States National Health Research Articles

Impact of the National Nursing Development Plan on nursing human resources in China: An interrupted time series analysis for 1978–2021

BackgroundShortages of nurses and unequal distribution of nursing staff have been huge challenges for global health services. ObjectivesThe aim of our study was to evaluate the impact of the National Nursing Development Plan on nursing human resources in China. MethodsAn interrupted time series design was used in this study. The data for this study were extracted from the National Health Statistics Yearbook from 1978 to 2021. The Ministry of Health issued the National Nursing Development Plan (2005–2010) in July 2005. Subsequently, the strategic plan was issued every 5 years: the National Nursing Development Plan (2011–2015), the National Nursing Development Plan (2016–2020), and the National Nursing Development Plan (2021–2025). This study used five indicators including 1) the number of registered nurses (RNs) in China, 2) the number of RNs per 1000 population in China, 3) the proportion of RNs in health technical personnel in China, 4) the doctor–nurse ratio and 5) the number of nurses working in primary medical institutions to evaluate the changing trend of nursing human resources in China from 1978 to 2021. ResultsInterrupted time series analysis showed that after the implementation of the National Nursing Development Plan (2005–2010), the building of nurses in China was gradually strengthening, and the number of RNs in China increased by 0.198 million per year (95%CI 0.174–0.223; P < 0.001); the number of RNs per 1000 population (Coefficient = 0.139; 95%CI 0.123–0.154; P < 0.001); the proportion of RNs in the total number of health professionals in China has increased from 29.6 % to 44.6 % (Coefficient = 0.010; 95%CI 0.009–0.010; P < 0.001); in China, the doctor–nurse ratio increased by 0.024 (95%CI 0.019–0.029; P < 0.001). In 2021, the number of RNs working in primary medical institutions increased by approximately 0.86 million compared with that in 2005, and the proportion of RNs in the country increased by 1.4 %. The development of nurses is especially tilted to the primary level to meet the health and nursing needs of the primary level. ConclusionsThe implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation. The implementation of the National Nursing Development Plan (2011–2015) and the National Nursing Development Plan (2016–2020) well continued the strategic plan from 2005 to 2010, further expanded the nursing workforce and further optimized the allocation efficiency. Tweetable abstractThe implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation.

Excess mortality during the Coronavirus disease pandemic in Korea

BackgroundAlthough the ongoing epidemics of Coronavirus disease 2019 (COVID-19) may have affected the mortality trend of the nation, the national level assessment of excess mortality (changes in overall mortality in the entire population) is still scarce in Korea. Therefore, this study evaluated the excess mortality during the COVID-19 pandemic in Korea using the certified mortality data.MethodsMonthly mortality and population data from January 2013 to June 2022 was obtained from the National Health Insurance Service database and Statistics Korea. A quasi-Poisson interrupted time-series model adjusted for age structure, population, seasonality, and long-term trends was used to estimate the counterfactual projections (expected) of mortality during the COVID-19 pandemic (March 2020 to June 2022). The absolute difference (observed—expected) and ratio (observed / expected) of mortality were calculated. Stratified analysis based on pandemic years (years 2020, 2021, and 2022), sex, and age groups (aged 0–4, 5–19, 20–64, and ≥ 65 years) were conducted.ResultsAn 8.7% increase in mortality was observed during the COVID-19 pandemic [absolute difference: 61,277 persons; ratio (95% confidence interval (CI)): 1.087 (1.066, 1.107)]. The gap between observed and estimated mortality became wider with continuation of the pandemic [ratio (95% CI), year 2020: 1.021 (1.003, 1.040); year 2021: 1.060 (1.039, 1.080), year 2022: 1.244 (1.219, 1.270)]. Although excess mortality across sex was similar, the adult [aged 20–64, ratio (95% CI): 1.059 (1.043, 1.076)] and elderly [aged 65-, ratio (95% CI): 1.098 (1.062, 1.135)] population showed increased excess mortality during the pandemic.ConclusionsDespite Korea's successful quarantine policy response, the continued epidemic has led to an excess mortality. The estimated mortality exceeded the number of deaths from COVID-19 infection. Excess mortality should be monitored to estimate the overall impact of the pandemic on a nation.

Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda.

Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?

This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19). From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea's cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities. All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased. In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Your New Year’s “resolution”—check your “screen!”

Your New Year’s “resolution”—check your “screen!”

Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis

ObjectiveThis case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic.DesignA qualitative...

Hospital spending and length of hospital stay for mental disorders in Hunan, China

ObjectivesTo describe hospital spending and length of stay for mental disorders in Hunan, China. MethodsWe extracted hospital care data for Hunan province from the Chinese National Health Statistics Network Reporting System. Patients with mental disorders (ICD-10 codes: F00 to F99) as the principal diagnosis and hospitalized between January 1, 2017 and December 31, 2019 were included. We retrieved information on age, sex, number of comorbidities, diagnosis, level of hospital, hospital costs, date of admission and discharge, length of stay (LOS), and method of payment of eligible participants. Spending at the provincial level, and spending and LOS at the individual level were described. Quantile regression and linear regression were conducted to investigate factors for hospital cost and LOS for major mental disorders. ResultsThe 2019 annual spending on mental disorders in Hunan province was 160 million US dollars, and 71.7% was paid by insurance. The annual spending on schizophrenia was 84 million dollars, contributing to a primary burden of mental disorders. The median spending for mental disorders was $1,085 per patient, and the median hospital stay was 22 days. The study identified several significant factors associated with hospital cost and LOS, including age, sex, comorbidity, and level of the hospital. In particular, a higher level of the hospital was associated with a higher hospital spending but a shorter LOS. Women with schizophrenia had a comparable hospital spending but a significantly shorter LOS than men with schizophrenia. ConclusionHospitalization spending for patients with mental disorders is substantial. Schizophrenia is the major burden of hospitalization for mental disorders. While patients treated at a higher level of hospital had higher spending, they stayed shorter in these hospitals.

Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study

ObjectivesThis study aimed to identify the prevalence of diabetes mellitus (DM) among patients with tuberculosis (TB) using a nationwide cohort in South Korea.DesignA retrospective cohort study.SettingThis study used the Korean...

Preterm prelabor rupture of membranes in singletons: maternal and neonatal outcomes.

To determine the effect of gestational age at delivery on maternal and neonatal outcomes in preterm prelabor rupture of membranes (PPROM) and assess various predictors of neonatal and infant mortality in these pregnancies. United States birth data from CDC-National Center for Health Statistics natality database for years 2004-2008 was used to identify singleton pregnancies with PPROM and delivery from 32 0/7 to 36 6/7weeks. Controls were singletons at 37-40weeks, without PPROM. Maternal and neonatal complications reported by all states were analyzed along with neonatal outcomes such as chorioamnionitis and hyaline membrane disease, reported by a subgroup of states. OR (95% CI) were calculated after adjusting for preeclampsia, diabetes, chronic hypertension, maternal race, and infant sex. There were 134,502 PPROM cases and similar number of controls. There was a significant decrease in need for prolonged ventilation, hyaline membrane disease, 5min Apgar score <7, and NICU admission with advancing gestational age. Placental abruption decreased and chorioamnionitis and cord prolapse were not different between 34 and 37weeks. We found reductions in early death, neonatal death, and infant mortality with advancing gestational age (p<0.001 for each). Gestational age at delivery was the strongest predictor for early death,neonatal death, and infant mortality in PPROM. These differences persisted after adjusting for antenatal steroid use. We provide population-based evidence showing a decrease in neonatal complications and death with advancing gestational age in PPROM. Gestational age at delivery in pregnancies with PPROM is the strongest predictor of mortality risk.

Epidemiological characteristics of ankylosing spondylitis in Guangxi Province of China from 2014 to 2021.

To explore the epidemiological characteristics of ankylosing spondylitis (AS) in Guangxi Province of China through a large sample survey of more than 50 million aboriginal aboriginal population. A systematic search was conducted using the International Classification of Diseases 10 (ICD-10) codes M45.x00(AS), M45.x03+(AS with iridocyclitis), and M40.101(AS with kyphosis) to search the database in the National Health Statistics Network Direct Reporting System (NHSNDRS). 14004 patients were eventually included in the study. The parameters analyzed included the number of patients, gender, marriage, blood type, occupation, age at diagnosis, and location of household registration data each year, and statistical analysis was performed. AS incidence rates increased from 1.30 (95% CI: 1.20-1.40) per 100,000 person-years in 2014 to 5.71 (95% CI: 5.50-5.92) in 2020 in Guangxi Province, and decreased slightly in 2021. Males have a higher incidence than females; the ratio was 5.61 : 1. The mean age of diagnosis in male patients was 45.4 (95% CI: 45.1-45.7) years, in females 47.6 (95% CI: 46.8-48.4) years. The most frequent blood type was O, and the most frequent occupation was farmer. The AS incidence rate was disparate in different cities. Liuzhou city had the highest eight-year average AS incidence rates from 2014 to 2021, and Chongzuo city had the lowest (p < 0.05). There was no significant difference in the incidence between different ethnic groups (p > 0.05). The AS person-years incidence rate was increasing in Guangxi province of China from 2014 to 2020, which had obvious gender and regional differences, showing the characteristics of local area aggregation.

Anemia in Indian Men: An Emerging Public Health Challenge.

Approximately one-quarter of the world's population is suffering from anemia, out of which 12.7% of men suffer from anemia around the globe. In India, anemia is a moderate public health problem (ranging from 20 to 39.9%). Prevalence of anemia is 25% in men and 31% in adolescent boys, in India. In recent years, there has been an alarming rise in anemia prevalence among adolescent boys (15-19 years) in 23 states, and among men (15-49 years) in 17 states. Anemia in the states of Jammu and Kashmir and Ladakh is a severe public health problem. Despite being a vital issue, indicators for anemia in men are not given due importance in national health statistics reports. This article highlights the issue to prioritize men's health in the context of anemia at state and national levels.

Associations of cold exposure with hospital admission and mortality due to acute kidney injury: A nationwide time-series study in Korea

BackgroundEmerging evidence supports an association between heat exposure and acute kidney injury (AKI). However, there is a paucity of studies on the association between cold exposure and AKI. ObjectiveWe aimed to investigate the associations of cold exposure with hospital admission and mortality due to AKI and to explore whether these associations were influenced by age and sex. MethodsInformation on daily counts of hospital admission and mortality due to AKI in 16 regions of Korea during the cold seasons (2010–2019) was obtained from the National Health Insurance Service (a single national insurer providing universal health coverage) and Statistics Korea. Daily mean temperature and relative humidity were calculated from hourly data obtained from 94 monitoring systems operated by the Korean Meteorological Administration. Associations of low temperatures (<10th percentile of daily mean temperature) and cold spells (≥2 consecutive days with <5th percentile of daily mean temperature) up to 21 days with AKI were estimated using quasi-Poisson regression models adjusted for potential confounders (e.g., relative humidity and air pollutants) with distributed lag models and univariate meta-regression models. ResultsLow temperatures were associated with hospital admission due to AKI [relative risk (RR) = 1.12, 95 % confidence interval (CI): 1.09, 1.16]. Cold spells were associated with hospital admission (RR = 1.87, 95 % CI: 1.46, 2.39) and mortality due to AKI (RR = 4.84, 95 % CI: 1.30, 17.98). These associations were stronger among individuals aged ≥65 years than among those aged <65 years. ConclusionOur results underscore the need for the general population, particularly the elderly, physicians, and other healthcare providers to be more vigilant to cold exposure, given the risk of AKI. Government agencies need to develop specific strategies for the prevention and early detection of cold exposure-related AKI.

Eviction as a social determinant of pregnancy health: County-level eviction rates and adverse birth outcomes in the United States.

Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county-level eviction rate, with control for individual- and county-level characteristics. Results were calculated separately for non-Hispanic white, non-Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12-13% increased odds of LBW. The magnitude of association with PTB was not as large. Non-Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming.

Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.

To assess the association between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access. 2012-2019 National Center for Health Statistics natality files. We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care. All live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming. Among all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first-trimester prenatal care, driven by earlier month of first prenatal care visit. Presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education, but other interventions may be needed.

Spending and Hospital Stay for Melanoma in Hunan, China

ObjectiveThis study aimed to describe the economic burden of Chinese patients with melanoma in Hunan province of China, and to investigate the factors for hospitalization spending and length of stay (LOS) in patients undergoing melanoma surgery.MethodsData was extracted from the Chinese National Health Statistics Network Reporting System database in Hunan province during 2017–2019. Population and individual statistics were presented, and nonparametric tests and quantile regression were used to analyze the factors for spending and LOS.ResultA total of 2,644 hospitalized patients with melanoma in Hunan were identified. During 2017–2019, the total hospitalization spending was $5,247,972, and out-of-pocket payment (OOP) was $1,817,869, accounting for 34.6% of the total expenditure. The median spending was $1,123 [interquartile range (IQR): $555–2,411] per capita, and the median LOS was 10 days (IQR: 5–18). A total of 1,104 patients who underwent surgery were further analyzed. The non-parametric tests and quantile regression showed that women were associated with less spending and LOS than men. In general, patients aged 46–65 and those with lesions on the limbs had higher hospitalization costs and LOS than other subgroups.ConclusionMelanoma causes heavy economic burdens on patients in Hunan, such that the median spending is close to 60% of the averagely annual disposable income. Middle-aged men patients with melanoma on the limbs present the highest financial burden of melanoma.

Temporal Association Between Interracial Couples and Odds of Low Birth Weight Infants: Trends in National Vital Statistics Data from 1971 to 2016.

Our study explores the temporal association between low birth weight (LBW) infants and the increasing population prevalence of interracial relationships. Our hypothesis was that the odds of LBW would decrease as the population prevalence of interracial relationships increased. National Center for Health Statistics Natality data for 1971-2016 was analyzed. LBW was defined as birth weight less than 2500gm. We restricted our analyses to singleton births by White and Black mothers with reported White or Black partners of the neonate. Logistic regression was used to calculate the odds ratios of LBW, both unadjusted and adjusted for maternal education and parental ages. The proportion of couples coded as interracial increased annually from 0.36% in 1971 to 3.86% in 2016 for White mothers and 0.59% to 8.63% for Black mothers during the same period. In each year the odds ratio of LBW was significant. As the proportion of White mothers with Black partners increased, their odds of LBW declined (OR1.75 to 1.30, p &lt; 0.001). The odds ratio of LBW among Black mothers with White partners did not change and remained stable between 0.70 and 0.80 (p = 0.22) over the same time period. As the annual proportion of White mothers with Black partners increased, their odds of LBW decreased when compared to White couples. Black mothers with White partners did not exhibit a similar change when compared to Black couples, with the odds ratio of LBW remaining stable.

Temporal Trends in Adverse Pregnancy Outcomes in Birthing Individuals Aged 15 to 44Years in the United States, 2007 to 2019.

BackgroundAdverse pregnancy outcomes (APOs) (hypertensive disorders of pregnancy [HDP], preterm delivery [PTD], or low birth weight [LBW]) are associated adverse maternal and offspring cardiovascular outcomes. Therefore, we sought to describe nationwide temporal trends in the burden of each APO (HDP, PTD, LBW) from 2007 to 2019 to inform strategies to optimize maternal and offspring health outcomes.Methods and ResultsWe performed a serial cross‐sectional analysis of APO subtypes (HDP, PTD, LBW) from 2007 to 2019. We included maternal data from all live births that occurred in the United States using the National Center for Health Statistics Natality Files. We quantified age‐standardized and age‐specific rates of APOs per 1000 live births and their respective mean annual percentage change. All analyses were stratified by self‐report of maternal race and ethnicity. Among 51 685 525 live births included, 15% were to non‐Hispanic Black individuals, 24% Hispanic individuals, and 6% Asian individuals. Between 2007 and 2019, age standardized HDP rates approximately doubled, from 38.4 (38.2–38.6) to 77.8 (77.5–78.1) per 1000 live births. A significant inflection point was observed in 2014, with an acceleration in the rate of increase of HDP from 2007 to 2014 (+4.1% per year [3.6–4.7]) to 2014 to 2019 (+9.1% per year [8.1–10.1]). Rates of PTD and LBW increased significantly when co‐occurring in the same pregnancy with HDP. Absolute rates of APOs were higher in non‐Hispanic Black individuals and in older age groups. However, similar relative increases were seen across all age,racial and ethnic groups.ConclusionsIn aggregate, APOs now complicate nearly 1 in 5 live births. Incidence of HDP has increased significantly between 2007 and 2019 and contributed to the reversal of favorable trends in PTD and LBW. Similar patterns were observed in all age groups, suggesting that increasing maternal age at pregnancy does not account for these trends. Black–White disparities persisted throughout the study period.

Trends in hospitalization for pediatric hip arthroplasty: an epidemiological Nationwide study in Italy from 2001 to 2015

BackgroundThe epidemiology of Pediatric Hip Arthroplasty (PHA) is unclear. Prevalence of PHA in Europe was reported in Scandinavian registries, but data on this procedure are not described in other countries. Therefore, it is challenging to redact a complete and valid epidemiological report on PHA in Europe. Nevertheless, national health statistics for PHA are helpful for an international audience, as different treatments are reported between countries. Moreover, sharing national statistics and correlating those to other countries’ protocols could be helpful to compare outcomes for different procedures internationally. The principal purpose is to evaluate the yearly hospital admission for PHA in Italy.MethodsData of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health.ResultsFrom 2001 to 2015, 770 PHA hospitalizations were performed in Italy, with an incidence of 0.5 procedures for every 100,000 pediatric Italian inhabitants. The average age of patients was 15.2 ± 4.6 years. The mean length of days of hospitalization was 10.9 ± 8.6 days. The majority of patients were male of 15–19 years old age group. A progressive decrease in days of hospitalizations was found during the years of the study.ConclusionsIn Europe, the incidence of hospital admission for PHA is not fully described. There is a lack of consensus on the best type of surgery to perform on young patients. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare them with other countries.

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

The Research and Development Survey (RANDS) during COVID-19.

The National Center for Health Statistics' (NCHS) Research and Development Survey (RANDS) is a series of commercial panel surveys collected for methodological research purposes. In response to the COVID-19 pandemic, NCHS expanded the use of RANDS to rapidly monitor aspects of the public health emergency. The RANDS during COVID-19 survey was designed to include COVID-19 related health outcome and cognitive probe questions. Rounds 1 and 2 were fielded June 9-July 6, 2020 and August 3-20, 2020 using the AmeriSpeak® Panel. Existing and new approaches were used to: 1) evaluate question interpretation and performance to improve future COVID-19 data collections and 2) to produce a set of experimental estimates for public release using weights which were calibrated to NCHS' National Health Interview Survey (NHIS) to adjust for potential bias in the panel. Through the expansion of the RANDS platform and ongoing methodological research, NCHS reported timely information about COVID-19 in the United States and demonstrated the use of recruited panels for reporting national health statistics. This report describes the use of RANDS for reporting on the pandemic and the associated methodological survey design decisions including the adaptation of question evaluation approaches and calibration of panel weights.