Home About us Contact
|
Home About us Contact | ||
|
|
||
Study Used Data (study + used_data)
Selected AbstractsMissing data assumptions and methods in a smoking cessation studyADDICTION, Issue 3 2010Sunni A. Barnes ABSTRACT Aim A sizable percentage of subjects do not respond to follow-up attempts in smoking cessation studies. The usual procedure in the smoking cessation literature is to assume that non-respondents have resumed smoking. This study used data from a study with a high follow-up rate to assess the degree of bias that may be caused by different methods of imputing missing data. Design and methods Based on a large data set with very little missing follow-up information at 12 months, a simulation study was undertaken to compare and contrast missing data imputation methods (assuming smoking, propensity score matching and optimal matching) under various assumptions as to how the missing data arose (randomly generated missing values, increased non-response from smokers and a hybrid of the two). Findings Missing data imputation methods all resulted in some degree of bias which increased with the amount of missing data. Conclusion None of the missing data imputation methods currently available can compensate for bias when there are substantial amounts of missing data. [source] Cost savings in migraine associated with less chest pain on new triptan therapy.HEADACHE, Issue 3 2003JT Wang Am J Manag Care. 2002 Feb;8(3 Suppl):S102-S107 Objectives: This article constructs an economic model to estimate cost of chest-pain-related care in migraine patients receiving almotriptan 12.5 mg compared with those receiving sumatriptan 50 mg. Study Design: This population-based, retrospective cohort study used data from the MEDSTAT Marketscan database (Ann Arbor, Michigan) to quantify incidence and costs of chest-pain-related diagnoses and procedures. After a 6-month exclusion period, the study used a pre-post design, with baseline and treatment periods defined, respectively, as 5 months before and after receiving sumatriptan therapy. An economic model was constructed to estimate annual cost savings per 1,000 patients receiving almotriptan instead of sumatriptan as a function of differing rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Results: Among a cohort of 1,390 patients, the incidence of chest-pain-related diagnoses increased significantly (43.6%) with sumatriptan, from 110 during the baseline period to 158 during the treatment period (P = .003). Aggregate costs for chest-pain-related diagnoses and procedures increased 33.1%, from $22,713 to $30,234. Payments for inpatient hospital services rose 10-fold; costs for primary care visits and outpatient hospital visits rose 53.1% and 14.4%, respectively. Payments for angiography increased from $0 to $462, and costs for chest radiographs and electrocardiograms increased 58.7% and 31.2%, respectively. Sumatriptan treatment was associated with a 3-fold increase in payments for services for painful respiration and other chest pain. The model predicted $11,215 in direct medical cost savings annually per 1000 patients treated with almotriptan instead of sumatriptan. Annual direct medical costs avoided for the health plan totaled $195,913. Conclusion: Using almotriptan instead of sumatriptan will likely reduce the cost of chest-pain-related care for patients with migraine headaches. Comment: In my view, this study takes conjecture a step too far. The lower reported chest adverse events (AEs) reported in clinical trials where all AEs are scrutinized will not necessarily lead to lower reporting in the clinic. This hypothesis remains to be proven in a well-designed post-marketing surveillance program, untarnished by commercial sponsorship. Until such an independent prospective study is carried out, the extrapolations described here and in similar papers are pure conjecture and should be classed as the lowest grade of evidence on a par with uncorroborated clinical opinion. DSM [source] Impact of Chest Pain on Cost of Migraine Treatment With Almotriptan and SumatriptanHEADACHE, Issue 2002Joseph T. Wang MS Chest-related symptoms occur with all triptans; up to 41% of patients with migraine who receive sumatriptan experience chest symptoms, and 10% of patients discontinue treatment. Thus, the cost of chest pain-related care was estimated in migraineurs receiving almotriptan 12.5 mg versus sumatriptan 50 mg. A population-based, retrospective cohort study used data to quantify the incidence and costs of chest pain-related diagnoses and procedures. An economic model was constructed to estimate annual cost savings per 1000 patients receiving almotriptan versus sumatriptan based on the reported rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Among a cohort of 1390 patients, the incidence of chest pain-related diagnoses increased significantly by 43.6% with sumatriptan (P=.003). Aggregate costs for chest pain-related diagnoses and procedures increased from $22 713 to $30 234. Payments for inpatient hospital services, costs for primary care visits, and costs for outpatient hospital visits increased by over 100%, 53.1%, and 14.4%, respectively. The model predicted $11 215 in direct medical cost savings annually per 1000 patients treated with almotriptan versus sumatriptan. Annual direct medical costs avoided totaled $194 358, and when applied to recent estimates of 86 million lives currently covered by almotriptan treatment, translates into an annual cost savings of just under $17 million for chest pain and associated care. Thus, using almotriptan in place of sumatriptan will likely reduce the cost of chest pain-related care. [source] Spiritual Seeking, Narcissism, and Psychotherapy: How Are They Related?JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION, Issue 2 2005PAUL WINK This study used data from a long-term longitudinal study of men and women to examine the relations among spirituality, narcissism, and psychotherapy. The findings indicated that in late adulthood (age late 60s/mid 70s) spirituality was related to autonomous or healthy narcissism but was unrelated to willful (overt) or hypersensitive (covert) narcissism, two pathological forms of the construct. Autonomy in early adulthood (age 30s) was a significant predictor of spirituality in late adulthood (a time interval of close to 40 years) and this relation was mediated by involvement in psychotherapy in midlife. Autonomy was related positively, and hypersensitivity was related negatively, to concern for the welfare of future generations. These findings are discussed in light of current concerns about the social implications of the therapeutic culture. [source] Body mass change strategies in blackbirds Turdus merula: the starvation,predation risk trade-offJOURNAL OF ANIMAL ECOLOGY, Issue 2 2005R. MACLEOD Summary 1It is theoretically well established that body mass in birds is the consequence of a trade-off between starvation risk and predation risk. There are, however, no studies of mass variation from sufficiently large wild populations to model in detail the range of diurnal and seasonal mass change patterns in natural populations and how these are linked to the complex environmental and biological variables that may affect the trade-off. 2This study used data on 17 000 individual blackbirds Turdus merula to model how mass changes diurnally and seasonally over the whole year and over a wide geographical area. Mass change was modelled in respect of temperature, rainfall, day length, geographical location, time of day and time of year and the results show how these mass changes vary with individual size, age and sex. 3The hypothesis that seasonal mass is optimized over the year and changes in line with predictors of foraging uncertainty was tested. As theory predicts, reduced day length and reduced temperature result in increased mass and the expected seasonal peak of mass in midwinter. 4The hypothesis that diurnal mass gain is optimized in terms of starvation,predation risk trade-off theory was also tested. The results provide the first empirical evidence for intraspecies seasonal changes in diurnal mass gain patterns. These changes are consistent with shifts in the relative importance of starvation risk and predation risk and with the theory of mass-dependent predation risk. 5In winter most mass was gained in the morning, consistent with reducing starvation risk. In contrast, during the August,November non-breeding period a bimodal pattern of mass gain, with increases just after dawn and before dusk, was adopted and the majority of mass gain occurred at the end of the day consistent with reducing mass-dependent predation risk. The bimodal diurnal mass gain pattern described here is the first evidence that bird species in the wild gain mass in this theoretically predicted pattern. [source] Children With Co-Occurring Anxiety and Externalizing Disorders: Family Risks and Implications for CompetenceAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 4 2009Joan P. Yoo PhD, MSSW This study used data from 340 mother-child dyads to examine characteristics of children with co-occurring diagnoses of anxiety and externalizing disorders and compared them with children with a sole diagnosis or no diagnosis. Comparisons were made using 4 child-diagnostic groups: anxiety-only, externalizing-only, co-occurrence, and no-problem groups. Most mothers were characterized by low income and histories of psychiatric diagnoses during the child's lifetime. Analyses using multinomial logistic regressions found the incidence of co-occurring childhood disorders to be significantly linked with maternal affective/anxiety disorders during the child's lifetime. In exploring implications for developmental competence, we found the co-occurrence group to have the lowest level of adaptive functioning among the 4 groups, faring significantly worse than the no-problem group on both academic achievement and intelligence as assessed by standardized tests. Findings underscore the importance of considering co-occurring behavior problems as a distinct phenomenon when examining children's developmental outcomes. [source] Quality of Care for Acute Myocardial Infarction in Rural and Urban US HospitalsTHE JOURNAL OF RURAL HEALTH, Issue 2 2004Laura-Mae Baldwin MD ABSTRACT: Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI. [source] Does Postpartum Length of Stay Affect Breastfeeding Duration?BIRTH, Issue 3 2003A Population-Based Study Women leaving the hospital early may also have household responsibilities that could interfere with breastfeeding. This study examined the relationship between postpartum length of stay and breastfeeding cessation. Methods: This study used data from 10,519 respondents to the California Maternal and Infant Health Assessment (MIHA) surveys from 1999 to 2001. MIHA is an annual statewide stratified random sample, population-based study of childbearing women in California. Survival analysis was used to examine the relationship between length of stay and length of time breastfeeding. Women were asked about the number of nights their infant stayed in the hospital at birth, whether they breastfed, and if so, the age of the child when they stopped. Hospital stay was defined in three categories: standard (2 nights for a vaginal delivery, 4 nights for a cesarean section), or shorter or longer than the standard stay. Results: Approximately 88 percent of women initiated breastfeeding. Unadjusted predictors of breastfeeding cessation included short or long postpartum stay; young maternal age; Hispanic, African American, or Asian/Pacific Islander race/ethnicity; being unmarried; low income or education level; primiparity; being born in the 50 United States or the District of Columbia; smoking during pregnancy; and low infant birthweight. After adjustment for potential confounders, women with a short stay remained slightly more likely to terminate breastfeeding than women with a standard stay (relative risk, 1.11, 95% confidence interval 1.01, 1.23). Conclusion: Women who leave the hospital earlier than the standard recommended stay are at somewhat increased risk of terminating breastfeeding early. (BIRTH 30:3 September 2003) [source] Craniosynostosis and maternal smoking,BIRTH DEFECTS RESEARCH, Issue 2 2008Suzan L. Carmichael Abstract BACKGROUND: Several previous studies suggested increased risk of craniosynostosis among infants born to women who smoked. METHODS: This study used data from the National Birth Defects Prevention Study, a multi-state, population-based case-control study of infants delivered from 1997,2003. Nonmalformed, liveborn controls were selected randomly from birth certificates or birth hospitals. Data from maternal telephone interviews were available for 531 cases and 5008 controls. RESULTS: Smoking during the first month of pregnancy was not associated with craniosynostosis. Smoking later in pregnancy was associated with increased risk, but only among mothers who smoked at least one pack/day. For example, during the second trimester, the odds ratio for smoking <5 cigarettes/day was 1.0 (95% confidence interval [CI] 0.6, 1.8), but the odds ratio (OR) for smoking 15 or more cigarettes/day was 1.6 (95% CI 0.9, 2.8), after adjustment for maternal age, education, race-ethnicity, sub-fertility, parity, folic acid supplement intake, body mass index, and study center. Among women who did not smoke, adjusted odds ratios suggested that secondhand smoke exposure at home, but not at work/school, was associated with modestly increased risk; the OR for home exposure was 1.3 (95% CI 0.9, 1.9). Results followed a similar pattern for some, but not all, specific suture types, but numbers for some groupings were small. CONCLUSIONS: The results suggest moderately increased risk of craniosynostosis among mothers who were the heaviest smokers and who continued to smoke after the first trimester. Results are somewhat equivocal, given that most confidence intervals included one. Birth Defects Research (Part A), 2008. © 2007 Wiley-Liss, Inc. [source] | |||||||||||||