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European Health Risk Monitoring (EHRM) Project

Review of surveys for risk factors of major chronic diseases and comparability of the results

October 2002

Hanna Tolonen, Hermann Wolf, Dimitrije Jakovljevic, Kari Kuulasmaa and the European Health Risk Monitoring Project (see next page)

Contents:

• Contributors to the European Health Risk Monitoring Project
• Copyright statement
• 1.Introduction
• 2. Previous surveys 
  • 2.1 WHO MONICA Project
  • 2.2 WHO-CINDI Programme
  • 2.3 The European Prospective Investigation into Cancer and Nutrition (EPIC)
  • 2.4 Risk factor monitoring in the Netherlands
  • 2.5 Risk factor monitoring in Germany
  • 2.6 UK National Health Surveys
    • 2.6.1 The Health Survey for England
    • 2.6.2 The Health Survey for Scotland
    • 2.6.3 The Health and Social Wellbeing Survey for Northern Ireland
  • 2.7 The National Health and Nutrition Examination Survey (NHANES III), USA
  • 2.8 National Cardiovascular Screening in Norway
  • 2.9 National Cardiovascular Screening in Italy
• 3. Organization of the surveys
  • 3.1 Implementation of the surveys
  • 3.2 Target population and frequency of surveys
  • 3.3 Sampling frame
  • 3.4 Sample selection
  • 3.5 Sample size
  • 3.6 Recruitment and response rates
  • 3.7. Timing of the surveys
  • 3.8 Selection of the personnel
  • 3.9 Training of the personnel
  • 3.10 Order of measurements
  • 3.11 Survey site
  • 3.12 Discussion and conclusion
• 4. Blood pressure measurement
  • 4.1 Methods
    • 4.1.1 Instruments
    • 4.1.2 Cuff
    • 4.1.3 Bell or diaphragm
    • 4.1.4 Position of the arm
    • 4.1.5 Sitting or supine
    • 4.1.6 Right or left arm
    • 4.1.7 Sequential blood pressure measurements
    • 4.1.8 Resting before measurement
    • 4.1.9 Seasonal and daily variation of the blood pressure
    • 4.1.10 Painful procedures before blood pressure measurement
    • 4.1.11 Room temperature
  • 4.2 Quality assurance
    • 4.2.1 Selection of the location for blood pressure measurement
    • 4.2.2 Selection of the measurers
    • 4.2.3 Training of the measurers
    • 4.2.4 Quality control during the survey
    • 4.2.5 Retrospective quality assessment report
  • 4.3 Indicators used for reporting the results
  • 4.4 Discussion and conclusions
• 5. Lipids measurements
  • 5.1 Methods
    • 5.1.1 Pre-analytic stage
      • 5.1.1.1 Seasonal variation
      • 5.1.1.2 Daily variation and fasting status
      • 5.1.1.3 Strenuous exercise
      • 5.1.1.4 Position of the subject
      • 5.1.1.5 Type of tubes
      • 5.1.1.6 Tourniquet use
      • 5.1.1.7 Serum or plasma
      • 5.1.1.8 Centrifuging and storing before centrifuging
      • 5.1.1.9 Haemolysis
      • 5.1.1.10 Storage after centrifuging
    • 5.1.2 Analytic stage
      • 5.1.2.1 Isolation of HDL
      • 5.1.2.2 Methods of total cholesterol and triglyceride determination
      • 5.1.2.3 Low density lipoprotein analysis
      • 5.1.2.4 Calibration
  • 5.2 Quality assurance
    • 5.2.1 Training
    • 5.2.2 Laboratory quality control
    • 5.2.3 Retrospective quality assessment report
  • 5.3 Indicators used for reporting the results
  • 5.4 Discussion and conclusions
• 6. Anthropometric measurements
  • 6.1 Methods
    • 6.1.1 Type of scale
    • 6.1.2 Type of height measurement instrument
    • 6.1.3 Type of measurement tape for waist and hip circumference measurement
    • 6.1.4 Removal of clothes
    • 6.1.5 Technique and resolution of weight measurement
    • 6.1.6 Technique and resolution of height measurement
    • 6.1.7 Technique and resolution of waist and hip measurement
    • 6.1.8 Use of self-reported data
  • 6.2 Quality assurance
    • 6.2.1 Selection of measurers
    • 6.2.2 Training of the measurers
    • 6.2.3 Testing of scales
    • 6.2.4 Testing the height measuring device
    • 6.2.5 Testing of measuring tape for waist/hip measurements
    • 6.2.6 Data quality control during the survey
    • 6.2.7 Retrospective quality assessment report
  • 6.3 Indicators used for reporting the results
  • 6.4 Discussion and conclusions
• 7. Smoking
  • 7.1 Definitions
  • 7.2 Questionnaires
    • 7.2.1 WHO MONICA Project
    • 7.2.2 Risk factor monitoring in the Netherlands
    • 7.2.3 Risk factor monitoring in Germany
    • 7.2.4 UK National Health Surveys
    • 7.2.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 7.2.6 FINBALT
    • 7.2.7 EUROHIS
    • 7.2.8 WHO recommendations
    • 7.2.9 Norwegian Age-40 Programme
    • 7.2.10 The Italian OEC Project
  • 7.3 Biochemical markers for exposure to tobacco smoke
    • 7.3.1 Types of biochemical markers
  • 7.4 Quality assurance
    • 7.4.1 Retrospective quality assessment report
  • 7.5 Indicators used for reporting the results
  • 7.6 Discussion and conclusions
• 8. Blood glucose measurement
  • 8.1 Methods
    • 8.1.1 Questionnaire assessment
    • 8.1.2 Blood glucose level
      • 8.1.2.1 Pre-analytic stage
      • 8.1.2.2 Collection and preparation stage
      • 8.1.2.3 Analysis stage
    • 8.1.3 Glycated hemoglobin
      • 8.1.3.1 Analysis method
  • 8.2 Quality assurance
    • 8.2.1 Training
    • 8.2.2 Laboratory quality control
    • 8.2.3 Retrospective quality assessment report
  • 8.3 Indicators used for reporting the results
  • 8.4 Discussion and conclusions
• 9. Questions on socio-economic status
  • 9.1 Questions
    • 9.1.1 WHO MONICA Project
    • 9.1.2 Risk factor monitoring in the Netherlands
    • 9.1.3 Risk factor monitoring in Germany
    • 9.1.4 UK National Health Surveys
    • 9.1.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 9,1.6 Norwegian Age-40 Programme
  • 9.2 Quality assurance
    • 9.2.1 Retrospective quality assessment report
  • 9.3 Indicators used for reporting the results
  • 9.4 Discussion and conclusions
• 10. Awareness and treatment of hypertension
  • 10.1 Questions
    • 10.1.1 WHO MONICA Project
    • 10.1.2 Risk factor monitoring in the Netherlands
    • 10.1.3 Risk factor monitoring in Germany
    • 10.1.4 UK National Health Surveys
    • 10.1.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 10.1.6 Norwegian Age-40 Programme
    • 10.1.7 The Italian OEC Project
  • 10.2 Quality assurance
    • 10.2.1 Retrospective quality assessment report
  • 10.3 Indicators used for reporting the results
  • 10.4 Discussion and conclusions
• 11. Awareness and treatment of high cholesterol
  • 11.1 Questions
    • 11.1.1 WHO MONICA Project
    • 11.1.2 Risk factor monitoring in the Netherlands
    • 11.1.3 Risk factor monitoring in Germany
    • 11.1.4 UK National Health Surveys
    • 11.1.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 11.1.6 The Italian OEC Project
    • 11.1.7 Risk factor monitoring in Norway
  • 11.2 Quality assurance
    • 11.2.1 Retrospective quality assessment report
  • 11.3 Indicators used for reporting the results
  • 11.4 Discussion and conclusions
• 12. Use of acetylsalicylic acid
  • 12.1 Questions
    • 12.1.1 WHO MONICA Project
    • 12.1.2 Risk factor monitoring in the Netherlands
    • 12.1.3 Risk factor monitoring in Germany
    • 12.1.4 UK National Health Survey
    • 12.1.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 12.1.6 The Italian OEC Project
  • 12.2 Quality assurance
  • 12.3 Indicators used for reporting the results
  • 12.4 Discussion and conclusions
• 13. Use of hormone replacement therapy (HRT)
  • 13.1 Questions
    • 13.1.1 WHO MONICA Project
    • 13.1.2 Risk factor monitoring in the Netherlands
    • 13.1.3 Risk factor monitoring in Germany
    • 13.1.4 UK National Health Survey
    • 13.1.5 National Health and Nutrition Examination Survey (NHANES III), USA
    • 13.1.6 Risk factor monitoring in Norway
  • 13.2 Quality assurance
  • 13.3 Indicators used for reporting the results
  • 13.4 Discussion and conclusions
• 14. Design, administration and quality assurance of questionnaire items
  • 14.1 Questionnaire design
    • 14.1.1 Wording of the questions
    • 14.1.2 Response alternatives
    • 14.1.3 Language and translation of the questions
    • 14.1.4 Recall period
    • 14.1.5 Order of questions
    • 14.1.6 Length of the questionnaire
    • 14.1.7 Pilot study
  • 14.2 Administration of the questionnaire
  • 14.3 Quality assurance
  • 14.4 Discussion and conclusions

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