Patient complaints as a means to improve quality of hospital care. Results of a qualitative content analysis / Patientenrückmeldung als Möglichkeit die Versorgungsqualität von Spitalpatienten zu verbessern. Ergebnisse einer qualitativen Inhaltsanalyse

Background: Many hospitals have defined procedures for a complaint management. A systematic analysis of patient complaints helps to identify similar complaints and patterns so that targeted improvement measures can be derived (Gallagher & Mazor, 2015). Aim: Our three-month, nurse-led practice development project aimed 1) to identify complaints regarding communication issues, 2) to systemise and prioritise complaints regarding communication issues, and 3) to derive clinic-specific recommendations for improvement. Method: We analysed 273 complaints of patients documented by the quality management (secondary data analysis). Using content analysis and applying the coding taxonomy for inpatient complaints by Reader, Gillespie and Roberts (2014), we distinguished communication-related complaints. By further inductive differentiation of these complaints, we identified patterns and prioritised fields of action. Results: We identified 186 communication-related complaints divided into 16 subcategories. For each subcategory, improvement interventions were derived, discussed and prioritised. Conclusions: Thus, patient complaints provided an excellent opportunity for reflection and workplace learning for nurses. The analysis gave impulse to exemplify the subject "person-centered care" for nurses.

Comportamento da mortalidade por câncer de mama nos municípios brasileiros e fatores associados / Breast cancer mortality in Brazilian municipalities and associated factors / Mortalidad por cáncer de mama en municipios brasileños y factores asociados

RESUMO Objetivo Analisar o comportamento da mortalidade por câncer de mama nos municípios brasileiros e avaliar a influência de fatores socioeconômicos e demográficos sobre as taxas e mortalidade. Métodos Foram calculadas taxas de mortalidade, padronizadas por faixa etária e corrigidas por causas mal definidas, centradas em 1990, 2000 e 2010. Posteriormente, foram estimados modelos de regressão, com dados em painel, que permitiram verificar o grau de associação entre os fatores de interesse e a taxa de mortalidade pela doença. Resultados Verificou-se uma tendência de crescimento da mortalidade no país. Contudo, os modelos indicaram que a mortalidade poderia ter diminuído (tendência negativa), principalmente no Sudeste e Sul, caso alguns fatores associados à doença (por exemplo, nível de renda, educação, longevidade, taxa de fecundidade, gastos em saúde, infraestrutura, entre outros) tivessem permanecido constantes durante o período considerado. Observou-se que a mortalidade por câncer de mama apresentou associação positiva/significativa com a longevidade e negativa/significativa com o nível de gastos públicos em saúde. A mortalidade foi maior nas regiões Sul e Sudeste, nos municípios com mais de 500 000 habitantes e naqueles onde a população é inferior a 5 000. Conclusões O crescimento da renda per capita, a elevação da expectativa de vida e a diminuição da taxa de fecundidade podem estar associados a elevadas taxas de mortalidade por câncer de mama e a uma tendência de crescimento na mortalidade por esse câncer nos municípios brasileiros.

ABSTRACT Objective To analyze breast cancer mortality trends in Brazilian municipalities and assess the influence of socioeconomic and demographic factors on mortality rates. Methods Age-adjusted mortality rates were calculated for the periods centered in 1990, 2000, and 2010 and corrected for ill-defined causes of death. After that, panel data regression models were developed for analysis of the association between the factors of interest and the mortality rate from breast cancer in Brazilian municipalities. Results A growing trend was detected in breast cancer mortality in Brazil. However, the models showed that the mortality could have decreased (negative trend), especially in the Southeast and South regions, if some associated factors (such as income, education, longevity, fertility rate, health spending, and infrastructure, among others) had remained constant during the study period. Breast cancer mortality was positively/significantly associated with longevity and negatively/significantly associated with public health spending. Mortality was higher in the South and Southeast, in municipalities with more than 500 000 inhabitants and in those with population below 5 000. Conclusions The growth in per capita income, the increase in life expectancy, and the decrease in fertility rates may be associated with high breast cancer mortality and a trend towards increased mortality from this cancer in Brazilian municipalities.

RESUMEN Objetivo Analizar las tendencias de la mortalidad por cáncer de mama en municipios brasileños y evaluar la influencia de factores socioeconómicos y demográficos sobre las tasas de mortalidad. Métodos Se calcularon las tasas de mortalidad, ajustadas por grupo etario y corregidas por causas mal definidas, para los años 1990, 2000 y 2010. Posteriormente, se calcularon modelos de regresión, a partir de datos de panel, que permitieron verificar el grado de asociación entre distintos factores de interés y la tasa de mortalidad por esta enfermedad. Resultados Se verificó que había una tendencia al aumento de la mortalidad en el país. Sin embargo, los modelos indicaron que la mortalidad podría haber disminuido (tendencia negativa), principalmente en el sudeste y el sur, si algunos factores asociados (por ejemplo, nivel de ingresos, educación, longevidad, tasa de fecundidad, gastos en salud, infraestructura, entre otros) hubieran permanecido constantes durante el período en estudio. Se observó que la mortalidad por cáncer de mama presentó una asociación positiva y significativa con la longevidad, y negativa y significativa con el nivel del gasto público en salud. La mortalidad fue mayor en las zonas sur y sudeste, en los municipios con más de 500 000 habitantes y en aquellos cuya población es inferior a 5000. Conclusiones El aumento de los ingresos per cápita, el incremento de la esperanza de vida y la disminución de la tasa de fecundidad pueden estar asociados a tasas altas de mortalidad por cáncer de mama y a una tendencia al aumento de dicha mortalidad en los municipios brasileños.

Problem Formulation in Knowledge Discovery via Data Analytics (KDDA) for Environmental Risk Management.

With the growing popularity of data analytics and data science in the field of environmental risk management, a formalized Knowledge Discovery via Data Analytics (KDDA) process that incorporates all applicable analytical techniques for a specific environmental risk management problem is essential. In this emerging field, there is limited research dealing with the use of decision support to elicit environmental risk management (ERM) objectives and identify analytical goals from ERM decision makers. In this paper, we address problem formulation in the ERM understanding phase of the KDDA process. We build a DM³ ontology to capture ERM objectives and to inference analytical goals and associated analytical techniques. A framework to assist decision making in the problem formulation process is developed. It is shown how the ontology-based knowledge system can provide structured guidance to retrieve relevant knowledge during problem formulation. The importance of not only operationalizing the KDDA approach in a real-world environment but also evaluating the effectiveness of the proposed procedure is emphasized. We demonstrate how ontology inferencing may be used to discover analytical goals and techniques by conceptualizing Hazardous Air Pollutants (HAPs) exposure shifts based on a multilevel analysis of the level of urbanization (and related economic activity) and the degree of Socio-Economic Deprivation (SED) at the local neighborhood level. The HAPs case highlights not only the role of complexity in problem formulation but also the need for integrating data from multiple sources and the importance of employing appropriate KDDA modeling techniques. Challenges and opportunities for KDDA are summarized with an emphasis on environmental risk management and HAPs.

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The effect of skewness and kurtosis on te Kenward-Roger approximation when group distribution differ / El efecto de la violación de simetría y curtosis en la aproximación Kenward-Roger cuando las distribuciones de los grupos difieren

BACKGROUND: This study examined the independent effect of skewness and kurtosis on the robustness of the linear mixed model (LMM), with the Kenward-Roger (KR) procedure, when group distributions are different, sample sizes are small, and sphericity cannot be assumed. METHODS: A Monte Carlo simulation study considering a split-plot design involving three groups and four repeated measures was performed. RESULTS: The results showed that when group distributions are different, the effect of skewness on KR robustness is greater than that of kurtosis for the corresponding values. Furthermore, the pairings of skewness and kurtosis with group size were found to be relevant variables when applying this procedure. CONCLUSIONS: With sample sizes of 45 and 60, KR is a suitable option for analyzing data when the distributions are: (a) mesokurtic and not highly or extremely skewed, and (b) symmetric with different degrees of kurtosis. With total sample sizes of 30, it is adequate when group sizes are equal and the distributions are: (a) mesokurtic and slightly or moderately skewed, and sphericity is assumed; and (b) symmetric with a moderate or high/extreme violation of kurtosis. Alternative analyses should be considered when the distributions are highly or extremely skewed and samples sizes are small

ANTECEDENTES: este estudio examina el efecto independiente de la violación de la simetría y de la curtosis en la robustez del modelo lineal mixto, con la corrección Kenward-Roger de los grados de libertad, cuando las distribuciones de los grupos difieren, los tamaños muestrales son pequeños y se viola el supuesto de esfericidad. MÉTODO: se realizó un estudio de simulación Monte Carlo con un diseño de tres grupos y cuatro medidas repetidas. RESULTADOS: cuando las distribuciones de los grupos son diferentes, el efecto de la violación de la simetría es mayor que el de la curtosis. Además, el emparejamiento de asimetría y curtosis con el tamaño de grupo se constatan como variables a considerar cuando se utiliza este procedimiento. CONCLUSIONES: KR constituye una buena opción cuando el diseño es equilibrado, y (a) los tamaños muestrales totales son iguales a 45 o 60, y las distribuciones son mesocúrticas y no extremadamente asimétricas, o bien, simétricas con distintos grados de violación de curtosis; o (b) con tamaños muestrales de 30 y distribuciones mesocúrticas y leve/moderadamente asimétricas, o bien, simétricas con una violación moderada/extrema de la curtosis. Con estos tamaños muestrales y distribuciones severa o extremadamente asimétricas no es recomendable utilizar KR

Consistency errors in p-values reported in Spanish psychology journals / Errores de consistencia en los valores p informados en las revistas españolas de Psicología

Background: Recent reviews have drawn attention to frequent consistency errors when reporting statistical results. Method: We have reviewed the statistical results reported in 186 articles published in four Spanish psychology journals. Of these articles, 102 contained at least one of the statistics selected for our study: Fisher-F, Student-t and Pearson-χ2. Results: Out of the 1,212 complete statistics reviewed, 12.2% presented a consistency error, meaning that the reported p-value did not correspond to the reported value of the statistic and its degrees of freedom. In 2.3% of the cases, the correct calculation would have led to a different conclusion than the reported one. In terms of articles, 48% included at least one consistency error, and 17.6% would have to change at least one conclusion. In metaanalytical terms, with a focus on effect size, consistency errors can be considered substantial in 9.5% of the cases. Conclusion: These results imply a need to improve the quality and precision with which statistical results are reported in Spanish psychology journals (AU)

Antecedentes: recientes trabajos han llamado la atención sobre la presencia de frecuentes errores de consistencia al informar de los resultados estadísticos. Método: hemos revisado los resultados estadísticos de 186 artículos publicados en cuatro revistas españolas de Psicología, 102 de los cuales contenían alguno de los estadísticos seleccionados para nuestro estudio: F de Fisher, t de Student y χ2 de Pearson. Resultados: de los 1.212 contrastes completos revisados el 12,2% presenta algún tipo de error de consistencia: el valor p informado no se corresponde con el valor del estadístico de contraste y sus grados de libertad. En el 2,3% de los casos el error detectado conllevaría un cambio en la conclusión estadística del contraste. En términos del número de artículos, el 48% de los revisados incluye algún error de consistencia y al menos el 17,6% tendría que cambiar alguna de sus conclusiones. En términos metaanalíticos, los errores de consistencia pueden considerarse importantes en el 9,5% de los casos. Conclusiones: estos resultados señalan la necesidad de mejorar la calidad y precisión con la que se informa de los resultados estadísticos en las revistas españolas de Psicología (AU)

On methods of access to the structure of social representations: the example of Europe

The aim of this study is to identify the logic behind a range of statistical methods used to reveal the structure of social representations. Subjects (N= 317) were asked to answer the following question: «For each category of European person, please indicate which other European he would most like to have contact with». The results of the similarity analysis lead us to the conclusion that there is an ethnocentric bias, and reveal the central factor of the representation. The representation obtained by factorial correspondence analysis seems closer to current reality and enables us to understand the divisions that have structured Europe and remained embedded in the subjects. Thus, the choice of analytical method is not merely anecdotal, given that representations obtained from the same data can vary immensely (AU)

El objetivo de este estudio es identificar la lógica detrás de una serie de métodos estadísticos utilizados para revelar la estructura de las representaciones sociales. Se solicitó a un número de sujetos (n = 317) responder a la pregunta siguiente: «Para cada categoría de europeo, por favor indique con qué otros europeos le gustaría tener contacto». Los resultados de los análisis de similitud nos llevan a la conclusión de que existe un sesgo etnocéntrico, y revelan el factor central de la representación. La representación obtenida por el análisis factorial de correspondencias se parece más a la realidad actual y nos permite entender las divisiones que han estructurado Europa y permanecen incorporadas en los sujetos. Por lo tanto, la elección del método analítico no es meramente anecdótica, puesto que las representaciones obtenidas a partir de los mismos datos pueden variar enormemente (AU)

Integration of syndromic surveillance data into public health practice at state and local levels in North Carolina.

OBJECTIVES: We sought to describe the integration of syndromic surveillance data into daily surveillance practice at local health departments (LHDs) and make recommendations for the effective integration of syndromic and reportable disease data for public health use. METHODS: Structured interviews were conducted with local health directors and communicable disease nursing staff from a stratified random sample of LHDs from May through September 2009. Interviews captured information on direct access to the North Carolina syndromic surveillance system and on the use of syndromic surveillance information for outbreak management, program management, and the creation of reports. We analyzed syndromic surveillance system data to assess the number of signals resulting in a public health response. RESULTS: Syndromic surveillance data were used for outbreak investigation (19% of respondents) and program management and report writing (43% of respondents); a minority reported use of both syndromic and reportable disease data for these purposes (15% and 23%, respectively). Receiving data from frequent system users was associated with using data for these purposes (p=0.016 and p=0.033, respectively, for syndromic and reportable disease data). A small proportion of signals (<25%) resulted in a public health response. CONCLUSIONS: Use of syndromic surveillance data by North Carolina local public health authorities resulted in meaningful public health action, including both case investigation and program management. While useful, the syndromic surveillance data system was oriented toward sensitivity rather than efficiency. Successful incorporation of new surveillance data is likely to require systems that are oriented toward efficiency.

Comparison of three software programs for evaluating DIF by means of the Mantel-Haenszel procedure: EASY-DIF, DIFAS and EZDIF

El análisis del DIF (Funcionamiento Diferencial de los Ítems) examina si las respuestas a un ítem difieren en función de características como el idioma o el grupo étnico, entre personas igualadas respecto de la habilidad medida por el test. El análisis del DIF puede realizarse a partir de diferentes técnicas estadística, siendo el estadístico Mantel Haenszel uno de los más relevantes. El estadístico Mantel-Haenszel puede calcularse mediante programas como el EZDIF, el DIFAS y recientemente el EASY-DIF. En este contexto, el objetivo de este trabajo es comparar estos tres programas informáticos usando datos simulados y reales. Se analizaron las características procedimentales e instruccionales de los tres programas y se compararon los resultados proporcionados por cada uno de ellos para el mismo conjunto de datos. DIFAS y EASY-DIF siempre proporcionan resultados equivalentes, mientras que el EZDIF es menos preciso cuando se utiliza una estrategia de igualación delgada. Los resultados también mostraron una mayor facilidad en la ejecución de los programas DIFAS y EASY-DIF, especialmente para profesionales de la evaluación con tests en contextos aplicados, ofreciendo el segundo un mayor rango de resultados para características claves en la detección del DIF(AU)

The analysis of differential item functioning (DIF) examines whether item responses differ according to characteristics such as language and ethnicity, when people with matching ability levels respond differently to the items. This analysis can be performed by calculating various statistics, one of the most important being the Mantel-Haenszel, which can be carried out with software programs such as EZDIF, DIFAS and, more recently, EASY-DIF. In this context, the aim of the present study is to compare these three software programs by using simulated and real data. The procedural characteristics and the results obtained from the same dataset were thus compared by the three programs. DIFAS and EASY-DIF always provide equivalent results, while EZDIF is less accurate when using the thin matching strategy. The results also showed that DIFAS and EASY-DIF were the easiest to run, especially for testing practitioners, with the second offering a broader range of results for key characteristics for detecting DIF(AU)

Pruebas robustas para modelos ANOVA de dos factores con varianzas heterogéneas / Robust tests for two-way ANOVA models under heteroscedasticity

El objetivo de esta investigación fue comparar la robustez de dosestadísticos heteroscedásticos, Welch-James desarrollado por Johansen (WJ)y el estadístico Tipo Box desarrollado por Brunner, Dette y Munk (BDM),junto con el Modelo Lineal General (GLM), no heteroscedástico, de dosmodos diferentes en función del cálculo del valor crítico. De una parte,cuando los valores críticos se basan en valores teóricos (WJ, BDM y GLMrespectivamente), y de otra parte, cuando se obtienen mediante remuestreobootstrap (WJB, BDMB y GLMB respectivamente). Para llevarlo a cabo serealizó un estudio de simulación sobre un diseño factorial carente dehomogeneidad, normalidad y ortogonalidad. Los resultados muestran quecuando la relación entre el tamaño de las celdas y el tamaño de las varianzasfue positiva el procedimiento WJ fue el más robusto y que cuando larelación fue negativa el procedimiento más robusto fue WJB. Ambosprocedimientos se comportaron de modo liberal cuando la forma dedistribución fue sesgada, en mayor medida, cuanto mayor era el grado dedesigualdad del tamaño de las celdas y la heterogeneidad de las varianzas(AU)

Theaim of this research was to compare the robustness of two heteroscedastictest statistics, the Welch-James statistic developed by Johansen (WJ) and theType-Box statistic developed by Brunner, Dette and Munk (BDM), togetherwith the General Linear Model (GLM), not heteroscedastic test statistic, intwo different manners depending on the calculation of the critical value. Onthe one hand, when the critical values are based on theoretical values (WJ,BDM and GLM respectively), and on the other hand, when they areobtained by means of bootstrap resampling (WJB, BDMB and GLMBrespectively). To carry out it a study of simulation was realized on afactorial design lacking in homogeneity, normality and orthogonally. Theresults show that when the relation between the size of the cells and the sizeof the variances was positive the procedure WJ was the most robust and thatwhen the relation was negative the most robust procedure was WJB. Bothprocedures behaved in a liberal way when the shape of the distribution wasskewed, in major measure major it were the degree of inequality of the sizeof the cells and the heterogeneity of the variances(AU)

Organizing "mountains of words" for data analysis, both qualitative and quantitative.

Qualitative research creates mountains of words. U.S. federal funding supports mostly structured qualitative research, which is designed to test hypotheses using semiquantitative coding and analysis. This article reports on strategies for planning, organizing, collecting, managing, storing, retrieving, analyzing, and writing about qualitative data so as to most efficiently manage the mountains of words collected in large-scale ethnographic projects. Multiple benefits accrue from this approach. Field expenditures are linked to units of work so productivity is measured, many staff in various locations have access to use and analyze the data, quantitative data can be derived from data that is primarily qualitative, and improved efficiencies of resources are developed.

Estatísticas nas Américas: por uma agenda de estudos históricos comparados / Statistics in the Americas: an agenda for historical studies compared

Esta publicação reúne artigos de vários autores. Parte foi elaborada para uma das sessões na Latin American Studies Association - LASA, realizada no Rio de Janeiro, e parte para uma sessão ocorrida no próprio IBGE, ambas em 2009, cujos debates realçaram o estado atual das pesquisas históricas da atividade estatística, sejam elas realizadas em instituições estatísticas ou em ambiente acadêmico. Quatro países – Argentina, Brasil, Canadá e México – revelaram suas realidades históricas, e os textos, elaborados em seus respetivos idiomas de origem – Espanhol, Português e Francês – reportam tais experiências. (...) A introdução foi traduzida para o Inglês, estando também neste idioma, ao final do livro, os resumos de todos os textos. A publicação está estruturada em quatro seções: uma em que se faz abordagens historiográficas, com revelação de métodos de análise; duas outras com narrativas socio-históricas, ora focando os estados e as instituições, ora a ciência e a técnica; por último, uma que se destina a refletir sobre como seguir adiante, dando curso, em futuro próximo, num espaço regional, a estudos comparados, pelos quais sejam realçadas as possíveis proximidades e os inevitáveis afastamentos nas histórias nacionais. Ao final, duas entrevistas revelam trajetórias intelectuais exemplares: a de Hernán Otero e a de Jean-Pierre Beaud, dois estudiosos da história da atividade estatística, em perspectiva sociológica, e suas produções bibliográficas, sob a escolha dos próprios autores. Que este livro, resultante dos recentes debates ocorridos sobre a pesquisa histórica das estatísticas, no âmbito das sessões da LASA e do IBGE, seja recepcionado como um convite à comunidade acadêmica brasileira no sentido de trabalhar este tema junto ao IBGE, e em agenda própria de pesquisa. Que seja visto, sobretudo, como um exemplo às instituições estatísticas de outros países, estimulando-as à prática de tais pesquisas, como forma de ampliar sua aceitação como organizações necessárias às sociedades democráticas. Que todos, então, pesquisadores acadêmicos e pesquisadores nas instituições estatísticas, e elas próprias, em seus programas de atividades, se irmanem na pesquisa histórica da atividade estatística (e, sempre que próprio, também da atividade geográfica, como no caso do IBGE). Nossos países só terão a ganhar, tornando nossas histórias pátrias melhor escritas. O CD-ROM que acompanha a publicação reproduz o conteúdo impresso.