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Results for “Secondary Data Analysis”

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At least 181 records · Page 10Linked to original sources

PubMed2003

Accuracy of collateral source reports in very mild to mild dementia of the Alzheimer type.

OBJECTIVES: To examine the reporting accuracy of collateral sources (knowledgeable informants) regarding very mild and mild dementia of the Alzheimer type (DAT) and to identify characteristics associated with collateral source accuracy. DESIGN: Secondary data analysis of initial visits of individuals enrolled in a longitudinal study of healthy aging and Alzheimer disease. SETTING: Urban Alzheimer disease research center. PARTICIPANTS: Pairs of 515 individuals with very mild (n = 203) or mild (n = 312) DAT and their collateral sources. MEASUREMENTS: Collateral sources were asked separately during a semistructured interview by experienced clinicians to report current ability of the individual with DAT in memory, orientation, and judgment and problem solving. The clinical performance of the individuals with DAT in these domains was compared with these predictions. RESULTS: Collateral sources were consistently and significantly accurate in reporting the cognitive capabilities of individuals with very mild and mild DAT. Although all types of collateral sources performed significantly better than chance, individual variables that correlated with collateral source accuracy included spousal relationship; living with the individual with DAT; frequent exposure to the individual; and age, education level, sex and dementia severity of the individual with DAT. CONCLUSION: Collateral sources are accurate in reporting the cognitive capabilities of individuals with DAT, even in the very mild stage of dementia.

Aged↗

PubMed2001

The validity of the 12-item General Health Questionnaire in Australia: a comparison between three scoring methods.

OBJECTIVE: To investigate the specificity and sensitivity of three different scoring methods of the 12-item General Health Questionnaire (GHQ-12) and hence to determine the best GHQ-12 threshold score for the detection of mental illness in community settings in Australia. METHOD: Secondary data analysis of the 1997 Australian National Survey of Health and Wellbeing (n = 10 641), using the Composite International Diagnostic Interview as the gold standard for diagnosis of mental illness. RESULTS: The area under the Receiver Operating Characteristic (ROC) curve for the C-GHQ scoring method was 0.84 (95% CI = 0.83-0.86) compared with the area for the standard scoring method of 0.78 (95% CI = 0.76-0.80). The best threshold with C-GHQ was 3/4, with sensitivity 82.9% (95% CI = 80.2-85.5%) and specificity 69.0% (95% CI = 68.6-69.4%). The best threshold score with the standard scoring method was 0/1, with sensitivity 75.4% (95% CI = 72.5-78.4%) and specificity 69.9% (95% CI = 69.5-70.3%). These were also the best thresholds for a subsample of the population who had consulted a health practitioner in the previous 4 weeks. CONCLUSION: In the Australian setting, the C-GHQ scoring method is preferable to the standard method of scoring the GHQ-12. In Australia the GHQ-12 appears to be a less useful instrument for detecting mental illness than in many other countries.

Adolescent↗

PubMedDate not supplied

Client characteristics and the cost of home care in the prospective payment system.

There has been much speculation in the literature about the effect of the prospective payment system (PPS) on the home care industry but few reports of systematic investigation. Clearly, comprehension of client characteristics is essential for categorizing home care clients into the correct Home Health Resource Groups, for allocating resources appropriately, and for implementing necessary organizational changes to accommodate clients who require variations in the amount of resources predicted by the PPS. The purposes of this study were to compare the characteristics of home health clients that resulted in a financial gain or a financial loss for one agency under the PPS with those of the interim payment system. A secondary data analysis of 140 cases compiled by one not-for-profit hospital-affiliated home care organization was completed. Results suggested that client characteristics of the projected loss group had more recertifications on admission and at the end of the 60-day episode, a longer stay (3 weeks), and more visits, particularly from skilled nursing. Comprehension of client characteristics and the subsequent ability to adjust for the proper case mix will be crucial if home care agencies are to remain financially viable under the PPS. Replication of this project needs to be done using more variables and multiple sites.

Adult↗

PubMed2002

The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Old.

OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans. DESIGN: Panel study; secondary data analysis. SETTING: United States (national sample). PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998). MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses. RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption. CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.

Age Distribution↗

PubMed2002

Use of item response theory to link 3 modules of functional status items from the Asset and Health Dynamics Among the Oldest Old study.

OBJECTIVE: To link, by using item response theory (IRT), 3 modules of functional status items in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. DESIGN: Secondary data analysis of the functional status items in the AHEAD study. In that study, participants completed a common set of functional status items and were randomly assigned to complete 1 of 2 modules containing different functional status items. SETTING: A nationally representative panel study of elderly. PARTICIPANTS: US baseline data from 4655 respondents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nineteen common items and 2 sets of supplemental items that measure functional status. RESULTS: A 2-parameter model for dichotomous items was used for linking the 3 modules of items. By using this model, both sets of supplemental items were successfully linked to the common items, allowing the placement of all items on the same underlying measure of ability. The small-muscle instrumental activities of daily living were the easiest of all the items for respondents to perform. The item on walking from the Longitudinal Study of Aging was the most difficult for respondents to perform. CONCLUSIONS: IRT-based linking methods were a useful way to overcome test dependency and to place items on a common metric even if different respondents answer different sets of items. Numerous important design features can degrade linking results and should be attended to in future linking studies.

Activities of Daily Living↗

PubMed2001

Teaching by the nurse: how important is it to patients?

Few studies address patients' perceptions of the importance of education by a nurse and how this relates to their view of quality care. This article reports on a secondary data analysis that examined the influence of demographic and background characteristics and health status on the importance of teaching to patients (n = 239) in ambulatory care. Health education by nurses was important to patients, some more than others. Teaching for health promotion was more important to men than to women (t = 2.51, p = 0.01) and more important to Blacks than to Whites (t = 3.43, p = 0.001). As patients' educational level increased, it was less important to have a nurse in ambulatory care teach them about their illness and treatments and about health promotion. Patient education and being able to call a nurse with questions were significantly more important to patients with lower incomes and lower mental and emotional health scores.

Ambulatory Care↗

PubMed2003

Role functioning and symptom remission in women with postpartum depression after antidepressant treatment.

The primary purpose of this pilot study was to compare improvement of symptoms and role functioning in women with postpartum depression after 8 weeks of treatment with antidepressants. The study was a secondary data analysis from the preliminary data of a double blind, randomized clinical trial. The participants (n=61) were primarily Caucasian and slightly over half were married, first time mothers, and middle- to upper-middle-class. At intake, most participants were moderately to severely ill. At week one and week eight of the study, measures of symptoms and functioning were only moderately correlated. After 8 weeks of antidepressant treatment, symptoms and most measures of functional status improved; however, improvement in one dimension did not imply improvement in the other. Recommendations are given for clinical practice and further research in this area.

Adaptation, Psychological↗

PubMed2002

[Effects of a regional intervention to promote asthma guidelines implementation].

AIM: Despite of asthma guidelines existing for years, secondary data analysis shows insufficient medical care of asthmatics in Germany. The aim of the present study was to improve asthma guideline adherence by promoting guidelines implementation. METHOD: We analyzed prospectively pre- and post-interventional medical care of a sample of 127 asthmatics who were recruited by physicians working in ambulatory care and in hospitals of the Region Neckar-Alb, Germany. Data came primarily from patient interviews by phone. Our intervention to promote guidelines implementation consisted of following methods: 1. analyzing regional asthma care followed by a feedback performance report to physicians; 2. delivering asthma patient diaries and peak flow meters to study patients; 3. developing and adapting regionally asthma guidelines for adult asthmatics in the Region of Neckar-Alb; 4. promoting guidelines utilization by publishing the adapted guidelines in a scientific journal, direct mailing of a short version to the practitioners, and boosting the guidelines at regional CE meetings; 5. reanalyzing asthma care of the study cohort and the implementation of the guidelines 13 months after the beginning of the intervention. We studied the effect of the intervention using a qualitative model comprising 18 quality indicators measuring the proportion of patients who were treated in accordance to the guidelines. To compare pre- and post-interventional proportions we used the McNemar test for statistical analysis. RESULTS: The proportion of asthmatics treated in accordance to the guidelines improved significantly from 48 % to 57 %. The increase was mainly due to an improvement of guidelines adherence within the field of promoting asthma self-management and continuous monitoring of patients (42 % pre- and 57 % post-intervention), whereas guidelines adherence in pharmacotherapy improved only from 53 % to 56 %. CONCLUSION: The proportion of asthmatics treated in accordance to guidelines can be improved by using a multifaceted regional approach to promote guidelines implementation.

Adult↗

PubMed2006

[Development of the quality of surgical gynaecological care in the State of Hesse, Germany under external quality assurance].

UNLABELLED: BACKGROUND AND RESEARCH GOAL: All German hospitals have to participate by law in comparative performance assessment, so called external quality assurance (QA). However, there is only limited research showing a positive impact of such state- and nationwide QA programmes. This article analyses whether the quality of surgical gynaecological care in Hessian hospitals changed after receiving regular feedback on the quality of care between 1998 to 2002. METHODS: Secondary data analysis of data from all hospitals with gynaecological services in Hesse (n = 84) was performed. The requirement of a constant caseload and continuous data supply reduced cases from 218,217 to 148,549. Considering twelve quality indicators we recalculated the performance of all Hessian hospitals for each quarter during 1998 and 2002. Changes over time were analysed by using rank correlation coefficients and considering multiple testing. RESULTS: Two indicators (antibiotic prophylaxis in breast surgeries and hysterectomies) showed a significant quality improvement over time. Six indicators (post-operative infections, inappropriate removals of cyst of ovaries, hormone receptor analysis and x-ray of tumour in breast cancer, ovary-preserving procedures for benign tumours and heparin prophylaxis) demonstrated a slight quality improvement and another four indicators (unplanned revision of operation, organ injuries, adjuvant therapy and breast-preserving surgery in breast cancer) tended towards reduced quality. CONCLUSION: During 1998-2002, we observed only marginal improvements in the quality of care. The expected significant improvement of all quality indicators, based on external QA and comparative performance reporting of all Hessian gynaecological hospitals did not eventuate.

Female↗

PubMed2005

The influence of race on fetal outcome.

The purpose of this study was to examine racial differences in fetal death by gestational age among South Carolinians during 1999 to 2000 in an attempt to identify sociodemographic risk factors that may contribute to the refinement of care protocols. This historical cohort design appended the 1999 to 2000 South Carolina Vital Records fetal death file (N = 944) to the birth file (N = 99, 726) to perform secondary data analysis. Inclusion criteria were maternal South Carolina residency, delivery of a singleton in South Carolina, and racial identification as white or black. Independent associations between race (black or white), gestational age categories of deliveries (fetal death or live birth), and maternal sociodemographic characteristics (maternal age and prenatal care) were examined using chi2 analysis. Black and white fetal mortality rates (FMRs) were examined. Logistic regression was used to control for confounding variables. The study sample consisted of 63.4% white and 36.6% black for all deliveries; 40.89% white and 59.11% black for fetal deaths. There was a significant racial difference in gestational age categories, initiation of prenatal care, maternal age, and fetal death rates (p = 0.0001). The black FMR was nearly 2.5 times greater than the white rate (p < 0.0001; 95% confidence interval, 2.2 to 2.9). There was an independent association between race and gestational age at fetal death (p = 0.0001) as well as race and maternal age. Results did not remain statistically significant after controlling for confounding variables. In this study, we identified several factors associated with an increased risk of fetal death. However, after controlling for gestational age, the odds of fetal death among blacks were no longer significantly elevated in comparison to those of whites. Future studies that examine racial disparities should consider gestational age in analytic models. Identifying racial demographics and behavioral risks may contribute to refinements in care protocols for high-risk mothers in an effort to reduce fetal mortality.

Adolescent↗

PubMedDate not supplied

Interactive relationships between hospital patients' noise-induced stress and other stress with sleep.

OBJECTIVE: The purpose of this study was to test the hypothesis that hospital noise-induced subjective stress would interact with other subjective environmental and personal stress in a relationship with poorer patient sleep. METHODS: A secondary data analysis was done using correlations and hierarchical multiple regression. Ninety-seven cardiac patients participated after transfer from critical care to a general unit. The independent variables were assessed with Topf's 24-item Disturbance Due to Hospital Noise Scale and 5-point items for other environmental stress (ie, bed, lights) and personal stress (ie, pain, anxiety). Sleep was evaluated with the Verran and Snyder-Halpern Sleep Scale. RESULTS: Hierarchical multiple regression led to a multiple R of 0.435 (P <.01). An interaction term, subjective noise stress x subjective bed stress x subjective pain x subjective anxiety accounted for a significant amount of sleep variance (12%, F = 13.63, P =.000). Subjective bed stress x subjective pain accounted for an additional 5% (F = 6.4, P =.013). CONCLUSIONS: Studies using research designs that assess relationships between multiple patient stress variable interactions and sleep or other stress-related outcomes may produce more accurate results than studies on the independent effects of different types of stress.

Adult↗

PubMed2002

Prevalence of household food poverty in South Africa: results from a large, nationally representative survey.

OBJECTIVES: Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition. DESIGN: Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey. SETTING: South Africa. SUBJECTS: A nationally representative sample of the entire country - stratified by race, province, and urban and non-urban areas - consisting of 28 704 households. RESULTS: A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females. CONCLUSIONS: The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity.

Adult↗

PubMed2003

The relationship between low income and household food expenditure patterns in Canada.

OBJECTIVES: To compare food expenditure patterns between low-income households and higher- income households in the Canadian population, and to examine the relationship between food expenditure patterns and the presence or absence of housing payments among low-income households. DESIGN: Secondary data analysis of the 1996 Family Food Expenditure Survey conducted by Statistics Canada. SETTING: Sociodemographic data and 1-week food expenditure data for 9793 households were analysed. SUBJECTS: Data were collected from a nationally representative sample drawn through stratified multistage sampling. Low-income households were identified using Statistics Canada's Low Income Measures. RESULTS: Total food expenditures, expenditures at stores and expenditures in restaurants were lower among low-income households compared with other households. Despite allocating a slightly greater proportion of their food dollars to milk products, low-income households purchased significantly fewer servings of these foods. They also purchased fewer servings of fruits and vegetables than did higher-income households. The effect of low income on milk product purchases persisted when the sample was stratified by education and expenditure patterns were examined in relation to income within strata. Among low-income households, the purchase of milk products and meat and alternatives was significantly lower for households that had to pay rents or mortgages than for those without housing payments. CONCLUSIONS: Our findings indicate that, among Canadian households, access to milk products and fruits and vegetables may be constrained in the context of low incomes. This study highlights the need for greater attention to the affordability of nutritious foods for low-income groups.

Canada↗

PubMed2004

Food store access and household fruit and vegetable use among participants in the US Food Stamp Program.

OBJECTIVE: Recent research on access to food among low-income populations in industrialised countries has begun to focus on neighbourhood food availability as a key determinant of dietary behaviour. This study examined the relationship between various measures of food store access and household fruit and vegetable use among participants in the Food Stamp Program, America's largest domestic food assistance programme. DESIGN: A secondary data analysis was conducted using the 1996-97 National Food Stamp Program Survey. The survey employed a 1-week food inventory method, including two at-home interviews, to determine household food use. Separate linear regression models were developed to analyse fruit and vegetable use. Independent variables included distance to store, travel time to store, ownership of a car and difficulty of supermarket access. All models controlled for a full set of socio-economic variables. SUBJECTS: A nationally representative sample of participants (n=963) in the Food Stamp Program. RESULTS: After controlling for confounding variables, easy access to supermarket shopping was associated with increased household use of fruits (84 grams per adult equivalent per day; 95% confidence interval 5, 162). Distance from home to food store was inversely associated with fruit use by households. Similar patterns were seen with vegetable use, though associations were not significant. CONCLUSIONS: Environmental factors are importantly related to dietary choice in a nationally representative sample of low-income households, reinforcing the importance of including such factors in interventions that seek to effect dietary improvements.

Adult↗

PubMed2006

Associations between television viewing and consumption of commonly advertised foods among New Zealand children and young adolescents.

OBJECTIVES: To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents. DESIGN: Secondary data analysis of a nationally representative, cross-sectional survey. SETTING: In homes or schools of New Zealand school students. PARTICIPANTS: In total, 3275 children aged 5 to 14 years. RESULTS: The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01). CONCLUSIONS: These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on children's diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.

Adolescent↗

PubMedDate not supplied

Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents.

Previous research has shown that homeless youth have high rates of suicidal ideation, sexual abuse, and abuse of alcohol and other drugs. However, little is known about how these rates differ by gender and ethnicity. Our objective was to describe patterns of sexual abuse, alcohol and other drug use, and indicators of suicidal behaviors in homeless adolescents and to determine gender and ethnic differences in these factors. We used secondary data analysis of data from surveys completed by 96 homeless youth whose average age was 17.9 years. Over 60% of the sample reported a history of sexual abuse; the majority were under the age of 12 years when they first tried alcohol, marijuana, and cocaine; 56.3% had injected drugs, and 46.9% had tried inhalants. During the past 12 months, 35.1% had seriously considered suicide and 12.3% had actually attempted suicide at least once. Significantly more Hispanics than Whites had considered suicide (chi 2 = 4.31, p = .038). A disproportionate number of Hispanics (95% of the sample) reported a history of sexual abuse. Participants with a history of sexual abuse were significantly more likely than those who did not have a history of sexual abuse to have used alcohol and/or marijuana (chi 2 = 9.93, p < .01) and to have considered suicide in the past 12 months (F = 14.93, p < .001). We found that sexual abuse history is greater in this sample than in the general population and is particularly prevalent among Hispanic/Latino subjects. As in other studies, sexual abuse was more common among females than among males. High prevalence of sexual abuse, alcohol and other drug use, and suicidal behaviors in this sample of homeless youth underscores the need to develop and test community-based interventions to improve their health status.

Adolescent↗

PubMed2004

Types and sources of social support and maternal-student role stress in married associate degree nursing students.

This paper presents findings from a secondary data analysis designed to determine, specifically, which types and sources of social support are associated with Maternal Student Role Stress for women in two age groups. Participants in the study were students in an Associate Degree nursing program who were married and had at least one child living at home. Data were collected at 11 community colleges in New York and New Jersey. For women aged 37 years and older, all types of support from their husbands and children were associated with less Maternal Student Role Stress. For women under 37 years of age, affirmation and aid from their husbands; aid from their children; and affect, affirmation, and aid from their mothers-in-law were associated with less Maternal Student Role Stress. Findings are interpreted in light of the groups' varied developmental stages, and recommendations for future research and practice are offered.

Adult↗

PubMed2007

Relationship of adolescent physical and sexual abuse to perimenstrual symptoms (PMS) in adulthood.

Research is lacking regarding adolescent physical and sexual abuse and perimenstrual symptoms (PMS). This study examined the relationship between adolescent physical and sexual abuse and PMS in adult women. Secondary data analysis of a longitudinal study of a community sample of 568 women (35% underrepresented ethnicities), using the database "Nursing Assessment of PMS: Neurometric Indices," was performed. History of both adolescent physical abuse and sexual abuse was significantly associated with PMS in adulthood. Women with a history of adolescent physical and sexual abuse had significantly more severe PMS patterns with more dysphoria than women without abuse.

Adolescent↗