An Overview of Methods in the Analysis of Dependent ordered catagorical Data: Assumptions and Implications

Subjective assessments of pain, quality of life, ability etc. measured by rating scales and questionnaires are common in clinical research. The resulting responses are categorical with an ordered structure and the statistical methods must take account of this type of data structure. In this paper we give an overview of methods for analysis of dependent ordered categorical data and a comparison of standard models and measures with nonparametric augmented rank measures proposed by Svensson. We focus on assumptions and issues behind model specifications and data as well as implications of the methods. First we summarise some fundamental models for categorical data and two main approaches for repeated ordinal data; marginal and cluster-specific models. We then describe models and measures for application in agreement studies and finally give a summary of the approach of Svensson. The paper concludes with a summary of important aspects.Dependent ordinal data; GEE; GLMM; Logit; modelling

Comparison of methods in the analysis of dependent ordered catagorical data

Rating scales for outcome variables produce categorical data which are often ordered and measurements from rating scales are not standardized. The purpose of this study is to apply commonly used and novel methods for paired ordered categorical data to two data sets with different properties and to compare the results and the conditions for use of these models. The two applications consist of a data set of inter-rater reliability and a data set from a follow-up evaluation of patients. Standard measures of agreement and measures of association are used. Various loglinear models for paired categorical data using properties of quasi-independence and quasi-symmetry as well as logit models with a marginal modelling approach are used. A nonparametric method for ranking and analyzing paired ordered categorical data is also used. We show that a deeper insight when it comes to disagreement and change patterns may be reached using the nonparametric method and illustrate some problems with standard measures as well as parametric loglinear and logit models. In addition, the merits of the nonparametric method are illustrated.Agreement:ordinal data; ranking; reliability.rating scales

The future role of Lantmännen : focusing on the member companies and members in 2030

Lantbruk påverkas av både interna och externa faktorer (Jordbruksaktuellt, 2018). Gårdarna i Sverige har de senaste åren genomgått strukturförvandlingar både internt och externt. Företagen har blivit större och färre (Jordbruksverket, 2020a) och dess produktion mer specialiserad (Edenbrandt, 2012). En av de externa faktorer som förändras är klimatet, som de senaste åren blivit allt svårare att förutse (SMHI, 2014). En stor del av Sveriges lantbruksföretag, cirka 40%, är medlemmar i det Svenska lantbrukskooperativet Lantmännen (Jordbruksverket, 2020b). Lantmännen är ett lantbrukskooperativ som är helägt av svenska bönder, vars huvuduppdrag är “bidra till lönsamheten på medlemmarnas gårdar och optimera avkastningen på medlemmarnas kapital i föreningen” (Lantmännen, 2020b). En av funktionerna som kooperativa företag väntas fylla är att bidra med nytta till sina medlemmar, vilket betyder att det ska vara fördelaktigt att vara medlem i kooperativet för den som handlar med kooperativet (Nilsson & Björklund, 2003). Då lantbruket förändras, kommer också Lantmännens medlemskår att förändras. Denna studie syftar till att undersöka hur medlemsföretagen och medlemmarna kommer utvecklas fram till 2030 och hur det kommer påverka Lantmännens sätt att agera som affärspartner samt dess styrning. Det är i dagsläget ovisst hur Lantmännens medlemsföretag kommer utvecklas fram till 2030, och det finns inga tidigare dokumenterade studier inom området. För att kunna bidra med medlemsnytta i framtiden är det viktigt för Lantmännen att anpassa sig efter deras medlemmar företagsutveckling. Studien är en fallstudie gjord på Lantmännen och bygger på tre följande scenarier: 1. Gårdarna blir större och färre, 2. Klimatet blir osäkrare, 3. Gårdarna blir mer specialiserade. Författarna har genom att studera data och artiklar tagit fram dessa tre scenarier som grund för uppsatsen, och har efter en litteraturöversikt funnit teorier som ansetts vara lämpliga vid forskning av denna karaktär. Genom semistrukturerade intervjuer med 13 personer med olika roller inom Lantmännen så har ett empiriskt underlag kommit fram, något som sedan har analyserats genom tematisk kodning. Teorierna som använts vid analys har varit kooperativ, business to business, Socialt kapital, Tillit i kooperativ, Corporate governance och Affärsmodell. Resultaten som kom fram under studien var att forskning och utveckling är en viktig grundpelare för kooperativet, den kooperativa företagsmodellen kommer vara viktig i framtiden och att medlemsföretagen, liksom Lantmännen, kommer förändras och behöva anpassa sig till de kommande förändringarna. De slutsatser som författarna kommit fram till är att det är troligt att ovan nämnda scenarier slår in, att lantbruksföretagen kommer i större grad drivas som aktiebolag, ha större andel arrenderad mark, mer ekonomiskt kunniga, ha en bättre riskhantering. Lantmännen kommer behöva ha kompetenta säljare som har en god relation till medlemmen. Vidare måste Lantmännen arbeta med logistikkedjan så den är välfungerande från åker till silo, arbeta med lobbying, forskning och utveckling samt ha en fortsatt diversifierad portfölj. Nyckelord: Lantbruk, Lantmännen, KooperativAgriculture is an industry that is affected by internal and external structural changes (Jordbruksaktuellt, 2018). In this study, the authors studied how the agricultural companies and their relationship with the agricultural cooperative Lantmännen, as well as Lantmännen's internal control, would be affected if the farms became larger and fewer, the climate more uncertain or the farms more specialized. Through 13 semi-structured interviews, the authors have collected data that they have analyzed along a theoretical framework. The chosen analytical method is the thematic analysis where the authors have sought for themes in the data. The theories on which the study is based are cooperative, business to business, business model, corporate governance, social capital, cooperative trust and preparedness theory. The conclusions reached by the authors were that the scenarios (the farms become larger and fewer, the climate more uncertain and the farms more specialized) are likely to occur: more agricultural companies will be run as limited companies, a larger part of the land will be let as farm tenancies, they will have more financial knowledge and have a different risk management thinking. Lantmännen will need to have competent salespeople who have a good relationship with their members, work with the logistics chain so that it works well from field to silo, work with lobbying, research and development and have a continuing, diversified portfolio

The functional barometer –a self-report questionnaire in accordance with the international classification of functioning, disability and health for pain related problems; validity and patient-observer comparisons

BACKGROUND: The International Classification of Functioning, Disability and Health, (ICF) provides a unified, international standardized framework for describing and classifying health and health-related functioning and disability. Based on an ICF core sets the Functional Barometer, (FB), was developed for assessments of perceived pain-related problems with functions, activity and quality-of-life by patients suffering from long-term pain. The aim was to evaluate the construct validity, and to compare the assessments of a patient’s problems from the perspectives of the patient and of the examining professional when using the validated FB and corresponding ICF-classification form, respectively. METHODS: Patients with long-term pain for more than 3 months that visited one of four pain clinics during specified time periods of data collections were eligible. The self-report Balanced Inventory for Spinal disorders was used for validation of the FB. Correspondingly to the validated FB an ICF-classification form for professional’s assessment was developed. The data sets for these inter-scale and the patient-professional comparisons were collected adjacent to the clinical examination. By the statistical method used for evaluation of the pairs of ordinal data presence of systematic disagreement was identified and measured separately from additional individual variations. RESULTS: The validation process resulted in a revised FB(2.0) that meets the requirements of good construct and content validity. The professionals’ ICF-classifications of the patients’ problems disagreed with the patients’ assessments on the FB(2.0); the percentage agreements ranged from 18% to 51%. The main reason was that the practitioners systematically underestimated the patients’ levels of problems but the different professionals contributed also to a large individual variability (noise) in assessment. CONCLUSIONS: This study presents an ICF-based validated self-report questionnaire, The FB, to be used for identifying and describing pain-related problems with current functioning, activities and quality-of-life as perceived by patients suffering from long-term pain. The strong evidences of underestimation of the patients’ problems and the variability in the professionals’ ICF-classifications demonstrated the importance of describing the patient’s problems both from the patient’s and the professional’s perspective beneficial for the patient’s rehabilitation

Modification of the asthma quality of life questionnaire (standardised) for patients 12 years and older

BACKGROUND: The age limit for some adult asthma clinical trials has recently been lowered to 12 years. In this study we have made minor modifications to the standardised version of the adult Asthma Quality of Life Questionnaire (AQLQ(S)) to make it valid for patients 12 years and older (AQLQ12+). METHODS: We have used two clinical trial databases, in which the AQLQ12+ was used, to compare the measurement properties of the questionnaire in patients 12–17 years and patients 18 years and older. A total of 2433 patients (12–75 years), with current asthma and with data that could be evaluated both at randomisation and end of treatment, were included. RESULTS: The analysis showed that internal consistency, responsiveness and correlations with other clinical indices were very similar in patients 12–17 years and patients 18 years and older. CONCLUSION: The measurement properties of the AQLQ12+ are similar in adolescents and adults and therefore the instrument is valid for use in adult studies which include children 12 years and older

How to embed a coworker from another national culture : a casestudy on Lantmännen Maskin

Syftet med studien har varit att studera vad som händer i en organisation när en individ från en annan nationell kultur kommer till arbetsplatsen, och vilka faktorer som påverkar inbäddningen. Studien har bestått av en fallstudie, där fyra anläggningar tillhörande Lantmännen Maskin och Swecon har besökts, två i Uppsala och två i Staffanstorp. Både chefer, anställda och anställda med annan kulturell bakgrund har intervjuats. Med kultur syftar vi på kulturer mellan nationsgränser. Fokus vid insamlingen av empiriska data har varit på hur chefer och anställda har arbetat med inbäddningen av deras nyanställda kollegor, vilka åtgärder som har gjorts och hur resultatet har blivit. De teorier vi valt att använda i studien är organisationsteori, organisationskultur, gruppbildning och inbäddning. Begreppen må vid första anblick verka många och omfattande, men de alla behövs och berörs. När en ny medarbetare från en annan kultur ska bäddas in i en organisation så behöver processer ske, som så småningom leder till en förändring. Förändringen är inte ett steg i processen, utan snarare en slutdestination och ett resultat av inbäddningen. Vikten av att förstå hur en organisation fungerar, kulturens påverkan på organisationen, vilka processer som sker för att möjliggöra inbäddningen som slutligen leder till en förändring, har varit avgörande för detta arbete. Studien visar att det finns ett mönster i hur en inbäddning går till. Det finns vissa steg, en process, som var återkommande för alla besökta anläggningar. Att ta emot en person med en annan kulturell bakgrund och bädda in den i organisationen kräver engagemang från övriga anställda och chefer. När processen är gjord och personen inbäddad så har det slutligen skett en lokal förändring. Den kulturella skillnad som visat sig spela störst roll är språket, och det som framförallt påverkas är kundnöjdheten och säkerheten.The purpose of this study was to investigate how a company embed new staff with different cultural background into their organisation and to identify which factors affect this embedding process. In the case study, four sites, two in Uppsala and two in Staffanstorp belonging to Swecon and Lantmännen Maskin, were visited. At these sites interviews were conducted with supervisors, employees and employees with different cultural background. When addressing culture in this report, we address the cultural differences between nationalities. How employees and supervisors work to embed their new colleagues, what actions has been taken and the outcome has been the main objective while collecting empirical data. The theories used in this study are organisational theory, organisational culture, formation of groups and embedding. These are extensive theories but are all important for the study. When embedding a new co-worker with different cultural background certain processes that lead to a change are required. These changes are not a part of the process but rather a goal and result of embedding. It has been central in in this study to understand how an organisation work, how culture affect it and what processes that are needed in order to enable embedding that result in a change. The study concludes that there’s a pattern to how an embedding process happens. There are certain steps, a process, which are recurring for all visited sites. Accepting a person with a different cultural background and to embed this person into the organisation requires engagement from key persons, which includes both the supervisors and employees. There are a number of key events also required for the embedding to be successful. When the process is completed there has been a local change. Language showed to be the most important cultural difference as it affects customer satisfaction and work site safety

Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups

BACKGROUND: Rating scales like the visual analogue scale, VAS, and the verbal rating scale, VRS, are often used for pain assessments both in clinical work and in research, despite the lack of a gold standard. Interchangeability of recorded pain intensity captured in the two scales has been discussed earlier, but not in conjunction with taking the influence of pain etiology into consideration. METHODS: In this cross-sectional study, patients with their pain classified according to its etiology (chronic/idiopathic, nociceptive and neuropathic pain) were consecutively recruited for self-assessment of their actual pain intensity using a continuous VAS, 0–100, and a discrete five-category VRS. The data were analyzed with a non-parametric statistical method, suitable for comparison of scales with different numbers of response alternatives. RESULTS: An overlapping of the VAS records relative the VRS categories was seen in all pain groups. Cut-off positions for the VAS records related to the VRS categories were found lower in patients with nociceptive pain relative patients suffering from chronic/idiopathic and neuropathic pain. When comparing the VAS records transformed into an equidistant five-category scale with the VRS records, systematic disagreements between the scales was shown in all groups. Furthermore, in the test-retest a low percentage of the patients agreed to the same pain level on the VAS while the opposite hold for the VRS. CONCLUSION: The pain intensity assessments on VAS and VRS are in this study, not interchangeable due to overlap of pain records between the two scales, systematic disagreements when comparing the two scales and a low percentage intra-scale agreement. Furthermore, the lower VAS cut-off positions relative the VRS labels indicate different meaning of the rated pain intensity depending on pain etiology. It is also indicated that the scales have non-linear properties and that the two scales probably have different interpretation. Our findings are in favor of using the VRS in pain intensity assessments but if still the VAS is preferred, the VAS data should be analyzed as continuous using statistical methods suitable for ordinal data. Furthermore, our findings indicate a risk to over or under estimate the patient's perceived pain when interpreting condensed VAS data

Health-related quality of life, utility, and productivity outcomes instruments: ease of completion by subjects with COPD

An important outcome of any clinical intervention is the change in the subject's own perceived state of health. This can be categorized as health-related quality of life (HRQL), utility (preference-based health state), and daily life performance. 174 Swedish subjects with chronic obstructive pulmonary disease (COPD) (mean age 64.3 ± 12 years) completed five self-administered questionnaires: Short Form 36 (SF-36), St George's Respiratory Questionnaire (SGRQ), EuroQol-5D (EQ-5D), Health States-COPD (HS-COPD), and Work Productivity and Activity Impairment Questionnaire for COPD (WPAI-COPD). The subjects scored these outcomes instruments for ease of completion using a 5-point scale. The time taken to complete them was noted and the administrators' opinion of the subjects' comprehension of the questionnaires recorded using a 4-point scale. A score of 1–3 ("very easy" to "acceptable") was recorded by 92% of subjects for the SF-36, 90% for SGRQ, 80% for EQ-5D, 83% for WPAI-COPD, and 53% for HS-COPD. The HS-COPD was graded "very difficult" to complete by 21% of subjects compared with 3–5% of subjects for the other questionnaires. The mean time taken to complete all questionnaires was 39 minutes, and the large majority of subjects scored "good" for understanding by the administrator. Age correlated significantly with the degree of the subject's opinion of the ease of completion of five outcomes instruments, while the influence of gender, socio-economic status and disease severity was not statistically significant