Large Epidemiological Surveys Research Articles

Coming of age in recovery: The prevalence and correlates of substance use recovery status among adolescents and emerging adults.

To date, no epidemiological survey has estimated the prevalence of adolescents identifying as being in recovery. This is necessary for planning and identifying the needs of youth with current and remitted substance use disorders. This study estimated the prevalence of recovery status in a large statewide epidemiological survey administered between January and March 2020. Participants were high school students in 9th through 12th grades throughout Illinois. Youth were asked if they were in recovery and if they had resolved problems with substances. Youth who reported recovery and problem resolving dual status (DS), recovery only (RO), and problem resolution only (PRO) were compared to propensity score matched control groups who reported neither status (neither/nor; NN). Outcomes included alcohol use, binge alcohol use, cannabis use, and prescription drug use in the past 30 days. Prevalence estimates were 884 (1.4%) for DS, 1546 (2.5%) for PRO, and 1,811 (2.9%) for RO. Relative to propensity matched control samples, all three groups had significantly lower odds of prescription drug use. The PRO group had lower odds of past month cannabis use. There were no significant differences for either alcohol outcome. Prevalence estimates of youth in recovery are slightly lower than those of adults in recovery, and estimates should be replicated. Youth in recovery and those resolving problems have numerous behavioral health needs, and relative to matched controls, have even odds for past 30-day alcohol use. These findings compel us to further define recovery for adolescents and emerging adults to allow for improving treatments and epidemiological research.

Understanding the epidemiology of substance use in India: A review of nationwide surveys.

Substance use is a public health concern on a global and national levels. There is a scarcity of nationally representative systematic research on the epidemiology of substance use in India. This narrative review aims to discuss the various large epidemiological surveys providing data on substance use in India. Attempts have been made to extract data pertaining to special population groups as well.

Same-sex sexual behaviour and psychological health: CONSTANCES, a population survey in France

RationaleHaving same-sex partners is linked to poor psychological health and increased risk of suicide attempt. This link seems to be stronger for men than women. However, in France, there have been few studies of population samples, and the size of these studies does not always allow an in-depth analysis of these associations. Methods and resultsThis study explored these associations by analysing data from a large epidemiological survey conducted in France from 2012 to 2019 that included 84,791 women and 75,530 men. The frequencies and risk ratios of depression, suicide attempts, alcohol dependence and regular cannabis use were calculated regarding two groups: those with only the other sex partners and those with any same sex partners. Risk of alcohol addiction and cannabis use was greatly increased for women who had homosexual relations, even after adjustment for social, demographic and sexual life factors, which was not the case for men. However, risk of depression and suicide attempts was increased for men who had homosexual relations; this was also true for women but to a lesser extent. The estimates remained unchanged after stratifying the population by three distinct social groups defined by education level. ConclusionsThe analysis of these differences was possible because of the large sample size of the CONSTANCES survey and its recruitment in the general population. This study helps increase knowledge of the health of sexual minorities. It can help clinicians pay more attention to the potential distress of their patients and can continue to inform policymakers of the effects of discrimination and stigmatisation linked to homosexual behaviour.

Comparison of physician- and self-assessed pubertal onset in Japanese children.

Physical examinations to assess pubertal development are challenging in large epidemiological surveys. This study aimed to assess the reliability of judgment of pubertal onset in Japanese children by the original pubertal self-assessment sheet. A total of 144 children aged 10 or 12 years were recruited between March 2019 and September 2020 from the pediatric endocrine outpatient clinics of participating institutions. Agreement between the physician- and participantassessed pubertal onsets was determined using unweighted kappa (UK) and Gwet's agreement coefficient (AC1). The physician's assessment of pubertal onset was in slight agreement with that of the self-assessment sheet in 10-year-old boys (UK: 0.23 and AC1: 0.14), whereas the agreement between the physician's assessment and self-assessment sheet results was good and the physician's assessment was fair (UK: 0.64 and AC1: 0.94) in 12-year-old boys. The physician's assessment of pubertal onset were in good and moderate agreement with the self-assessment sheet in 10-year-old girls (UK/AC1: 0.74/0.78, respectively). In 12-year-old girls, although it showed poor agreement with UK (0.46), there was a very good agreement with AC1 (0.88). Although self-assessment of breast development was in good agreement with that of the physician's assessment for determining pubertal onset in girls, large-scale epidemiological studies are difficult to conduct for adolescent boys, especially for those in the early pubertal stage.

Retracted: Analysis of Influencing Factors for Chronic Diseases: A Large Sample Epidemiological Survey from Liaoyang.

[This retracts the article DOI: 10.1155/2022/1537906.].

Prevalence and clinical correlates of misophonia symptoms in the general population of Germany.

Misophonia refers to a phenomenon in which affected individuals have a selective intolerance to sounds of mostly oral or nasal origin. This intolerance is typically associated with strong emotional reactions such as anger, irritation, and disgust. The aim of this study was to conduct the first large epidemiological survey to determine the prevalence of misophonia symptoms in the adult population in Germany. We conducted a large-scale representative population survey between December 2020 and March 2021. For this purpose, a sample of 2,519 people were visited in their households and assessed with the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Questionnaire (AMISOS-R) to document misophonic symptoms. The primary estimate of clinical misophonia symptoms prevalence was based on the MQ Severity Scale and a secondary estimate was based on the AMISOS-R. The survey further included self-ratings to measure perfectionism, not-just-right experience (NJRE), autonomous sensory meridian response (ASMR) and general health as well as demographic data. Five percent of the sample scored equal or above the MQ Severity Scale threshold for clinical misophonia symptoms (5.9% based on AMISOS-R). Individuals with clinical misophonia symptoms had a higher rate of perfectionism, a higher occurrence of NJRE, higher susceptibility to ASMR, and a worse general health status than those scoring below the cut-off-score. All those factors also independently predicted the severity of misophonia symptoms in a multiple regression model. Misophonia is a frequent condition and should further be examined as an independent diagnostic entity.

Serosurvey of spotted fever group Rickettsia in equids from western Pará, Amazon, Brazil.

From a previous large epidemiological survey, we randomly selected 474 serum samples (463 horses and 11 mules) distributed among four municipalities of Pará state, Amazon region, Brazil, and from three types: farm animal, urban carthorse, and sport horse. Samples were tested by indirect fluorescence antibody test (IFAT ≥ 64) for antibodies reactive to spotted fever group (SFG) rickettsiae using Rickettsia rickettsii as crude antigens. From the 474 equids tested, 149 (31.4%) had ticks attached during sampling, belonging mostly to the species Dermacentor nitens. The overall seroprevalence for SFG rickettsiae was 31.4% (95% confidence interval: 27.3-35.9%) with 149 seropositive animals out of 474 screened. Notably, 77 equids (16.2%) had high endpoint titers ranging from 512 to 16,384, indicating that they had been exposed to SFG rickettsiae not long before sampling. Animal type affected rickettsial seroprevalence, with significantly higher values among farm horses when compared with urban and sport animals. Presence of dogs and tick infestation were negatively associated with equid seropositivity to R. rickettsii. This is the first report of SFG rickettsiae-reactive antibodies in equids from Pará state, Brazilian Amazon.

Combining parametric and nonparametric models to estimate treatment effects in observational studies.

Performing causal inference in observational studies requires we assume confounding variables are correctly adjusted for. In settings with few discrete-valued confounders, standard models can be employed. However, as the number of confounders increases these models become less feasible as there are fewer observations available for each unique combination of confounding variables. In this paper, we propose a new model for estimating treatment effects in observational studies that incorporates both parametric and nonparametric outcome models. By conceptually splitting the data, we can combine these models while maintaining a conjugate framework, allowing us to avoid the use of Markov chain Monte Carlo (MCMC) methods. Approximations using the central limit theorem and random sampling allow our method to be scaled to high-dimensional confounders. Through simulation studies we show our method can be competitive with benchmark models while maintaining efficient computation, and illustrate the method on a large epidemiological health survey.

Questionnaire-based epidemiological survey of primary focal hyperhidrosis and survey on current medical management of primary axillary hyperhidrosis in Japan

To obtain current epidemiological information on primary focal hyperhidrosis in Japan, a large epidemiological survey was conducted using a web-based questionnaire. The prevalence of primary focal hyperhidrosis was 10.0% and the site-specific prevalence was highest for primary axillary hyperhidrosis (5.9%). The proportion of respondents with primary focal hyperhidrosis who had consulted a physician was 4.6%, which was similar to the low prevalence reported previously in 2013 in Japan. A questionnaire survey for physicians and individuals with primary axillary hyperhidrosis on the current medical management of primary axillary hyperhidrosis showed that physicians recognized the existence of patients who were very worried about hyperhidrosis, but failed to provide active treatment. Regarding the information provided by patients to physicians at presentation, it was found that patients failed to provide sufficient information to the physicians about their worries in daily life. Among individuals who had sought medical care with primary axillary hyperhidrosis, 62.3% reported that they were not currently receiving treatment, highlighting a challenge to be addressed regarding continued treatment. Frequently chosen options leading to willingness to receive treatment were less expensive treatment and highly effective treatment as well as feeling free to consult a physician, suggesting a desire for an improved medical environment.

Analysis of Influencing Factors for Chronic Diseases: A Large Sample Epidemiological Survey from Liaoyang.

Purpose Northeast China is a region with a serious aging population. There are fewer articles on epidemiological surveys on the prevalence of chronic diseases in aging areas of China. The study is aimed at understanding the prevalence of chronic noncommunicable diseases such as hypertension and diabetes mellitus (DM) in Liaoning Province, northeast China, and analyzing the risk factors for these chronic diseases. Methods A questionnaire survey and physical examination were conducted in 5008 permanent residents in 2 streets (Henan Street and Hebei Street) covered by Liuerbao Central Health Center in Liaoyang and 4 villages (Miaogou Village, Wangjia Village, Heyan Village, and Shuiquan Village) covered by Shuiquan Health Center in Tianshui Town of Liaoyang from January 2020 to December 2020. Results A total of 4990 patients were included. The prevalence rates of hypertension, DM, dyslipidemia, and obesity in residents in Liaoyang were 54.13%, 12.30%, 43.31%, and 20.52%, respectively. The prevalence of hypertension and DM was highest in both male and female patients aged 40-60 years, which was higher than that in the other age groups (P < 0.05). The prevalence of dyslipidemia was highest in men over 60 years old and women 18 − <40 years old. Obesity was most common in men aged over 60 and in women 40 − <60 years old. The proportion of male smokers in all age groups was significantly higher than that of female smokers. Smoking, dyslipidemia, and significant overweight or obesity are common risk factors for hypertension and DM. Conclusion In Liaoyang, northeast China, the prevalence of noninfectious chronic diseases was high, and the prevalence rate in people over 40 years old was significantly higher than that in people under 40 years old. The prevalence and progression of chronic diseases were obviously related to local living and eating habits; thus, health education needs to be improved.

Peking Union Health Application (PUHApp): Modern solution for effective epidemiological survey administration and health promotion

Large scale population-based epidemiological health surveys require effective administration. The diverse phenotype data sets also lead to challenge to quick and visual feedback of health check-up results or meeting the need of self-health management. With the rapid popularization of smartphone use, the smartphone-based applications bring about new inspirations for traditional epidemiological studies to fulfill various health and research needs. In 2015, we designed a software named Peking Union Health Application (PUHApp), which can be used noncommercially via smartphone or modern desktop web browser. PUHApp has been used by over 50 000 individuals to obtain their e-health reports. Diverse health data have been linked to this application. The module of self-health assessment and disease risk prediction modules enable individuals to estimate their physical fitness conveniently. By describing the concepts and usage of PUHApp, we aim to demonstrate its key role as modern solution for effective epidemiological survey administration and health promotion, and to provide practical cases that could be helpful for other researchers.

Vitamin D deficiency is associated with thyroid autoimmunity: results from an epidemiological survey in Tianjin, China.

The pathogenesis of Hashimoto's thyroiditis (HT) is unclear, although some studies have identified an association between vitamin D deficiency and thyroid autoantibody positivity. This study aimed to investigate vitamin D status, and its relationships with thyroid autoantibody positivity and HT, via a large epidemiological survey. The epidemiological survey was conducted in Tianjin, China. All participants underwent testing for serum 25-hydroxyvitamin D (25OHD), thyroid function, and thyroid autoantibodies, and some participants underwent testing to evaluate CD4+ T-cell differentiation and concentrations of related cytokines. The study included 1812 participants and revealed prevalences of 13.1% for thyroid peroxidase antibodies (i-TPOAb) and 14.0% for thyroglobulin antibodies (i-TgAb). Logistic regression analysis revealed that thyroid autoantibody positivity was associated with sex, age, and 25OHD classification. An increased likelihood of i-TPOAb positivity was associated with 25OHD deficiency (odds ratio [OR]: 2.428, 95% confidence interval [CI]: 1.383-4.261) and 25OHD inadequacy (OR: 1.198, 95% CO: 0.828-1.733; p = 0.008). An increased likelihood of i-TgAb positivity was associated with 25OHD deficiency (OR: 2.366, 95% CI: 1.366-4.099) and 25OHD inadequacy (OR: 1.263, 95% CI: 0.883-1.807; p = 0.009). Relative to healthy subjects, patients with HT had significantly higher proportions of Th1 and Th17 cells, as well as higher concentrations of related cytokines. This study revealed that vitamin D deficiency was associated with thyroid autoantibody positivity, and that vitamin D deficiency seems to be involved in the pathological mechanism underlying HT. Large randomized controlled trials are needed to investigate the effects of vitamin D supplementation on HT.

Prevalence of Depressive Symptoms Among University Students in Pakistan: A Systematic Review and Meta-Analysis.

Background: In Pakistan, almost 30% population is between 15 to 29 years of age, with university enrollment rates of 10–15%. Although there is a growing concern on mental health of university students across the globe, studies from low and middle income countries such as Pakistan are scarce. We conducted a systematic review and meta-analysis of prevalence of depressive symptoms among Pakistani university students.Methods: PubMed, Web of Science, PsycInfo and Google Scholar were searched between 15 to 30th January 2020. Cross-sectional and longitudinal studies, published till 31st December 2019 were included. Data on study characteristics and prevalence of depressive symptoms were extracted. Meta-analysis was conducted using random effects models. To estimate subgroup difference based on study characteristics, meta-regression and sub-group analyses were conducted.Results: In total, 26 studies involving 7,652 participants were included in review. Overall prevalence of depressive symptoms was 42.66% (95% CI: 34.82% to 50.89%), with significant heterogeneity among studies. Subgroup analyses revealed a significant difference in prevalence estimates based on depression screening instrument and study major. Statistically significant differences were observed among studies employing different psychometric scales (test for subgroup differences, Q = 21.92, p < 0.05) and between students from different study majors (test for subgroup differences, Q = 3.76, p = 0.05).Conclusion: Our study found that overall prevalence of depressive symptoms among university students in Pakistan was 42.66%, however, findings should be interpreted with caution. Large scale epidemiological surveys using valid and reliable tools are needed to better estimate prevalence of depression among Pakistani university students.

NDSP 06: Prevalence and risk factors for obesity in urban and rural areas of Pakistan: A study from second National Diabetes Survey of Pakistan (NDSP), 2016–2017

ObjectiveTo study the pattern and prevalence of obesity in a large representative sample of Pakistani population aged 20 years and above. MethodologyThis study is a sub analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016–2017, a large community-based epidemiological survey carried out from February 2016 to August 2017 in all 4 provinces of Pakistan. An estimated sample size of 10,834 people was calculated using a multistage sampling technique. Out of 213 clusters, Twenty-seven clusters were selected from all four provinces of Pakistan. Households were identified and selected members of every 10th household were advised to come to the campsite after an overnight fast. All the study participants underwent anthropometric measurements including height, weight, and waist circumference by using standardized techniques and oral glucose tolerance tests were done. Data were analyzed on the statistical package for social sciences (SPSS), version 20. ResultsOverall weighted prevalence of generalized obesity was 57.9% (42% in males and 58% in females) and central obesity 73.1% (37.3% in males and 62.7% in females) as per WHO Asia pacific cutoffs. The highest prevalence of generalized obesity was found in Punjab 60%, followed by Khyber, Pakhtunkhwa 59.2%. Moreever, highest prevalence of abdominal obesity was observed in Baluchistan 82.1%, followed by Punjab 73.3%. Obesity (generalized and abdominal) was found significantly associated with diabetes, hypertension, and dyslipidemia. ConclusionThe prevalence of obesity is at epidemic proportions in Pakistan, calling for urgent lifestyle intervention strategies to prevent and manage this important cardiometabolic risk factor.

Comparisons of conventional and novel anthropometric obesity indices to predict metabolic syndrome among vegetarians in Malaysia

Our study aimed to compare the ability of anthropometric obesity indices to predict MetS and to determine the sex-specific optimal cut-off values for MetS among Malaysian vegetarians. Body weight, height, waist circumference (WC), blood pressure (BP), fasting venous blood sample were collected from 273 vegetarians in Selangor and Kuala Lumpur, Malaysia. The abilities of body mass index (BMI), body fat percentage (BF%), waist to height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), and body roundness index (BRI) to identify MetS were tested using receiver operating characteristic (ROC) curve analyses. MetS was defined according to the Joint Interim Statement 2009. The ROC curve analyses show that BMI, BF%, WHtR, LAP and VAI were able to discriminate MetS in both sexes. LAP was a better predictor to predict MetS, followed by WHtR for male and female vegetarians. The suggested WHtR’s optimal cut-offs and LAP’s optimal cut-offs for MetS for male and female vegetarians were 0.541, 0.532, 41.435 and 21.743, respectively. In conclusion, LAP was a better predictor to predict MetS than other anthropometric obesity indices. However, WHtR could be an alternative obesity index in large epidemiology survey due to its convenient and cost-effective characteristics.

The prevalence of awake bruxism and sleep bruxism in the Dutch adolescent population.

ObjectivesThis study aimed to assess the prevalence of awake bruxism and sleep bruxism in the Dutch adolescent population.Materials and MethodsAs part of a large epidemiologic survey on oral health of the general Dutch adolescent population in 2017, a total of 920 subjects were asked about their bruxism behaviour during daytime and during sleep. The collected data were subjected to stratified analysis by two age groups (for 17 and 23 years, respectively), gender and socio‐economic status.ResultsA prevalence of 4.1% and 4.2% was found for awake bruxism and of 7.6% and 13.2% for sleep bruxism. Women reported awake bruxism more often than men in the 17‐year‐old age group (5.0% and 3.2%, respectively), while in the 23‐year‐old age group it was the other way around (4.0% and 4.4%, respectively). Regarding sleep bruxism, women reported higher percentages than men in both age groups (7.8% versus 7.5% and 14.9% versus 11.5%, respectively). Concerning socio‐economic status (SES), awake bruxism was more often found in high SES groups (4.6% versus 3.7% and 4.9% versus 4.0% in both age groups, respectively) as well as for sleep bruxism in the 23‐year‐old group (16.5% versus 8.6%). In the 17‐year‐old group, sleep bruxism was more often reported in the low SES group (9.7% versus 5.3%).ConclusionsSleep bruxism is a common condition in the Dutch adolescent population, while awake bruxism is rarer.Clinical relevanceDental caregivers can use this information when negative healthcare outcomes are present amongst adolescents.

8.M. Workshop: Researching the health effect of gender-based violence on women: challenges and implications

Abstract Violence against women is a pervasive human rights violation, which is still under-recognized despite some recent progress. From sexist ubiquitous online harassment, to physical and sexual violence that affects at least 1 in 3 women in her lifetime, this prevalent and large spectrum of violence constitutes a profound health problem. It affects women's physical and mental health, making its prevention one of the most far-reaching public health objectives. Public health research on this topic is lacking, and few large epidemiological surveys and cohorts collect data on this subject. However, research is much needed to bring to light the extent of the problem, and guide the development and implementation of effective interventions, policies, and prevention strategies. In this symposium we propose to shed light on some health effects of gender-based violence and discuss methodological issues associated with conducting research on violence against women. Through the presentation of four studies, we highlight challenges in the framing of research questions, and in defining exposure variables and collecting data in standard epidemiological studies. We also reflect on barriers and enablers we encountered and brainstorm action levers for pragmatic and ethical intervention studies. Between them, the four studies cover various types of violence and health outcomes, and touch on the involvement of several health and healthcare stakeholders. First, Barbier et al describe the prevalence of physical, sexual and psychological intimate partner violence against European women, as well as perpetrator's characteristics, using data from the European Union Agency for Fundamental Rights survey on violence against women. Second, Miani et al. reflect on the potential and limitations of using standard hospital records to measure violation of a woman's integrity during childbirth (e.g. obstetric violence) in Germany. Opportunities for intersectional analyses are also assessed. Third, El-Khoury et al. present results from the French Health barometer, a general population telephone survey, which recruited more than 25,000 adults aged18 to 75 in 2017. This first analysis quantifies sex-differences in the effect of sexual violence on suicide risk. Using adjusted mediation analyses, sexual victimisation was found to explain 49% and 40% of the increased risk women have compared to men in suicidal ideation and suicidal imagery respectively. Last, Hatem et al present preliminary results of a pilot study and the protocol of a future intervention study in the French “Maison des Femmes” (House of women), a center which provides medical, social and judicial support and care for women victim of violence. We discuss pragmatic and ethical concerns, difficulties and importance of such intervention studies. We conclude the session with a discussion with the audience, providing an opportunity for interdisciplinary dialogue and feedback on international experiences. Key messages Violence against women (VAW) is a widespread phenomenon taking many forms; similar to its effect on women’s health. VAW should be accounted for in all large epidemiological studies, using appropriate terms and measurement strategies.

Oral hypofunction and its association with frailty in community-dwelling older people.

This large epidemiological survey of older people examined oral hypofunction and the relationship between oral hypofunction and frailty. Participants were community-dwelling adults aged 65-85 years in Japan. The oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function), and oral hypofunction was defined as having abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the total Kihon Checklist score. We analyzed 978 subjects with complete data. The relationship between oral function and frailty status was analyzed using multivariate multinomial logistic regression analyses. Approximately 60% of the older adults had oral hypofunction. The multivariate odds ratios (ORs) for a pre-frail or frail status were significantly higher for older people with reduced occlusal force, reduced tongue-lip motor function and deteriorated swallowing function than in those without deterioration of those items. Of the oral function items, swallowing function was most strongly associated with the frailty status, and the ORs (95% confidence interval [CI]) for deteriorated swallowing function in pre-frail and frail patients were 6.4 (3.9-10.8) and 10.2 (5.4-19.1), respectively. Those with oral hypofunction had significantly higher adjusted ORs for pre-frail (OR 1.4, 95% CI 1.1-2.0) and frail (OR 2.1, 95% CI 1.2-3.5) statuses. Many community-dwelling older people have reduced oral function or oral hypofunction, which is significantly associated with frailty in older people. Geriatr Gerontol Int 2020; 20: 917-926.

Clinical profile of chronic kidney disease of unknown origin in patients of Yavatmal district, Maharashtra, India

We present a case series of patients with chronic kidney disease of unknown etiology (CKDu) coming from a well-defined geographic area, Yavatmal, district of Maharashtra, in central of India. These patients presented with advanced renal failure, variable proteinuria, and bilateral hyperechoic kidneys, largely normotensive and belonged to poor economic class from agricultural communities. The study highlights the need for large epidemiological survey in Yavatmal region to detect patients with CKDu and investigate the possible etiology.

Web-Based Versus Paper-Pencil Assessment of Behavioral Problems Using the Youth Self-Report

Abstract. This is the first study investigating the use of a web-based version of the Youth Self-Report (YSR) compared to paper-pencil (PP) assessment. Students aged 10–18 years were recruited from Austrian schools and either completed a PP ( N = 841) or a web-based ( N = 2,769) version. Psychometric properties and indicators of data quality were analyzed. Moreover, cost estimations for the web-based and PP assessments were given. Acceptable model fits (RMSEA &lt; .05) of the 8-syndrome model were observed for both versions and measurement invariance testing revealed strong invariance between both formats. While there was no significant difference in the number of missing items, a slightly higher proportion of web-based datasets were analyzable (97.7% vs. 93.7%). A larger amount of information was provided in the open-ended questions in the web-based version ( p &lt; .001). Mean problem scores were equivalent, with the exception of the thought problems syndrome scale in which a slightly higher score was observed in the web-based version ( p &lt; .001). In our study, the web-based format reduced costs by 72% compared to the PP format. Our findings suggest that large web-based epidemiological surveys are cost-efficient, can be applied without the risk of disadvantages compared to PP assessments and might be superior regarding some aspects of data quality.