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Objective To construct a human health literacy indicator system for prevention of parasitic diseases based on Delphi method. Methods Based on literature reviews and expert interviews, a questionnaire was designed and a two-round Delphi consultation was performed. A human health literacy indicator system for prevention of parasitic diseases was constructed according to the deletion criteria and experts’ advice. Results A total of 14 experts completed the two-round consultation. The second-round authority coefficients were 0.91 to 0.96 for the first-level indicators, 0.87 to 0.97 for the second-level indicators and 0.86 to 0.97 for the third-level indicators. A human health literacy indicator system for prevention of parasitic diseases was constructed with the main framework of basic knowledge and awareness, healthy behaviors, and healthy skills, which contained 3 first-level indicators, 12 second-level indicators and 48 third-level indicators. Among the three first-level indicators, basic knowledge and awareness had the highest weighting coefficient (0.336 5), followed by healthy behaviors (0.334 9), and healthy skills had the lowest weighting coefficient (0.328 6). The three secondary-level indicators with the highest combined weights included awareness of the epidemic status (0.088 2), awareness of the resource of infection (0.085 8) and basic awareness of parasitic diseases (0.085 5). Conclusion A human health literacy indicator system for prevention of parasitic diseases is preliminarily constructed, which provides insights into the development of health literacy evaluation tools for prevention of parasitic diseases in the new era.
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Objective:To construct the evaluation index system of core competence of specialized gynecological nurses, and to provide reference for the curriculum setting and effect evaluation of standardized training for specialized gynecological nurses.Methods:The draft evaluation index system was prepared through literature research and group discussion. From May to June 2021, two rounds of Delphi letter consultation was used among 18 experts, to complete the selection and modification of evaluation index, and to determine the index weight.Results:The effective response rate of the two rounds of Delphi expert consultation was 100%, the expert authority coefficient was 0.938, and the Kendall harmony coefficient of the two rounds of expert letter consultation was 0.117 and 0.304, respectively (both P<0.01). Finally, the evaluation index system of core competence of specialized gynecological nurses was formed, including 4 first-level indexes, 11 second-level indexes and 48 third-level indexes. Conclusions:The evaluation index system of core competence of specialized gynecological nurses established in this study is scientific and reliable, which can provide reference for the curriculum setting and effect evaluation of standardized training for specialized gynecological nurses.
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The construction of the comprehensive evaluation index system of the famous classical formula preparations after the marketing has both theoretical and practical significance. In this study， literature related to the post-marketing comprehensive evaluation of traditional Chinese medicine（TCM） compound preparations was retrieved from China National Knowledge Infrastructure（CNKI）， China Science and Technology Journal Database（VIP）， Wanfang Data Knowledge Service Platform（WanFang） and SinoMed from January 1， 2000 to April 30， 2022. CiteSpace 6.1.R2， a scientometrics software， was used to visualize the keywords involved， and to analyze the dynamic evolution trend and research hotspots in this field. Then， the existing comprehensive post-marketing evaluation index system of TCM compound preparations was screened and extracted， and the research status was systematically analyzed by mathematical statistics. It was found that there were problems such as the generalized boundaries between assessment dimensions and assessment elements， the lack of data sources for individual evaluation indexes， unset weight of some index system and insufficient application degree. In addition， according to the characteristics of famous classical formulas， the authors discuss the importance of evidence evaluation based on combination of disease and syndrome， pharmacovigilance of famous classical formulas preparations， and whole-process quality control of famous classical formulas， and put forward the construction strategy of comprehensive post-marketing evaluation of the famous classical formula preparations， which is oriented by clinical value， centered on evidence evaluation， and guaranteed by the whole-process quality control.
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Objective:To construct a social loss indicator system based on the perspective of epidemic prevention and control against background of emerging major infectious diseases at the national, hospital, and individual levels, and to provide decision-making basis for public general hospitals to formulate prevention and control strategies for emerging major infectious diseases.Methods:Literatures published before December 23, 2020 were retrieved from CNKI, Wanfang, VIP, Web of Science, Google Scholar with such keywords as " infectious diseases" " public health emergencies" " social losses" " COVID-19" " evaluation". Then a preliminary social loss indicator system of public general hospitals for emerging major infectious diseases was constructed from such dimensions as country, hospital, and individual, by implementing literature analysis and expert consultation. Based on such a preliminary system, three questionnaires were designed for the country, hospitals, and individuals and the corresponding data were collected from December 25, 2021 to May 20, 2022. In the end, a factor analysis was made on the questionnaire data to optimize the social loss indicator system and determine the weights of each indicator.Results:The social loss indicator system consists of 14 level-1 indicators and 60 level-2 indicators. Level-1 indicators at country aspect consisted of government governance capacity, direct economic losses, social security, online public opinion, indirect economic losses, and international cooperation; indicators at hospital aspect consisted of hospital manpower, material resources, and information resources, hospital services, and hospital operations; indicators at the individual aspect consisted of physical health, psychological and social health, and external environment. Level-1 indicators of the highest weight at all aspects were social security, manpower, material and information resources, as well as physiological health. And the level-2 indicators of the highest weight were high medical expenses, overwork for staff other than doctors and nurses and medical insurance.Conclusions:The social loss indicator system for emerging major infectious diseases constructed in this study proves scientific and reasonable, helpful for the formulation of prevention and control strategies of public general hospitals.
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Objective:To establish a graded post management system for specialist nurses in medical institutions, so as to provide a reference for the selection, stratification, employment, and promotion of specialist nurses in China.Methods:Through literature review and brainstorming, the primary screening indicators of the graded post indicator management system for specialist nurses were constructed. Two rounds of Delphi method were used to consult 25 experts to construct the graded post management system for specialist nurses.Results:The effective recovery rates for two rounds of consultation were 100% and 96%, respectively, with expert authority coefficients of 0.86 and 0.89, and Kendall harmony coefficients of 0.31 and 0.54. The final establishment of a specialist nurses graded post management indicator system included 8 first level indicators, 31 second level indicators.Conclusions:The graded post management indicator system for specialist nurse could provide theoretical support for the management of specialist nurse. It was conducive to clarifying the admission standards and hierarchical framework for specialist nurses, standardizing the establishment of positions and responsibilities, and improving the competition and incentive mechanism.
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We reviewed and developed an indicator system framework for assessing teaching effect of laparoscopic simulation training through literature research, expert consultation, analytic hierarchy process and factor analysis. We also made an empirical study on the constructed index system. The system included 3 domains (A1: evaluation of laparoscopic simulator; A2: operation evaluation of experimental animals; A3: evaluation of clinical practice), 10 second-level indicators and 23 third-level indicators for assessing teaching effect of laparoscopic simulation training. The indicator system framework has good internal consistency (Cronbach α= 0.968) and external consistency (>0.72). The empirical study found that: in the results of A1-A3 in the first level indicator, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.05). In the evaluation results of the 10 secondary indicators in the secondary indicators B1-B10, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.01). For the first time, we have established and evaluated a comprehensive evaluation indicator system which is reliable and effective and can be used for further evaluation of teaching effect of laparoscopic simulation training. The following empirical studies have verified the effectiveness and practicability of the evaluation system.
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Objective:to provide a new type of fall prevention early warning bracelet and share the feedback of clinical preliminary application data in order to reduce the incidence of falls in inpatients.Methods:The convenience sampling method was used to select the inpatients who were hospitalized in the Department of Geriatrics of Hunan Provincial People ′s Hospital from January to February 2021. The 30 patients who did not use bracelets in November 2020 were taken as the routine group and 30 patients who used bracelets in December 2020 were taken as the experimental group. The two groups were monitored during hospitalization and 2 weeks after discharge. The patients in the routine group were given routine anti-fall signs and health education, while the patients in the experimental group were given the use and health education of early warning bracelets on the basis of routine. The incidence of fall was recorded. The inpatients ′ nursing job satisfaction scale and the self-designed bracelet use feedback questionnaire (experimental group) were used to evaluate the application effect. Results:No fall occurred in the experimental group, but 4 patients fell in the routine group (13.3%). The incidence of fall in the experimental group was significantly lower than that in the routine group ( χ2=4.29, P=0.038). The scores of all dimensions of nursing satisfaction in the experimental group were also higher than those in the routine group ( t values were -8.20--4.05, all P<0.05). Another 26.7% (8/30) of patients said that wearing a bracelet would have a certain impact on hand movement or rest, but all the 30 patients surveyed indicated that they were willing to continue to wear the bracelet. Three nurses said it would not necessarily reduce the incidence of falls, but all the 10 nurses involved said the shift was more convenient. Conclusions:The preliminary clinical trial feedback of the bracelet is good, and the patients and their families have high recognition, which is helpful for the patients and their families to participate in the fall prevention activities and improve the self-management of the patients.
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Objective To create a risk assessment indicator system for re-establishment of imported malaria. Methods The risk assessment indicator system for re-establishment of imported malaria was preliminarily constructed through literature review and thematic discussions. A total of 26 malaria control experts were selected to carry out a two-round Delphi consultation of the indicator system. The active coefficient, authority coefficient and coordination coefficient of the experts and the coefficient of variation on each indicator were calculated for indicator screening and the weight of each indicator was calculated. The reliability of the indicator system was evaluated using Cronbach’s coefficient α, and the content validity of the indicator system was evaluated using the authority coefficient of the expert, while the structural validity of the indicator system was evaluated using Kaiser-Meyer-Olkin (KMO) test and factor analysis. Results Two rounds of Delphi expert consultations were completed by 23 malaria control experts, and a risk assessment indicator system for re-establishment of imported malaria was constructed, including 3 primary indicators, 7 secondary indicators, and 21 tertiary indicators. The active coefficient (100.00% vs. 88.46%; P < 0.01) and coordination coefficient of the expert (0.372 vs. 0.286; P < 0.01) were significantly greater in the second round of the Delphi expert consultation than in the first round. After the second round of the Delphi expert consultation, the authority coefficient of the experts ranged from 0.757 to 0.930 on each indicator, and the coefficients of variation were 0.098 to 0.136, 0.112 to 0.276 and 0.139 to 0.335 for the primary, secondary and tertiary indicators, respectively. The overall Cronbach’s coefficient α of the indicator system was 0.941, and there were significant differences in the KMO values for primary (KMO value = 0.523; χ2 = 18.192, P < 0.05), secondary (KMO value = 0.694, χ2 = 51.499, P < 0.01) and tertiary indicators (KMO value = 0.519; χ2 = 477.638, P < 0.01), while the cumulative contribution rate of six principal components in the tertiary indicators was 84.23%. The normalized weights of three primary indicators of the source of infection, transmission condition and control capability were 0.337, 0.333 and 0.329, and the three secondary indicators with the greatest normalized weights included the number of imported cases and malaria parasite species (0.160), introduction of imported cases in China and medical care seeking (0.152), vector species and density (0.152), while the five tertiary indicators with the greatest normalized weights included the malaria parasite species of imported cases (0.065), vector populations (0.064), and the time interval from onset to medical care seeking (0.059), number of imported cases (0.056), and the time interval from medical care seeking to definitive diagnosis (0.055). Conclusions A risk assessment indicator system for re-establishment of imported malaria is successfully created, which provides insights into the assessment of the risk of re-establishment of imported malaria and management of key high-risk factors in malaria-eliminated areas.
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Objective:To establish a set of scientific and reasonable indicator system of common prosperity in the field of health, so as to promote the construction and evaluation of the demonstration area of common prosperity with high quality of health.Methods:According to the requirements of promoting common prosperity demonstration area with high quality of health in Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis in July 2021, and experts were convened to carry out expert brainstorming to determine indicator system in the form of meetings. Delphi method was used to conduct two rounds of expert consultation on the indicator system.Finally, the analytic hierarchy process and percentage weight method were used to calculate the indicator weight value.Results:The final indicator system included 4 first-level indicators and 30 second-level indicators. Among the first-level indicators, the weight values of the development, equilibrium, inclusiveness, and sustainability were 0.326 4, 0.242 8, 0.245 8, and 0.185 0. There were 8 second-level indicators in developmental indicator dimension, of which the indicator with the highest weight was the per capita health expectancy. The balance indicator dimension included 6 second-level indicators, of which the indicator with the highest weight was the per capita financing difference of basic medical insurance between the urban workers with the urban-rural residents. The inclusive indicator dimension included 6 second-level indicators, and the proportion of personal health expenditure to total health expenditure had the highest weight. The sustainability indicator dimension included 10 second-level indicators, and the proportion of government health expenditure in fiscal expenditure had the highest weight.Conclusions:The indicator system constructed in this research could provide certain guidance and reference for promoting the construction of common prosperity in health, and provide some reference for follow-up research in this field.
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Objective:To build an investigator-initiated clinical research process management indicator system based on the theory of Hazard Analysis and Critical Control Point(HACCP).Methods:A plan was developed according to HACCP principles, and 23 experts were invited to form an expert advisory group. Literature research, panel discussion, and Delphi method were used to collect clinical research process management indicators, and the weight of each indicator was calculated via Analytic Hierarchy Process(AHP).Results:Two rounds of expert consultation were carried out with a high positive coefficient and a high expert authority level, and finally formed 3 primary indicators and 14 secondary indicators. The primary indicators were project establishment, project process management, and project implementation assessment, with weights of 0.142 8, 0.714 4, and 0.142 8, respectively.Conclusions:This study established a clinical research process management system based on HACCP theory from 3 dimensions: project establishment, project process management, and project implementation assessment, carried out precise management of clinical research according to the weights of secondary indicators, focusing on the content of indicators with great weight, and provided an important reference for the management of investigator-initiated clinical research.
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Objective:To establish a set of evaluation indicator system of policy coordination of integrated county healthcare consortium based on the construction practice of integrated county healthcare consortium in Zhejiang province.Methods:Based on the guiding opinions and relevant supporting policy documents issued by Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis, and the indicator system was modified and perfected in two rounds by Delphi method. The weight value of the indicators was calculated by the priority chart method.Results:The indicator system included 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. Among the first-level indicators, the weight values of health insurance payment, personnel salary, price reform, fiscal and finance were 0.406, 0.281, 0.141 and 0.172, respectively.Conclusions:The indicator system established in this study has certain rationality and feasibility, which can provide reference for promoting the construction of integrated county healthcare consortium in China from the perspective of policy coordination, and provide reference for relevant scholars to carry out follow-up research.
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Objective:To establish the ecological health evaluation indicator system of college English classroom.Methods:The ecological health evaluation indicator system of college English classroom was formed through the combination of literature study and teaching practice, and a questionnaire was developed from it after several revisions. The improved Delphi method was conducted twice among the chosen experts. The evaluation indicators were chosen and revised according to the results of the consultations. SPSS 20.0 was used for statistical analysis.Results:The enthusiasm coefficients of experts in the two rounds' consultations were 83% and 100% respectively; their authority coefficients were 0.79 and 0.82 respectively; the coordination coefficients Kendall's W of experts' opinions of the importance of the indicators were 0.255 and 0.203 respectively ( P < 0.05). The revised indicator system included 5 first-class, 17 second-class and 48 third-class indicators. Conclusion:The ecological health evaluation indicator system of college English classroom established by this research is relatively scientific and valid, which may provide a method for College English teachers to diagnose the health state of their College English classroom ecology.
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Objective To establish an indicator system for assessment of schistosomiasis transmission risk after transmission interruption in Hubei Province, so as to provide insights into the precise control of schistosomiasis. Methods The indicator system was preliminarily established based on data collection, literature review, expert interviews. Two rounds of expert consultation were performed. The indicator system was screened based on the importance, operability, sensitivity and comprehensive score of the indicators, and the weights of each indicator were calculated. The credibility of the Delphi method was evaluated by calculating the active coefficient of the experts, degree of expert authority and coordination levels of experts’ opinions. Results An indicator system for assessment of schistosomiasis transmission risk was preliminarily established, including 3 primary indicators, 12 secondary indicators and 44 tertiary indicators. A Delphi consultation was performed among 17 experts participating in schistosomiasis control, management and research. Following two rounds of consultation, a risk assessment indicator system was finally constructed, including 3 primary indicators, 10 secondary indicators and 35 tertiary indicators. Among the primary indicators, the variable with the highest normalized weight was the current status of schistosomiasis (0.420 2), followed by social factors (0.397 3) and natural environments (0.182 5). Among the secondary indicators, those with high combined weights included risk monitoring (0.142 3), current snail status (0.140 1), and current prevalence of human and livestock infections (0.137 8). Among the tertiary indicators, those with high combined weights included the positive rate of wild feces (0.049 8), the prevalence of snail infections (0.047 4), and the area of snail habitats submerged by floods (0.046 8). During the two-round consultation, the active coefficients of the experts were 85.00% and 100.00%, the degree of expert authority was both 0.75 and greater, and the coordination levels of experts’ opinions were 0.405 to 0.521 and 0.592 to 0.695 (all P values < 0.05). Conclusion An indicator system for assessment of schistosomiasis transmission risk is successfully established after transmission interruption in Hubei Province based on the Delphi method, which provides insights into the identification of the schistosomiasis transmission risk and the targets for schistosomiasis control in Hubei Province.
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Objective:To establish a set of comprehensive appraisal indicator system for the full-time scientific research personnel in Level-three general hospitals, improve the management of full-time scientific research personnel at hospital.Methods:Firstly, an initial indicator system was established by literature review and in-depth interviews with experts. Secondly, Delphi method was used to screen the indicators to confirm the indicator system. Finally, Analytic Hierarchy Process (AHP) was used to determine the weights of indicators at all levels, consistency tests were also conducted.Results:A set of comprehensive appraisal index system for full-time scientific research personnel in Level-three general hospitals was established, including four first-level indicators, which covered the comprehensive quality, scientific research capacity, scientific research performance and academic impact, as well as other 17 secondary indicators and 53 third-level indicators. Among these indicators, the scientific research performance has the largest weight value (0.5224), and according to the consistency test results, CR was less than 0.1. Besides, through the consistency test, the weight assignment is reasonable.Conclusions:The appraisal index system of full-time scientific research personnel in Level-three general hospitals is reliable. It can be used as a tool for evaluation of full-time scientific research personnel, which also provide reference for other hospitals to improve the management of full-time scientific research personnel.
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Objective:To construct a nursing grading evaluation indicator system for patients with stroke at home to provide a basis for graded care. Methods:Based on literature analysis, qualitative interviews and panel meeting, an evaluation indicator system was preliminarily drafted. June to September, 2018, the indicator system was consulted to experts three times. It was used to evaluate 210 patients with stroke at home from September to December, 2018 to test its reliability and validity. Results:The effective recovery rates of the three times of consultation were 85.00%, 89.47% and 100%, and the authority coefficient were 0.878, 0.879 and 0.879. The indicator system included four first-level indicators, 30 second-level indicators and 120 items. The scale-level content validity index (CVI) universal agreement was 0.733, average CVI was 0.927; the item-level CVIs were 0.83 to 1.00. For the overall level, the Cronbach's α coefficient was 0.928, and the Guttman Spilt half-factor coefficient was 0.794. For the dimensions, the Cronbach's α coefficient and the Guttman Spilt half-factor coefficients were all above 0.700. The correlated coefficients inter-evaluator of each indicators were 0.492 to 0.963 (P< 0.05). Conclusion:The nursing grading evaluation indicator system for patients with stroke at home is simple and operable, with satisfactory reliability and validity to grade the level of care for patients with stroke at home.
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This paper selects 12 indicators of 47 Chinese materia medica (CMM) listed companies from 2013 to 2017, and builds an enterprise competitiveness evaluation system. Firstly, the global principal component analysis (GPCA) method is used to aggregate 12 indicators into four principal components, which named as scale capability, profitability, growth ability and technological innovation ability, and calculate the competitiveness score of the enterprise. Secondly, the Q-type cluster analysis method is used to divide the enterprise into four echelons based on the competitiveness score of the enterprise, and then use the combination of dynamic and static to analyze the development status of the four types of enterprises from static and dynamic perspectives. This study finally drew relevant conclusion and suggestions, providing reference for the companies making a targeted development strategy.
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Objective@#To validation and optimization the indicator system of risk assessment for mechanical cuts.@*Methods@#The risk assessment index system of mechanical cutting injury established earlier was used to assess the risk of mechanical cutting injury in 40 cases of mechanical cutting injury registered from January 2015 to December 2017 and 40 similar positions without accidents in the same period. The multiple stepwise regression analysis was used to screen the indicator system, and to adjust the weight coefficient of each index. The total coincidence rate and Kappa value were compared between before and after optimization respectively.@*Results@#The new index system has 3 first-class indicators, 10 second-class indicators and 14 three-class indicators, fewer than the old index system which has 3 first-class indicators, 10 second-class indicators, 34 three-class indicators. There three indicators have revamped in the first-class. The total of coincidence rates of the new and old indicator systems were 67.50% and 90.00%, the difference was statistically significant (P<0.01). The Kappa value were 0.35 and 0.80, respectively.@*Conclusion@#The evaluation results with new indicator systems is more consistent with the actual hazard detection the the old indicator systems, and scientific, reasonable and practical, and the indicator system of risk assessment for mechanical cuts can be used for the risk assessment of mechanical cutting injuries.
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Objective@#To develop the outcome evaluation index system for home care service of disabled elderly based on the long-term care insurance in Guangzhou.@*Methods@#Delphi method was used to develop the outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou. The Analytic Hierarchy Process was used to determine the weights of all indexes.@*Results@#After two rounds of expert consultation, questionnaire response rates were 86.67%, 100%; expert authority coefficients were 0.843, 0.858; coefficients of variation ranged from 0.07 to 0.23 and 0.00 to 0.14; coordination coefficients ranged from 0.221 to 0.355 and 0.379 to 0.433 (P<0.01). The final index system consisted of 5 first-level indicators, 17 second-level indicators, and 59 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (CR<0.1) was performed.@*Conclusions@#The outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou was scientific and reliable, the weights of all indexes were reasonable, which could provide reference for the designated service institution on evaluation and improvement of the effect of home care service of long-term care insurance for disabled elderly.
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Objective@#To build a comprehensive evaluation system for printable and online materials, and provide reference for the compilation and selection of patient education materials.@*Methods@#Taking Suitability Assessment of Materials (SAM) as frame and combined Patient Education Materials Assessment Tool (PEMAT) and CDC Clear Communication Index, we screened indicator of the evaluation system preliminary and all of them have been adjusted with the language habits and social and cultural characteristics of our country. By Delphi method, 15 experts in related fields were selected to conduct 2 rounds of expert consultation to establish the final indicator system. The weights of the different indicators were also analyzed by Analytic Hierarchy Process (AHP).@*Results@#The indicator system of printable and online patient education materials was consisted of 7 first-level indicators,28 second-level indicators,84 third-level indicators. The positive coefficients and the authority coefficients of the experts were 100% and 0.87 of the two rounds. The coordination factors of the experts in second-level and third-level were respectively 0.362 and 0.255 for the second round. The top three indicators of the first-level indicators were content (0.271 5), behavioral suggestion (0.190 4), and language expression (0.190 4); the highest-level index weight was scientific content (0.095 7), and the lowest was the use of commonly numbers, correct interpretation of numbers and units′ meaning (0.007 0).@*Conclusion@#The comprehensive evaluation system for printable and online materials is scientific, comprehensive and easy to operate. It can provide reference for medical worker to prepare and select printable and online materials.
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Objective@#To explore the establishment of an evaluation indicator system for disease prevention and control workload at public hospitals, based on the current situation of disease prevention and control work undertaken by public hospitals of and above secondary level in Beijing, and to provide evaluation assistance for them to do better in this regard.@*Methods@#This research was based on our pervious study of the current situation description of disease prevention and control work undertaken by public hospitals in Beijing, by which the contents of routine disease prevention and control work at hospitals have been initially established. The unit strength of each work was consulted, and the disease prevention and control work was classified according to the results. Meanwhile the consistency test of the work intensity within the category was carried out. After integration, the classification and evaluation indicator of disease prevention and control work in public hospitals of and above secondary level in Beijing was finally established.@*Results@#The workload evaluation indicator system was divided into eight parts: report work, report quality control work, monitoring work, training work, work of public health related clinical diagnosis and treatment, work of clinical examination and vaccination, work of sampling and testing and public health related consultation work. The work intensity of each category ranged from 4.78 to 7.34.@*Conclusions@#The evaluation indicator system of workload is suitable for the evaluation of basic works. The unified transformation of workload by using the value of work intensity is conducive to management evaluation, but the limitation of the indicators exists in time and region, making it necessary to adjust by the local specific situation at the promotion and application level.