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Secondary Data Analysis (secondary + data_analysis)
Selected AbstractsMatching motivation enhancement treatment to client motivation: re-examining the Project MATCH motivation matching hypothesisADDICTION, Issue 8 2010Katie Witkiewitz ABSTRACT Aims The current study was designed to re-examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns. Design, setting and participants Secondary data analyses of data from Project MATCH (n = 1726), a large multi-site alcoholism treatment-matching study. Measurements Percentage of drinking days was the primary outcome measure, assessed from 1 month to 12 months following treatment. Treatment assignment, alcohol dependence symptoms and baseline percentage of drinking days were included as covariates. Findings The results provided support for the motivation matching hypothesis in the out-patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT. Conclusions Results from the current study lend partial support to the motivation-matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out-patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive,behavioral techniques. [source] Does progressive stage transition mean getting better?ADDICTION, Issue 10 2007A test of the Transtheoretical Model in alcoholism recovery ABSTRACT Aims To test two central assumptions of stage movement in the Transtheoretical Model (TTM) vis-à-vis alcoholism recovery: (assumption 1) individuals making a forward transition to the action-oriented stages (i.e. preparation/action) will manifest relatively greater drinking improvements than their counterparts remaining in the pre-action stages (i.e. pre-contemplation, contemplation); and (assumption 2) individuals remaining in the pre-action stages across time will not demonstrate clinically relevant improvement in drinking outcomes. Design and setting Secondary data analyses of data from Project MATCH, a large multi-site alcoholism treatment-matching study. Measurements At baseline and 3 months post-treatment, the following variables were measured: stage-of-change (based on the University of Rhode Island Change Assessment measure and the most recent stage assignment algorithm), drinks per drinking day (DDD) and percentage days abstinent (PDA). Findings Six of the eight tests of assumptions 1 and 2 failed to support the basic tenets of the TTM. Our study demonstrated that individuals making a progressive stage transition to the action-oriented stages (i.e. preparation/action) do not necessarily manifest greater improvements in drinking-related behavior than individuals remaining in the pre-action stages (i.e. pre-contemplation, contemplation), and that individuals remaining in the pre-action stages over time actually do manifest statistically significant and clinically important improvements in drinking-related behavior. Conclusions Our findings challenge not only the criterion validity associated with stage movement in the TTM account of alcoholism recovery, but also recent TTM-based substance abuse treatment approaches which systematically promote forward stage transition as a primary clinical goal and marker of therapeutic success. [source] Meaningful Change and Responsiveness in Common Physical Performance Measures in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006Subashan Perera PhD OBJECTIVES: To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness. DESIGN: Secondary data analyses using distribution- and anchor-based methods to determine meaningful change. SETTING: Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors. PARTICIPANTS: Older adults with mobility disabilities in a strength training trial (n=100), subacute stroke survivors in an intervention trial (n=100), and a prospective cohort of community-dwelling older people (n=492). MEASUREMENTS: Gait speed, Short Physical Performance Battery (SPPB), 6-minute-walk distance (6MWD), and self-reported mobility. RESULTS: Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed, 0.27 to 0.55 points for SPPB, and 19 to 22 m for 6MWD. Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed, 0.99 to 1.34 points for SPPB, and 47 to 49 m for 6MWD. Based on responsiveness indices, per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change. CONCLUSION: Best initial estimates of small meaningful change are near 0.05 m/s for gait speed, 0.5 points for SPPB, and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed, 1.0 point for SPPB, and 50 m for 6MWD. For clinical use, substantial change in these measures and small change in gait speed and 6MWD, but not SPPB, are detectable. For research use, these measures yield feasible sample sizes for detecting meaningful change. [source] Impact of Terminal Digit Preference by Family Physicians and Sphygmomanometer Calibration Errors on Blood Pressure Value: Implication for Hypertension ScreeningJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2008Theophile Niyonsenga PhD The accuracy of blood pressure (BP) measurement is important; systematic small errors can mislabel BP status in many persons. The objective of this study was to assess the impact of 2 types of measurement errors on the evaluation of BP in family medicine: errors associated with terminal digit preference and those associated with calibration errors of sphygmomanometers. Secondary data analyses from 2 different projects were used to derive empiric distributions of terminal digit and BP device errors. Taking into account both types of errors, the proportion of false positives (falsely high BP) and false negatives (falsely normal BP) varied between 0. 82% and 5.18% of the population of consulting family physicians. In the United States, false positives and false negatives in patients' BP evaluations might lead to overtreating or undertreating 1.15 million to 7.25 million patients. Results support the need for the development of systematic interventions for quality control of BP measurements and periodic retraining for health professionals. [source] Subtypes of major depression in substance dependenceADDICTION, Issue 10 2009Mark J. Niciu ABSTRACT Aims This study evaluated features that differentiate subtypes of major depressive episode (MDE) in the context of substance dependence (SD). Design Secondary data analysis using pooled data from family-based and case,control genetic studies of SD. Setting Community recruitment through academic medical centers. Participants A total of 1929 unrelated subjects with alcohol and/or drug dependence. Measurements Demographics, diagnostic criteria for psychiatric and substance use disorders and related clinical features were obtained using the Semi-Structured Assessment for Drug Dependence and Alcoholism. We compared four groups: no life-time MDE (no MDE), independent MDE only (I-MDE), substance-induced MDE only (SI-MDE) and both types of MDE. Findings Psychiatric measures were better predictors of MDE subtype than substance-related or socio-demographic ones. Subjects with both types of MDE reported more life-time depressive symptoms and comorbid anxiety disorders and were more likely to have attempted suicide than subjects with I-MDE or SI-MDE. Subjects with both types of MDE, like those with I-MDE, were also more likely than subjects with SI-MDE to be alcohol-dependent only than either drug-dependent only or both alcohol- and drug-dependent. Conclusions SD individuals with both types of MDE have greater psychiatric severity than those with I-MDE only or SI-MDE only. These and other features that distinguish among the MDE subtypes have important diagnostic and potential therapeutic implications. [source] Comparing United States versus International Medical School Graduate Physicians Who Serve African- American and White ElderlyHEALTH SERVICES RESEARCH, Issue 6 2006Daniel L. Howard Objective. To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. Data Sources. Secondary data analysis of the 1986,1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. Study Design. Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and ,2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. Data Collection/Extraction Methods. Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. Principal Findings. Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. Conclusion. IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations. [source] Access to Health Care Services for the Disabled ElderlyHEALTH SERVICES RESEARCH, Issue 3p1 2006Donald H. Taylor Jr. Objective. To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures. Data Source. Secondary data analysis of Medicare claims data (1999,2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of the 1999 National Long Term Care Survey (NLTCS). Study Design. Longitudinal cohort study. Walking difficulty and compensatory strategy were measured at the 1999 NLTCS, and used to predict health care use as measured in Medicare claims data from the survey date through year-end 2000. Data Extraction. Respondents to the 1999 community NLTCS with complete information on key explanatory variables (walking difficulty and compensatory strategy) were linked with Medicare claims to define outcome variables (health care use and cost). Principal Findings. Persons who reported it was very difficult to walk had more downstream home health visits (1.1/month, p<.001), but fewer outpatient physician visits (,0.16/month, p<.001) after controlling for overall disease burden. Those using a compensatory strategy for walking also had increased home health visits/month (0.55 for equipment, 1.0 for personal assistance, p<.001 for both) but did not have significantly reduced outpatient visits. Persons reporting difficulty walking had increased downstream Medicare costs ranging from $163 to $222/month (p<.001) depending upon how difficult walking was. Less than half of the persons who used equipment to adapt to walking difficulty had their difficulty fully compensated by the use of equipment. Persons using equipment that fully compensated their difficulty used around $300/month less in Medicare-financed costs compared with those with residual difficulty. Conclusions. Difficulty walking and use of compensatory strategies are correlated with the use of Medicare-financed services. The potential impact on the Medicare program is large, given how common such limitations are among the elderly. [source] Tales of resistance and other emancipatory functions of storytellingJOURNAL OF ADVANCED NURSING, Issue 11 2009Jane S. Grassley Abstract Title.,Tales of resistance and other emancipatory functions of storytelling. Aim., This paper is the report of a study to explore how the process of storytelling might facilitate women's emancipatory knowing, using examples from women's breastfeeding stories. Background., Storytelling, as an interactive process, can give women a way to explain pivotal life events, justify choices, examine reality and find meaning in experiences. Emancipatory functions of storytelling have been identified as contextual grounding, bonding with others, validating and affirming experiences, venting and catharsis, resisting oppression and educating others. Method., Secondary data analysis was conducted in 2008 on breastfeeding stories originally gathered from 13 women from 2002 to 2004 for a feminist hermeneutic study of maternal breastfeeding confidence. The stories were re-examined through the lens of the emancipatory functions of storytelling. Illustrations of contextual grounding, validating and affirming experiences, venting and catharsis and acts of resistance were found in the breastfeeding stories and presented as exemplars of emancipatory knowing. Findings., Women revealed the difficulties they encountered breastfeeding, transforming these experiences as they discovered their meaning. They described collisions that occurred when personal, familial, healthcare professionals' or cultural expectations differed from their experience. The stories suggested possible liberation from old ideologies about breastfeeding as women redefined the difficulties they encountered. Conclusion., Storytelling has potential as a simple, yet profound, and powerful emancipatory intervention which nurses can use to help women in their care make sense of and transform experiences of health and illness. Storytelling may have global implications for nursing practice and research. [source] The Co-Occurrence of Chronic Diseases and Geriatric Syndromes: The Health and Retirement StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009Pearl G. Lee MD OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality. DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS). SETTING: Nationally representative health interview survey. PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older. MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education). RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions. CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes. [source] Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010SeonAe Yeo RNC Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source] Crossing national boundaries: A typology of qualified immigrants' career orientationsJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 5 2010Jelena Zikic Abstract This qualitative study examines objective,subjective career interdependencies within a sample of 45 qualified immigrants (QIs) in Canada, Spain and France. The particular challenges in this type of self-initiated international careers arise from the power of institutions and local gatekeepers, the lack of recognition for QIs' foreign career capital, and the need for proactivity. Resulting from primary data analysis, we identify six major themes in QIs' subjective interpretations of objective barriers: Maintaining motivation, managing identity, developing new credentials, developing local know-how, building a new social network and evaluating career success. Secondary data analysis distinguishes three QI career orientations,embracing, adaptive and resisting orientations,with each portraying distinct patterns of motivation, identity and coping. This study extends the boundaryless career perspective by providing a more fine-grained understanding of how qualified migrants manage both physical and psychological mobility during self-initiated international career transitions. With regards to the interdependence between objective and subjective career aspects, it illustrates the importance of avoiding preference to one side at the neglect of the other, or treating the two sides as independent of one another. Practical implications are proposed for career management efforts and receiving economies. Copyright © 2010 John Wiley & Sons, Ltd. [source] Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back PainPAIN MEDICINE, Issue 4 2009Natalia E. Morone MD ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source] Cluster Subtypes within the Preparation Stage of Change for Sun Protection BehaviorAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 1 2010Marimer Santiago-Rivas Objective: Numerous effective tailored interventions for smoking cessation and other behaviors have been developed based on the Transtheoretical Model. Recent studies have identified clusters within each stage of change. The goal of this study is to determine if replicable clusters exist within the Preparation stage of change for sun protection. Method: Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Two random samples of approximately 128 participants were selected from subjects in the Preparation stage (N = 258). Cluster analyses were performed using Ward's Method on the standardised scores from the three scales of Pros, Cons, and Self-Efficacy. Interpretability of the pattern, pseudo F test, and dendograms were used to determine the number of clusters. Results: A four-cluster solution replicated across subsamples. Differences between clusters on eight of the nine Processes of Change, and on behavioral measures, were found. Discussion: The cluster solutions were robust, easily interpretable, and demonstrated good initial external validity. They replicated patterns found for other behaviors that have demonstrated long-term predictability and can provide the basis for a tailored intervention. [source] Nutrition and physical activity behaviours among Mäori, Pacific and NZ European children: identifying opportunities for population-based interventionsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2006Jennifer Utter Objectives:To describe how the prevalences of nutrition and physical activity behaviours vary by ethnicity, while controlling for other socio-demographic characteristics, and to identify appropriate points of intervention for defined ethnic populations of New Zealand children. Methods:Secondary data analysis of the 2002 National Children's Nutrition Survey. Results:Few ethnic differences were significant for fruit and vegetable consumption and indicators of physical activity. Where ethnic differences in physical activity were significant, Mäori children and Pacific children were more active than New Zealand European/Other (NZEO) children. Pacific children and Mäori children were significantly more likely to skip meals than NZEO children. Pacific children and Mäori children were significantly more likely to buy some/most of the food they consumed at school from the tuckshop or dairy while NZEO children were more likely to bring their school food only from home. Likewise, Pacific children and Mäori children were significantly more likely to be high consumers of some fatty and sugary foods than NZEO children. Conclusions and Implications:Meal skipping and purchasing food away from home were common for Mäori children and Pacific children; school-based programs that aim to improve access to and subsidise the price of healthy foods, including breakfast, could greatly benefit Mäori and Pacific students. Efforts to improve fruit and vegetable consumption and physical activity should be more universally applied and made culturally appropriate for all children. [source] Prevalence of Breastfeeding and Acculturation in Hispanics: Results from NHANES 1999,2000 StudyBIRTH, Issue 2 2005Maria V. Gibson MD The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. Methods: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999,2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. Results: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14,0.40) even after education, age, and income were taken into account. Conclusions: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful. (BIRTH 32:2 June 2005) [source] Disabled children (0,3 years) and integrated services , the impact of Early SupportHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2008Alys Young PhD MSc BA(Hons) CQSW Abstract Early Support (ES) is the flagship government programme aimed at improving multi-agency working with, and supporting enhanced outcomes for, children with a disability 0,3 years and their families. This paper draws on results from the recently completed Department for Education and Skills commissioned national evaluation of ES involving 46 pathfinder projects throughout England. Data were collected by survey at two points in time (9 months apart), by focus groups with service providers and parents, and through secondary data analyses, including exploratory economic evaluation. This paper outlines some of the key findings pertaining to the relationship between integrated children's services and the impact of ES. As such, we address three concerns: what the evidence from ES can tell us about the relationships between universal and targeted provision within integrated children's service structures, the relationship between specific short-term initiatives and their longer-term sustainability within integrated children's services structures and the potential costs and benefits of ES looking forward to its implementation on a national basis within an integrated children's services environment. Although focused primarily on children with a disability in the early years, implications will be drawn for the implementation of Lead Professional Guidance and the Common Assessment Framework more generically. [source] Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010SeonAe Yeo RNC Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source] Weighting and adjusting for design effects in secondary data analysesNEW DIRECTIONS FOR INSTITUTIONAL RESEARCH, Issue 127 2005Scott L. Thomas Institutional researchers frequently use national datasets such as those provided by the National Center for Education Statistics (NCES). The authors of this chapter explore the adjustments required when analyzing NCES data collected using complex sample designs. [source] Categorizing Urgency of Infant Emergency Department Visits: Agreement between CriteriaACADEMIC EMERGENCY MEDICINE, Issue 12 2006Rakesh D. Mistry MD Abstract Background The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization. Objectives To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits. Methods This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (,) between the implicit criteria and alternative methods were measured. Results A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD ± 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (,= 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (,= 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (,= 0.35 and ,= 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent. Conclusions The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available. [source] Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2008Patricia A. Areán Abstract Objective In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRIMSe) study, we hypothesized that older minorities who receive mental health services integrated in primary care settings would have greater service use and better mental health outcomes than older minorities referred to community services. Method We identified 2,022 (48% minorities) primary care patients 65 years and older, who met study inclusion criteria and had either alcohol misuse, depression, and/or anxiety. They were randomized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services. Service use and clinical outcomes were collected at baseline, three months and six months post randomization on all participants. Results Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral; there were no treatment by ethnicity effects. There were no treatment effects for any of the clinical outcomes; Whites and older minorities in both integrated and referral groups failed to show clinically significant improvement in symptoms and physical functioning at 6 months. Conclusions While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source] Refinement of an osteoporosis risk-assessment questionnaire for use in community pharmacyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2008Lee Ser Poh pharmacy practice advanced student Objective To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre-BMD test screen. Method A secondary data analysis was conducted on the responses of 193 participants to a risk-assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively. Key findings A total of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non-BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high-risk category when BMD results were incorporated in the risk assessments (X2 = 0.78, degrees of freedom (df) = 1, 0.3 < P < 0.5). A statistically significant difference in risk categorisation was found between the pharmacists and researchers in the non-BMD group (X2 = 23.9, df = 1, P < 0.001). Risk factors identified to be significantly affecting BMD and of use for identifying patients at high risk for osteopenia/osteoporosis were age, weight, postmenopause and absence of hormone replacement therapy (HRT). These four factors were used to construct a simple risk index to guide pharmacists' initial risk categorisation. Conclusion The findings of this study suggested that BMD testing may increase the effectiveness of risk assessments and enhance the screening procedures in the community pharmacy. The simple risk index could serve as a pre-BMD test screen, with a BMD test recommended when necessary. A refined risk-assessment questionnaire could serve to guide pharmacists in directing individualised counselling and advice for at-risk patients, through identification of modifiable risk factors and conditions. [source] Patterns of Treatment Services and Costs for Young Offenders with Mental DisordersJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2005Deborah Shelton PhD PROBLEM:,This study describes mental health treatment service delivery patterns and costs for youth in a juvenile justice system. METHODS:,A secondary data analysis on a random sample of juvenile offenders (N = 312) was completed. Service patterns and costs were described. Selected variables were examined for their ability to predict who received treatment. FINDINGS:,Only 23% of youth diagnosed with a mental disorder received any treatment. Older youth and African American youth received fewer services, and race was the only significant predictor for receiving treatment (p = .001). CONCLUSIONS:,Mental health treatment services were scarce, and the data reflects a race bias in the provision of services. Although the law protects the right to treatment for these individuals, provision of services remains a challenge. [source] Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010SeonAe Yeo RNC Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source] Treatment Completion in a Brief Motivational Intervention in the Emergency Department: The Effect of Multiple Interventions and Therapists' BehaviorALCOHOLISM, Issue 2007Janette Baird Background:, The aim of this study was to identify therapist behaviors during a brief motivational intervention (BMI) given to injured emergency department patients that predicted participant return for a second BMI session and 12-month alcohol-related outcomes. Method:, This was a secondary data analysis of a randomized controlled trial (n = 539) previously demonstrating that random assignment to a BMI and booster session resulted in a significant reduction of 12-month postintervention alcohol-related injuries and negative consequences relative to standard care. Results:, Participants who actually received 2 BMI sessions had significantly less alcohol-related negative consequences than those who received only 1 BMI session. Therapists who reported a higher focus on emotional support and low focus on participant drinking behaviors during the initial BMI session were more likely to have assigned participants return for the second BMI session. Conclusion:, The results of these secondary analyses show that compliance with a 2-session therapeutic intervention (BIB) predicted fewer negative alcohol-related consequences, and that therapists' supportive emotional emphasis during the first BMI session was important in predicting participants returning for the second MI session. [source] Serum 6-Beta-Naltrexol Levels Are Related to Alcohol Responses in Heavy DrinkersALCOHOLISM, Issue 9 2000Mary E. McCaul Background: There is strong evidence for the role of the endogenous opioid system in alcohol reinforcement and consumption; however, recent human laboratory studies and clinical trials have reported mixed effects of naltrexone (a nonselective opioid antagonist) on alcohol-related behaviors. This paper reports a secondary data analysis of a human laboratory study that examines the relationship between serum levels of 6-beta-naltrexol, the major, biologically active metabolite of naltrexone, and subjective effects of alcohol. Methods: The study used a within-subjects design to examine the effects of naltrexone (0, 50, and 100 mg/day) on subjective responses to alcohol (none, moderate, and high dose) in heavy drinkers (n= 23). Each subject received three doses of naltrexone in random order; each naltrexone dose was administered over an 8 day period on an inpatient unit, with a 1 week outpatient washout between doses. After stabilization at each of the naltrexone doses, subjects participated in three alcohol challenge sessions (none, moderate, and high dose) in random order; thus, each subject participated in a total of nine alcohol administration sessions. Results: Doubling the naltrexone dose (50 vs. 100 mg/day) doubled the mean serum 6-beta-naltrexol levels. At each naltrexone dose, there was a 4-fold range in 6-beta-naltrexol levels across subjects. Before alcohol administration, higher 6-beta-naltrexol levels were associated with higher ratings of sedation. After high-dose alcohol administration, higher 6-beta-naltrexol levels were associated with significantly lower ratings of liking and best effects. Conclusions: These findings provide further evidence of the involvement of the opioid system in the modulation of alcohol effects and suggest that serum 6-beta-naltrexol concentrations may be important in predicting therapeutic response to naltrexone. [source] Gender and culture differences in the quality of life among Americans and Koreans with atrial fibrillationNURSING & HEALTH SCIENCES, Issue 3 2009Younhee Kang rn, msn-anp Abstract This study examined the gender and culture differences in relation to the quality of life among Americans and Koreans with atrial fibrillation. It employed secondary data analysis and a descriptive comparative design. The settings were the cardiology outpatient clinics and the outpatient clinic in two urban hospitals in the USA and one university hospital in Korea. The quality of life was measured by the Short-Form Health Survey. The data from 129 subjects were analyzed by two-way ANCOVA and a post-hoc test. In relation to physical function, there was a statistically significant effect shown by gender, but no significant differences were found by the main effect of culture and the interaction effect of gender and culture. The significant interaction effect of gender and culture on mental health was shown. In conclusion, gender differences in the quality of life perceived by patients with atrial fibrillation varied with their cultural background. Thus, patients' cultural background should be considered in nursing practice. [source] Pilot Study Examining the Utility of Microarray Data to Identify Genes Associated with Weight in Transplant RecipientsNURSING & HEALTH SCIENCES, Issue 2 2006Ann Cashion Purpose/Methods:, Obesity, a complex, polygenic disorder and a growing epidemic in transplant recipients, is a risk factor for chronic diseases. This secondary data analysis identified if microarray technologies and bioinformatics could find differences in gene expression profiles between liver transplant recipients with low Body Mass Index (BMI < 29; n = 5) vs. high (BMI > 29; n = 7). Blood was hybridized on Human U133 Plus 2 GeneChip (Affymetrix) and analyzed using GeneSpring Software. Results:, Groups were similar in age and race, but not gender. Expression levels of 852 genes were different between the low and high BMI groups (P < 0.05). The majority (562) of the changes associated with high BMI were decreases in transcript levels. Among the 852 genes associated with BMI, 263 and 14 genes were affected greater than 2- or 5-fold, respectively. Following functionally classification using Gene Ontology (GO), we found that 19 genes (P < 0.00008) belonged to defense response and 15 genes (P < 0.00006) belonged to immune response. Conclusion:, These data could point the way toward therapeutic interventions and identify those at-risk. These results demonstrate that we can (1) extract high quality RNA from immunosuppressed patients; (2) manage large datasets and perform statistical and functional analysis. [source] Potential bias caused by control selection in secondary data analysis: Nonaspirin nonsteroidal anti-inflammatory drugs and hemorrhagic stroke,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2010Nam-Kyong Choi PhD Abstract Background This study investigated the potential for bias introduction when selecting controls for secondary analysis of case-control study data. Methods We used a data set previously collected for an acute brain bleeding analysis (ABBA) study, which was designed to investigate the risk of hemorrhagic stroke (HS) resulting from the use of phenylpropanolamine in Korea. Cases in that study had experienced an HS. Each HS case was matched with age- and gender-based hospital and community controls. Information was obtained on drug exposures including nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs). Odds ratios (OR) for, and 95% confidence intervals (CI) of, experiencing an HS were calculated using conditional logistic regressions for each control group. Results A total of 940 patients were matched with 1880 controls. The OR of HS occurring in NANSAID users was 1.18 (95%CI, 0.80,1.73) in community controls and 0.67 (95%CI, 0.45,0.98) in hospital controls. The majority of the hospital controls were selected from patients who had visited neurology, neurosurgery, or orthopedic departments. Conclusion The difference between OR values estimated from hospital and community controls could be the result of selection bias. The study data were originally obtained for a different purpose than this study, and NANSAID use was not considered when the hospital controls were selected. When performing secondary analyses, extra care is needed to note whether the results are consistent across control groups and whether there are indications of bias related to the selection of those controls. Copyright © 2010 John Wiley & Sons, Ltd. [source] Surveillance of occupational health disparities: Challenges and opportunities,,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010Kerry Souza ScD Abstract Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA). Am. J. Ind. Med. 53:84,94 2010. Published 2010 Wiley-Liss, Inc. [source] Spatial segregation, segregation indices and the geographical perspectivePOPULATION, SPACE AND PLACE (PREVIOUSLY:-INT JOURNAL OF POPULATION GEOGRAPHY), Issue 2 2006Lawrence A. Brown Abstract What could be more inherently geographical than segregation? However, the richness of the spatial variations in segregation is seldom captured by the dominant genre of empirical research. Returning the ,geography' to segregation research, we argue that local areas need to be given considerably more attention, using measures that explicitly reveal the spatial fabric of residential clustering along racial/ethnic lines. We first critique global measures such as the Dissimilarity Index and its spatial counterparts. Attention then turns to local measures such as the Location Quotient and Local Moran's I, applying them to Franklin County, Ohio, the core of Columbus MSA (Metropolitan Statistical Area). Our interpretation of the findings also employs local knowledge concerning neighbourhood characteristics, ongoing urban processes, historical occurrences, and the like. Thus, while local indices based on secondary data expose the terrain of clustering/segregation, follow-up fieldwork and/or secondary data analysis in a mixed-methods framework provides a better understanding of the ground-level reality of clustering/segregation. Tangible evidence of the gain from this approach is provided by our evaluation of conventional frameworks for understanding racial/ethnic aspects of residential patterning , assimilation, stratification and resurgent ethnicity , and in our proposal for a new framework, ,market-led pluralism', which focuses on market makers who represent the supply side of housing. Copyright © 2006 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||