的平均答复率约为60％。但是，响应率会根据所研究的主题和所使用的技术而有所不同。公开发表的医师调查的平均应答率仅为54％，非医师的平均应答率为68％。此外，多变量模型表明，随文书副本和电话提醒一起提供的书面提醒，与未使用这些技术的调查相比，其答复率分别高出约13％。其他技术（例如匿名性和经济诱因）与更高的响应率无关。

结论：尽管几种邮件调查技术与更高的响应率相关，但对已发布邮件的响应率调查往往比较温和。但是，调查的回应率充其量只能间接表明无回应者的偏见程度。研究人员，期刊编辑和读者应更多地关注偏倚的评估，而不是特定的响应率阈值。