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Vol. 7 No. 4 (2022): IJPDS Special Issue: Bringing Together Non-routine and Routine Data
Representativeness of survey participants in relation to mental disorders: a linkage between national registers and a population-representative survey
Natalie C Momen
National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark
Mathias Lasgaard
DEFACTUM - Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark
Nanna Weye
National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark; Department of Disease Burden, Norwegian Institute of Public Health, Norway
Jordan Edwards
Offord Centre for Child Studies, McMaster University, Ontario, Canada
National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Queensland Brain Institute, University of Queensland, St Lucia QLD 4072, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
Oleguer Plana-Ripoll
National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark
Surveys and registers have provided important insights into the mental health of the community. However, both sources have strengths and limitations. While participation in surveys has been shown to be lower among those with mental disorders, misclassification and limited information on confounders are typical issues for registers.
To examine if participants of the Central Denmark Region's 2017 How are you? survey were representative of the general population in terms of mental disorder diagnoses.
By linking data from the Central Denmark Region's 2017 How are you? survey with the Danish national registers, we compared the frequency of mental disorder diagnoses among (a) participants in the survey (n = 32,417), before and after applying non-response weights, and (b) the entire population who were eligible to participate (n = 1,063,082; 16 years of age or older on 10th January 2017 and registered as living in the Central Denmark Region). Using logistic regression models, we estimated associations between being diagnosed with any mental disorder and nine general medical conditions to assess whether selection into the survey appeared to bias these associations.
Based on register data, 10.4% (n = 110,492) of the eligible population had received a diagnosis of any mental disorder prior to the date of this survey. Among the unweighted survey sample, 8.2% (n = 2,648) had received a diagnosis; once non-response weights were applied, this corresponded to 9.5%. Representativeness varied by sex, age and type of mental disorder. For example, people with organic disorders or substance use disorders were generally underrepresented among survey participants of all ages; however, representativeness of common disorders such as mood or neurotic disorders was generally good. With respect to the association of any mental disorder and general medical conditions, we found that estimates were similar for survey samples (both weighted and unweighted) compared to the entire eligible population.
People with a previous diagnosis of a mental disorder are slightly underrepresented in the survey. However, this selection bias was minimized when non-response weights were applied. Associations between mental disorders and general medical conditions did not appear to be affected by selection bias. With the application of non-response weights, the survey provided a sample representative of the general population in terms of mental disorder diagnoses.
Epidemiology is a foundational science for health research. In particular, it is essential to understand the prevalence of disorders, in order to design appropriate services [1]. Within the epidemiological tool box, surveys and register-based research have provided essential information to guide health planning. On one hand, surveys have played a critical role in mental health research. They can estimate the prevalence of different types of mental disorders, and explore service use and unmet need [2–4]. Whether these studies are multinational (e.g. World Mental Health Surveys [5] and the Wellcome Global Monitor [6]) or single site and smaller, population-based surveys have provided information on the epidemiology of mental health issues. On the other hand, several nations now have access to administrative registers (e.g. the Nordic countries) [7], which are useful to complement survey data. National registers, like electronic healthcare databases, provide large samples which often include the entire population, and thus are not subject to selection bias. However, the registers are administrative and often lack details about relevant exposures or confounders.
Each of these data sources have strengths and limitations. In particular, there are well known factors that influence participation in surveys [8–14]. Disorders associated with premature mortality may be underrepresented in surveys and previous research has also indicated that participation is lower in health surveys among people with poor mental health [15–17]. If selection into the survey is systematically different between those with and without disorders of interest, observed associations could be biased. This could be relevant, for example, in studies that use survey data to look at the associations between mental disorders and general medical conditions. Conversely, identifying cases based only on registers reflect those who seek help and not all health care provided may be included in register-based research [18]. This may mean surveys are a better source of information for mild mental disorders. Additionally, surveys and registers capture different details: while registers identify those who have received a diagnosis from a health care provider, surveys can provide greater depth by measuring symptoms and indicators of impairment [19–21]. Furthermore, the standardization of self-reported measures can be more culturally sensitive for measuring mental disorders [22]. Combining register data with survey data can fill these gaps [23, 24]. Register data can be supplemented by data from surveys on topics that registers do not capture well (e.g. work patterns [25], social relations [26], over-the-counter medication use [27], smoking [28], or alcohol intake) [28], while the registers can provide long follow-up periods or relevant confounders like education, income, health care utilization, comorbid diagnoses etc. Conversely, we can use the national registers to explore factors that influence selection bias in surveys. For example, survey participants can be compared to the general population to assess how representative participants are [29, 30].
When using a data source to find out information about a population, it is important to try to identify the data source's limitations and, if possible, quantify them. In this article, we attempt to do this with a Danish population-based survey: How are you? (original Danish title Hvordan har du det?). It is also referred to as the Danish National Health Survey [31] and can be used to supplement the register data [31]. This survey has been run in 2010, 2014, 2017 and 2021. It is a national survey based on five regional stratified random samples and one national random sample, and is concerned with health-related quality of life, health behaviour, morbidity, and social relations in the Danish population. Weighting procedures are used in the survey to correct for survey design and non-response in relation to socio-demographic characteristics, visits to general practitioners, and somatic hospital admissions [31]; these weights ensure that participants are representative of the entire population regarding these characteristics. However, it is unknown the extent to which participants are representative regarding mental disorders. Several previous surveys have suggested that non-participants have more mental disorders than participants [9–12, 32, 33]. As data from How are you? is being used by researchers to describe health in Denmark, we believe it would be useful to consider how representative the survey population is. In this article, we aim to assess the extent of any selection bias with regards to mental disorder diagnoses in the 2017 Central Denmark Region How are you? survey, by comparing the frequency of diagnoses among survey participants, with the entire population eligible to participate in the survey. We make these comparisons by sex, age and type of mental disorder. Additionally, we estimate the association between mental disorders and general medical conditions in survey participants and in the eligible population. It is important to note that the Danish national registers are not free of limitations (as has been previously highlighted) [34, 35], however we hope that triangulation can help us to understand whether those with mental disorder diagnoses are well represented in the survey.
The Danish national registers
The Danish Civil Registration System holds continuously updated information on all individuals residing in Denmark [36]. Each person in the entire population is assigned a unique Central Person Register number, which allows linkage to person-level data in the other Danish national registers, including the health registers - for example, the National Patient Register [37, 38], which contains information on diagnoses made during hospital visits, or the Danish Psychiatric Central Research Register [39], which contains psychiatric diagnoses made during inpatient, outpatient and emergency visits. An introduction to the Danish national registers is provided by Thygesen and Ersboll [40].
The 2017 central Denmark region How are you? survey
The 2017 Central Denmark Region How are you? survey is a questionnaire-based survey, one of six mutually exclusive random subsamples that cover all of Denmark: one in each of the five Danish administrative regions, and one national sample [31, 41]. It is based on stratified random selection of participants who were 16 years of age or older on 10th January 2017 and were registered as living within the Central Denmark Region on that date, identified from the Danish Civil Registration System (which includes the entire Danish population). The survey includes questions about participants' health, including physical health, mental health and health behaviours (such as physical activity, smoking and alcohol intake) [31, 42, 43]. Survey data, such as that from this survey, can also be provided to Statistics Denmark to anonymize the data and link it to the national registers.
The study was approved by the Danish Data Protection Agency, and data access was agreed by Statistics Denmark and the Danish Health Data Authority. According to Danish law, informed consent is not required for register-based studies. All data were de-identified and not recognizable at an individual level. The survey was reported to the Register of Research Projects of the Central Denmark Region (record number 1 16 02 593 16). All survey participants were informed that their survey data would be linked to the registers. Linkage was carried out by Statistics Denmark.
Study population and design
This cross-sectional study included the 1,063,082 individuals in Denmark who met the eligibility criteria for participating in the 2017 Central Denmark Region How are you? survey. A total of 52,000 persons were invited to participate in the survey. Invitation to participate was random in terms of all factors (e.g. sex, age, education), but stratification ensured coverage of all municipalities in the region (i.e. municipalities with fewer inhabitants were oversampled). The survey was sent out via secure Digital Post (a system used by Danish authorities and businesses to communicate with the population) or by regular postal services to the 10% of the invitees not registered to use digital post. The subsample not registered to use digital post received a paper questionnaire; these were mostly the elderly [31]. Those who did not respond after a reminder were sent a paper questionnaire and two reminders delivered to their home address. Invitees were informed that participation was voluntary and responses would be kept confidential. They were provided with contact details in case they had further questions and informed that participants would be entered into a prize draw. The response rate of 62% resulted in 32,417 participants. Those invited to participate were a random sample of the entire eligible population; however, it is unclear whether those who agreed to participate were representative of the eligible population. Statistics Denmark had access to information on both participants and non-participants, and they calculated non-response weights to correct for differences in selection probabilities (based on municipality) and response rates. These were constructed using a model-based calibration approach [44] based on information from the national registers on participants and non-participants (i.e., sex, age, municipality of residence, social background, and healthcare utilization through visits to general practitioners and somatic hospitals). These weights are made available with the survey data for use in statistical analyses. Once they are applied, the sample is expected to be representative of the target population at least in relation to the characteristics included in the model; however, these weights did not include direct information on mental disorders.
In this study, we explored the representativeness of the How are you? survey participants through several data obtained from national registers: demographic characteristics, proportion of participants who had been diagnosed with mental disorders before the survey was carried out, and associations between mental disorders and general medical conditions. Given that details of those who were invited to participate but declined cannot be provided for ethical reasons (thus, we could not identify non-responders in the registers), we carried out a comparison of survey participants with the entire eligible population.
A summary of the data obtained from each data source is provided in Supplementary Table 1. As mentioned above, all individuals who met the eligibility criteria to participate in the survey were identified in the Civil Registration System [36]. From here, we obtained details about each individual's date of birth and sex. We linked them to their health and education data in other registers. Information on mental disorder diagnoses prior to the survey date was obtained from the Danish Psychiatric Central Research Register [39], which contains psychiatric diagnoses made in psychiatric inpatient contacts since 1969, and also in outpatient or emergency contacts since 1995, with a range of health care providers. Prior to 1994, diagnoses were coded according to International Classification of Diseases, version 8 (ICD-8); from 1994 onwards, ICD-10 was used. Mental disorders were ascertained in the period 1969 to January 2017. Details of the specific diagnoses and earliest age of diagnosis within each mental disorder group are presented in Supplementary Table 2 [45].
Information on nine categories of general medical conditions (circulatory, endocrine, pulmonary, gastrointestinal, urogenital, musculoskeletal, hematological, cancer and neurological; defined as in previous studies) [46, 47] was obtained. This was retrieved using the National Patient Register [37, 38] (which comprises data on diagnoses made during inpatient contacts since 1977, and also in outpatient or emergency contacts since 1995) and the Danish National Prescription Register [48] (which includes information on all redeemed prescriptions since 1995). General medical conditions were ascertained after individuals reached 1 year of age, from 1995 onwards, when prescription data became available. Criteria for the general medical conditions are presented in Supplementary Table 3.
Finally, information about the education group (primary/ early childhood, secondary, above secondary, missing) in the year prior to the survey was obtained for each individual. This came from Statistics Denmark's registers on education [49]. Information through responses from the How are you? survey was not used in this study, as those were only available for survey participants.
Statistical analyses were carried out in Stata 16 and Microsoft Excel. For all analyses, we considered three populations: the entire population eligible for the survey, survey participants, and survey participants after adjusting for non-response weights provided by Statistics Denmark. We ascertained the number of people within the categories of each of the following variables as of 10 January 2017: sex (male, female), age group (16–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75+ years), and education group (primary/early childhood, secondary, above secondary, missing). Additionally, we determined the number of people who had received a diagnosis of any mental disorder (ICD-10 F codes) and 10 specific types of mental disorders (each F code subgroup, as per Supplementary Table 2). We carried out Chi-squared tests to compare the frequencies of mental disorders observed in the survey sample, with the frequencies expected if the proportions had been the same as in the entire eligible population. For the observed frequencies, we calculated the frequencies as observed (i.e. unweighted, not taking the non-response weights into consideration), as well as the frequencies with the non-response weights (i.e. weighting each individual as per their assigned non-response weight to make the sample representative).
We then carried out the same descriptive analyses to consider the frequency of any mental disorder in each population disaggregated into fourteen groups depending on sex and age group. When looking at specific types of mental disorders in each population by sex and age, however, due to small numbers, we used broader age categories (16–34, 35–54, 55+ years), resulting in six groups.
Finally, we estimated associations between being diagnosed with any mental disorder and the nine general medical conditions (Supplementary Table 3) [46] through logistic regression models to calculate odd ratios (ORs) and 95% confidence intervals (CIs). These were estimated for the three populations to assess whether the associations were different in survey participants. The models were adjusted for sex, age group and education.
The characteristics of the entire eligible population (1,063,082 individuals in Denmark who met the eligibility criteria for participating in the 2017 Central Denmark Region How are you? survey) and 32,417 survey participants before and after weights were applied are shown in Table 1.
Entire eligible population(n = 1,063,082) Survey participants (n = 32,417)
Unweighted Weighted
Characteristic Frequency % (95% CI) Frequency % (95% CI) P value from Chi squared testa Frequency % (95% CI) P value from Chi squared testa
Sex <0.001 0.973
Male 529,675 49.82 (49.73–49.92) 15,105 46.60 (46.06–47.14) 16,153 49.83 (49.18–50.47)
Female 533,407 50.18 (50.08–50.27) 17,312 53.40 (52.86–53.94) 16,264 50.17 (49.53–50.83)
Age group <0.001 0.861
16–24 162,736 15.31 (15.24–15.38) 3,791 11.69 (11.35–12.04) 4,962 15.31 (14.80–15.82)
75+ 97,991 9.22 (9.16–9.27) 3,123 9.63 (9.32–9.96) 2,925 9.02 (8.68–9.38)
Education <0.001 0.001
Primary/early childhood 6,319 0.59 (0.58–0.61) 74 0.23 (0.18–0.29) 153 0.47 (0.37–0.60)
Secondary 736,507 69.28 (69.19–69.37) 22,430 69.19 (68.69–69.69) 22,249 68.63 (68.03–69.23)
Above secondary 303,099 28.51 (28.43–28.60) 9,597 29.60 (29.11–30.10) 9,506 29.32 (28.74–29.91)
Missing 17,157 1.61 (1.59–1.64) 316 0.97 (0.86–1.09) 510 1.57 (1.38–1.79)
Table 1: Characteristics of all those eligible for the 2017 Central Denmark Region How are you? survey and the survey participants (unweighted and weighted according to sampling and participation weights). aComparing the frequencies observed in the unweighted and weighted survey participants, with the frequencies expected if the proportions had been the same as in the entire eligible population.
Compared to the entire eligible population, there was underrepresentation of the following groups in the survey participants: males, individuals <45 years of age, and individuals with education up to primary/early childhood levels or missing education data. However, once the sampling weights were applied, characteristics of participants were more similar in terms of sex and age group.
Based on register data, 10.4% (n = 110,492) of the eligible population had received a diagnosis of any mental disorder prior to the date of the survey (see Supplementary Table 4). Among the unweighted survey sample, 8.2% (n = 2,648) had received a diagnosis; once weights were applied, this corresponded to 9.5%. Figure 1 shows the proportions in the entire eligible population, unweighted survey sample and weighted survey sample who had been diagnosed with any mental disorder and 10 specific types of mental disorders. While those with most types of mental disorders were, at least slightly, underrepresented, the largest relative differences were for organic disorders (prevalence of 0.57% in the eligible population and 0.30% in the weighted survey participants) and substance use disorders (prevalence of 1.87% in the eligible population and 1.37% in the weighted survey participants). For eating disorders (prevalence of 0.46% in the eligible population and 0.53% in the weighted survey participants) and developmental disorders (prevalence of 0.53% in the eligible population and 0.54% in the weighted survey participants), the survey sample was in fact slightly overrepresented, although the differences were not statistically significant according to results from the Chi-squared test.
Figure 1: Prevalence of mental disorder diagnoses between all those eligible for the 2017 Central Denmark Region How are you? survey and the survey participants (before and after weights were applied).
Underrepresentation of those with mental disorder diagnoses in the survey sample was not universal (Figure 2). For example, the largest relative differences were observed for females in the 75+ age group (prevalence of 10.63% in the eligible population and 6.5% in the weighted survey participants) and males in the 75+ age group (prevalence of 6.45% in the eligible population and 4.11% in the weighted survey participants). For females, the weighted survey was generally representative for all other age groups. However, males with mental disorders were slightly underrepresented, especially among the middle-aged groups (25–34, 35–44, and 45–54 years). For the majority of sex and age groups, application of the weights improved representativeness (Supplementary Table 5).
Figure 2: Prevalence of mental disorder diagnoses between all those eligible for the 2017 Central Denmark Region How are you? survey and the the survey participants (before and after weights were applied), by sex and age group.
The results for types of mental disorders by sex and age group are shown in Supplementary Figure 1 and Supplementary Table 6. Again, there was variation in representation of types of mental disorders by sex and age group. For example, people with organic disorders or substance use disorders were underrepresented among survey participants; however, representativeness of common disorders such as mood, neurotic, and behavioral disorders was generally good, especially for females.
Logistic regression models were used to explore the odds of general medical condition comorbidity among those with any mental disorder diagnosis, compared to those without a mental disorder diagnosis, in each of the three populations separately. For example, in all three populations, those with a mental disorder were at increased odds of a circulatory medical condition; although the point estimates differed slightly for each population, the conclusion would be similar. This was the case for most general medical conditions: the ORs were similar for the survey samples (both weighted and unweighted) compared to the entire eligible population (Figure 3 and Supplementary Table 7), suggesting that associations among survey participants were not biased. However, for some general medical conditions, differences were observed e.g. the OR for the entire eligible population was lower than the ORs for the survey samples for endocrine conditions and pulmonary conditions.
Figure 3: Odds ratios (and 95% confidence intervals) for associations between any mental disorder and nine general medical conditions, among all those eligible for the 2017 Central Denmark Region How are you? survey and the survey participants (before and after weights were applied). Adjusted models included sex, age group, and education.
By combining the Danish register data with data from the 2017 Central Denmark Region How are you? survey, we have shown that people with a previous diagnosis of a mental disorder are underrepresented in the survey. However, this selection problem is minimized when sampling weights are applied. This pattern is not the same across all age groups, or even all mental disorders, with underrepresentation not observed for eating disorders or developmental disorders, and minimal for others (e.g. personality disorders or behavioral disorders). Additionally, while selection may be an issue for some sex- and age- groups for some mental disorder types, associations between mental disorders and general medical conditions do not appear to be strongly affected by selection bias.
The application of non-response weights meant that the survey provided a sample representative of the entire eligible population in terms of a range of characteristics, including sex and age group. While the survey underrepresents those with mental disorder diagnoses, we found that this bias was relatively small. People diagnosed with any mental disorder represented 10.4% of the entire eligible population; among the weighted survey participants, this was less than 1%-point less (9.5%). The weighted survey participants were also fairly representative in terms of specific types of mental disorders: for the most common types of disorders, neurotic disorders, 5.1% of the entire eligible population had received a diagnosis, compared to 4.7% of the weighted survey participants. The slight overrepresentation of those with eating disorders may reflect characteristics observed in individuals with eating disorders [50]. This variation should be considered by researchers when carrying out surveys that are used to investigate mental health. The response rates to surveys have been generally declining [51, 52], which can affect their generalizability and the representativeness compared to the target populations [53]. However, the How are you? surveys have maintained reasonable response rates, with the 2017 Central Denmark Region survey achieving 62%. Bias may be more impactful in surveys that have low response rates, but applying weights may mitigate this [54]. A recent study considering primary health care utilization in Danish registers and the same survey highlights the importance of applying the calibrated survey weights to address non-response; it concluded that applying the weights reduced the bias caused by differential selection [55].
The observation that people with mental disorder diagnoses are slightly underrepresented in the HHDD survey is in line with descriptions of other surveys. Two surveys in the Dutch population reported that depression and anxiety symptoms were more common in non-participants than participants [32, 33]. A study in the United States found that those with records of substance use were underrepresented [11]. A Finnish register based study reported that subjects (across sexes and education levels) with any psychiatric disorder, as identified in the Finnish Hospital Discharge Register, participated less in their survey than those without psychiatric disorders [9]. Haapea et al. [9] discuss this as possibly resulting due to characteristics associated with some mental disorders e.g. passivity or cognitive impairment, which may be supported by the underrepresentation of people with organic disorders in the Danish survey. Studies of individuals with schizophrenia suggested that longer duration [10] and increased severity [10, 12] of schizophrenia were less likely to participate. While some surveys have managed reasonable response rates among people with organic disorders [56, 57], Paganini-Hill et al. [57] reported that there appeared to be a higher proportion of dementia on death records among non-responders to their survey. For those with cognitive impairments (e.g. dementia, intellectual disabilities, etc), participation may not be possible. Therefore, the survey may not be representative of this group. If researchers want to try to increase participation among people with mental disorders, and in particular these subgroups, they may need to take further measures to target them. Stolzmann et al. [58] discuss that pen-and-paper surveys are generally better for conducting surveys among people with mental disorders, as information technology based-methods have varying levels of use and desirability among those with mental health conditions.
There are limitations of our study that should be considered when interpreting the results. First, the Danish national registers, which we compare the survey to, cannot be considered a 'gold standard' for identifying people with mental disorders. The Danish Psychiatric Central Research Register includes information on hospital contacts for mental disorders (inpatient, outpatient, and emergency room visits), but we do not have any information on mental disorders treated only in general practice or by independent psychiatrists and psychologists, or on people who do not seek any medical treatment for their mental disorders. As a result, it is likely that the national registers are more likely to identify more severe cases of mental disorders. Therefore, they may not be able to indicate representation of people with milder cases of mental disorders. Second, it is not possible to identify people who have recovered from mental disorders in the Danish Psychiatric Central Research Register. Our study classifies anyone who had received a mental disorder diagnosis prior to survey eligibility as having a mental disorder; however, it is possible that individuals will no longer have the mental disorder by the time they decided whether to respond to the survey. Therefore, misclassification is possible in both directions. However, it should be considered that by combining the surveys and the registers, we are trying to improve our understanding of the limitations of these data sources – research can, and should, continue to consider these, with the aim of providing estimates of mental disorder prevalence [23, 24]. Third, selection bias could also arise from excess mortality if a disorder is associated with increased risk of premature mortality. However, we defined our study population as being eligible to participate in the survey, and this selection mechanism would have affected both survey participants and the eligible population.
Our work could help guide other researchers with access to both survey and administrative data when considering and designing future studies aimed at measuring the representativeness of survey data. Combining data sources may provide opportunities to better understand our data [59]. This type of survey-register linkage could provide more precise non-response weights in relation to mental disorders, or could use quantitative bias analysis techniques to adjust for selection bias [60]. This investigation of survey data is a useful task to understand our data sources and there is a need to replicate this work in other surveys, and especially in child and youth samples. Additionally, there is a need to explore representativeness across other population indicators, for example other health conditions or immigrant status.
Although people with mental disorder diagnoses are underrepresented in the 2017 Central Denmark Region How are you? survey, this appears to be a relatively minor issue after sampling weights are applied. In other surveys, if researchers want to investigate the prevalence of mental disorders, they need to consider the possibility of underrepresentation, which may reduce a survey's ability to indicate absolute numbers of mental disorders in a population of interest. However, when looking at the association between any mental disorders and general medical conditions, the results for survey participants (both weighted and unweighted) were similar results to those obtained for the entire eligible population – the 2017 Central Denmark Region How are you? survey appears to provide a good sample to do this type of research.
The authors have no declarations of interest.
The project is supported by the Danish National Research Foundation (Niels Bohr Professorship to John McGrath) and the Lundbeck Foundation (Lundbeck Foundation Fellowship R345-2020-1588 to Oleguer Plana-Ripoll). John McGrath is also supported by the John Cade Fellowship (APP1056929) from the National Health and Medical Research Council. The How are you? survey was funded by the Central Denmark Region.
We would like to thank researchers at DEFACTUM for feedback on this study.
The study was approved by the Danish Data Protection Agency. Access to individual-level Denmark data is governed by Danish authorities. These include the Danish Data Protection Agency, the Danish Health Data Authority, the Ethical Committee, and Statistics Denmark. All data were de-identified and not recognizable at an individual level. The survey was reported to the Register of Research Projects of the Central Denmark Region (record number 1 16 02 593 16). All survey participants were informed that their survey data would be linked to the registers. Linkage was carried out by Statistics Denmark.
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Edwards J, Thind A, Stranges S, Chiu M, Anderson KK. Concordance between health administrative data and survey-derived diagnoses for mood and anxiety disorders. Acta Psychiatr Scand. 2020;141(4):385–95. 10.1111/acps.13143
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Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatr Res. 2004;13(2):122–39. 10.1002/mpr.169
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Edwards J, Georgiades K. Reading Between the Lines: A Pursuit of Estimating the Population Prevalence of Mental Illness Using Multiple Data Sources. Can J Psychiatry. 2022;67(2):101–3. 10.1177/07067437211016255
Edwards TH, Stoll S. A Bayesian approach to quantifying uncertainty from experimental noise in DEER spectroscopy. J Magn Reson. 2016;270:87–97. 10.1016/j.jmr.2016.06.021
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Bliddal M, Liew Z, Pottegard A, Kirkegaard H, Olsen J, Nohr EA. Examining Nonparticipation in the Maternal Follow-up Within the Danish National Birth Cohort. Am J Epidemiol. 2018;187(7):1511–9. 10.1093/aje/kwy002
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der Wiel AB, van Exel E, de Craen AJ, Gussekloo J, Lagaay AM, Knook DL, et al. A high response is not essential to prevent selection bias: results from the Leiden 85-plus study. J Clin Epidemiol. 2002;55(11):1119–25. 10.1016/s0895-4356(02)00505-x
Cheung KL, Ten Klooster PM, Smit C, de Vries H, Pieterse ME. The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health. 2017;17(1):276. 10.1186/s12889-017-4189-8
Musliner KL, Liu X, Gasse C, Christensen KS, Wimberley T, Munk-Olsen T. Incidence of medically treated depression in Denmark among individuals 15-44 years old: a comprehensive overview based on population registers. Acta Psychiatr Scand. 2019;139(6):548–57. 10.1111/acps.13028
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Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–90. 10.2147/CLEP.S91125
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Christensen AI, Lau CJ, Kristensen PL, Poulsen HS, Breinholt Larsen F. 35 Years of health surveys in Denmark: a backbone of public health practice and research. Scand J Public Health. 2022:14034948221083113. 10.1177/14034948221083113
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DOI: https://doi.org/10.23889/ijpds.v7i4.1759
Mental disorders, register-based research, survey based research, epidemiology
Naomi C. Hamm, Amani F Hamad, Elizabeth Wall-Wieler, Leslie L Roos, Oleguer Plana-Ripoll , Lisa M Lix, Multigenerational Health Research using Population-Based Linked Databases: An International Review , International Journal of Population Data Science: Vol. 6 No. 1 (2021): IJPDS Standard Issue


Coming straight from the malting house where malted barley is produced, Briess CBW Golden Light Dry Malt Extract is produced from the same malt that goes to homebrewers and commercial breweries from the Briess American warehouses.
This means that there's a thorough quality control of the raw materials and, respectively, excellent results each time you use the extract in your brews. All the fine flavours obtained through a proper mash of Briess base malts, condensed into a dry dehydrated form for more convenient use.
Description: Briess CBW Golden Light Dry Malt Extract can be used both as a single source of maltose in extract recipes, and as an addition to all-grain brews for obtaining higher gravity or adjusting the colour of the wort.
It lends a neutral malty flavour and a very light colour, which makes the extract suitable for brewing virtually any style of beer with the use of adjuncts and specialty malts.
When used on its own, CBW Golden Light Dry Malt Extract has a pleasant flavour profile that is equal to that of a base malt with a touch of light crystal malt.


Vintage and Museum Quality Specialists. Each earring measures about 1" x 1". The largest coral measures about 3/8" x 1/4".
Signed by Navajo artist, Gilo Nakai. The earrings weigh around 18 grams. If the item breaks we will repair it for FREE. We are flexible and are happy to work with you! All international orders will cost only 12.00.
We also will work with international buyers to help them not pay as much going through the process. Do you own a store? Nativo Arts wants to work with you! We are the #1 supplier to stores who want to sell the best and finest Native American jewelry. Make us offers today by clicking the blue make offer button at the top of the page!
Nativo Arts was established to offer the largest selection of the best quality vintage Native American jewelry in the world, for the best prices. It has taken decades to acquire the collection that we offer to the world today.
From A-list celebrities to average Joe's, we work with everyone from all walks of life. Nativo Arts has supplied a vast number of movies with the best quality Native American jewelry. It is important to respect Native American culture and to realize how much difficulty and hard work an artist puts into a piece. We thank you for your interest and we are happy to work with you! "The Largest and BEST Collection of Museum Quality Vintage Native American Jewelry in the World". The item "STRIKING VINTAGE NAVAJO CORAL STERLING SILVER NATIVE AMERICAN HEART EARRINGS" is in sale since Wednesday, January 2, 2019. This item is in the category "Jewelry & Watches\Ethnic, Regional & Tribal\Native American\Earrings".


Stof quilters basics is an incredibly lovely range. The fabrics are great for quilting on their own and the colours match and coordinate beautifully accross many other Stof ranges. The patterns are all small which is perfect for patchworkers.


Bev and Andy are qualified fitness professionals who are on hand to help you achieve your health and fitness goals.
Bev has been in the fitness industry for over 25 years motivating and helping people reach their personal and physical goals. Having completed 9 marathons she understands that the emotional component of training is just as important as the physical. She incorporates both aspects into all of her classes to ensure that the whole person is completely engaged.
She loves putting together the perfect play list for each class to make you laugh, reflect, feel energetic and nostalgic. You will feel alive, happy and always leave feeling better than when you walked in.
Be prepared, with physical and mental toughness, you can handle and do anything.
Well, there are two: Just sitting and being close to my amazing husband and two fantastic boys, that is just about as good as it gets.
Close second, running in the woods with my dogs at dusk, it is heavenly.
Under Pressure by Queen, Love it! Starts out heavy with fear and then transitions to love and how love is more powerful than anything we are faced with, just beautiful.
Kind of like a Confetti Popper. Lots of colors, movements cadences and drills for the whole body and of course…glitter!
Lynda was inspired after running her first 5K at the age of 40 and has not stopped since. Fitness is now a way of life, a place to release some stress, connect with friends and get a great workout!
If you are looking to build physical, mental and emotional strength then come and try out a class. Most of all, come to Community Cycle to have fun, get fit and meet friends!
Ironman competitor and Ironman USTA training coach. Her knowledge, energy and passion will inspire you to work harder and be so glad you did!
Andy has been teaching indoor Cycling for over 15 years. As an avid outdoor cyclist both road, mountain, Andy brings the outdoor experience to his classes. Teaching with a strong understanding of watts, cadence, endurance and aerobic/anaerobic threshold, Andy will teach you to get what you want out of each class, whether it be related to distance, power, increased fitness or BMI, Andy will help you set and achieve your goals.
When Andy is not cycling you either catch him with his band where he plays guitar. (Bev has been dying to get in on this and be the tambourine girl, but told "It's guys only"), or hanging out at Peet's in Wellesley with his cycling buds.
Live your best life through happiness. When you're happy everything else will fall into place.
Anytime I'm with Susan, my wife and our kids Max & Sara.
I recently rode my bike through Iceland with some friends, it's pretty tough to get any better than that!
Kind of like a Frisbee, Strong, Smooth, Clear and Effective from takeoff to landing.
Diane has been in the healthcare industry for 32 years. Engaging and enjoying all the people she has met along the way.
Four years ago Diane decided to continue reaching out to people and become a cycle instructor and personal trainer. Fitness to Diane is a way to motivate, inspire and help clear your mind. Lets never forget the most important is the continued connection with friends.
I can, I will, end of story!
Fourteen years as a Cycling and Yoga teacher in Wellesley and Chestnut-Hill, Renu brings her dynamic lifestyle brand to Community Cycle. You probably are no stranger to her happy and healthy classes that compel you to stretch boundaries. Her fun and soulful spirit is contagious - she will ignite you, crush you and ultimately, uplift you.
Creating an immersive cycling experience where riders connect to the beat of the music and commit to finding their inner athlete at any level is the driving ethos behind each of her classes. Passionate about music, you will soon be following her insane playlists on Spotify!


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Nikola Jokic "will break every record I have" with Nuggets
Class never retires. Or rests. When Nikola Jokic passed him — literally, in this case — for the Nuggets' all-time assist record late this past Wednesday, Alex English immediately fired off a tweet hailing the two-time reigning NBA MVP.
"I couldn't think of a better player (to do it)," English explained to me by phone from his native South Carolina on Thursday. "I'm honored.
"Every record that I have there, he'll break."
Including the big one.
"Eventually, he'll be the (Nuggets') all-time leading scorer," said English, whose 11 seasons of silky greatness have topped the franchise's scoring charts since 1990. "I think he's going to be there.
"He'll just eclipse me, eventually, as the all-time leading scorer. But I don't mind. When people break these records, it's like, 'That's awesome,' like LeBron (James) is looking to break Kareem (Abdul-Jabar's) records. My all-time scoring record has been in place a while. I think records are made to be broken. That's something you have to prepare for."
You know what else the Nuggets legend, who just turned 69 years young, is preparing for? Watching Denver go on an insanely long, insanely fun NBA Playoffs run.
"I'm telling you, they've got a good squad that's built for longevity," English said, "and built for making it into the playoffs and winning the (NBA) championship."
These Nuggets remind him of the 2009 Western Conference finalists that got Kobe-ed. And the 1985 Western Conference finalists English helped carry to within three wins of playing for a league crown before injuries — and the 1-2 punch of James Worthy and Byron Scott — cut those dreams short.
"I really like the squad," English said of the Nuggets, who take a conference-best record of 32-13 into Friday's showdown with Indiana looking for nine wins in a row.
"They've got a lot of experience. They've got great bench guys that can come in like Bones (Hyland) and (Bruce) Brown — these guys, they're an upgrade from what they've had in the past. And (there's) MPJ. And Jamal Murray looks like he's back and I just pray to God that he stays healthy. Then The Big Guy."
Spoiler alert: The Big Guy — who heads into the weekend averaging 25.1 points, 11.0 rebounds and 9.9 assists, nearly a triple-double per night — is English's pick, at the season's midway point, to bag a third straight MVP award.
"He's the all-time great," the Nuggets legend said.
"(This season) puts him in the stratosphere with the Abdul-Jabars, the Jordans, the Jameses, the Oscars (Robertson), the greatest. The greatest of the great.
"The only other person that I like as well is (Memphis star) Ja Morant. I think he's inspired and (carried) this team like no other player other than Jokic, as far as controlling the game and making things happen. And he's got a good squad around him as well."
Just not as good as the Nuggets, who rallied to beat Minnesota at midweek despite being outrebounded (26-24) and getting 10 shots blocked.
Much like the Avs at this time a year ago, this bunch can light up the opposition whenever it flips the switch, outscoring the Wolves in the fourth quarter, 34-23.
"They're right in sync and they just keep pounding and pounding and pounding," English chuckled.
"They're playing great basketball right now. This might be the opportunity for me to be able to come (to Denver) for the NBA Finals to watch them play. That's my hope."
The Blade knows. When your stars get stuck in second or third gear and you're winning anyway, that's not the sign of a good team. It's the mark of a great one.
Want more sports news? Sign up for the Sports Omelette to get all our analysis on Denver's teams.
Want more Nuggets news? Sign up for the Nuggets Insider to get all our NBA analysis.
According to NFL Network, Brock Purdy wins over Dak Prescott.
Breaking: Big Ten Basketball Game Has Been Postponed

redpajama_set_name: RedPajamaCommonCrawl


The band split soon thereafter and Ferre chose to follow Werrason and his Wenge Musica Maison Mere. Ferre's most memorable contribution is the song Vita Imana in Solola Bien album. After working with Werrason for a decade, he eventually left.
En Israël Crise. Message Officiel du Technion pour Etudiants, Professeurs, Visiteurs.
Take the prelude to my family's 2007 foray to Europe for instance. I remember it now ... had graduated at the top of the racers' class. For me, mere graduation was far from certain, so I returned home and started the life we all know: career and family.
Pendant la semaine, je rentre à la maison et j'utilise ... Mes parents font des achats en ligne tout le temps. Ma mère fait les courses en ligne et mon père adore le rock, alors il achète des billets pour des concerts sur internet.


Attack your writing with these Jinhao Shark fountain pens! This fun plastic pen is actually a decent writer. It features either a hooded or exposed steel nib, fills via standard international cartridge/converter (converter included, no ink) or converted to an eyedropper, and the shark head cap unscrews open and pushes to post. The translucent triangular grip assists in proper pen position. Perfect for kids, the avid shark enthusiast, or anyone who enjoys a fun affordable pen.


College Application Portfolio during the summer. Here's to a new adventure.
Each session is a week-long, 15-hour workshop with a maximum 5:1 student-teacher ratio.
$600 includes 15 hours of small-group instruction, workshop binder, and healthy snacks.
$150 is due with your registration to reserve your space in one of the workshops. The remaining balance of $450 is due on or before the first day of the workshop session you attend.
To register online, complete this registration form, save it as a pdf, e-mail it to melissa.granadatreehousestudio@gmail.com, and use the PayPal option below to pay the $150 deposit.
To register by post, complete this registration form, print it, and mail it with the $150 deposit payable to Granada Treehouse Studio at 1846 Granada Avenue, San Diego, California 92102.
Bring your laptop each day. We'll supply healthy snacks and a binder with workshop material on the portfolio elements. Each morning will include direct instruction, writing time, individual feedback, and revision time. Two of the mornings will also include group sharing and feedback. The workshop is aimed at the elements of the Common Application, but you may write to one or more of the UC prompts if you prefer. You'll need to spend two or more hours working at home each day of the workshop in order to make the most of the week.
Before the workshop begins, please create a Common Application account and a list of your top three to five schools.
Individual Sessions: If you are interested in individual writing sessions with Melissa contact her at melissa.granadatreehousestudio@gmail.com.


text:
The Vampire Diaries Recap for Season 6 Episode 12: [SPOILER] Dies!
Please note that this articolo is The Vampire Diaries recap for Season 6 Episode 12. The post contains spoilers and specific scene descriptions. Do not read any further until te have watched "Prayer for The Dying".
parole chiavi: The Vampire Diaries, recap, season 6, 6x12
inviato da nermai più di un anno fa
I remember visiting this website once...
It was called Vampire Diaries Recap for Season 6 Episode 12: [SPOILER] Dies in Twin Merge!
Here's some stuff I remembered seeing:
Warning: Please note that this article is
recap for Season 6 Episode 12 – directed by Jeffrey Hunt and written by Brett Matthews & Rebecca Sonnenshine. The post contains spoilers and specific scene descriptions. Do not read any further until you have watched "Prayer for The Dying" which originally aired Thursday, January 29, 2015 on The CW.
Sobbing? Curled up in fetal position? THIS IS WHAT TVD DOES TO YOU!
….1. Kai killed the new owner of the Mystic Grill, used Elena as target practice, and made sure to recycle a lone can. Thankfully — with the help of Jo's cloaking spell as well as her handy dandy science lab skills and flammable body — Elena managed to escape. 2. Enzo stalked Stefan all the way to an art exhibit at Duke University where he annoyed his way into discovering the "big" secret — namely, that the real Sarah Salvatore is alive. 3. Caroline ran a risky experiment on a dying man: She fed her blood to him, "cured" his cancer, then ran home to do the same to her mom. Unfortunately she didn't stick around for the side effects — vampire blood actually accelerates cancer cell formation! 4. As for everyone else: Jeremy took the ol' crossbow for a whirl, Liv revealed that Luke was more powerful than her, and Matt binge-watched
Scroll on down to find out what happened in TVD 6×12!
Surprise: Caroline receives a late night visit from none other than Colin Phelps. We're not sure if he grabbed a cab, drove, or literally crawled his way from the hospital all the way to the Forbes house, but he manages to track her down. He's all like, 'Sorry for vomiting blood all over your door, but WHAT THE EFF DID YOU DO TO ME.' Caroline gasps in horror because not only did she mess with an innocent bystander's life, but now her mom, Liz, will suffer the same fate.
'Happy Deathday, girl! Is there a hunk hiding behind your door by any chance?'
Worst Dad Ever: Guess who drops by for a visit? Papa Parker! He conveniently finds the most inopportune moment — namely, when Liv has her naked body pressed against a former were-hunk's chiseled form — and is all, 'Hello there! It's me, your dad — the guy who wants you to participate in a barbaric ritual that might leave you dead. But let's go celebrate your last birthday, eh?' He actually has the nerve to hand her a gift despite the fact she might be a goner in a few mere hours, but that's none of our business. Anyway, he takes her and Luke out to a fancy schmancy restaurant where they try to convince him that Jo is strong enough to take on Kai during the twin merge; Luke is not keen on killing off his sister and depriving the world of her beautiful curls, that's for damn sure. Their dad appears to be all ears….until they exit the joint and he grabs them both by the hand and starts chanting. 'DAD! STOP! YOUR YAMMERING IS LITERALLY GOING TO KILL MY SISTER!' Luke bellows, but to no avail. Thankfully, Tyler swoops in and tackles Daddy Gemini to the ground and knocks him unconscious. While this will not bode well for Tyler — talk about making a terrible impression with his girlfriend's dad — at least Liv and Luke are alive. For now.
'Hahahaha gotcha! You know when they kill me off they will milk one final mother-daughter bonding scene for all its worth so as to fill your hearts with excruciating pain.'
RIP Sheriff? Hooray, Liz doesn't die — that's the good news. Unfortunately, she's technically still dying, but at least she doesn't have to go by supernatural means. Maybe she'll luck out and be one of the few Mystic Falls residents who actually dies in a realistic way — and not because some serial killer witch gave her a heart attack by absorbing the magic in the vampire blood that's coursing through her veins. Luckily though, even though Kai leaves Liz high and dry (someone should seriously have a talk with this dude about his bedside manner) in the midst of her cardiac arrest — and abducts Jo so that no real doctors can tend to her — Elena swoops in, and using her minimal Bio 101 college skills, manages to save her.
More people should almost die in Elena's arms…just saying.
Delena Kiss: After Sheriff Forbes almost dies in her arms, Elena is frazzled and frantic. She's sick and tired of losing people she loves, and when she bumps into Damon she tells him, 'Death sucks! Live it up.' Actually she says, "life is short," then presses her lips against his; and in that instant it's as though the heavens crack open! A glorious stream of light pours through the nearby shutters and illuminates them whole in the dingy hospital hallway. Suddenly, we're reminded of their kiss in the Season 5 finale because the
same thing happened — and if this symmetry is not a sign that their love drives away sorrow and darkness, we don't know what is.
'Um, Stefan, the flowers aren't for my mom. They're for our wedding….'
'If I have to die with this terrible hairstyle, at least I'll go out like a badass.'
RIP Luke Parker: 'Tis true, fang fans. Even though they're technically not each other's twin, Luke and Kai decide to give it the old "college try" and end up facing off in the dreaded twin merge. You see, after finding out through his dad that Jo and Kai were about to participate in the sadistic ritual (they honestly can just draw straws and declare a leader through that), Luke hurries on over and magically knocks out his sister. He grabs Kai by the face like a true boss and tells him to pick on someone his own size; Kai's like, 'But you're shorter than me,' and Luke's all, 'Not if you factor in my hair height, punk.' Anyway, they grasp hands and start chanting in Latin. A great gust of wind pours through them and leaves start swirling and we suddenly realize that two mega powerful beings are engaged in a witch's version of a rap battle — and it's
! They both fall to the ground and Jo awakens to find her brothers temporarily incapacitated; she rushes to Luke's side, prayer and hoping that he has won. Unfortunately, because this is TVD the villain reigns supreme. Luke dies and Kai emerges the victor. Meanwhile, on the other side of town Papa Parker senses the outcome of this competition and tries to convince Liv to skip town with him. She refuses to leave her education and Tyler behind — so her dad is like, 'Whatever, girl. See ya never!' and skedaddles.
Moment of truth: Did you cry when Luke died or did you rejoice that Kai lived to wreak even more havoc on Mystic Falls? Do you think Stefan will tell Caroline how he feels about her now that Sheriff Forbes has basically given him her blessing? And what did you think of that Delena smooch in this hospital hallway? Share your thoughts in a comment!
What Your Favorite TVD Character Says About You
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In 18th century New Orleans, this immoral family hopes to build a home for themselves. But the city is lawless, and the witches and werewolves aren't going to give up their territory without a fight. If there's anything a vampire likes, it's a good bloodbath, and Klaus Mikaelson isn't afraid to begin a war over the woman he loves.
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Sports medicine is a branch of medicine evolved in late 20th century.It deals with the treatment of musculo-skeletal sports injuries. It not only deals with the sports injuries but it also focusses on the physical fitness and well-being of sportively active people.This branch of medicine is involved in the treatment and prevention of the injuries that could be caused due to sports or exercises.Sports injuries can occur during any sport either indoor or outdoor. It can also happen in people who are not involved in sports. Some of the injuries caused by accidents are also treated using sports medicine.
Who should consider sports medicine?
People suffering from sport injuries such as sprains or dislocation are the first candidates for the sports medicine. Strains and fractures caused during any sports ,or falling or accidents can also be treated by this method.Some of the other common sport injuries that affects the joints or any post traumatic arthritis cases are all the candidates for sports medicine.
The common knee injury that can be seen in athletes is an ACL tear , which is caused by the hyper- extension of the knee than the normal limits. Some of them are caused while landing from a jump or tackling a football.These tears or injuries are commonly associated with sports people who play games such as rugby, football , wrestling and martial arts. Traumatic injury which can cause meniscal cartilage tear is another indication for which the sports medicine is used. Shoulder joint injuries such as rotator cuff injuries can all be treated .
How to diagnose sports associated injuries?
To diagnose sports associated injuries , a physician performs physical examination of the affected region or joints such as knee, shoulder or ankle . The physician checks for the tenderness, swelling and range of motion of the joints. Further , X-rays of the joints are taken. Computed tomographic (CT) scan, or magnetic resonance image (MRI) are also be used for this purpose. MRI is the most suited option for the detection and analysis of the ACLtear. It can clearly detect the bruising of the bones in the knee, which is resulted from an ACL injury. MRI not only detects the ACL tear, but it can also detect the damage to the surrounding other three ligaments and cartilages or other meniscus injuries.
What steps are taken to prevent the sports injury?
Sports injuries can be prevented by taking some precautions such as wearing protective gear of the associated game such as eye gears, mouth and elbow guards ,pads and athletic shoes without fail during the practice as well as the gaming sessions to get protection from different injuries. Following the right exercise schedule without overdoing , having balanced healthy diet, keeping fitness and avoiding playing when not fit physically are some of the measures that are suggested to prevent sports injuries.
How beneficial are the sports medicine treatments ?
Some of the treatment the conservative methods such as the physical therapy, anti inflammatory medications, elevating the injured part while sitting or sleeping and icing the affected region. Exercises are the other methods considered to regain the motion and strengthen the muscles.As far as the athletes are concerned,arthroscopic surgical treatments are available for faster recovery from sports injury.


Our species created about 5 billion gigabytes of information from the dawn of time until 2003. Before long, we will create that much information many times per day, according to IBM. The problem: No one is doing enough to select and preserve the bits that really matter.
One of the great paradoxes of the digital age is that we are producing vastly more information than ever before, but we are not very good at preserving knowledge in digital form for the long haul. There's a difference between creating big server farms to store the information somewhere for near-term retrieval (industry is very good at that) and in fact choosing and preserving the data that matters, and being able to render it useful, at some time in the future (something that, scarily, we are not nearly as good at). We are radically underinvesting in the processes and technologies that will allow us to preserve our cultural, literary and scientific records.
Consider the experience of pulling out an old shoebox from under a bed and discovering a series of floppy disks there from the 1980s. Perhaps you smile, thinking of what might be on them; perhaps you shiver. How would you find out? Most of us have not preserved a vintage Macintosh SE to be able to play them back. Data formats have changed multiple times since then. From 8-inch to 5-and-a-quarter inch to 3-and-a-half-inch floppy disks to compact disks to thumb drives, we are continuously making progress in how we store our media — and trapping information in lost formats in the process. Best that you put the box back under the bed and not worry too much about it.
Obsolescence of this kind may, in fact, be a blessing. It's important that much of the information we create is ephemeral. Otherwise, the world will become far too cluttered. Our behaviors would shift, torqued by the constant surveillance to which we increasingly subject ourselves. We will have an even harder time finding the knowledge that's important in the vast ocean of the unimportant – much less making sense of it all.
It's fine when it's your old term papers that are locked away in an obsolete format. And many blogs, tweets, photos and status updates don't need to be kept for the long run. It's not so fine, though, when the lost knowledge has historical significance.
The problem is not that it's impossible to transfer information from one format to another; with enough effort and cost, most data can be transferred to formats that can be read today. A cloud-based world, to which we are headed, is likely to be simpler to manage than a world of shoe-boxes, floppy disks and thumb drives.
But different problems come into relief in a digital era in which we are creating information at such speed and scale. First, most of the parties holding the data are for-profit firms, whose core business is not long-term storage. Unlike universities, libraries and archives, these firms are unlikely to be around for hundreds of years. In the blog-hosting business, the industry has changed enormously in just a decade or so. Even in traditional publishing, consolidation and change have been the watchword, not persistence of firms over the centuries. Second, the scale of what is being created is so far beyond what has been created in the past, which means that we will need new, technologically sophisticated approaches – which can scale along with the pace of production – to curate the meaningful bits of it.
Today, librarians and archivists are not involved enough in selecting and preserving knowledge in born-digital formats, nor in developing the technologies that will be essential to ensuring interoperability over time. Librarians and archivists do not have the support or, in many cases, the skills they need to play the central role in preserving our culture in digital format.
The good news: the National Archives is much stronger and more advanced when it comes to digital matters, under the leadership of David Ferriero. The completely wonderful Internet Archive, the brainchild of Brewster Kahle, saves iterations of the web in a converted church in San Francisco. A group of universities has come together in a partnership called the Digital Preservation Network, founded at the University of Virginia, to address key aspects of the problem. And despite the GAO's deep and valid concerns, the Library of Congress has projects focused on this task, including the National Audio-Visual Conservation Center, which features recording and playing devices to help render materials in now-obsolete formats.
But no small handful of institutions is up to the scale of this task. The scope of the issue is enormous and will take a coordinated, national effort to accomplish for the United States alone, let alone the world. Too few librarians and archivists have the technical ability to lead the way.
The deeper problem behind the problem of digital preservation is that we undervalue our libraries and archives. We tend to think of them in the wrong light, solving an analog-era set of problems. We are underinvesting badly in them during this transition from the analog to the digital. If we fail to support libraries in developing new systems, those who follow us will have ample reason to be angry at our lack of foresight.
Drew Faust, now president of Harvard University, wrote an important book on the Civil War, titled "This Republic of Suffering." Her primary texts were gripping letters sent home from the battlefields, sometimes marked with blood and grime, the physical manifestations of war. Faust's book draws upon these letters to bring to life gripping accounts from 150 years ago. The book represents a major contribution to our understanding of our country's most challenging moments.
A century and a half ago, in 1865, Walt Whitman wrote of those who died in the Civil War: "Their precious precious blood" would live on "in unseen essence and odor of surface and grass, centuries hence." So, too, do their last words, in the form of their letters. They live on, not just in Whitman's "Leaves of Grass," but in Faust's book and a film, by Ric Burns based on Faust's work, that commemorate and describe the lives of these soldiers.
Will we have the emails, texts, Skype calls and voice mails sent home from the battlefields of the 21st century? Historians who seek to follow Faust's example decades from now may not be able to repeat her methodology for a major event that occurs today.
If we don't address our underinvestment in libraries and archives, we will have too much information we don't need and too little of the knowledge we do.
John Palfrey is the author of "BiblioTech: Why Libraries Matter More Than Ever in the Age of Google." He is Head of School at Phillips Andover Academy. Palfrey led the effort to reorganize the Harvard Law School Library, and is the founding chairman of the Digital Public Library of America. The author of several books including Born Digital, Palfrey lives in Andover, Massachusetts.


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Fox Entertainment's SideCar names exec team
Fox Entertainment's new company SideCar has unveiled its executive roster, led by Gail Berman. SideCar is a "content development accelerator," headed up by The Jackal Group founder and CEO Berman. The new ...
Fox Entertainment's new company SideCar has unveiled its executive roster, led by Gail Berman.
SideCar is a "content development accelerator," headed up by The Jackal Group founder and CEO Berman. The new unit was established to identify and incubate scripted and unscripted content for the Fox network and its third-party platforms. Fox Entertainment will retain ownership of all series that originate under the SideCar banner.
Among new key positions named are Hend Baghdady (pictured), who assumes the role of executive vice president of development and productions.
Baghdady was previously SVP of alternative and production for The Jackal Group, where her credits included executive producing Tidying Up with Marie Kondo for Netflix.
Meanwhile, Alana Romoff has been named VP of development, and Matthew Chadwick is stepping into the role of VP of alternative programming and production.
Romoff previously oversaw the development and production of The Jackal Group's scripted television projects, while Chadwick was head of production at Animation Domination High-Def Studios.
Other key roles include Susan Lierle as SVP of business and legal affairs; Jeff Nemon as SVP of drama development; and Eduardo Lopez-Mendez as manager of business and legal affairs.
"This truly is an amazing team of accomplished executives," said Berman in a statement. "I've worked with most of them for the past four years, and the reason they've all come over to SideCar is because what they've produced has been stellar. Now, we all have a unified purpose of determining how best to serve the needs of Fox, as well as those of our third-party partners."
Alana Romoff, Fox Entertainment, Gail Berman, Hend Baghdady, Matthew Chadwick, SideCar
Gail Berman to head up new Fox content accelerator SideCar
BermanBraun rebrands as Whalerock Industries
Gary Auerbach, Jackal Group reach first-look deal
Former Fox COO joins The Jackal Group