Issues in the reporting of epidemiological studies: a survey of recent practice.

OBJECTIVES: To review current practice in the analysis and reporting of epidemiological research and to identify limitations. DESIGN: Examination of articles published in January 2001 that investigated associations between risk factors/exposure variables and disease events/measures in individuals. SETTING: Eligible English language journals including all major epidemiological journals, all major general medical journals, and the two leading journals in cardiovascular disease and cancer. MAIN OUTCOME MEASURE: Each article was evaluated with a standard proforma. RESULTS: We found 73 articles in observational epidemiology; most were either cohort or case-control studies. Most studies looked at cancer and cardiovascular disease, even after we excluded specialty journals. Quantitative exposure variables predominated, which were mostly analysed as ordered categories but with little consistency or explanation regarding choice of categories. Sample selection, participant refusal, and data quality received insufficient attention in many articles. Statistical analyses commonly used odds ratios (38 articles) and hazard/rate ratios (23), with some inconsistent use of terminology. Confidence intervals were reported in most studies (68), though use of P values was less common (38). Few articles explained their choice of confounding variables; many performed subgroup analyses claiming an effect modifier, though interaction tests were rare. Several investigated multiple associations between exposure and outcome, increasing the likelihood of false positive claims. There was evidence of publication bias. CONCLUSIONS: This survey raises concerns regarding inadequacies in the analysis and reporting of epidemiological publications in mainstream journals

Thyroid stimulating hormone (TSH) concentrations and menopausal status in women at the mid-life: SWAN

objective We evaluated menopausal symptoms, menstrual cycle bleeding characteristics and reproductive hormones for their associations with thyroid stimulating hormone (TSH) concentrations in women at the mid-life from five ethnic groups. methods This report is from the baseline evaluation of the Study of Women's Health Across the Nation (SWAN), a community-based multiethnic study of the natural history of the menopausal transition. Enrollees were 42–52 years old (pre- and early perimenopausal) African American, Caucasian, Chinese, Hispanic and Japanese women ( n  = 3242). Enrollees were interviewed about self-reported diagnosed hypo- and hyperthyroidism or thyroid treatment, menopausal symptoms and menstrual cycle bleeding characteristics. Serum was assayed for TSH, oestradiol, testosterone, FSH and SHBG. results There were 6·2% of women with TSH > 5·0 mIU/ml and 3·2% with TSH  5·0 mIU/ml ( P  < 0·008) or < 0·5 mIU/ml ( P  < 0·02). Women with TSH values outside the range of 0·5–5·0 mIU/ml were more likely to report shorter or longer menstrual periods ( P  = 0·004 for both) than women within that range. FSH, SHBG, dehydroepiandrosterone sulphate (DHEA-S), testosterone, and oestradiol concentrations were not associated with TSH concentrations. conclusion In mid-aged women, there was a 9·6% prevalence of TSH values outside the euthyroid range of 0·5–5·0 mIU/ml. Although TSH was associated with bleeding length and self-reported fearfulness, it was not associated with indicators of the menopausal transition, including menopausal stage defined by bleeding regularity, menopausal symptoms or reproductive hormone concentrations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73917/1/j.1365-2265.2003.01718.x.pd

A randomized controlled trial comparing two types of retractors at caesarean delivery

The aim of this study was to determine if the use of a self-retaining, symmetrical retractor (OB/Mobius®) during caesarean delivery is associated with differences in post-operative pain experience. Consenting women undergoing caesarean delivery were randomly assigned to OB/Mobius® versus conventional retraction instruments. Women were blinded to retractor type and filled out surgical pain surveys each post-operative day. Additional outcome variables were collected through a provider survey and chart review. Of the 154 randomised women, 144 completed the study. There was no difference in the symmetry, quality or intensity of postoperative pain based on the method of retraction. The OB/Mobius® retractor did not confer an improvement in the quality or intensity of post-caesarean discomfort in the first three days following delivery. Nor did the groups differ in operative times, blood loss or pain medication usage. However, the retractor may offer improved visualisation and retraction in obese women.Impact statement Use of a plastic sheath self-retaining retractor has been minimally studied in caesarean deliveries. Recently it was found that the use of such a retractor reduced wound infection, but another study in obese women did not show improved rates of infection (Hinkson et al. ; Scolari Childress et al. ). The study of sheath self-retaining retractors to decrease post-operative pain has not been reported previously. This study offers an investigation into a generalisable population of parturients who undergo caesarean delivery and if the primary use of a self-retaining retractor versus sole use of traditional hand-held retractors decreased post-operative pain while in the hospital. Although this study did not show an improvement in post-operative pain, provider experience reports demonstrated some improvement in visualisation, particularly in the obese population with the use of this novel retractor, thus making it an option for providers who do caesarean deliveries without an assistant and find hand-held retractors inadequate

The silent consumer: women\u27s reports and ratings of abortion services

BACKGROUND: Abortion is one of the most common surgical procedures performed on women in the United States, and its safety has been demonstrated. Little research has focused, however, on women\u27s reports and ratings of the service. OBJECTIVES: This study explored the association of demographic factors, medical outcomes, and client ratings of service dimensions with global satisfaction. RESEARCH DESIGN: For this cross-sectional study, permission to access clinic medical records was obtained. Surveys were distributed after the procedure, with instructions to return by mail. SUBJECTS: Study subjects were 797 women who underwent an outpatient surgical abortion at 1 of 2 New England health centers in 1996 and 1997. MEASURES: Demographic data, pregnancy history, and information on the procedure were collected from medical records. Survey items measured reports of access, medical outcomes, and satisfaction ratings with service domains. RESULTS: Women with positive ratings of staff sensitivity and of the counseling process and information received and those who had the procedure at a younger gestational age were less likely to report that care could be better. Although very few women reported a medical complication, this was associated with agreement that care could have been better, as was reporting agreement that the wait between the preexamination visit and the procedure was too long. CONCLUSIONS: Satisfaction with abortion services is high. Education and counseling play very important roles. Survey items could routinely be used to monitor services

Learning Over Time: Uses of Intercontextuality, Collective Memories, and Classroom Chronotopes in the Construction of Learning Opportunities in a Ninth-grade Language Arts Classroom

Framed within interactional sociolinguistics, microethnographic discourse analysis, and cognitive science, we examine how intercontextuality, collective memories, and classroom chronotopes were used in generating learning opportunities in a ninth-grade language arts classroom. Five consecutive videorecorded lessons were analyzed focusing on how the teacher and students constructed relationships among past, present, and future events and contexts. Among the grounded theoretical constructs generated were (1) that the teacher and students socially constructed collective memories as interpretive frames for their reading and writing; and (2) they juxtaposed and problematized differing chronotopes in constructing learning opportunities and building a curriculum. We view these grounded theoretical constructs as contributions to current discussions of the nature and use of time in classrooms