Metaplot: A new Stata module for assessing heterogeneity in a meta-analysis

Background The proposed sequential and combinatorial algorithm, suggested as a standard tool for assessing, exploring, and reporting heterogeneity in the meta-analysis, is useful but time-consuming particularly when the number of included studies is large. Metaplot is a novel graphical approach that facilitates performing sensitivity analysis to distinguish the source of substantial heterogeneity across studies with ease and speed. Method Metaplot is a Stata module based on Stata’s commands, known informally as "ado". Metaplot presents a two-way (x, y) plot in which the x-axis represents the study codes and the y-axis represents the values of I2 statistics excluding one study at a time (n-1 studies). Metaplot also produces a table in the ’Results window’ of the Stata software including details such as I2 and χ2 statistics and their P-values omitting one study in each turn. Results Metaplot allows rapid identification of studies that have a disproportionate impact on heterogeneity across studies, and communicates to what extent omission of that study may reduce the overall heterogeneity based on the I2 and χ2 statistics. Metaplot has no limitations regarding the number of studies or types of outcome data (binomial or continuous data). Conclusions Metaplot is a simple graphical approach that gives a quick and easy identification of the studies having substantial influences on overall heterogeneity at a glance.

Do Disability Policies Shape How People Perceive Work Limitation? An International Perspective

This study explored the role that cross-country disability policy differences play in shaping individuals’ work limitation reporting styles. We used anchoring vignettes available in comparable U.S. and European survey data to test and adjust for reporting differences in self-reported work limitation measures. We found that disability policy generosity scores showed statistically significant predictive power for respondents’ work limitation classification scales, with the association stronger and more statistically significant at the lower end and the middle of the scale. That is, respondents under more generous disability regimes tended to apply a more inclusive (i.e., lenient) scale in classifying a mild, moderate, or severe work limitation. Because there is no natural interpretation of the magnitude of the correlation, we conducted counterfactual policy simulations to illustrate the strength of the association; for example, if the United States were to adopt more generous disability policies such as those in Sweden, there might be an associated increase of more than 36 percentage points in the proportion of Americans aged 50 years and above reporting work limitation (of any severity). This research contributes to a better understanding of the role of disability policy in reporting heterogeneity in comparative disability research, an area that has been seldom studied.

The association between depressive symptoms and self-reported sleep difficulties among college students: Truth or reporting bias?

The strong association between self-reported sleep difficulties and depressive symptoms is well documented. However, individuals who suffer from depressive symptoms could potentially interpret the values attached to a subjective scale differently from others, making comparisons of sleep difficulties across individuals with different depressive symptoms problematic. The objective of this study is to determine the existence and magnitude of reporting heterogeneity in subjective assessment of sleep difficulties by those who have depressive symptoms. We implement an online survey using Visual Analogue Scales and anchoring vignettes to study the comparability of subjective assessments of sleep difficulties among college students in Switzerland (N = 1, 813). Using multivariate linear regressions and double-index models, our analysis shows that reporting heterogeneity plays only a marginal role in moderating the association between sleep difficulties and depression, irrespective of the severity of the depressive symptoms of the individuals. This suggests that unadjusted comparisons of self-reported sleep difficulties between college students are meaningful, even among individuals with depressive symptoms.

How Self-Rated is Self-Rated Health? Exploring the Role of Individual and Institutional Factors in Reporting Heterogeneity in Russia

In recent years the literature exploring the state dependent nature of individual self-rated health has grown rapidly. We contribute to this ‘reporting heterogeneity’ research field in two main ways. First, we are among the few studies to examine the determinants of reporting heterogeneity in self-rated health in the Russian context. Second, echoing the social determinants of health literature, we augment the standard battery of individual level socioeconomic and demographic characteristics with aggregated macro level variables serving as proxies for local environmental and social conditions. We are not aware of other heterogeneity studies that have incorporated this approach. Estimating a generalized ordered probit model we resolve the identification problem through the inclusion of an objective disease index. In terms of reporting heterogeneity, we find that response behaviour is systematically influenced by individual characteristics but also by aggregate regional socioeconomic characteristics. In particular, the finding that an individual’s relative standing in their local economy can condition their response to subjective health questionnaires is important and merits further examination. We argue that both a relative income mechanism and a mechanism that links the cognitive process of choice with the sense of optimism that individuals have for their institutional environment are plausible explanations for the observed aggregate level effects.

Naloxone dosing in the era of ultra-potent opioid overdoses: a systematic review

ABSTRACTObjectivesEvaluate the relationship between naloxone dose (initial and cumulative) and opioid toxicity reversal and adverse events in undifferentiated and presumed fentanyl/ultra-potent opioid overdoses.MethodsWe searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings (1972 to 2018). We included interventional, observational, and case studies/series reporting on naloxone dose and opioid toxicity reversal or adverse events in people >12 years old.ResultsA total of 174 studies (110 case reports/series, 57 observational, 7 interventional) with 26,660 subjects (median age 35 years; 74% male). Heterogeneity precluded meta-analysis. Where reported, we abstracted naloxone dose and proportion of patients with toxicity reversal. Among patients with presumed exposure to fentanyl/ultra-potent opioids, 56.9% (617/1,085) responded to an initial naloxone dose ≤0.4 mg compared with 80.2% (170/212) of heroin users, and 30.4% (7/23) responded to an initial naloxone dose >0.4 mg compared with 59.1% (1,434/2,428) of heroin users. Among patients who responded, median cumulative naloxone doses were higher for presumed fentanyl/ultra-potent opioids than heroin overdoses in North America, both before 2015 (fentanyl/ultra-potent opioids: 1.8 mg [interquartile interval {IQI}, 1.0, 4.0]; heroin: 0.8 mg [IQI, 0.4, 0.8]) and after 2015 (fentanyl/ultra-potent opioids: 3.4 mg [IQI, 3.0, 4.1]); heroin: 2 mg [IQI, 1.4, 2.0]). Where adverse events were reported, 11% (490/4,414) of subjects experienced withdrawal. Variable reporting, heterogeneity and poor-quality studies limit conclusions.ConclusionsPractitioners have used higher initial doses, and in some cases higher cumulative naloxone doses to reverse toxicity due to presumed fentanyl/ultra-potent opioid exposure compared with other opioids. High-quality comparative naloxone dosing studies assessing effectiveness and safety are needed.

The Effect of Health System Responsiveness on Health Outcome: Evidence from Spain

Background For the last two decades, the health system responsiveness has gained attention in the health policy area. However, little is known about its effect within the healthcare system on health outcome. This study aims to investigate the influence of health system responsiveness on self-assessed health. Particularly it examines if self-assessed health is affected by satisfaction with communication, dignity and waiting time.Methods The study used data from the Spanish Health Care Barometer Survey (SHBS) between 2011 and 2013. The Ordered Probit and the Hierarchical Ordered Probit (HOPIT) model was used to model anchoring vignettes and to control the problem of reporting heterogeneity arises from self-reported health.Results The result suggests a strong positive association between reporting very good self-assessed health and most of the domains of health system responsiveness. Specifically, after adjusting for reporting heterogeneity, satisfaction with waiting time and communication were found to be statistically significant and positively associated with reporting better self-assessed health for respondents in primary care and hospital care settings, respectively in Spain. The marginal effect of a one unit increase in satisfaction with waiting time in primary care and communication in hospital care is associated with a 2% and 4% increase in the in the likelihood of reporting very good health status respectively, keeping other variables constant.Conclusions Overall, the result suggests that improving patient’s satisfaction with health systems responsiveness may have a positive influence on patients’ health outcomes.